Urology Flashcards
(107 cards)
1
Q
What is the most common cancer of the urinary system?
A
Bladder cancer - transitional cell carcinoma
2
Q
Describe the classifications of various bladder cancers
A
- Non muscle invasive bladder cancer
- Muscle invasive bladder cancer
- Locally advanced or metastatic bladder cancer
3
Q
What subtypes of bladder cancer are there?
A
- Transitional cell carcinoma
- Squamous cell carcinoma
- Adenocarcinoma
- Sarcoma
4
Q
What are the risk factors for bladder cancer?
A
- Smoking***
- Increasing age
- Male (M:F = 3:1)
- Aromatic hydrocarbon exposure
- Previous radiation to pelvis
5
Q
What type of bladder cancer is schistosomiasis infection related to?
A
Squamous cell carcinoma
6
Q
What is the most common presentation of bladder cancer?
A
- Painless haematuria (visible or non visible)
- Recurrent UTIs
- Lower urinary tract symptoms
7
Q
What is the difference between T1 and T2 in bladder cancer staging?
A
T1 = invasion through lamina propria into sub epithelial CT T2 = invasion into muscular propria layer
8
Q
What are common causes of haematuria?
A
UTI Renal calculi Bladder cancer Prostate cancer Renal cancer
9
Q
What is the investigation required for all cases of painless haematuria?
A
Cystoscopy
10
Q
What procedure is used for biopsy and potential resection in bladder cancer?
A
TURBT - Transurethral resection of bladder tumour
11
Q
What imaging is indicated as part of the haematuria workup?
A
USS
CT scan of pelvis
12
Q
What is the management for a non muscle invasive bladder cancer?
A
- Resection via TURBT
- If deemed higher risk - BCG injection as adjuvant
- Radical cystectomy
13
Q
What is the rate of recurrence of superficial bladder cancers?
A
70% within 3 years
14
Q
What is the definitive treatment for muscle invasive bladder cancer?
A
Radical cystectomy
15
Q
What is usually used as neoadjuvant chemotherapy for muscle invasive bladder cancer?
A
Cisplatin combination therapy
16
Q
How is urinary diversion achieved following a radical cystectomy?
A
Ileal conduit formation Bladder reconstruction (from small bowel)
17
Q
What is the management for locally advanced or metastatic bladder cancer?
A
Chemotherapy - typically cisplatin based or carboplatin + gemcitabine based
18
Q
What are the potential risks of bladder cancer?
A
Upper urinary tract tumours
Urethral tumours
19
Q
Describe the pathophysiology of pyelonephritis
A
Typically bacterial infection of the renal pelvis and parenchyma causing supparative inflammation due to neutrophil infiltration
20
Q
What is the most common infective organism involved in pyelonephritis?
A
Escherichia coli
21
Q
Which organisms commonly are transferred from catheters?
A
Enterococcus faecalis
Staphylococcus aureus
Pseudomonas
22
Q
Which commensal organism can cause pyelonephritis?
A
Staphylococcus saprophyticus
23
Q
What is the classical traid for presentation of pyelonephritis?
A
Fever
Unilateral loin pain
Nausea and vomiting
(developing over 1-2 days)
24
Q
What important differential should always be considered with back pain, tachycardia and/or hypotension?
A
Ruptured aortic aneurysm
25
What investigations are indicated for pyelonephritis?
Urinalysis
Urine culture
Routine bloods
Renal USS
26
Why is a renal USS indicated for cases of pyelonephritis?
To assess for evidence of obstruction - if infected and obstructed this is a urological emergency
27
What investigation should be done if an obstructive cause is suspected for pyelonephritis?
CT KUB
28
What are the complications of pyelonephritis?
Severe sepsis
Multi-organ failure
Renal scarring --> CKD
Pyonephrosis (infected obstructed kidney)
29
What is emphysematous pyelonephritis?
Severe form of acute pyelonephritis often caused by gas-forming bacteria - causes gas to collect within and around the kidney
30
What interventions may be used for severe cases of pyelonephritis?
Nephrostomy
Percutaneous drainage
Nephrectomy
31
What broad spectrum antibiotics are usually indicated for pyelonephritis?
Cefalexin
| Ciprofolxacin
32
What are the most common types of calcium renal stones?
Calcium oxalate
Calcium phosphate
Mixed oxalate and phosphate
33
What is the composition of struvite stones?
Magnesium ammonium phosphate
34
What do struvite stones most commonly cause?
Staghorn calculi
35
Which types of stone are radiolucent?
Urate stones
36
What associated condition is associated with cystine stones?
Hypocystinuria
37
What predisposes patients to development of urate stone formation?
High purine levels one the blood (from diet or haematological disorders)
38
Which vessels cross the ureter at the pelvic brim?
Iliac vessels
39
What are common clinical features of renal stones?
Ureteric colic - sudden onset loin to groin pain
| Haematuria (usually non visible)
40
What are the main DDx for flank pain?
```
Pyelonephritis
Ruptured AAA
Biliary pathology
Bowel obstruction
Lower lobe pneumonia
MSK pain
```
41
What is the gold standard diagnostic tool for renal stones?
CT KUB (non contrast)
42
Why may a USS be useful in cases of known stone disease?
Assessing for hydronephrosis
43
What are the indications for admission with renal stones?
Obstructive AKI
Pain uncontrolled by simple analgesia
Evidence of infected obstruction
Large stones >5mm
44
How may an obstruction in the renal system be relieved?
Retrograde stent insertion
| Nephrostomy
45
What is the definitive management of renal stones?
Extracorporeal shock wave lithotripsy (ESWL)
Percutaneous nephrolithotomy (PCNL)
Flexible uretero-renoscopy
46
What are the main complications of renal stones?
Infection
Post-renal AKI
Recurrence --> renal scarring and loss of kidney function
47
Which foods are high in oxalate?
Nuts
Rhubarb
Sesame
48
What conditions may predispose to bladder stones?
Chronic urinary retention
Schistosomiasis infection
Passed ureteric stones
49
What is the definitive management for bladder stones?
Cystoscopy
50
Which age does renal cell cancer have a peak incidence at?
50-70yrs
51
What is the pathophysiology of RCC?
Adenocarcinoma of the renal cortex
52
What is the microscopic appearance of RCC?
Polyhedral clear cells with dark staining nuclei and lipid+glycogen rich cytoplasm
53
What does the term "tumour thrombosis" refer to in RCC?
Invasion through the renal vein into the lumen
54
What risk factors are involved in RCC?
```
Smoking (x2 risk)
Industrial exposure to carcinogens
Dialysis
Hypertension
Obesity
Anatomical abnormalities
```
55
What genetic disorders may predispose to RCC?
von Hippel Lindau disease
BAP1 mutant disease
Birthings-Hogg-DUbe syndrome
56
Why may patients with RCC present with a left varicocele?
Compression of the left testicular vein at the point where it joins the left renal vein
57
What paraneoplastic syndromes are associated with RCC?
```
Polycaethemia (EPO)
Hypercalcaemia (PTH)
Hypertension (renin)
PUO
Features of metastasis
```
58
What is the gold standard imaging for RCC?
CT abdo-pelvis pre and post IV contrast
59
What classification system is used for RCC?
American joint committee on cancer (AJCC)
60
What is the definitive treatment for RCC?
Nephrectomy (partial or radical)
61
What biological agents can be used in management of metastatic RCC?
Tyrosine kinase inhibitors eg. Sunitinib, Pazopanib
62
What proportion of patients with RCC have metastatic disease at presentation?
25%
63
Which part of the prostate does cancer normally tend to occur?
Peripheral zone
64
What type of cancer are the majority of prostate cancers?
Adenocarcinomas
65
What are the two categories for prostate adenocarcinomas?
Acinar - originates in glandular cells
| Ductal - originates in cells lining the ducts
66
What gene is involved with predisposition to developing prostate cancer?
BRACA1 or BRACA2
67
What are the main risk factors for prostate cancer?
Age (>75)
Afro-carribean ethnicity
Family history
68
What are some clinical features seen in prostate cancer?
```
LUTS eg. frequency, hesitancy
Dysuria
Haematuria
Incontinence
Suprapubic pain
```
69
What is being assessed for on a DRE of the prostate?
Asymmetry
Nodulatirty
Fixed irregular mass (>0.2mL)
70
What are the main DDx for prostate cancer?
BPH
Prostatits
Other causes of haematuria eg. bladder cancer, stones etc
71
What other conditions can raise the PSA besides prostate cancer?
```
BPH
Prostatitis
Vigorous exercise
Ejaculation
Recent DRE
```
72
What two approaches are used for taking a biopsy of the prostate?
Transperineal (template)
| Transrectal US guided biopsy (TRUS biopsy)
73
How is a gleason grading score calculated?
The sum of the most common glandular growth pattern added to the highest grade pattern seen
74
What imaging technique can be used to aid diagnosis of prostate cancer?
Multi-parametric MRI (mp-MRI)
75
How is staging of prostate cancer done?
CT abdo-pelvis and bone scan
76
Describe active surveillance of prostate cancer
3 monthly PSA readings
6 month to yearly DRE
Re-biopsy at 1-3 yearly intervals
77
What is the surgical management of prostate cancer?
Radical prostatectomy - removal of prostate, seminal vesicles and surrounding tissue +/- dissection of pelvic lymph nodes
78
What are the main side effects of radical prostatectomy?
Erectile dysfunction
Stress incontinence
Bladder neck stenosis
79
What radiotherapy may be offered to those with prostate cancer?
External beam radiotherapy (focused beam radiotherapy)
| Brachytherapy (transperineal implantation of radioactive seeds into prostate gland)
80
What chemotherapy drugs are commonly used to treat metastatic prostate cancer?
Docetaxel (if testosterone resistant)
| Cabazitaxel (use with prednisolone - good for relapsed prostate cancer)
81
How can growth of a prostate cancer be prevented?
Androgen deprivation therapies - LHRH + GnRH agonists or orchidectomy
82
What hormonal therapies are available to lower levels of serum testosterone?
Enzalutamide
| Abiraterone
83
What percentage of males >80yrs have BPH?
90%
84
What enzyme does the prostate use to convert testosterone to dihydrotestosterone?
5𝝰-reductase
85
What is the static component of BPH?
TGFβ induces proliferation and inhibits proliferation - leads to a net increase in cells
86
What is the dynamic component of BPH?
𝝰-adrenoreceptor mediated prostatic smooth muscle contraction due to hyperplasia
87
What are the risk factors for BPH development?
Age
Family history (1st degree)
Afro-caribbean ethnicity
Obesity
88
What is the typical clinical presentation of BPH?
LUTS:
- Voiding (hesitancy, weak stream, terminal dribbling, incomplete emptying)
- Storage (frequency, nocturne, nocturnal enuresis, urge incontinence)
89
How is a prostate cancer differentiated from BPH on a DRE?
BPH = firm, smooth and symmetrical prostate
Prostate cancer = nodular and asymmetric
90
What are the score ranges on the international prostate symptom score (IPSS)?
```
0-7 = mild
8-19 = moderate
20+ = severe
```
91
What investigations are indicated in BPH?
```
Urinary frequency and volume chart
Urinalysis
Post void bladder scan
DRE
PSA (depends on DRE result)
USS of renal tract
Urodynamic studies
```
92
What conservative advice can be given to patients with BPH?
```
Symptom diary
Medication review (for iatrogenic causes of LUTS)
Lifestyle advice (moderating caffeine + alcohol intake)
```
93
What medical management can be offered to those with symptomatic BPH?
𝝰-adrenoreceptor agonists eg. Tamsulosin
| 5𝝰-reductase inhibitors eg. Finasteride
94
What surgical management can be offered for BPH?
Transurethral resection of the prostate (TURP) - removal of the obstructive prostate tissue
95
What complications of TURP are there?
Haemorrhage
Sexual dysfunction
Retrograde ejaculation
Urethral stricture
96
What complications of BPH are there?
High pressure retention - chronic or acute on chronic urinary retention resulting in AKI
97
What is TURP syndrome?
Fluid overload and hyponatraemia from the TURP procedure causing:
- Condusion
- Nausea
- Agitation
- Visual changes
98
What is the pathophysiology of acute bacterial prostatitis?
Ascending urethral infection usually caused by E coli.
Enterobacter, Serratia, Pseudomonas and Proteus species are also common.
STIs rarely case it
99
What are the risk factors for acute bacterial prostatitis?
Indwelling catheters
Phimosis or urethral stricture
Recent surgery - cystoscopy or transracial prostate biopsy
Immunocompromisation
100
What additional risk factors are there for chronic prostatitis?
Intraprostatic ductal reflux
Neuroendocrine dysfunction
Dysfunctional bladder
101
What are the clinical features of acute bacterial prostatitis?
LUTS
Systemic infection features
Perineal or suprapubic pain
Urethral discharge
102
What will be felt on a DRE of a patient with prostatitis?
Tender and boggy prostate
| Inguinal lymphadenopathy
103
When may chronic prostatitis be suspected?
Males complaining of pelvic pain/discomfort for at least 3 months (prostatodynia)
Along with LUTS
104
What investigations are indicated for prostatitis?
Urine culture **
STI screen
Routine bloods
105
What investigation may be done in patients not responding to antimicrobial therapy in prostatitis and why?
Transrectal prostatic ultrasound (TRUS) or CT scan
| To rule out prostate abscesses
106
What antimicrobial management is usually used for acute bacterial prostatitis?
Prolonged use of a quinolone (good penetration into prostate)
107
What is the mainstay treatment for prostatitis?
Prolonged antibiotic treatment
| Analgesia
