Urology Flashcards
(107 cards)
What is the most common cancer of the urinary system?
Bladder cancer - transitional cell carcinoma
Describe the classifications of various bladder cancers
- Non muscle invasive bladder cancer
- Muscle invasive bladder cancer
- Locally advanced or metastatic bladder cancer
What subtypes of bladder cancer are there?
- Transitional cell carcinoma
- Squamous cell carcinoma
- Adenocarcinoma
- Sarcoma
What are the risk factors for bladder cancer?
- Smoking***
- Increasing age
- Male (M:F = 3:1)
- Aromatic hydrocarbon exposure
- Previous radiation to pelvis
What type of bladder cancer is schistosomiasis infection related to?
Squamous cell carcinoma
What is the most common presentation of bladder cancer?
- Painless haematuria (visible or non visible)
- Recurrent UTIs
- Lower urinary tract symptoms
What is the difference between T1 and T2 in bladder cancer staging?
T1 = invasion through lamina propria into sub epithelial CT T2 = invasion into muscular propria layer
What are common causes of haematuria?
UTI Renal calculi Bladder cancer Prostate cancer Renal cancer
What is the investigation required for all cases of painless haematuria?
Cystoscopy
What procedure is used for biopsy and potential resection in bladder cancer?
TURBT - Transurethral resection of bladder tumour
What imaging is indicated as part of the haematuria workup?
USS
CT scan of pelvis
What is the management for a non muscle invasive bladder cancer?
- Resection via TURBT
- If deemed higher risk - BCG injection as adjuvant
- Radical cystectomy
What is the rate of recurrence of superficial bladder cancers?
70% within 3 years
What is the definitive treatment for muscle invasive bladder cancer?
Radical cystectomy
What is usually used as neoadjuvant chemotherapy for muscle invasive bladder cancer?
Cisplatin combination therapy
How is urinary diversion achieved following a radical cystectomy?
Ileal conduit formation Bladder reconstruction (from small bowel)
What is the management for locally advanced or metastatic bladder cancer?
Chemotherapy - typically cisplatin based or carboplatin + gemcitabine based
What are the potential risks of bladder cancer?
Upper urinary tract tumours
Urethral tumours
Describe the pathophysiology of pyelonephritis
Typically bacterial infection of the renal pelvis and parenchyma causing supparative inflammation due to neutrophil infiltration
What is the most common infective organism involved in pyelonephritis?
Escherichia coli
Which organisms commonly are transferred from catheters?
Enterococcus faecalis
Staphylococcus aureus
Pseudomonas
Which commensal organism can cause pyelonephritis?
Staphylococcus saprophyticus
What is the classical traid for presentation of pyelonephritis?
Fever
Unilateral loin pain
Nausea and vomiting
(developing over 1-2 days)
What important differential should always be considered with back pain, tachycardia and/or hypotension?
Ruptured aortic aneurysm