Urology Flashcards
most common type of bladder cancer and risk factors
transitional cell carcinoma
smoking, azo dyes, rubber industry, male, cystitis
associations of squamous cell bladder carcinoma
schistosomiasis (swimming in rivers)
BCG
what do you do if find microscopic haematuria
if >60, rule out UTI and investigate
investigations in haematuria
FBC, clotting , U&E, PSA
urinalysis and cytology
flexible cystoscopy + biopsy
CT urography
management of a local bladder cancer
TURBT
intrathecal mitomycin / BCG
management of a locally invasive bladder cancer (i.e. muscle wall)
cystectomy and ileal conduit
monitoring of post op bladder cancer
regular flexi cystoscopy
high chance of recurrence
most common type of prostate cancer and location
adenocarcinoma of peripheral zone
where does prostate Ca metastesise to?
obturator and internal iliac lymph nodes
bone
investigations in prostate cancer
DRE -hard , irregular, nodular PSA - do before DRE urinalysis biopsy TRUSS isotope bone scan gleeson staging
what staging is used in prostate cancer
gleeson
management of local prostate cancer
watch and wait - active surveillance (DRE +PSA)
TURP / radical prostatectomy
management of metastatic prostate cancer
TURP / orchidectomy
RT : external beam / brachytherapy
GnRH analogues: goserelin
anti androgens
investigations in BPH
DRE - smooth, tender, nodular, >30g
PSA
urinalysis
international prostate symptom score
management of BPH according to international prostate symptom score
<7: WW
8-19 : Tamsulosin (alpha blocker - can cause P. HTN)
>19.5: finasteride (5 alpha reductase i ), TURP
testicular tumour in a 35-65 year old, most likely to be..?
+ associations
seminoma
normal AFP, high FAP, radiosensitive - RT
testicular tumour in a young man (<30) likely to be..?
+ associations
non seminoma (yolk sac, teratoma, choriocarcinoma)
high beta HCG and AFP
needs chemo / orchidectomy
risk factors for testicular cancer
cryptorchidism, klinefelter’s, mumps orchitis, infertility, FHx
what is cryptorchidism and management
testes not descended by 3 months of age
fix by 6-18 months
what is the most common type of kidney stone?
calcium oxolate
what is in struvite stones and what causes it
magnesium, phosphate, ammonia
urease producing bacteria : klebsiella, proteus
risk factors for kidney stones
dehydration, metabolic disturbance, congenital abnormality, structural abnormality eg. strictures, gout, obesity, immobility, hypertension, hyperparathyroidism, FHx
which kidney stones are radio- opaque
calcium oxalate and calcium phosphate
which kidney stones are associated with alkaline urine (>7)
struvite
which kidney stones are associated with acidic urine and are radiolucent
uric acid
investigations in kidney stones
FBC, U&E, eGFR, CRP, calcium, phosphate , urate
urinalysis/ MSU
NON CONTRAST CT
management of kidney stones
analgesia: PR diclofenac tamsulosin (alpha blocker) nifedipine (CCB) EWSL ureteroscopy and laser
what is stress incontinence
reduced sphincter tone (S2,3,4 and pedundal nv)
management of stress incontinence
life style advice pelvic floor exersizes physio ring pessary Duloxetine surgery - tape/ colposuspension
what is urge incontinece
overactive detrusor (sympathetic NS)
management of urge incontinence
lifestyle advice 6 weeks bladder training Oxybutynin - antimuscarinic Mirabegron (B3 adrenergic receptor blocker) botulinum toxin injections
investigations in incontinence
neuro, vaginal and PR exam
MSU
post void residual volume
urodynamics / flow studies
causes of unilateral hydronephrosis
obstruction, stones, tumours
causes of bilateral hyrdronephrosis
urethral stenosis, BPH, prostate/bladder ca
associated presentation of renal cell carcinoma
haematuria polycythaemia due to raised EPO hypercalcaemia due to raised PTH hypertension raised ACTH - cushing's lung, bone and brain mets
presentation of testicular torsion
pain, change in colour, retracted, loss of cremasteric reflex
management of testicular torsion
urgent surgical review
+/- doppler USS
