Urology Flashcards
most common composition of renal stone
calcium oxalate
composition of struvite stones
magnesium
ammonium
phosphate
types of renal stone
calcium oxalate struvite uric acid calcium phosphate cystine
predisposition to renal crystal formation
altering pH
what pH condition causes struvite stones
alkali
stag-horn calculi
large calculi that extend into at least 2 calyces
Ix of renal stone
CT KUB (CT stone search)
most common type of stone to form stag horn calculi
struvite
Mx renal stone <5mm
conservative Mx
increase fluid intake
analgesia (diclofenac)
alpha-blockers
Mx renal stone <2cm
extracorporeal shock wave lithotripsy (ECSWL)
Mx renal stone <2cm + pregnant
ureteroscopy
Mx renal staghorn calculi
Percutaneous nephrolithiotomy
Mx renal stone if evidence of ureteric obstruction or infection
nephrostomy + stent
types of bladder cancer
transitional cell (papillary vs non-papillary)
squamous cell
main risk factor for squamous cell bladder ca
schistosomiasis
Ix bladder cancer
cystoscopy + biopsy
Mx superficial bladder cancer
transurethral resection of bladder (TURB)
Mx high grade bladder cancer
TURB + intra-vesical chemo
haematuria in someone just back from lake malawi
schistosomiasis
role of PSA
liquification of semen
is there a screening programme for prostate Ca
no - but pt can request PSA but must be counselled about risk of false positive and negatives
upper limit of normal PSA
(age-20)/10
cause of BPH
natural ageing process - imbalance of androgen/oestrogen
g/s Ix of BPH
Rectal USS with biopsy
Mx of BPH
- alpha blocker (tamsulosin)
- 5 alpha reductase inhibitor (finasteride)
- transurethral resection of prostate (TURP)
s/e of alpha blockers
drowsiness depression dry mouth low BP ejaculatory failure increased weight
(relief on stopping drug)
s/e of 5 alpha reductase inhibitors
excreted in semen
impotence
reduced libido
gynaecomastia
(no relief on stopping drug - 3-6m later)
most common type of prostate ca
adenocarcinoma
most common area for prostate cancer
peripheral zone
most common place for prostate ca mets
bone - sclerotic lesions
Ix prostate Ca
rectal USS + biopsy
gleason score
used from prostate biopsies
5-6 biopsies taken from each side of prostate
2 grades assigned to each pt - primary grade is largest area of tumour, secondary grade is next largest area
Mx prostate ca
any of: active surveillance radical prostatectomy +/- lymph node dissection radical XRT hormone therapy
how does hormonal Tx used in prostate Ca work
prostate ca depends on testosterone for growth, so depriving ca cells of testosterone delays tumour progression
circulating testosterone exerts -ve feedback on pituitary LH secretion
hormonal Tx used in prostate Ca
Androgen deprivation therapy
- LHRH agonists (Leuprorelin, Goserelin)
Anti-Androgens
- Steroidal (cyproterone acetate)
- Non-steroidal (bicalutamide, flutamide)
risk of starting LHRH agonists in prostate Ca
they initially stimulate LH and FSH, so more testosterone.
need to give anti-androgen cover for 3d.
risk of spinal cord compression
Mx of man with prostate ca and back pain
radical prostatectomy + dexamethasone for spinal cord compression
balanitis
inflammation of the glans penis
most common cause of balanitis
candida
Mx balanitis
improve hygiene
gentle saline washes
if severe discomfort - 1% hydrocortisone
presentation of epididymal cyst
posterior to testicle
can get above it
man with swollen testis but it can be felt -Dx?
epididymal cyst
Mx epididmyal cyst
supportive
presentation of hydrocele
non-tender swelling
transilluminates
can get above it
hydrocele can be the presenting feature of - ?
testicular ca
Ix hydrocele
Doppler USS with colour
presentation of varicocele
left side
“bag of worms”
varicocele can be the presenting feature of - ?
renal cell carcinoma
Ix varicocele
Doppler USS
paraphimosis
foreskin can’t be pulled back over glans - most commonly due to foreskin being pulled back for catheterisation and not placed back
prevents venous return leading to oedema
Mx paraphimosis
iced glove
manual decompression
phimosis
the foreskin can’t be retracted past the glans
mx phimosis
daily gentle traction
topical steroid to soften foreskin
Ix of ?renal injury
CT with contrast
Ix ?bladder injury
CT cystography
Ix ?urethral injury
retrograde urethrogram
classification of testicular tumours
germ cell (95%)
- seminoma
- non-seminoma (yolk sac, teratoma, choriocarcinoma)
tumour marker for non-seminoma testicular tumour
AFP
tumour marker for seminoma testicular tumour
PLAP, hCG
Ix testicular ca
USS
Mx testicular ca
orchidectomy (inguinal approach)
1st Ix of frank haematuria, pt >50
CT urogram
1st Ix of frank haematuria, pt <50
USS
2nd Ix of frank haematuria
cystoscopy
Microscopic haematuria (+) and no symptoms - Ix?
no Ix
Microscopic haematuria (++) and no symptoms - Ix?
no Ix
Microscopic haematuria (++) and symptoms - Ix?
<50 = USS >50 = CT urogram
man with macroscopic haematuria + on on warfarin - what do u do?
Urgent referral to urology for Ix
woman aged 23 with microscopic haematuria in urine.
check in 2w time and no haematuria.
check again and haematuria. Ix?
cystoscopy
man with dark urine, muscle pain and difficulty getting out chair - Dx? Ix?
rhabdomyolysis
CK
alpha-1-adrenoceptors - role?
contraction of smooth muscle
alpha-2-adrenoceptors - role?
release of noradrenaline
man taking methotrexate but wants to conceive - how long should he wait after stopping Tx?
at least 6m
<65 y/o normal post-void volume
50ml
> 65y/o post-void volume
100ml
Ix recurrent UTI
- urine analysis
- FVC
- Flow + Scan
- US KUB & post-void scan
- cystoscopy (rule out bladder ca)
Ix hydronephrosis
USS
drugs causing erectile dysfunction
SSRIs
Beta blockers
