Urology Flashcards
In which part of the prostate do adenocarcinomas tend to arise in?
Peripheral prostate
What medication may offer benefit for 1 -2 years for patients with metastatic prostate cancer?
LHRH agonist e.g. goserelin
Name some risk factors associated with bladder cancer
Smoking; aromatic amines (rubber); chronic cystitis; schistosomiasis
What investigation is diagnostic of bladder cancer?
Cystoscopy and biopsy
What stage would you give to a bladder cancer tumour confined to the lamina propria?
T1
What does it mean if a bladder cancer tumour is classed as T2?
What would be felt at EUA?
T2 = Superficial muscle is involved
A rubbery thickening would be felt
What does it mean if a bladder cancer tumour is classed as T3?
What would be felt at EUA?
T3 = Deep muscle involved
A mobile mass would be felt
What does it mean if a bladder cancer tumour is classed as T4?
What would be felt at EUA?
T4 = Invasion beyond bladder
Fixed mass would be felt
What our the treatments for bladder cancers staged Tis/ Ta/ T1?
Diathermy via e.g. TURBT
Chemo/intravesical BCG as maintenance
What our the treatments for bladder cancers staged T2-3?
Radical cystectomy. Neoadjuvant chemo.
What our the treatments for bladder cancers staged T4?
Palliative chemo/radiotherapy
What type of cancer is haemodialysis RF for?
Renal cell carcinoma
List 4 ways that renal cell carcinoma can present and why
- Increased BP due to renin secretion
- Polycythaemia from EPO secretion
- Bone mets (check ALP)
- Cannon ball mets on CXR
What treatments are renal cell carcinoma resistant to?
Radiotherapy and chemotherapy
What are the 4 stages of testicular cancer?
1) No mets
2) Infradiaphragmatic node involvement
3) Supradiaphragmatic node involvement
4) Lung involvement
Which nodes do testicular cancer initially spread via?
Para-aortic lymph nodes
Name 2 useful tumour markers for testicular cancer
AFP and hCG
Give details of the surgery used in testicular cancer
Radical orchidectomy: inguinal incision, occlude spermatic cord before mobilisation to decrease intra-operative spread.
Which type of testicular tumour is v radiosensitive?
Seminomas!
What is a hydrocele?
An abnormal quantity of peritoneal fluid between parietal and visceral layers of tunica vaginalis
What is balantis?
Inflammation of foreskin & glans.
Name 2 risk factors for balantis
Diabetes and children with tight foreskins
What are the treatment options for balantis?
Abx (linked with strep + staph), circumcision
What is phimosis?
Foreskin occludes the meatus.
What is paraphimosis?
When tight foreskin is retracted and becomes irreplaceable –> prevents venous return –> oedema and ischaemia of glans.
How does phimosis present in young boys? What should be attempted?
Recurrent balantis and ballooning. Try retraction.
How does phimosis present in adults?
Painful sex, infection, ulcers
When does paraphimosis typically occur?
After catheterisation
What are the treatments for paraphimosis?
- Ask patient to squeeze glans
- 50% Glucose-soaked swabs
- May need dorsal slit
If the prostate is described as “boggy” on DRE, what is the likely diagnosis?
Prostatitis
What is the gold standard way to image stones?
Non-contrast CT
What is the best imaging modality for hydronephrosis?
USS
How do thiazide diuretics prevent the development of calcium kidney stones?
They decrease calcium excretion (less to urine to form stones)
What treatment options are available for stones over 5mm or where the pain is not resolving?
- Medical expulsion therapy (nifedipine or an alpha blocker - e.g. Tamsulosin)
- Extracorpeal lithotripsy
- Percutaneous nephrolithotomy (keyhole surgery)
What part of the prostate is affected in BPH?
Inner (transitional) zone
What 2 drugs can be given to a patient with BPH as they await surgery?
- a-blockers e.g. Tamsulosin: decrease muscle tone
- 5a-reductase inhibitors (e.g. finasteride): decreases testosterone being converted to dihydrotestosterone
What advice must you give to men taking finasteride?
Wear condoms as finasteride is excreted in semen
Simply, how do PDE 5 inhibitors work biochemically?
They increase cGMP
Name 3 things that uroflowmetry measures
Voided volume, max. flow rate, time taken to void
What is the treatment for lower UTIs in women?
Trimethoprim of nitrofurantoin
What is the treatment for non-pregnant women with upper UTIs?
Urine culture
E.g. IV Co-amoxiclav, then oral when afebrile (complete a 7 day course)
What is the treatment for UTIs in men?
2 week course of a quinolone e.g. levofloxacin
