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Phase 3B > Urology > Flashcards

Urology Flashcards

1
Q

What is acute urinary retention?

A

Sudden inability to pass urine

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2
Q

What is the most common cause of acute urinary retention?

A

BPH

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3
Q

Name three other causes of acute urinary retention in men.

A

Prostate cancer
Prostatitis
Balanitis

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4
Q

Name three causes of acute urinary retention in women.

A

Prolapse
Vulvovaginitis
Pelvic mass

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5
Q

Which conditions involving the bladder can cause acute urinary retention?

A

Bladder calculi
Bladder cancer
Urethral strictures
Cystitis

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6
Q

10% of acute urinary retention is caused by drugs, such as what?

A

Anti-cholinergics
Opioids and anaesthetics
Alcohol
Alpha-adrenoreceptor agonists

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7
Q

What neurological conditions can cause acute urinary retention?

A 
Peripheral neuropathy
MS
Parkinsons'
Cerebrovascular accident
Cauda equina
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8
Q

What is found on abdominal examination in acute urinary retention?

A

Tender enlarged bladder with dullness to percussion above the symphysis pubis, almost to umbilicus.

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9
Q

What should be noted on DRE in acute urinary retention?

A

Anal tone

Prostatic size, nodules, and tenderness

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10
Q

What may be noted on examination of genitals in acute urinary retention?

A

Phimosis, discharge, inflammation, prolapse

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11
Q

How are prolapsed disc or cord compression checked on examination?

A

Lower limb power and reflexes

Perineal sensation

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12
Q

How is acute urinary retention diagnosed?

A

Routine bloods including PSA
Urinalysis for infection, haematuria, proteinuria, glycosuria
USS: post void residual volume and hydronephrosis
CT and MRI if indicated

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13
Q

How is acute urinary retention managed?

A

Immediate bladder decompression

Alpha blocker before removal of catheter

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14
Q

Define benign prostatic hyperplasia.

A

Increase in size of prostate gland without malignancy present

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15
Q

What is the pathophysiology of BPH?

A

Failure of apoptosis, hormone dependent

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16
Q

How does BPH present?

A 
Urinary frequency
Urgency
Hesitancy
Post micturition dribbling
Incomplete bladder emptying
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17
Q

How is BPH diagnosed?

A 
Check for palpable bladder
DRE
Urinanalysis and MSU for MC&S
Routine bloods
PSA
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18
Q

What should be noted on DRE for BPH?

A

Tone of anal sphincter
Size, texture, contour of prostate
Median sulcus clearly defined

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19
Q

Elevated ALP may suggest…

A

Bony metastases

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20
Q

What may a palpable bladder suggest?

A

Chronic outflow obstruction

Neurogenic bladder

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21
Q

If a BPH patient has moderate to severe voiding symptoms, what drugs can be offered?

A

Alpha blockers e.g. Tamsulosin

5-alpha reductase inhibitors (5-ARI) e.g. Finasteride

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22
Q

How do alpha blockers work?

A

Reduce the tone in the muscle of the neck of the bladder

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23
Q

When may doxazosin be described in patients with BPH?

A

It is less selective, so may be prescribed if patient also has hypertension.

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24
Q

What are the side effects of tamsulosin?

A

Rhinitis
Dizziness and headache
Intra-operative floppy iris syndrome

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25
Q

How do 5-ARIs work?

A

They block the synthesis of dihydrotestosterone from testosterone.

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26
Q

What is the main side effect of 5-ARIs?

A

Adverse effect on sexual performance which may continue after discontinuation.

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27
Q

What is the second line treatment of BPH?

A

When no response to monotherapy AND prostate>30g/PSA>1.4ng/mL

Combine alpha blocker and 5-ARI

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28
Q

What is the surgical management of BPH?

A

TURP - transurethral resection of the prostate

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29
Q

What are the risk factors for prostatitis?

A

HIV infection
BPH and prostate cancer
STI
Indwelling catheters

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30
Q

What are the causes of prostatitis?

A

Gram negative bacteria
STI
If non bacterial - elevated prostatic pressures

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31
Q

What are the four types of prostatitis?

A

Acute bacterial
Chronic bacterial
Chronic prostatitis
Asymptomatic inflammation

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32
Q

What are the symptoms of prostatitis?

A

Fever, malaise, arthralgia, myalgia
LUTS including nocturia and dysuria
Pain - lower back, abdo, perineal, urethral
Pain on ejaculation/premature ejaculation
Urethral discharge

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33
Q

What are the signs of prostatitis?

A

Pyrexia
Nodular/boggy/tender/hot or normal gland
Inguinal lymphadenopathy

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34
Q

How does the prostate gland feel in chronic prostatitis?

A

Hard from calcification

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35
Q

How is prostatitis diagnosed?

A

Urine culture and microscopy for WCC and bacterial count
Oval fat bodies and lipid laden macrophages
PSA may be elevated

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36
Q

What is the management of acute prostatitis?

A

Possibly admission
Analgesia
Ciprofloxacin 4 weeks

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37
Q

What is the management of chronic infective prostatitis?

A

Refer
Ciprofloxacin 4-6 weeks, repeated courses may be necessary
TURP may be required

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38
Q

What is the management of chronic abacterial prostatitis?

A

Analgesia

Alpha blocker plus antibiotic

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39
Q

What is neurogenic bladder?

A

Bladder dysfunction that may be either flaccid or spastic, which may co-exist with bladder outlet obstruction

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40
Q

What are the CNS causes of neurogenic bladder?

A

CVD
Spinal injury
ALS

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41
Q

What are the PNS causes of neurogenic bladder?

A

Diabetes
Alcohol
Vitamin B12 deficiency neuropathies
Disc damage

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42
Q

What are the mixed CNS and PNS causes of neurogenic bladder?

A

Parkinson’s

MS

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43
Q

Describe flaccid/hypotonic bladder.

A

Large bladder volume, pressure low, contractions absent

Damage at S2-S4

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44
Q

Describe the spastic bladder.

A

Normal/small volume, involuntary contractions occur
Damage above T12
Detrusor-sphincter dyssnergia

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45
Q

What is the main symptom of neurogenic bladder?

A

Overflow incontinence, retaining of urine

Spastic have LUTS too

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46
Q

How is neurogenic bladder monitored?

A

Renal function - serum creatinine
Hydronephrosis - Renal USS 1-2 yearly
Urodynamics if high risk
Large post-void residual volume

47
Q

Patients with hydronephrosis or nephropathy undergo what?

A

Cystography
Cystoscopy
Cystometrography

48
Q

What is the management of flaccid bladder?

A

Intermittent self catheterization

49
Q

What is the management of spastic bladder?

A

Trigger voiding with suprapubic pressures and anti-cholinergics
Treat urge incontinence

50
Q

What are prostate cancers and where do they arise?

A

Adenocarcinomas arising in the peripheral zone of the prostate gland

51
Q

What are the risk factors for prostate cancer?

A

Increasing age
Afro-Caribbean
FH

52
Q

How does prostate cancer present?

A

LUTS and raised PSA on screening

Locally invasive disease - haematuria, haematospermia, perineal and suprapubic pain, impotence

53
Q

What are the signs of prostate cancer?

A

Irregular asymmetrical gland, induration, lack of median sulcus, lack of mobility - adhesion to surrounding tissue, palpable seminal vesicles.

54
Q

What are the investigations for prostate cancer?

A 
PSA
PCA3 urine test
Urinalysis
Renal function tests
Transrectal needle biopsy
55
Q

What factors influence whether men should have a prostate biopsy?

A

PSA level
DRE findings
Comorbidities
Risk factors

56
Q

What are the possible treatments of prostate cancer?

A

Watchful waiting
Radical prostatectomy
Curative radiotherapy
Brachytherapy

57
Q

What is the most common androgen deprivation therapy?

A

GNRH agonists such as goserelin

58
Q

What are the other forms of anti-androgen therapy?

A

Bilateral orchiectomy

Cytoproterone acetate

59
Q

How do anti-androgens inhibit prostate cancer growth?

A

Inhibit androgen receptor signalling

60
Q

What is flare phenomenon, an adverse effect of anti-androgen therapy?

What is the cause, and how can it be prevented against?

A

Bone pain, acute bladder outlet obstruction, obstructive AKI, spinal cord compression, fatal cardiovascular events due to hypercoagulation status

Caused by an initial increase in luteinizing hormone prior to receptor down regulation

Flutamide can pre-emptively attenuate the tumour flare.

61
Q

What are the other adverse effects of anti-androgen therapy?

A

Hot flushes
Sexual dysfunction
Osteoporosis
Gynaecomastia

62
Q

Define the acute scrotum.

A

Acute scrotal pain with or without oedema or erythema

63
Q

What are the differentials for acute scrotum?

A 
Torsion of the testes
Epididymitis/orchitis
Hydrocele
Tumour
Idiopathic scrotal oedema
64
Q

What is bell-clapper testis and what is it a risk factor for?

A

Lack of normal fixation of posterior lateral aspect of testis to tunica vaginalis
Intravaginal testicular torsion

65
Q

Which type of testicular torsion occurs in neonates?

A

Extravaginal - before the testis is fixed in the scrotum by the gubernaculum

66
Q

What are the symptoms of testicular torsion?

A

Left>right
Sudden severe testicular pain, may be abdo
N+V

67
Q

What are the signs of testicular torsion?

A

Swollen tender testis retracted upwards, erythema
Lifting testis up over symphysis increases pain
Absence of cremasteric reflex on affected side

68
Q

Where does the cremasteric reflex originate?

A

L1/L2

69
Q

How is testicular torsion diagnosed?

A

Colour Doppler USS

70
Q

How is testicular torsion managed?

A

Attempt manual reduction by outwards rotation of testis

Bilateral orchiopexy

71
Q

What are the complications of testicular torsion?

A

Infarction of testicle

Subfertility from ischaemia-reperfusion injury

72
Q

What are the causes of epididymo-orchitis?

A

STI (chlam/gono)
UTI (gram neg)
Mumps

73
Q

What are the risk factors for epididymo-orchitis?

A

STI/UTI
MSM
Catheters

74
Q

What are the symptoms of EO?

A

Acute unilateral scrotal pain and swelling

75
Q

What are the signs of EO?

A

Tenderness, palpable swelling of epididymitis

Secondary hydrocele, erythema, pyrexia

76
Q

How is EO diagnosed?

A

Gram stained urethral smear, MC&S
NAAT urethral swab
Exclude TT

77
Q

How is EO treated?

A

Doxycycline 100mg PO BD 10-14d
If STI, add IM 250mg ceftriaxone
If enteric: olfloxacin 200mg PO BD 14d

78
Q

What is a hydrocele?

A

An abnormal collection of fluid within the remnants of the processus vaginalis

79
Q

What are the main types of hydoceles?

A

Simple (usually congenital)
Communicating
Non-communicating

80
Q

What are the causes of secondary hydrocele?

A 
Epididymo-orchitis
TB
TT
Tumours
Trauma
Generalised oedema
81
Q

What are the features of a hydrocele?

A

Scrotal enlargement with a non-tender smooth swelling which transilluminates.
Lies anterior to and below the testis
Impalpable testis

82
Q

What are important investigations to rule out a transilluminating teratomas?

A

Serum AFP and hCG

83
Q

How is a hydrocele managed?

A

Infancy - resolve by 2 years

Large - therapeutic aspiration

84
Q

Where do 95% testicular tumours arise and what are the subtypes?

A

Germ cells

Seminoma and non-seminomatous germ cell tumours (NSGCTs)

85
Q

What are the risk factors for testicular cancer?

A

Cryptorchidism or testicular maldescent
FH
Klinefelter syndrome
Malignancy in contralateral testicle

86
Q

What are the symptoms of testicular cancer?

A

Painless lump
Dragging sensation
Hydrocele
Gynaecomastia from bhCG

87
Q

How is testicular cancer diagnosed?

A

Tumour marker assay
Bilateral testicular USS
Tissue histology

88
Q

What is the treatment of testicular cancer?

A

Radical orchidectomy and prosthesis

89
Q

What is the staging system of testicular cancer?

A

Royal Marsden

90
Q

What elements produce AFP and bhCG?

A

AFP - yolk sac tumours

bHCG - trophoblastic elements - teratomas and seminomas

91
Q

What are the three types of priapism?

A

Ischaemic (low flow)
Non-ischaemic (high flow)
Recurrent ischaemic (intermittent)

92
Q

What is the most common cause of priapism?

A

Sickle cell disease

93
Q

What are the consequences of priapism?

A

Ischaemic damage leading to erectile dysfunction, disfigurement, gangrene.

94
Q

What does an ABG of the corpus cavernosum show in priapism?

A

Low pH: ischaemic

Normal pH: non-ischaemic

95
Q

How is priapism diagnosed?

A

Doppler USS and ABG

96
Q

What is the treatment of ischaemic priapism?

A

Aspiration of blood from corpus cavernosum, injection of normal saline
Injection of phenylephrine

97
Q

What inotrope is used in sepsis?

A

Adrenaline increases cardiac output

Noradrenaline causes peripheral vasoconstriction

98
Q

Why does sepsis result in hypovolaemia?

A

Massive vasodilation causes hypotension

99
Q

What is the management of an ileus?

A

Drip and suck

NG tube inserted to decompress all the gas and allow a period of rest for the bowel

100
Q

Bilious vomiting and an inguinal lump =

A

Obstructed hernia

101
Q

What is the pathognomic sign of torsion of testicular appendage?

A

Blue dot sign

102
Q

What is the treatment of torsion of testicular appendage?

A

Ibruprofen and conservative management

Exclude testicular torsion

103
Q

What imaging modality is used to image urinary tract stones?

A

Non-contrast (stones are white)

104
Q

In priapism, what is done before the penis is drained?

A

Dorsal nerve block

105
Q

What are the PCRMP age adjusted upper limits for PSA (ng/ml)?

A

50-50 years: 3.0
60-69 years: 4.0
>70 years: 5.0

106
Q

Name some complications of radical prostatectomy.

A

Incontinence

Erectile dysfunction

107
Q

Retrograde ejaculation can occur after what?

A

Alpha-blocker therapy

TURP

108
Q

What is the first line investigation of a testicular mass?

A

Ultrasound

109
Q

Name a life threatening complication of a TURP.

A

TURP syndrome

Venous destruction and absorption of the irrigation fluid

110
Q

What causes the symptoms of TURP syndrome?

A

Fluid overload

Hyponatraemia

111
Q

What are the causes of unilateral hydronephrosis?

A 
PACT
Pelvic-ureteric obstruction
Aberrant renal vessels
Calculi
Tumours of renal pelvis
112
Q

What are the causes of bilateral hydronephrosis?

A 
SUPER
Stenosis of the urethra
Urethral valve
Prostatic enlargement
Extensive bladder tumour
Retro-peritoneal fibrosis
113
Q

What are four medical indications for circumcision?

A

Phimosis
Paraphimosis
Recurrent balanitis
Balanitis xerotica obliterans

114
Q

What are three causes of haematospermia?

A

Trauma
UTI especially prostatitis
STI
Exclude cancer with physical examination

Phase 3B (20 decks)

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