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Specialties > Urology > Flashcards

Urology Flashcards

1
Q

Describe the histopathology of BPH (which cells are involved etc

A

There is nodular and diffuse proliferation (hyperplasia) of the glandular epithelial and stromal (musculofibrous) layers around the prostate - this occurs in the
TRANSITIONAL ZONE

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2
Q

Pathophysiology of BPH

A

testosterone –> 5 alpha reductase –> dihydrotestosterone - which acts on the glandular and stromal cells of the prostate –> hyperplasia

Static component - increased tissue bulk –> narrowing of lumen

Dynamic component - increase in prostatic smooth muscle tone

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3
Q

Aetiology of BPH

A

Age

  • Hyperactivity of receptors (for dihydrotestosterone)
  • Increased oestrogen –> primes androgen receptors
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4
Q

Presentation of BPH

A

Frequency
Urgency
Nocturia

Hesitancy
Straining
Poor stream 
Post void dribbling
incomplete emptying
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5
Q

Investigations for BPH

A

Triad - what is this hypertrophy from

  • DRE
  • PSA
  • TRUSS
Others 
Freq/vol chart 
MSU - rule out UTI
KUB USS 
Scoring system - IPSS (dont forget this one)
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6
Q

Management of BPH

A 
1) Behavioural 
Avoid triggers (caffeine, alcohol etc), void twice, limit fluid intake

Mild - watch and wait

Moderate (symptoms bother them)
alpha blocker - tamsulosin or doxazocin
5 alpha reductase inhibitor - finasteride

Severe
Surgery
<80g TURP/ TUVP
>80g open prostatectomy

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7
Q

Side effects of alpha blocker

A

Sexual dysfunction eg ED

Dizziness 
Postural hypotension 
Dry mouth 
Depression 
EXTRA-PYRAMIDAL SIGNS
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8
Q

Side effects of 5 alpha reductase

A

Remember symptoms may not improve for 6 months

Gynaecomastia
Sexual dysfunction - ED, reduced libido, ejaculation problems

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9
Q

Indications for surgery in BPH

A 
RUSHES 
Retention
UTIs 
Stones 
Haematuria
Elevated creatinine
Symptom severity ^
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10
Q

Complications of TURP

A

Short term
Bleeding, sepsis

Long term 
Retrograde ejaculation 
ED 
TURPT syndrome 
Strictures 
Incontinence
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11
Q

Complications of BPH

A 
UTIs 
Retention 
TURPT syndrome 
Hydronephrosis 
Stones
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12
Q

What is the underlying pathophysiology of TURP syndrome

A

There is absorption of irrigating fluids (during TURP surgery) into the prostatic venous sinuses

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13
Q

Presentation of TURP syndrome

A

FLUID OVERLOAD
Hyponatraemia
Hypothermia
Hypertension

N+V+headache/ confusion

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14
Q

Risk factors for TURP syndrome

A 
>60g resected 
High volumes of fluids for irrigation 
Surgery >1hr 
Perforation 
Large blood loss
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15
Q

Manage TURP syndrome

A

Supportive
O2
Correct hyponatraemia
Monitor BP

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16
Q

epidemiology of acute urinary retention

A

1/3 in 5 years for males over 80

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17
Q

Causes of urinary retention

A

Obstruction

  • BPH
  • Prostate cancer
  • Stones
  • Strictures
  • Surrounding malignancy - remember ovarian, important ∆∆

Neurological

  • MS
  • SCC
  • DM
  • GB
  • Parkinson’s

Drugs

  • Anticholinergics
  • Antihistamine
  • TCAs
  • NSAIDS
  • Opioids
  • Benzos

Gynae

  • Post partum
  • Prolapse
  • Ovarian cyst
  • Uterine fibroids

Infections

  • Prostatitis
  • Balantitis
  • Cystitis
  • Vaginitis
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18
Q

Presentation of
- Acute
- Chronic
Urinary retention

A

Acute
PAIN
Inability to pass urine

Chronic
Painless
May have overflow

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19
Q

Investigations for acute urinary retention

A

Just give em a catheter

MC+S + urinalysis

U+E + check creatinine!!! for AKI

FBC, CRP - infection?

PSA (?cause) - useless as is raised in retention!

USS later to find cause/ >300ml = retention

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20
Q

Management of acute urinary retention

A

CATHETER
*men should be offered alpha blocker before this

measure over 15 mins
<200ml - no retention
>400 defs retention

Secondary management:
TWOC
Prostate surgery

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21
Q

Complications of urinary retention

A

AKI

UTI

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22
Q

Pathophysiology of prostate cancer

A

80% adenocarcinoma
Malignant disease of the glandular origin - occurs in the
PERIPHERAL ZONE

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23
Q

What are the different types of spread of prostate cancer

A

Local - through the capsule
Haematogenous
Lymphatic

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24
Q

Aetiology of prostate cancer

A

Familial
Genetic
- BRCA
- HPC-1

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25
Q

Presentation of prostate cancer

A

LUTS
Haematuria

B symptoms

Bone pain if spread

Palpable lymph nodes

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26
Q

Investigations for prostate cancer

A

PSA >4
TRUSS + biopsy
DRE - hard and irregular

MRI + CT staging

Bone isotope scan for mets

Testosterone

PCA3 - urine
PSMA - serum

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27
Q

Lymph spread in prostate cancer

A

Obturator

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28
Q

Staging of prostate cancer

A

T1 - not palpable or visible on imaging

T2 - palpable/visible on imaging

T3 - through the capsule (b, to the seminal vesicle)

T4 - beyond the seminal vesicle

N1 - local LN
M1 - other LNs/ other sites - bone. lung. liver

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29
Q

Grading system for prostate

A

Level of differentiation - the management plan is determined on this

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30
Q

Management of prostate cancer

A

Very low risk
Watch and wait
Brachy

Low/intermediate risk
Radio/brachy

High risk
Radical prostatectomy
Radiotherapy

Metastatic disease
80% are androgen sensitive 
Castration:
- Orchidectomy 
- LHRH 
- Anti androgens (Gosrelin) 
- Cyproterone acetate
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31
Q

Complications of prostate cancer

A

ED
Hormone induced gynaecomastia
hormone induced hot flush
radiation induced LUTS

Surgery

  • incontinence
  • infertility
  • ED
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32
Q

Histopathology of bladder cancer

A

Transitional cell carcinoma
Squamous cell carcinoma (schistosomiasis)

Transitional cell papilloma
Adenocarcinoma

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33
Q

RFs for bladder cancer

A 
Smoking 
Schistosomiasis (SCC)
Azo dyes 
Paints 
Pelvic radiation 
HNPCC - upper tract urolithial cancers 
M:F
Cyclophosphamide
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34
Q

Presentation of bladder cancer

A

Painless haematuria (micro or macro)
Bone pain
Weight loss
Symptoms of pressure eg LUTS

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35
Q

Investigations for bladder cancer

A 
Urine dip - haematuria (micro or macro) 
KUB USS
Flexi cystoscopy - with biopsy TURBT 
U+E 
CT staging +/-
Urinary cystology

FBC - mild anaemia

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36
Q

Staging and management of bladder cancer

A

T1 - into lamina propria
TURBT + intravesicle chemo - mitomycin C

T2 - into muscle
Radical/partial cystectomy with pelvic LN dissection +/- chemo + urinary diversion into internal resevoiur (via ileum) with drainage via urethra

T3 - into fat - same

T4 - pelvic organs eg vagina, ureter - Chemo

N1 - ONE LN in the true pelvic region
N2 - >1 LN in the true pelvic region
N3 - outer eg common iliac

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37
Q

Complications of bladder cancer

A

Hydronephrosis
Urinary retention
Recurrence

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38
Q

Causes of haematuria

A 
Obstruction - stones
Trauma 
Cancers 
UTI 
Prostatitis 
BPH
Coagulopathies 
Warfarin stuff

Pseudo

  • Rifampicin
  • Menstruation
  • Beetroot
  • Haemolytic anaemias
  • myoglobulinuria - rhabdo
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39
Q

Investigations for haematuria

A 
MC+S 
Urine dip 
DRE 
PSA 
FBC - CLOTTING 
U+Es

KUB - USS
Flexi cyst
non contrast CT for stones

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40
Q

Timing of haematuria in the stream

A

Total - bladder/ upper tract

Initial/terminal - lower (up to the bladder neck)

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41
Q

Pathogens causing UTI

A

E Coli - 70-95%
Staph Saprophyticus 5-20%

Enterobacter

  • Klebsilla - hospital - stones*
  • Proteus - hospital - stones*
  • Enterococci
  • GBC

** Struvite stones - these are phosphate stones

42
Q

What counts as a complicated UTI?

A

Patient features:

  • Male
  • Pregnant
  • Immunocompromised
  • Children

Recurrent (>2 in 6m or 3 in 12m)
Decreased renal function

Shit in the way:
Stones
Structural abnormality
Indwelling catheter

43
Q

RF for UTI

A 
Immunocompromised 
Sex 
Female 
Structural abnormality 
Obstruction (eg stones) 
Poor hygiene
Catheter 
Spermicide
44
Q

Abx for UTIs

A

Trimethoprim - 3 days
Nitro - 7 days
Males/ab resistance - cipro

Complicated

  • Outpatient - nitro/ Cephalxin
  • Inpatient - IV gentamycin
45
Q

What is bacteruria

A

presence of bacteria in the urine - with or without symptoms

46
Q

What is pyuria

A

Presence of leukocytes in the urine associated with infection

47
Q

What is sterile pyuria and give example

A

Presence of elevated leukocytes in urine but unable to culture

  • Fastidious organism
  • Chlamydia
  • Recently treated UTI
48
Q

Investigations for UTI

A

Urine dip
MC+S of MSU = GOLD STANDARD
FBC/ WCC/ ESR/CRP/ U+Es
Blood cultures

KUB USS - other cause

49
Q

∆∆ in females for UTI

A

Its abdominal pain so if you haven’t thought about ectopic pregnancy then srsly don’t bother turning up to the exam Alice xo

Stones 
STI
Overactive bladder 
Urolithial cancer 
Atypical infection
50
Q

Complications of UTI

A

Sepsis
Worsening of confusion

RENAL ABSCESS

51
Q

Common pathogens causing prostatitis

A

E. Coli is the main dude

Enterococci
Pseudomonas

52
Q

RF for prostatitis

A

RECENT UTI - main dude

Others: messin around with the prostate:
UROGEN instrumentation
Recent prostate biopsy
Intermittent bladder catheterisation

53
Q

Presentation of prostatitis

A

Haematuria
Painful ejaculation
Abdo pain
Rectal and perianal pain

O/E - warm, soft boggy prostate

54
Q

O/E findings of prostatitis

A

warm, soft, boggy prostate

55
Q

Investigations for prostatitis

A

PSA
DRE
TRUSS - check for abscess

U+E
FBC
ESR/CRP

Blood cultures
STI screen
MC+S of MSU

Culture of prostatic secretions

56
Q

Management of prostatitis

A

Abx

No sepsis - oral cipro + NSAID relief + drainage if abscess

Sepsis? - IV taz and gent

Chronic - 4/6 weeks cipro + alpha blocker + NSAID

57
Q

Complications of urethritis

A

Reactive arthritis
Meningitis
Endocarditis

58
Q

Aetiology of epididymo-orchitis

A

<35 - STI
>35 - UTI
Elderly - catheter

59
Q

Pathophysiology of epididymo-orchitis

A

retrograde ascent of urinary pathogens

60
Q

Presentation of epididymo-orchitis

A

Testicular pain and swelling (over days, unlike testicular torsion which is V important to rule out!!!)

Fever
Urethral discharge
LUTS

61
Q

Investigations for epididymo-orchitis

A

NAAT/ urine sample for STI
U+E
Blood cultures
MC+S

Colour doppler USS - enlarged hyperaemic epididymis

62
Q

Management

A

STI related? -
Ceftriaxone IM 1 dose and oral doxy for 2 weeks

UTI related?
Levofloxacin

63
Q

What is a hydrocoele

A

collection of excessive fluid in the tunica vaginalis

64
Q

Types of hydrocoele

A

Communicating
- There is a patent process vaginalis which connects the tunica vaginalis with the peritoneum (common in infants)

Non- communicating
abnormal collection of fluid in the tunica vaginalis (eg from infection etc)

65
Q

Aetiology of hydrocoele

A

Communicating:
Patient process vaginalis

Non- communicating: 
Epididymo-orchitis 
Tumour 
Cyst 
Torsion
66
Q

Presentation of hydrocoele

A

soft non-tender swelling of the hemi-scrotum
anterior and below the testicle

O/E
You can get ‘above’ the swelling
Transilluminate

Enlargement post - activity

67
Q

Investigations for hydrocoele

A

Can be a clinical diagnosis but if unsure - USS

68
Q

Management of hydrocoele

A

Supportive

If it doesn’t spontaneously resolve, can aspirate or surgical repair

69
Q

Pathophysiology of varicocoele

A

There is venous congestion in the panpiniform plexus
90% occur in the LEFT as
Left –> left renal artery
Right –> IVC

There is also testosterone pooling

70
Q

Aetiology of varicocoele

A

Idiopathic
- Incompetent valves in renal vein/ increased hydrostatic venous pressure

Secondary

  • Pelvic or renal tumour
  • Nutcracker syndrome - SMA compresses the left renal vein
71
Q

Complications of varicocoele (and how)

A

Infertility
Increase in temperature –> testicular atrophy –> infertility

BPH
(due to pooling of testosterone if the blood goes via the prostate via communicating vessels)

Hydrocoele - literally no fucking clue why x

72
Q

Presentation of varicocoele

A

BAG O’ WORMZ
Dull ache
Commonly presents as subfertility

73
Q

Investigations for varicocoele

A

Doppler USS

74
Q

Management of varicocoele

A

Supportive

Surgery if ongoing pain

75
Q

Presentation of epididymal cyst

A

Extra-testicular mass (can separate from the body of the testes) found POSTERIOR

Can transilluminate

76
Q

Conditions associated with epididymal cyst

A

CF
VHL
PKD

77
Q

Investigations of epididymal cyst

A

USS

78
Q

Management of epididymal cyst

A

Supportive

Surgical removal

79
Q

Aetiology of testicular torsion

A

Trauma

Bell clapper deformity

80
Q

What is testicular torsion

A

twisting of the testicle on the spermatic cord

81
Q

Presentation of testicular torsion

A

severe, sudden onset testicular pain –> referred to lower abdomen
N+V
Redness/ heat
Transverse lie
Loss of cremasteric reflex
Lifting of the testes does NOT relieve the pain

82
Q

Management of testicular torsion

A

Surgery

- May fix both testes as bell clapper is often bilateral

83
Q

Histopathology of testicular cancer

A 
Germ cell (95%) 
- Seminomas (55%)
- Non- seminomas 
Teratoma (5-10%)
Choriocarcinoma 
Yolk sac 
Embryonal

Non-germ cell

  • Leydig
  • Sarcoma
84
Q

Aetiology of testicular cancer

A

Fam Hx
Cryptochiridism
Kleinfelter
Mumps

85
Q

Presentation of testicular cancer

A

Painless lump (but can be painful)
Haemospermia
Hydrocoele/ varicocoele
Gynaecomastia

86
Q

Why do you get gynaecomastia in testicular cancer

A

Bc of the raised b-HCG

87
Q

Investigations for testicular cancer

A

Blood tings:

  • LDH
  • AFP (teratoma, yolk sac, embryonal but not in seminomas)
  • b-HCG (choriocarcinoma and seminomas)

USS - gold stanny
CT - abdo-pelvis

88
Q

Where does testicular cancer spread to (LN)

A

Retroperitoneal

Para-aortic

89
Q

Management of testicular cancer

A

Depends on stage + seminoma or non-seminoma

Orchidectomy

Early sem - radio/carboplatin chemo
Early non-sem - RPLND
Late stage either - BEP chemo

90
Q

Complications of testicular cancer

A

Infertility

91
Q

Staging of testicular cancer

A

A - confined to testes
B - regional LN
C - beyond regional LNs

92
Q

Aetiology of erectile dysfunction

A

Psych - depression/ relationship problems
Neuro - MS/ stroke
CVS - diabetes, obesity, HTN
Drugs - SSRI, BB, any antipsychotics rly, alcohol
Surgical - PROSTATE!
Hormonal - hyperprolaccy, hypothyroid
Age

93
Q

Investigations for erectile dysfunction

A

Testosterone
Prolactin
TSH
FSH/LH

BP
HbA1c/ fasting glucose
Cholesterol

94
Q

Management of erectile dysfunction

A

Modify risk factors etc etc etc

Sildenafil (CI in hypotension, SE facial flushing, headahces)
Alprostadil

Physical

  • Vacuum
  • Rings
  • Kegel

Psychological

  • CBT
  • Psychodynamic
  • Couples therapy
  • Mixed therapy
95
Q

Types of renal stones + RF for each

A 
Calcium 
- Calcium oxylate 
Rhubarb, tea, chocolate, nuts
- Calcium phosphate 
Hyperparathyroidism

Uric acid - gout related shit - obesity

MAP - Struvite
- Kelb + proteus UTIs

Crystine
- Inherent disorder of metab

96
Q

Common locations for renal stones

A

Srsly

pelv-ureter
passing over internal iliac
VUJ

97
Q

Investigations for renal stones

A

NCCT - gold stannid
U+E+Cr
FBC - wcc infection
MC+S on MSU

98
Q

Presentation of renal stones

A

Loin to groin pain (colic)
N+V
Microscopic haematuria
LUTS depending on site of stone

99
Q

Management of renal stones

A

Housekeeping

  • Fluids Fluids Fluids
  • Morphine
  • Odansetron

Depends on

  • Size
  • Obstructive vs non-obstructive

<5mm + no obstruction - hydration and will pass

Non-obstructive 
<10mm alpha blocker, CCB - nifedipine 
10-15 Shock wave lithotripsy 
>15mm - perc ureteroscopy 
>20mm - perc nephrolithotomy

Obstructive - as above + surgical decompression

100
Q

Complications of renal stones

A

Obstruction -> hydronephrosis

Infection –> pyelonephritis –> SEPSIS

Pressure necrosis

101
Q

Prevention of renal stones

A
  • Hydration
  • Low animal protein, low salt
  • Thiazide diuretics

Specialties (3 decks)

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