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Surgery Block > Urology > Flashcards

Urology Flashcards

1
Q

What is the most common cancer of the urinary system?

A

Bladder cancer - transitional cell carcinoma

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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
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3
Q

What subtypes of bladder cancer are there?

A
  • Transitional cell carcinoma
  • Squamous cell carcinoma
  • Adenocarcinoma
  • Sarcoma
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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
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5
Q

What type of bladder cancer is schistosomiasis infection related to?

A

Squamous cell carcinoma

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6
Q

What is the most common presentation of bladder cancer?

A
  • Painless haematuria (visible or non visible)
  • Recurrent UTIs
  • Lower urinary tract symptoms
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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
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8
Q

What are common causes of haematuria?

A 
UTI
Renal calculi
Bladder cancer
Prostate cancer
Renal cancer
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9
Q

What is the investigation required for all cases of painless haematuria?

A

Cystoscopy

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10
Q

What procedure is used for biopsy and potential resection in bladder cancer?

A

TURBT - Transurethral resection of bladder tumour

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11
Q

What imaging is indicated as part of the haematuria workup?

A

USS

CT scan of pelvis

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12
Q

What is the management for a non muscle invasive bladder cancer?

A
  1. Resection via TURBT
  2. If deemed higher risk - BCG injection as adjuvant
  3. Radical cystectomy
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13
Q

What is the rate of recurrence of superficial bladder cancers?

A

70% within 3 years

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14
Q

What is the definitive treatment for muscle invasive bladder cancer?

A

Radical cystectomy

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15
Q

What is usually used as neoadjuvant chemotherapy for muscle invasive bladder cancer?

A

Cisplatin combination therapy

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16
Q

How is urinary diversion achieved following a radical cystectomy?

A 
Ileal conduit formation 
Bladder reconstruction (from small bowel)
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17
Q

What is the management for locally advanced or metastatic bladder cancer?

A

Chemotherapy - typically cisplatin based or carboplatin + gemcitabine based

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18
Q

What are the potential risks of bladder cancer?

A

Upper urinary tract tumours

Urethral tumours

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19
Q

Describe the pathophysiology of pyelonephritis

A

Typically bacterial infection of the renal pelvis and parenchyma causing supparative inflammation due to neutrophil infiltration

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20
Q

What is the most common infective organism involved in pyelonephritis?

A

Escherichia coli

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21
Q

Which organisms commonly are transferred from catheters?

A

Enterococcus faecalis
Staphylococcus aureus
Pseudomonas

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22
Q

Which commensal organism can cause pyelonephritis?

A

Staphylococcus saprophyticus

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23
Q

What is the classical traid for presentation of pyelonephritis?

A

Fever
Unilateral loin pain
Nausea and vomiting
(developing over 1-2 days)

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24
Q

What important differential should always be considered with back pain, tachycardia and/or hypotension?

A

Ruptured aortic aneurysm

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25
Q

What investigations are indicated for pyelonephritis?

A

Urinalysis
Urine culture
Routine bloods
Renal USS

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26
Q

Why is a renal USS indicated for cases of pyelonephritis?

A

To assess for evidence of obstruction - if infected and obstructed this is a urological emergency

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27
Q

What investigation should be done if an obstructive cause is suspected for pyelonephritis?

A

CT KUB

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28
Q

What are the complications of pyelonephritis?

A

Severe sepsis
Multi-organ failure
Renal scarring –> CKD
Pyonephrosis (infected obstructed kidney)

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29
Q

What is emphysematous pyelonephritis?

A

Severe form of acute pyelonephritis often caused by gas-forming bacteria - causes gas to collect within and around the kidney

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30
Q

What interventions may be used for severe cases of pyelonephritis?

A

Nephrostomy
Percutaneous drainage
Nephrectomy

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31
Q

What broad spectrum antibiotics are usually indicated for pyelonephritis?

A

Cefalexin

Ciprofolxacin

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32
Q

What are the most common types of calcium renal stones?

A

Calcium oxalate
Calcium phosphate
Mixed oxalate and phosphate

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33
Q

What is the composition of struvite stones?

A

Magnesium ammonium phosphate

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34
Q

What do struvite stones most commonly cause?

A

Staghorn calculi

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35
Q

Which types of stone are radiolucent?

A

Urate stones

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36
Q

What associated condition is associated with cystine stones?

A

Hypocystinuria

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37
Q

What predisposes patients to development of urate stone formation?

A

High purine levels one the blood (from diet or haematological disorders)

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38
Q

Which vessels cross the ureter at the pelvic brim?

A

Iliac vessels

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39
Q

What are common clinical features of renal stones?

A

Ureteric colic - sudden onset loin to groin pain

Haematuria (usually non visible)

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40
Q

What are the main DDx for flank pain?

A 
Pyelonephritis
Ruptured AAA
Biliary pathology
Bowel obstruction
Lower lobe pneumonia
MSK pain
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41
Q

What is the gold standard diagnostic tool for renal stones?

A

CT KUB (non contrast)

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42
Q

Why may a USS be useful in cases of known stone disease?

A

Assessing for hydronephrosis

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43
Q

What are the indications for admission with renal stones?

A

Obstructive AKI
Pain uncontrolled by simple analgesia
Evidence of infected obstruction
Large stones >5mm

44
Q

How may an obstruction in the renal system be relieved?

A

Retrograde stent insertion

Nephrostomy

45
Q

What is the definitive management of renal stones?

A

Extracorporeal shock wave lithotripsy (ESWL)
Percutaneous nephrolithotomy (PCNL)
Flexible uretero-renoscopy

46
Q

What are the main complications of renal stones?

A

Infection
Post-renal AKI
Recurrence –> renal scarring and loss of kidney function

47
Q

Which foods are high in oxalate?

A

Nuts
Rhubarb
Sesame

48
Q

What conditions may predispose to bladder stones?

A

Chronic urinary retention
Schistosomiasis infection
Passed ureteric stones

49
Q

What is the definitive management for bladder stones?

A

Cystoscopy

50
Q

Which age does renal cell cancer have a peak incidence at?

A

50-70yrs

51
Q

What is the pathophysiology of RCC?

A

Adenocarcinoma of the renal cortex

52
Q

What is the microscopic appearance of RCC?

A

Polyhedral clear cells with dark staining nuclei and lipid+glycogen rich cytoplasm

53
Q

What does the term “tumour thrombosis” refer to in RCC?

A

Invasion through the renal vein into the lumen

54
Q

What risk factors are involved in RCC?

A 
Smoking (x2 risk)
Industrial exposure to carcinogens
Dialysis 
Hypertension
Obesity
Anatomical abnormalities
55
Q

What genetic disorders may predispose to RCC?

A

von Hippel Lindau disease
BAP1 mutant disease
Birthings-Hogg-DUbe syndrome

56
Q

Why may patients with RCC present with a left varicocele?

A

Compression of the left testicular vein at the point where it joins the left renal vein

57
Q

What paraneoplastic syndromes are associated with RCC?

A 
Polycaethemia (EPO)
Hypercalcaemia (PTH)
Hypertension (renin)
PUO
Features of metastasis
58
Q

What is the gold standard imaging for RCC?

A

CT abdo-pelvis pre and post IV contrast

59
Q

What classification system is used for RCC?

A

American joint committee on cancer (AJCC)

60
Q

What is the definitive treatment for RCC?

A

Nephrectomy (partial or radical)

61
Q

What biological agents can be used in management of metastatic RCC?

A

Tyrosine kinase inhibitors eg. Sunitinib, Pazopanib

62
Q

What proportion of patients with RCC have metastatic disease at presentation?

A

25%

63
Q

Which part of the prostate does cancer normally tend to occur?

A

Peripheral zone

64
Q

What type of cancer are the majority of prostate cancers?

A

Adenocarcinomas

65
Q

What are the two categories for prostate adenocarcinomas?

A

Acinar - originates in glandular cells

Ductal - originates in cells lining the ducts

66
Q

What gene is involved with predisposition to developing prostate cancer?

A

BRACA1 or BRACA2

67
Q

What are the main risk factors for prostate cancer?

A

Age (>75)
Afro-carribean ethnicity
Family history

68
Q

What are some clinical features seen in prostate cancer?

A 
LUTS eg. frequency, hesitancy
Dysuria
Haematuria
Incontinence 
Suprapubic pain
69
Q

What is being assessed for on a DRE of the prostate?

A

Asymmetry
Nodulatirty
Fixed irregular mass (>0.2mL)

70
Q

What are the main DDx for prostate cancer?

A

BPH
Prostatits
Other causes of haematuria eg. bladder cancer, stones etc

71
Q

What other conditions can raise the PSA besides prostate cancer?

A 
BPH
Prostatitis
Vigorous exercise 
Ejaculation
Recent DRE
72
Q

What two approaches are used for taking a biopsy of the prostate?

A

Transperineal (template)

Transrectal US guided biopsy (TRUS biopsy)

73
Q

How is a gleason grading score calculated?

A

The sum of the most common glandular growth pattern added to the highest grade pattern seen

74
Q

What imaging technique can be used to aid diagnosis of prostate cancer?

A

Multi-parametric MRI (mp-MRI)

75
Q

How is staging of prostate cancer done?

A

CT abdo-pelvis and bone scan

76
Q

Describe active surveillance of prostate cancer

A

3 monthly PSA readings
6 month to yearly DRE
Re-biopsy at 1-3 yearly intervals

77
Q

What is the surgical management of prostate cancer?

A

Radical prostatectomy - removal of prostate, seminal vesicles and surrounding tissue +/- dissection of pelvic lymph nodes

78
Q

What are the main side effects of radical prostatectomy?

A

Erectile dysfunction
Stress incontinence
Bladder neck stenosis

79
Q

What radiotherapy may be offered to those with prostate cancer?

A

External beam radiotherapy (focused beam radiotherapy)

Brachytherapy (transperineal implantation of radioactive seeds into prostate gland)

80
Q

What chemotherapy drugs are commonly used to treat metastatic prostate cancer?

A

Docetaxel (if testosterone resistant)

Cabazitaxel (use with prednisolone - good for relapsed prostate cancer)

81
Q

How can growth of a prostate cancer be prevented?

A

Androgen deprivation therapies - LHRH + GnRH agonists or orchidectomy

82
Q

What hormonal therapies are available to lower levels of serum testosterone?

A

Enzalutamide

Abiraterone

83
Q

What percentage of males >80yrs have BPH?

A

90%

84
Q

What enzyme does the prostate use to convert testosterone to dihydrotestosterone?

A

5𝝰-reductase

85
Q

What is the static component of BPH?

A

TGFβ induces proliferation and inhibits proliferation - leads to a net increase in cells

86
Q

What is the dynamic component of BPH?

A

𝝰-adrenoreceptor mediated prostatic smooth muscle contraction due to hyperplasia

87
Q

What are the risk factors for BPH development?

A

Age
Family history (1st degree)
Afro-caribbean ethnicity
Obesity

88
Q

What is the typical clinical presentation of BPH?

A

LUTS:

  • Voiding (hesitancy, weak stream, terminal dribbling, incomplete emptying)
  • Storage (frequency, nocturne, nocturnal enuresis, urge incontinence)
89
Q

How is a prostate cancer differentiated from BPH on a DRE?

A

BPH = firm, smooth and symmetrical prostate

Prostate cancer = nodular and asymmetric

90
Q

What are the score ranges on the international prostate symptom score (IPSS)?

A 
0-7 = mild
8-19 = moderate
20+ = severe
91
Q

What investigations are indicated in BPH?

A 
Urinary frequency and volume chart 
Urinalysis
Post void bladder scan
DRE
PSA (depends on DRE result)
USS of renal tract
Urodynamic studies
92
Q

What conservative advice can be given to patients with BPH?

A 
Symptom diary 
Medication review (for iatrogenic causes of LUTS)
Lifestyle advice (moderating caffeine + alcohol intake)
93
Q

What medical management can be offered to those with symptomatic BPH?

A

𝝰-adrenoreceptor agonists eg. Tamsulosin

5𝝰-reductase inhibitors eg. Finasteride

94
Q

What surgical management can be offered for BPH?

A

Transurethral resection of the prostate (TURP) - removal of the obstructive prostate tissue

95
Q

What complications of TURP are there?

A

Haemorrhage
Sexual dysfunction
Retrograde ejaculation
Urethral stricture

96
Q

What complications of BPH are there?

A

High pressure retention - chronic or acute on chronic urinary retention resulting in AKI

97
Q

What is TURP syndrome?

A

Fluid overload and hyponatraemia from the TURP procedure causing:

  • Condusion
  • Nausea
  • Agitation
  • Visual changes
98
Q

What is the pathophysiology of acute bacterial prostatitis?

A

Ascending urethral infection usually caused by E coli.
Enterobacter, Serratia, Pseudomonas and Proteus species are also common.
STIs rarely case it

99
Q

What are the risk factors for acute bacterial prostatitis?

A

Indwelling catheters
Phimosis or urethral stricture
Recent surgery - cystoscopy or transracial prostate biopsy
Immunocompromisation

100
Q

What additional risk factors are there for chronic prostatitis?

A

Intraprostatic ductal reflux
Neuroendocrine dysfunction
Dysfunctional bladder

101
Q

What are the clinical features of acute bacterial prostatitis?

A

LUTS
Systemic infection features
Perineal or suprapubic pain
Urethral discharge

102
Q

What will be felt on a DRE of a patient with prostatitis?

A

Tender and boggy prostate

Inguinal lymphadenopathy

103
Q

When may chronic prostatitis be suspected?

A

Males complaining of pelvic pain/discomfort for at least 3 months (prostatodynia)
Along with LUTS

104
Q

What investigations are indicated for prostatitis?

A

Urine culture **
STI screen
Routine bloods

105
Q

What investigation may be done in patients not responding to antimicrobial therapy in prostatitis and why?

A

Transrectal prostatic ultrasound (TRUS) or CT scan

To rule out prostate abscesses

106
Q

What antimicrobial management is usually used for acute bacterial prostatitis?

A

Prolonged use of a quinolone (good penetration into prostate)

107
Q

What is the mainstay treatment for prostatitis?

A

Prolonged antibiotic treatment

Analgesia

Surgery Block (12 decks)

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