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Phase 3B > Urology > Flashcards

Urology Flashcards

1
Q

What is an epidymal cyst?

A

-Most common cause of scrotal swelling seen in primary care

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2
Q

What are the features of an epididymal cyst?

A
  • Lump
  • Separate from the body of the testicle
  • Found posterior to the testical
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3
Q

Which conditions are associated with epididymal cysts?

A
  • PCKD
  • CF
  • Von Hippel-Lindau syndrome
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4
Q

How is epididymal cysts diagnosed?

A

-USS

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5
Q

How is an epididymal cyst managed?

A
  • Supportive therapy

- Surgical removal or sclerotherapy for larger symptomatic cysts

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6
Q

What is a hydrocele?

A

-Abnormal collection of fluid between the 2 layers of the tunica vaginalis

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7
Q

What are the causes of hydroceles?

A
  • Non-communicating/simple hydrocele: Overproduction of fluid within the tunica vaginalis
  • Communicating hydrocele: processus vaginalis fails to close allowing peritoneal fluid to communicate with scrotal portion
  • Hydrocele of the cord: processus vaginalis closes segmentally, trapping fluid with the spermatic cord
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8
Q

Which conditions may hydroveles develop secondary to?

A
  • Epididymo-orchitis
  • Testicular torsion
  • Testicular tumours
  • Trauma
  • Generalised oedema
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9
Q

How do hydroceles present?

A
  • Scrotal enlargement with a soft non-tender swelling
  • Painless
  • Lies anterior to and below the testes
  • Transluminates with pen torch
  • Testes can be difficult to palpate if hydrocele is large
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10
Q

Investigations for hydroceles?

A
  • Simple: none
  • USS
  • Duplex sonography
  • Serum alpha fetoprotein and HCG levels to exclude malignant teratomas
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11
Q

Treatment for hydroceles?

A

-Many of infancy resolve spontaneously before 2years
-Conservative approach depending on severity in adults
>Exclusion of malignancy
-Scrotal support
-Therapeutic aspiration
-Surgical removal (in some cases)

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12
Q

What is a varicocele?

A
  • Anbnormal dilatation of testicular veins in the pampiniform venous plexus, caused by venous reflux
  • Usually asymptomatic but associated with infertility
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13
Q

What is an important cause of varicocele that must be excluded?

A

-Renal cell carcinoma

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14
Q

Causes of varicoceles?

A
  • Reflux (from renal vein->testicular veins:Usually the left)
  • Vein incompetence
  • Swollen testicles could be caused by kidney cancer
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15
Q

Why does varicoceles usually occur on the left?

A
  • Left testicular vein drains into the left renal vein. Increased chance of becoming obstructed.
  • Right testicular vein drains in the the IVC
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16
Q

What is the epidemiology of a varicocele?

A
  • Unusual in boys under 10
  • Incidence increases after puberty
  • Cause of infertility
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17
Q

Clinical presentation of a varicocele?

A
  • Usually asymptomatic
  • Scrotum described as feeling like a ‘bag of worms’
  • Scrotal heaviness
  • Incidentally when having infertility investigations
  • Lower scrotum on varicocele side
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18
Q

Investigations and varicoceles?

A
  • Sperm count
  • US colour doppler studies
  • Venography, CT
  • Serum FSH, LH and LHRH (relate to sperm production)
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19
Q

What is the treatment for varicoceles?

A

-Surgical repair when there is pain, possible infertility consequences and possible testicular atrophy

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20
Q

What are the main differential diagnoses for scrotal swelling?

A
  • Inguinal hernia
  • Testicular tumour
  • Acute epididymo-orchitis
  • Epididymal cysts
  • Hydrocele
  • Testicular torsion
  • Varicocele
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21
Q

Define testicular torsion?

A

-Twisting of the spermatic cord resulting in testicular iscahemia and necrosis

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22
Q

Aetiology of testicular torsion?

A
  • Occlusion of the testicular blood vessels

- Usually following sport or physical activity

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23
Q

Pathophysiology of testicular torsion

A
  • Blood vessel occlusion leads to ischaemia of the testicle

- Acute inflammation causes pain and swelling to try and block the occlusion

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24
Q

Epidemiology of testicular torsion?

A
  • Mainly affects males between 10-30 (commonly 13-15)
  • Can occur in new borns
  • Most likely left side affected
  • Bilateral cases are rare
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25
Q

Clinical presentation of testicular torsion?

A
  • Acute swelling of the scrotum
  • Pain: sudden and severe
  • Lower abdo pain
  • Nausea and vomiting
  • Reddening of scrotal skin
  • Swollen tender testes (retracting upwards)
  • Cremasteric reflex lost
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26
Q

Investigations for testicular torsion?

A
  • Urinalysis to exclude infection

- Doppler USS: shows reduced blood flow

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27
Q

Treatment for testicular torsion?

A
  • Surgery (within 6 hours to keep the testicle)

- if torted tesis -> both testes should be fixed to treat bell clapper testis (bilateral)

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28
Q

What is BPH?

A
  • Benign prostatic hyperplasia
  • Enlarged prostate gland without malignancy
  • Common in older men
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29
Q

What is the cause of BPH?

A

-May be due to failure of apoptosis but cause is unknown

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30
Q

What are the risk factors for BPH?

A
  • Increasing age

- Ethnicity: black men > white men > asian men

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31
Q

Which zone of the prostate gland does BPH occur in?

A

-Transitional zone

>hyperplasia of both glandular and connective tissue elements within the gland

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32
Q

How does BPH present?

A

-LUTS
>Voiding symptoms (obstructive): weak/intermittent urinary flow, straining, hesitancy, terminal dribbling, incomplete emptying
>Storage symptoms (irritative): urgency, frequency, urgency incontinence, nocturia
>Post micturition: dribbling
>Complications: UTI, retention, obstructive uropathy

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33
Q

Investigations ofr BPH?

A
  • PR: smooth enlarged prostate
  • U&Es and renal USS
  • Rule out malignancy
  • Serum PSA
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34
Q

What is the treatment for BPH?

A
  • Watchful waiting
  • Alpha blockers
  • 5-alpha-reductase inhibitors
  • Urethral or suprapubic catheterisation
  • Prostatectomy/TURP
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35
Q

What are some example alpha blockers/a1 receptor antagonists? How do they work?

A
  • Tamsulosin
  • Alfuzosin
  • Relax smooth muscle in the bladder neck and prostate
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36
Q

What are some examples of 5 alpha reductase inhibitors and how do they work?

A
  • Finasteride
  • Blocks conversion of testosterone to dihydrotestosterone (cause of prostate growth)
  • Can slow disease progression
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37
Q

What are the adverse effects of alpha 1 antagonists ie tamsulosin?

A
  • Dizziness
  • Postural hypotension
  • Dry mouth
  • Depression
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38
Q

What are the adverse effects of 5 alpha reductase inhibitors?

A
  • Erectile dysfunction
  • Reduced labido
  • Ejaculation problems
  • Gynaecomastia
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39
Q

What are some complications of BPH?

A
  • Symptom progression leading to bladder obstruction or progression to malignancy
  • Infections
  • Stones
  • Haematuria
  • Acute retention
  • Chronic retention
  • Interactive obstructive uropathy
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40
Q

What is the most common type of bladder cancer?

A

-Transitional cell carcinomas

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41
Q

What are the risk factors for transitional cell carcinoma of the bladder?

A
  • Smoking
  • Exposure to aniline dyes in the printing/textile industry
  • Rubber manufacture
  • Cyclophosphamide
  • Pelvic irradiation
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42
Q

What are the risk factors for squamous cell carcinoma of the bladder?

A
  • Schistosomiasis
  • BCG treatment
  • Smoking
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43
Q

What is the link between schistosomiasis and bladder cancer?

A

-Schistosomiasis = parasite that causes chronic inflammation of the UT
>leads to SCC
>20 year lag

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44
Q

What layers form the bladder wall?

A
  • Transitional epithelium
  • Lamina propria
  • Submucosa
  • Detrusor muscle
  • Adventitia
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45
Q

What is the epidemiology of bladder cancer?

A
  • 50% worldwide: schistosomiasis

- 50% UK: smoking

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46
Q

What are the 2 categories of LUTS?

A
  • Storage symptoms

- Voiding symptoms

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47
Q

What are storage symptoms?

A
  • Frequency
  • Urgency
  • Incontinence
  • Painful micturition or reduced bladder senstation
  • Nocturia
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48
Q

What are examples of Voiding symptoms

A
  • Intermittent stream
  • Hesitancy
  • Straining
  • Dribbling
  • Feeling of incomplete emptying
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49
Q

What are red flags of LUTS?

A
  • Haematuria

- Dysuria

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50
Q

What is the clinical presentation of bladder cancer?

A
  • Painless haematuria
  • Recurrent UTIs
  • Voiding irritability
  • LUTS
  • Dysuria
  • Abdo pain
  • Weight loss/bone pain
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51
Q

Investigations for bladder cancer?

A
  • Urine dipstick (non-visible haematuria)
  • Blood tests (FBC, U&E, LFTs)
  • Flexible cystoscopy with biopsy
  • Ct urogram: provides staging
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52
Q

What is the treatment for bladder cancer in situ (non muscle invasive bladder ca)?

A

-Resection +/- intravesicle chemo

>Mitomycin and BCG vaccine

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53
Q

How is localised bladder cancer managed?

A

-Depends on pts fitness
>Radical surgery: cyctectomy +/- prostatectomy +/- urethrectomy +/- neoadjuvant chemo
>Radical radiotherapy if not fit/unwilling to have cystectomy

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54
Q

How do you treat locally advance bladder cancer?

A
  • Radical surgery +/- chemo

- Radical radiotherapy

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55
Q

How do you treat metastatic bladder cancer?

A
  • Combination chemo
  • Poor survival
  • Urinary diversion for severe symptoms if unfit for radical surgery. Create urostomy
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56
Q

What is the 2WW criteria for suspected urological malignancy?

A

-PSA above normal levels
>45 with any:
-Unexplained visible haematuria without UTI
-Persistent visible haematuria after treatment of UTI
>60 with any:
-Unexplained non-visible haematuria with either,
>raised WCC, dysuria

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57
Q

What is the role of the prostate gland?

A

-Produces seminal fluid that nourishes the sperm
>Production of fluid is triggered by
dihydrotestoerone
-Located below male bladder and surrounds the urethra

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58
Q

What zone of the prostate is affected by malignant cancer?

A

-Peripheral zone
(compared to BPH affecting the transitional zone)
-Presents later than BPH because peripheral zone is further away from the urethra

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59
Q

What type of cancer is most commonly found in the prostate?

A
  • Adenocarcinoma

- Usually multifocal

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60
Q

Why should prostate cancer be considered as 2 different diseases?

A
  • Localised and advanced disease

- Both have different symptoms, outcomes and treatments

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61
Q

What are causes/risk factors for prostate cancer?

A
  • Age
  • Obesity
  • Afro-caribbean ethnicity
  • Family history
  • Mutations in androgen receptor genes
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62
Q

What is the epidemiology of prostate cancer?

A
  • Disease of the elderly

- Most men die with prostate cancer rather than from it

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63
Q

What is the most common presenting complaint for prostate cancer?

A

-Can be asymptomatic or mimic BPH
>increased frequency, nocturia, urinary hesitancy, post-void dribbling
-Pain (back, perineal, testicular)
-Haematuria or haematospermia

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64
Q

What are the non-urinary symptoms of prostate cancer?

A

-Non-specific: weight loss, anorexia, fever, anaemia
-Hypercalcaemia: due to bone mets causing increased bone breakdwon: anorexia, thirst, confusion, collapse
-Marrow replacement: purpura, anaemia, immune suppression
-Paraneoplastic:
>Cushing’s
>Dementia
>Peripheral neuropathy
>Erythrocytosis
>Acanthosis nigricans

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65
Q

Which lymph nodes does prostate cancer metastasise to initially?

A
  • Obturator nodes

- Also commonly spreads to bone

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66
Q

What are the investigations for prostate cancer?

A
  • PSA
  • Prostate specific membrane antigen
  • Urine test for PCA3
  • Transrectal ultrasound scan
  • Prostate biopsy
  • MRI/CT and bone scanning
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67
Q

What is considered normal for the upper limit of PSA?

A

Age: 50-59 = 3ng/ml
Age: 60-69 = 4ng/ml
Age: 70+ = 5ng/ml

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68
Q

When should someone be referred due to a raised PSA?

A

-Men aged: 50-69 with PSA >3 or abnormal DRE

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69
Q

What are some causes of false +ve raised PSA?

A
  • Prostatitis
  • UTI
  • BPH
  • Vigorous DRE
  • Vigorous exercise
  • Ejaculation
  • Urinary retention
  • Instrumentation of the Urinary tract
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70
Q

How must a PSA test be timed in order to obtain an accurate result?

A
  • 6 weeks following prostate bipsy
  • 4 weeks following proven UTI
  • 1 month following prostatitis
  • 1 week following DRE
  • 48hrs post vigorous exercise/ejaculation
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71
Q

What is the most important physical examination to perform in someone with ?prostate cancer?

A 
-DRE
>Asymmetrical
>hard
>Nodular enlargement (craggy)
>loss of median sulcus
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72
Q

Which grading system is used for grading prostate cancer?

A

-Gleason grading system

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73
Q

What is the treatment for localised prostate cancer?

A
  • Radical prostatecomy + radiotherapy
  • Focal therapy (high intensity USS)
  • Watchful waiting in the elderly, multiple co-morbidities
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74
Q

What is the difference between watchful waiting and active surveillance?

A
  • Watchful waiting: less invasive form of monitoring. Treatment is guided by symptoms
  • Active surveillance: follow up for physical examinations, measurement of PSA level and treatment depends on those factors
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75
Q

What are the risks for radical prostatectomy?

A
  • Incontinence

- Sexual dysfunction

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76
Q

Arguements for radical treatment of localised prostate cancer?

A
  • Curative
  • Prostate cancer cells killed
  • Reduces pt anxiety
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77
Q

Arguements against radical surgery for localised prostate cancer?

A
  • Disease of the elderly
  • Cause of death
  • Adverse effects of Rx
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78
Q

Arguments for screening for prostate cancer?

A
  • Commonest cancer in men

- Men die from it

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79
Q

Arguments against prostate cancer

A
  • Uncertain natural history
  • Morbidity of treatment
  • False +ves
  • Pts can be treated when they’d never develop symptoms
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80
Q

How do you treat locally advanced prostate cancer?

A
  • Radiotherapy +/- radical prostatectomy

- Brachytherapy (radiotherapy inserted into prostate using device)

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81
Q

What are some complications of radiotherapy for prostate?

A
  • Bowel cancer
  • Bladder cancer
  • Increased frequency of urination
  • Fibrosis
  • Urethral strictures
  • Skin changes/inflammation
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82
Q

How is metastatic prostate cancer treated?

A

-Androgen deprivation essential
>surgical castration or medical castration if pt refuses surgery
>stops action of dihydrotestosterone

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83
Q

What is surgical castration?

A

-Removal of testes to get rid of testosterone level to reduce symptoms and improve survival

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84
Q

Explain how medical castration works?

A

-GNRH analogues
>-ve feedback on testosterone
-LH antagnoists (block testosterone production from Leydig cells)
-Peripheral androgen receptor antagnosists

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85
Q

What are some examples of GNRH analogues?

A
  • Buserelin
  • Goserelin (Zoladex)
  • Lueprorelin
  • Triptorelin
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86
Q

Which medication should be co-prescribed for someone starting on a GNRH analogue?

A

-Anti-androgen treatment ie cyproterone
>used to reduce the risk of tumour flare
>start cyproterone 3/7 before GNRH

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87
Q

What is castration-resistant prostate cancer and how is it treated?

A

-Disease continues to progress despite castration
>abiraterone =2nd line hormonal therapy
>cytotoxic chemotherapy: docetaxel, carbazitaxel
-Bisphosphonates to protect bones

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88
Q

What is the main complication of TURP?

A

-Transurethral resection of the prostate syndrome

>Venous destruction and absorption of the irrigation fluid occurs

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89
Q

What are the risk factors of TURP syndrome?

A

-Surgical time >1hr
-Height of bag >70cm
-Resected >60g
-Large blood loss
>Perforation of the bladder
>Large amount of fluid used
-Poorly controlled CHF

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90
Q

What are the features of TURP syndrome?

A

-Early features: restless, headache, tachypnoea, burning sensation in face and hands
-Greater severity features:
>resp distress, hypoxia, pulmonary oedema
>N+V
>visual disturbance
>Confusion
>Haemolysis
>Acute renal failure

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91
Q

What investigations should be done for TURP?

A
  • Hyponatraemia (from the large volume of fluid absorbed)

- Metabolic acidosis

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92
Q

How is TURP syndrome managed?

A
  • ABCDE + resus +02

- Fluid overload management

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93
Q

Which cells in the testicles produce a) testosterone, b) sperm

A

a) Leydig cells in the presence of LH

b) sertoli cells

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94
Q

What are the causes of testicular cancer?

A
  • Unknown (majority of cases)
  • Larger risk factors in those with undescended testicles
  • FH
  • Genetic factors: chromosome 12 abnormalities
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95
Q

What are the risk factors for testicular cancer?

A
  • For teratomas and seminomas (25-35years)
  • Cryptorchidism (undescended testes)
  • Infertility
  • Family hx
  • Klinefelter’s syndrome
  • Mumps orchitis
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96
Q

What are the main types of cancer in the testicles?

A

-Mainly arise from the germ cells: Seminomas, teratomas

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97
Q

What is the epidemiology of testicular cancer?

A

-Most common cancer in young men

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98
Q

How does testicular cancer present?

A
  • Painless lump
  • Testicular +/- abdo pain
  • Dragging sensation in the testicles
  • Hydrocele
  • Gynaecomastia from B-HCG production
  • Mets in lungs: cough/dyspnoea
  • Mets in para-aortic lymph nodes: back pain
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99
Q

Investigations for testicular cancer?

A

-USS: helps differentiate between masses in the testes and other intra-scrotal
swellings
-Serum conc. of tumour markers: alpha fetoprotein, Beta-HCG
-Tumour staging with CT CAP

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100
Q

Treatment of testicular cancer?

A
  • Orchidectomy
  • Radiotherapy (seminomas mets below the diaphragm)
  • Chemotherapy (widespread tumours from teratoma mets)
  • Sperm banking
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101
Q

Define urinary tract infection?

A

-Inflammatory response of the urothelium to bacterial invasion usually associated with bacteriuria and pyuria

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102
Q

How can UTIs be classified?

A
  • Upper vs lower
  • Clinical risk ie uncomplicated vs complicated
  • Timing: single/isolated vs unresolved, acute vs chronic
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103
Q

What are the 5 main pathogens responsible for causing UTIs seen in primary care?

A
  • E. coli
  • Coagulation negative staph species (ie staph epidermidis)
  • Proteus spp. (gram -ve bacillus)
  • Enterococci (gram +ve cocci)
  • Klebsiella species (gram -ve bacillus)
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104
Q

What kind of urinary tract abnormalities encourage bladder infections?

A
  • Urinary obstruction or stasis
  • Previous damage to the bladder epithelium ie previous infections
  • Bladder stones
  • Poor bladder emptying ie neuro problems
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105
Q

Describe the most common pathway to a UTI?

A

-Colonic flora exists naturally
-Which colonise the vagina and then the urethral meatus
-Ascent of bacteria up the urethra = bacteriuria
=UTI

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106
Q

What are some bacterial factors that increase the likelihood of UTI?

A

-Fimbriae/pili allow strong adheretion to the urothelium, vaginal epithelium, vaginal mucous
-Ability to avoid host defences
>capsule resistant to phagocytosis
>toxin release
>enzyme production ie secreation of urease
>abx resistance

107
Q

What is the function of urease enzyme in UTIs?

A
  • Produced by infecting bacteria
  • Increases the risk of stone formation (calcium phosphate)
  • Increase pH >7.2 through production of ammonium = dispruption of normal commensal bacteria which are usually protective against infection
108
Q

Examples of bacteria that produce urease:

a) gram -ve?
b) gram +ve?

A

Gram -ve: Proteus, klebsiella, pseudomonas, providencia

Gram +ve: Staph, mycoplasma

109
Q

What host factors increase the risk of UTI?

A
  • Oestrogen depletion (causes pH to rise = less acidic protection)
  • Incomplete bladder emptying/outlet obstruction
  • Reflux of the urine within the urinary tract
  • Pregnancy
  • Lowered levels of Tamm-Horsfall protein
  • Lowered levels of commensal flora
  • Raised urinary pH
110
Q

Epidemiology of UTIs?

A
  • More common in women
  • UTIs in men indicates underlying UT abnormality
  • Most common cause: E.coli (from pts own urine)
111
Q

Why are UTIs more common in women?

A
  • Shorter urethra
  • Closer proximity to anus
  • Ease of transmission of bacteria from anal region to vagina/urethra
112
Q

Clinical presentation of Lower UTI?

A
  • Increased frequency of micturition
  • Dysuria (painful urination)
  • Suprapubic pain and tenderness
  • Haematuria
  • Smelly urine
113
Q

Symptoms of acute pyelonephritis?

A
  • Loin pain and tenderness
  • Nausea and vomiting
  • Fever/rigors
  • Be aware of elderly: they may be generally unwell
114
Q

Investigations for UTI?

A

-Symptoms + urinalysis
>MS+C of MSSU
>Shows leucocytes, blood, raised pH, nitrites

115
Q

What’s the difference between a complicated and an uncomplicated UTI?

A

Complicated if:

  • Male
  • Pregnant
  • Children
  • Recurrent/persistent infection
  • Immunocomprimised pt
  • Infection that occurs in hospital
  • Presence of a UT abnormality
  • SIRS or urosepsis
  • Associated urinary tract disease ie stones
116
Q

How is recurrent UTI defined?

A
  • > 2 episodes in 6/12
  • > 3 episodes in 12/12
  • Reinfection with same bacteria
  • Bacterial persistence
  • Unresolved infection
117
Q

Investigation of recurrent or complicated UTI?

A
  • MSSU
  • Examination: DRE, pV (check for fistulae)
  • Post void bladder scan
  • USS of renal tract
  • KUB XR or NCCT KUB to rule out stones (Only CT if symptoms suggest stones)
  • Flexible cystoscopy
118
Q

Treatment of uncomplicated UTI?

A

-Treat on basis of symptoms
-3/7 course of Trimethoprim or nitrofurantoin
>increase fluid intake
>regular voiding
>void before and after intercourse
>hygeine
>OCP advice if abx interfere

119
Q

Treatment of complicated UTI?

A
  • Trimethorpim, amoxicillin or nitrofurantoin
  • MSSU
  • Longer course of abx to the sensitivity of the bacteria
  • Investigate further for recurrent UTIs
120
Q

How are pregnant women treated for UTI?

A
  • Culture

- Nitrofurantoin

121
Q

Treatment of recurrent UTIs?

A
  • Increase fluid intake
  • Regular voiding and double voiding
  • Voiding before and after sex
  • Vaginal oestrogen replacement
  • Avoid spermacides and perfumed soaps
  • Cranberry juice
  • Self-start abx if at risk
122
Q

How is acute pyelonephritis treated?

A
  • Hospital admission should be considered

- Broad spec cephalosporin or quinolone for 10-14 days

123
Q

Define bacteriuria?

A
  • Presence of bacteria in the urine: can be asymptomatic or symptomatic
  • Asymptomatic bacteriuria without pyuria is rarely a concern
  • Prevalence of asymptomatic bacteriruira increases with age and in pregnancy
124
Q

When does bacteriuria need treating?

A
  • In pregnant pts (high risk of pyelonephritis and pre-term labour)
  • If causing symptoms
125
Q

Define pyuria?

A
  • Presence of leucocytes in the urine

- Can be ass. with infection or sterile causes (bladder cancer)

126
Q

Causes of bacterial colonisation or urine?

A
  • Immunosuppression
  • Disease ie DM, renal failure
  • Steroids and chemo
  • Urolithiasis
  • Tumour
  • Fistula with the bowel
  • Neuropathic bladder/chronic retention
  • Indwelling catheter
  • Intermittent self catheterisation
  • Paraplegic pts
127
Q

Causes of raised pressure in the urinary tract? (ass with increased risk of colonisation)

A
  • In the lumen: stones, sloughed papillae
  • In the wall: tumour, stricture, PUJ obstruction, iatrogenic
  • Outside the wall: tumour, retroperitoneal fibrosis
  • Inability to effectively empty the bladder ie neuro causes
128
Q

Where are the main origins of sepsis in the body in order of likelihood?

A
  • Urinary tract
  • Respiratory tract
  • GI tract
  • Hepatobiliiary
  • Other
  • Skin/soft tissue
129
Q

What are the stages of sepsis?

A
  • Systemic inflammatory response syndrome
  • Sepsis
  • Severe sepsis
  • Septic shock
130
Q

What is the criteria for diagnosis of SIRS?

A 
-2 of the following:
>temp >38 or <36
>Hr >90
>RR >20
>pCO2 <4.3kPa
>Wcc >12000 or <4000
131
Q

Criteria for diagnosis of sepsis and severe sepsis?

A 
-Sepsis: 
>2 SIRS criteria 
>confirmed or suspected infection
-Severe sepsis:
>sepsis
>signs of end organ damage ie SBP<90 OR LACTATE >2
>septic shock + persistent hypotension
132
Q

Diagnosing a UTI in a pt known to have colonised urine?

A
  • Fever

- Pain

133
Q

What are the investigations for sepsis?

A

-Sepsis screening tool ie BUFALO, FABULOS

134
Q

What is the treatment of urosepsis?

A 
-Given in 1 hour:
>high flow o2
>blood cultures
>iv abx
>iv fluids
>lactate
>monitor urine output hourly
-Manage systemic factors ie diabetes, immune system supports
-Relieve pressure: catheter, nephrostomy
135
Q

What are some important key points about urosepsis regarding drainage, colonised urine and catheters?

A
  • Drainage is important treatment in urosepsis
  • Colonised urine is ofthen a mutlisystem disorder that does not need treating, but is a risk factor for urosepsis
  • Catheters: consider a suprapubic catheter in pts requiring long term catheterisation
136
Q

Define pyelonephritis

A
  • Infection of the renal parenchyma and soft tissues of the renal pelvis/upper ureter
  • Acute pyelonephritis is ass. with neutrophil infiltration of the renal parenchyma
137
Q

Which bacteria is the most common of pyelonephritis?

A

-E.coli
>known as UPEVC (uropathogenic E.coli)
>have P pili on their surface to allow ureteral ascent

138
Q

Pathogenesis of pyelonephritis?

A
  • Bacteria from the colon ascending the urinary tract

- Can progress from lower urinary tract infections that have not resolved

139
Q

What is emphysematous pyelonephritis and which type of pt is it most common in?

A
  • Rare life threatening kidney infection (fulminant onset - needs fast recognition)
  • Gas forming organisms ie E perfingens (gas builds up in the renal parenchyma)
  • May need an emergency nephrectomy
  • More common in diabetics
140
Q

What is pyelonephritis in children most commonly associated with?

A

-Vesico-ureteric reflux
>incompetent valve between the bladder and ureter
>allows reflux of urine up the ureter during bladder contraction
-Chronic reflux and repeated infections = significant renal compromise
-Typically ass with multiple structural/functional abnormalities

141
Q

What is the clinical presentation of pyelonephritis?

A
  • Classic triad: loin pain, fever, pyuria
  • Ass. w/ systemic upset and rigors
  • May have severe headaches
  • Often fluid deplete O/A
142
Q

Investigations for pyelonephritis?

A
  • Regular observation (watch for decompensation)
  • Ex: shows tender loin area
  • PV: rule out vaginal/ovarian/appendix pathology
  • Bloods (inc. cultures)
  • Urgent USS: rule out obstruction of upper tracts
143
Q

Treatment of pyelonephritis?

A
  • IV infusion (to replace fluid losses
  • IV abx: gent/augmentin
  • HDU if required
  • Drain obstructed kidney
  • Catheter
  • Analgesia
  • Convert to PO abx when getting better
  • 10-14 days of treatment
144
Q

What is cystitis and what causes it?

A
  • UTI in the bladder

- Mainly caused by uropathogenic E.coli

145
Q

How does cyctitis present?

A
  • Dysuria
  • Increased frequency of urination
  • Urgency
  • Sharp pain on urination
  • Haematuria
  • Offensive smelling/cloudy urine
146
Q

Investigations for cystitis?

A

-Hx + examination = diagnosis
-Dipstick:
>urinary nitrites (bacteria break down nitrates >nitrites)
>leucocyte elastase
>pyuria
-Urinary MS+c plus susceptibility for testing of pathogens

147
Q

Treatment of cystits?

A
  • Trimethoprim or amoxicillin or nitrofurantoin

- High fluid intake during and after treatment for a few weeks

148
Q

Define prostatitis

A
  • Inflammation of the prostate
  • Variable symptoms
  • hard to treat
  • Associated LUTs
149
Q

Which organism is most commonly associated with acute bacterial prostatits?

A

-E.coli

>gram -ve bacteria enter the prostate gland via the urethra

150
Q

What are the risk factors for acute bacterial prostatitis?

A
  • Recent UTI
  • Urogenital instrumentation
  • Intermittent bladder cathererisation
  • Recent prostate biopsy
151
Q

Presentation of acute bacterial prostatitis?

A 
-Systemically unwell
>fevers
>rigors
>significant voiding LUTS
>pelvic pain
-Tender prostate on DRE
152
Q

Presentation of chronic bacterial prostatitis?

A
  • Symptoms >3/12, recurrent UTIs
  • Pelvic pain, voiding LUTs
  • Uropathogens in urine/ blood
153
Q

What is chronic pelvic pain syndrome?

A
  • Chronic abacterial prostatitis
  • Inflammation of the prostate without presence of infection
  • Chronic pelvic pain +/- LUTs +/- UTIs
154
Q

Epidemiology of prostatitis?

A
  • Common in men of all ages

- Most common type of urinary tract problem in men <50

155
Q

Investigations for prostatitis?

A
  • Urinalysis and MSSU
  • Urine and semen cultures (presence of coliforms)
  • Blood tests for presence of infection ie wcc
  • STI screen
  • Urodynamic tests if predominant LUTs
  • Imaging (transrectal urethral US +/- abdo/pelvis CT)
156
Q

What is the treatment of acute prostatitis?

A
  • IV abx (gentamycin and co-amoxiclav/tazocin/carbapenam)
  • Long course (2-4/52 of quinolone once well)
  • +/- TRUSS-guided abscess drainage if >1cm
157
Q

What is the treatment for chronic prostatitis?

A
  • 4-6 week course of quinolone

- Alpha blockers and NSAIDs for 6weeks-3months if needed)

158
Q

Complications of prostatitis?

A

-Retention
>if prostate becomes really inflamed = obstruction of bladder outflow as it surrounds the urethra (may need a suprapubic catheter
-Severe sepsis

159
Q

What is urethritis and what is it most commonly cause by?

A
  • Inflammation of the urethra
  • -Urethral pain/dysuria +/- discharge
  • Predominantly STI related
  • Best managed by GUM
160
Q

Define epididymo-orchitis

A
  • Infection of the epipdidymis and/or testes
  • Painful swelling
  • Commonly spread locally from infections from the genital tract (chlamydia/gonorrhoea) or the bladder
161
Q

What are the causes of epididymo-orchitis?

A

-Pathogenesis depends on age and lifestyle
> age<35: STI>UTI
> age>35: UTI>STI
-Always take a sexual hx
-can be caused following urological intervention ie cystoscopy
-Elderly: catheter related

162
Q

Clinical presentation of epididyo-orchitis?

A
  • Acute presentation: unilateral testicular pain and swelling
  • Urethral discharge (can be asymptomatic)
  • Must rule out testicular torsion
163
Q

What features are suggestive of testicular torsion?

A
  • Age <20
  • Short duration of pain, sudden onset
  • Associated nausea and abdo pain
  • Previous short-duration orchalgia
  • High riding/bell-clapper testis
164
Q

Investigtions of epididymo-orchitis?

A
  • Void urine and then perform CT +/- urethral swab
  • MSSU
  • US to rule out abscess
  • Sexual history
165
Q

Treatment of epididymo-orchitis?

A

-If STI suspected: refer to GUM
-Abx:
>Quinolone if >35/suspecting UTI
>Doxycycline +/- stat azithromycin if STI more likely (contact tracing)
-If organism is unknown: IM CEFTRIAXONE SINGLE DOSE + DOXYCYLCINE 100MG BD 10-14/7
-Supportive underwear
-NSAIDs if required

166
Q

What is dialysis and how does it work?

A
  • Removal or uraemic toxins from the blood by the process of diffusion across a semipermeable membrane towards the low concentration present in the dialysis fluid
  • Gradient maintained by replacing the used dialysis fluid with fresh solution
167
Q

What’s the differene between haemodialysis and peritoneal dialysis?

A
  • Haemodilaysis: blood is removed from the circulation and expose to dialysis fluid across an artificial semi-permeable membrane
  • Peritoneal dialysis- peritoneum is used as the semi-permeable membrane and dialysis fluid is instilled into the peritoneal cavity
168
Q

Why do pts need anticoagulating if they’re undergoing haemodialysis?

A

-Blood undergoes contact with foreign surfaces which activates the clotting cascade
>heparin is usually used

169
Q

WHat else do pts need before receiving haemodialysis?

A

-AV fistula

170
Q

What are some possible complications of an AV fistula?

A
  • Infection
  • Thrombosis
  • Stenosis
  • Steal syndrome (ichaemia)
171
Q

What is the most common acute complication of haemodialysis?

A

-Hypotension

>excessive removal of extracellular fluid

172
Q

What is the most common serious complication of peritoneal dialysis?

A

-Bacterial peritonitis caused by staph epidermidis

173
Q

Which pts are more likely to choose haemodialysis?

A
  • Elderly/live alone
  • Those who are afraid to operate the peritoneal dialysis machine
  • If unsuitable for peritoneal dialysis ie prev abdo sx, abdo disease/hernia, recurrent PD peritonitis
174
Q

Which pts are more likely to choose peritoneal dialysis?

A

Young/full time work

  • Wanting control over own care
  • Lack of suitable haemodialysis
175
Q

What is haemofiltration adn what is it used for?

A
  • Removal of plasma water and dissolved constituents and replacing it with a solution of desired biochemical composition
  • Commonly used in the management of AKI on ITU
176
Q

Difference between haemodialysis and haemofiltration?

A
  • Haemodialysis: semipermeable membrane allowing only small solutes to pass through it
  • Haemofiltration: highly permeable membrane > larger solutes also able to pass through. More expensive
177
Q

What are the leading causes of death in all long term dialysis pts?

A
  • CV disease (results from atheroma - dialysis can lead to hyperlipidaemia
  • Sepsis: peritonitis (staph aureus)
178
Q

Why are kidney transplants better than long term dialysis?

A
  • Better survival
  • Better quality of life
  • Economic advantage
  • Enable successful pregnancy in younger pts
179
Q

Indications for dialysis in AKI?

A
  • Hyperkalaemia
  • Metabolic acidosis
  • Pulmonary oedema
  • Uraemic pericarditis
  • Severe uraemia
180
Q

Complications of dialysis?

A
  • Hypotension
  • Arrhythmias (disruption of normal electrolyte balance)
  • Dialysis disequillibiration syndrome: occurence of neuro signs and symptoms attributed to cerebral oedema
181
Q

How is continence maintained between episodes of bladder emptying?

A

-Detrusor muscle is relaxed during storage
-Sphincter mechanisms of the bladder neck and urethral muscles remain contracted during storage
>under sympathetic control (storage)
-On voiding the sphincter relaxes and detrusor contracts
>parasympathetic (pissing)

182
Q

What are the neural roots that control the Lower urinary tract?

A
  • Parasympathetic: (cholinergic) S3-S5. Detrusor contraction during voiding
  • Sympathetic: (noradrenergic) T10-L2. Urethral contraction and inhibition of detrusor contraction
183
Q

Define incontinence?

A

-Involuntary/uncontrolled leakage or urine

184
Q

What are risk factors for urinary incontinence?

A
  • Advancing age
  • Previous pregnancy and childbirth
  • High BMI
  • Hysterectomy
  • Family history
185
Q

What are the 4 classifications of incontinence?

A
  • Stress incontinence (sphincter weakness)
  • Urge incontinence (overactive bladder - detrusor overactivity
  • Overflow incontinence
  • Mixed incontinence
186
Q

Causes of stress incontinence?

A

-Result of sphincter weakness
-In women:
>usually secondary to birth trauma, neurogenic, congenital, gynae prolapse
-In men:
>Most commonly iatrogenic nerve damage from a prostatectomy, neurogenic

187
Q

Causes of urge incontinence?

A
  • Strong desire to void, pt may be unable to hold their urine
  • Usually caused by detrusor overactivity
  • Less commonly called by bladder hypersensitivity fro local pathology ie UTI, stones, tumours
  • Causes: idiopathic
188
Q

Causes of overflow incontinence?

A
  • Most often seen in men with prostatic hypertrophy (causing outflow obstruction and therefore leakage)
  • Will have a hx of inability to pass urine
189
Q

Name some neurological causes of incontinence?

A
  • Brainstem damage: incoordination of detrusor muscle activity and sphincter relaxation
  • Paraplegia/tetraplegia
  • Autonmic neuropathy ie diabetics
  • MS
  • Elderly people ie dementia, immobility
190
Q

Presentation of stress incontinence?

A 
-Small leak when intra-abdominal pressure rises
>coughing
>laughing
>standing up
>sneezing
191
Q

Presentation of urge incontinence/overactive bladder?

A
  • Ass. w/ urgency
  • Pathology: detrusor overactivity. Rise of detrusor pressure on filling (normal should keep pressure same on filling and stay relaxed)
192
Q

Presentation of overflow incontinence?

A
  • Leakage of small amounts of urine
  • Pain
  • Distended bladder felt rising out of the pelvis on abdo examination
193
Q

What will be the main consequence of not treating overflow incontinence?

A
  • Bladder is v full
  • if Obstruction is not relieved with a catheter, renal damage will develop
  • Urine will back up ureters and cause hydronephrosis
194
Q

Epidemiology of incontinence?

A
  • More common in women
  • Overflow incontinence (common in men with BPH)
  • Increases with age
195
Q

Investigation for incontinence?

A
  • History is most diagnostic tool
  • Bladder diaries (for >3 days)
  • Vaginal examination (to exclude pelvic organ prolapse and to assess kegel exercises
  • Urine dip and culture
196
Q

Treatment of stress incontinence?

A
  • Pelvic floor exercises (8 contract 3x day for 3/12)
  • Duloxetine
  • Surgery: sling or colposuspension
197
Q

Treatment of urge incontinence/overactive bladder?

A
  • Bladder retraining
  • Anticholinergic agents ie oxybutynin, tolterodine
  • Beta 3 adrenergic agonists ie mirabegron
  • Intravesicle botox
  • Detrusor myomectomy
  • Cystoplasty
198
Q

How do anticholinergic agents work to treat urge incontinence?

A
  • Oxybutynin, tolterodine are anti-muscarinic specifically

- Block ACh and therefore parasympathetic stimulation which can reduce the activity of the overactive bladder

199
Q

How do beta 3 adrenergic agonists work?

A

-Triggers sympathetic nervous system and therefore storage

200
Q

How do you treat overflow incontinence?

A

-Relieve the urine build up with a catheter initially
-Treat the underlying cause
ie BPH: 5 alpha reductase inhibitor

201
Q

Where abouts in the urinary tract can obstructions occur?

A
  • Any point between the kidney and urethral meatus

- Results in dilation of the tract proximal to the obstruction

202
Q

Define hydronephrosis?

A

-Dilation of the renal pelvis or calyces as a result of obstruction of the outflow of urine distal to the renal pelvis

203
Q

What’s the mneumonic to remember the causes of hydronephrosis?

A
  • SUPER PACT
  • Super: bilateral causes
  • Pact: unilateral
204
Q

What are the bilateral causes of hydronephrosis?

A
  • Stenosis of the urethra
  • Urethral valve dysfunction
  • Prostatic enlargement
  • Extensive bladder tumour
  • Retroperitoneal fibrosis
205
Q

What are the unilateral causes of hydronephrosis?

A
  • Pelvic-ureteric obstruction (congenital or acquired)
  • Abnormal renal vessels
  • Calculi
  • Tumours of the renal pelvis
206
Q

How is hydronephrosis investigated?

A
  • USS
  • IV urogram (assess the postion of the obstruction)
  • Antegrade or retrograde pyelography
  • CT scan for renal colic if suspected
207
Q

How id hydronephrosis managed?

A
  • Remove the obstruction and drain the urine
  • Acute upper urinary truct obstruction - nephrostomy tube
  • Chronic upper urinary tract obstruction - ureteric stent of pyeloplasty
208
Q

Define obstructive uropathy?

A
  • Functional or anatomical obstruction of urine flow at any level of the urinary tract
  • Can be supravesicle or infravesicle
209
Q

Renal causes of urinary tract obstructions?

A
  • Congenital ie cysts in PKD
  • Neoplastic: Wilm’s tumour, RCC, Multiple myeloma
  • Inflammatory: TB
  • Metabolic: kidney stones
  • Misc: sloughed papillae, trauma
210
Q

Ureter causes of urinary tract obstruction?

A
  • Congenital: strictures, ectopic kidney
  • Neoplastic: TCC of the ureter, mets
  • Inflammatory: TB, schistosomiasis
  • Misc: retroperitoneal fibrosis, pregnancy
  • Kidney stones
211
Q

Bladder and urethra causes of urinary tract obstruction?

A
  • congenital: phimosis (narrow foreskin), vaginal distention
  • Neoplastic: bladder cancer, prostate cancer
  • Inflammatory: prostatitis
  • Misc: BPH, overflow incontinence
212
Q

What are the 3 simple reasons that cause urinary obstruction?

A
  • Proximal dilatation
  • Hydronephrosis
  • Detrusor muscle is trabeculated
213
Q

What are the permanent changes that occur to the kidneys after obstruction has occurred?

A
  • Tubulointerstitial fibrosis
  • Tubular atrophy and apoptosis
  • Interstitial inflammation
214
Q

What are the phases of renal recovery after obstruction?

A
  • Tubular function recovery

- GRF recovery

215
Q

What is the clinical presentation of upper urinary tract obstruction?

A
  • Dull ache in the flank or loin
  • Complete anuria: suggests bilateral obstruction
  • Polyuria: suggestive of partial obstruction as a result of tubular damage and impairment of concentrating mechanisms
216
Q

Clinical presentation of bladder outlet obstruction?

A
  • Urinary hesitancy/difficulty urinating
  • Poor stream
  • Terminal dribbling/sense of incomplete emptying
217
Q

Investigations for urinary tract obstructions?

A
  • Imaging: USS, CT
  • Serum creatinine (assesses function of affected kidney)
  • Blood tests: FBC, U&E, Coag, ABG, serum Cr
  • Urine dipstick: MC&S to rule out infection
218
Q

Treatment of urinary tract obstruction?

A

-ABCDE
-Fluid resus
-Pain management
-Abx and diagnosis
-Goal: re-establish urinary flow
>catheter
>manage post obstructive diuresis

219
Q

What is acute urinary retention?

A
  • Sudden (<6 hours) inability to voluntarily pass urine
  • Painful
  • Most common urological emergency
  • 600ml-1L can not be cleared
  • Catheter! and alpha blockers
220
Q

What are the causes of acute urinary retention?

A
  • Most common cause: BPH
  • Other urethral obstructions: strictures, calculi, constipation, masses
  • Medications: anticholinergics,opioids, benzos
  • Neuro: cauda equina
  • Post op
  • Post partum
221
Q

How does acute urinary retention present?

A

-Subacute onset of:
>inability to pass urine
>lower abdo discomfort
>considerable pain/distress

222
Q

What are the signs of acute urinary retention?

A
  • Palpable distended urinary bladder

- Lower abdo tenderness

223
Q

How is acute urinary retention investigated?

A
  • Rectal and neuro exam
  • Pelvic examination
  • Urine sample
  • U&E and Cr: ?kidney injury
  • FBC & CRP: ?infection
  • Bladder USS: volume >300ml
224
Q

How is acute urinary retention managed?

A

-Decompression of the bladder via catheterisation
-Find the underlying cause
>UTI
>BPH
>neuro - refer
>gynae
>urology - if no obv cause found

225
Q

What is the chronic urinary retention?

A
  • Incomplete bladder emptying
  • Often a comlpication of BPH
  • Increases risk of infections and stones
  • Painless (unlike acute retention)
226
Q

How might acute on chronic retention present?

A

-As overflow incontinence

227
Q

What causes chronic urinary retention?

A
  • BPH
  • Prostate cancer
  • Drugs: antispasmodics, antihistamines, anticholinergics, BOTOX
  • Iatrogenic: surgery
  • Urethral strictures
  • Neuro: MS,diabetic neuropathy, stroke
228
Q

What are the symptoms of chronic urinary retention?

A
  • Frequency, urgency hesitancy
  • Poor urinary stream
  • Post-micturition dribbling
  • Nocturia
  • Urinary incontinence
  • Painless inability to pass urine
229
Q

What are some important differentials to exclude in someone with urinary retention?

A
  • Spinal cord injury
  • Pelvic/sacral fracture
  • Herniated disc
  • Infections
  • MS
  • Myogenic failure to due to chronic detrusor over distension
230
Q

How should chronic retention be investigated?

A
  • Urinalysis
  • MSSU
  • Bloods: U&Es
  • Bladder diary
  • Imaging of urinary tract
231
Q

Hoow is chronic retention managed?

A

-Offer ISC
-Offer indwelling catheter
-Stop any participating/aggravating meds
-Alpha blockers/sx for BPH
-Lifestyle measures
>regulate fluid intake, avoid evening drinking
>reducing alcohol intake
>reducing tea and coffee

232
Q

What are the possible complications of chronic urinary retention?

A
  • Acute on chronic retention: painful
  • Hypertrophy of detrusor muscle and formation of bladder diverticula
  • Hydronephrosis
  • Urinary incontinence due to overflow
233
Q

What is interactive obstructive uropathy?

A
  • Very obstructed urinary tract
  • Nocturnal enuresis is an indicator
  • Residular volume can be up to 4L
  • Check U&Es
  • Lying/standing BPs may be affected
  • Long term options; TURP or indwelling catheter
234
Q

Indications for surgery for bladder retention problems?

A 
-RUSHES:
>Retention
>UTIs
>Stones
>Haematuria
>Elevated Cr due to bladder outlet obstruction
>Symptom deterioration
235
Q

What are the surgical options for bladder outflow problems?

A
  • Bladder neck incision
  • TURP
  • Laser therapy
236
Q

Complications of TURP?

A
  • Immediate: sepsis, haemorrhage, TURP syndrome
  • Early: sepsis, haemorrhage, clot retention
  • Late: retrograde ejaculation, ED, urethral stricture, bladder neck stenosis, urinary incontinence
237
Q

Which compartment of the penis fills with blood in erection?

A

-Corpus cavernosa

238
Q

What is the nerve supply to the penis?

A
  • PSNS: S2,3,4 (Point)
  • SNS: T11-L2 (shoot)
  • cavernous nerve carries both fibres and passes posterolaterally to the prostate = high damage in prostatectomy
239
Q

How does an erection occur?

A
  • Inflow of blood to the corpora cavernosum
  • Trabecular smooth muscle relaxation and arteriolar dilation
  • NO is the main mediator of the smooth muscle relaxation
240
Q

What are the endocrine role in erections?

A

-Testosterone required for normal erectile function
-Acquired low test = ED.
>Primary: pituitary, hypothalamus
>Secondary: testes (tumour, injury, drugs ie beta blockers)
>congenital syndromes: Klinefelters, Noonans

241
Q

How does the penis return to its flacccid state?

A

-Phosphodiesterase

242
Q

Define ED?

A

-Inability to attain and maintain an erection sufficient for satisfactory sexual performance

243
Q

Risk factors for ED?

A
  • Lack of exercise
  • Obesity
  • Smoking
  • Hypercholesterolaemia
  • HTN
  • Metabolis syndrome
  • DM
244
Q

Causes of ED?

A
  • Vascular
  • Neurogenic
  • Hormonal
  • Anatomical
  • Drug induced
  • Pscyhogenic
245
Q

What are some vascular causes of ED?

A
  • CVD
  • Atherosclerosis
  • Hypertension
  • DM
  • Hyperlipidaemia
  • Smoking
  • Iatrogenic
  • Trauma
246
Q

What are some central neuro causes of ED?

A
  • Parkinsons, stroke
  • MS
  • Tumours
  • Traumatic brain injury- hypothalamic-pituitary def
  • CVA
  • Intervertebral disc disease
247
Q

What are some peripheral neuro causes of ED?

A

-Polyneuropathy
-Peripheral neuropathy
DM
-Alcoholism
-Uraemia
-Surgery

248
Q

What are some hormonal causes of ED?

A
  • Hypogonadism
  • Hyperprolactinaemia
  • Thyroid disease
  • Cushing’s
249
Q

What are some anatomic causes of ED?

A
  • Peyronie’s disease (penis bends when it gets an erection due to fibrous growth
  • Micropenis and other penile anomalies
250
Q

What are some durg causes of ED?

A
  • Beta blockers
  • Antidepressants: SSRIs and TCAs
  • Antihypertensives
  • Recreational drugs
  • H2 antagonists ie ranitidine
251
Q

What are some psychosexual causes of ED?

A
  • General: disorders of sexual intimacy, lack of arousal

- SItuation: partner, performance/stress

252
Q

What are some psych illness causes of ED?

A
  • Generalised anxiety disorders
  • Depression
  • Psychosis
  • Alocholism
253
Q

What lab tests would be done for someone with ED?

A
  • Fasting glucose
  • Lipid profile
  • Morning testosterone
  • Usually all normal
254
Q

Treatment for hormonal or psychological causes of ED?

A
  • Testosterone replacement (Contra-indicated in hx of prostate cancer)
  • Psychosexual counselling
255
Q

Medical treatment for ED?

A

-Phosphodiesterase (PDE5) inhibitors)

>prevent smooth muscle from relaxing

256
Q

Mechanism of action of PDE5 inhibitors?

A

-Blocks phosphodiesterase = stops the erection from returning to a flaccid state
=increased arterial blood flow, vasodilation and erection maintenance
-Action on nitric oxide: erectile chemical

257
Q

Examples of phospodiesterase inhibitors?

A
  • Sildenafil
  • Tadalafil
  • Vardenafil
258
Q

Common side effecots of phosphdiesterase inhibitors?

A
  • Headache
  • FLushing
  • Dyspepsia
  • Nasal congestion
  • Dizziness
  • VIsual disturbance
259
Q

Contraindications of phosphodiesterase inhibitors?

A
  • Someone already taking nitrates

- Someone taking alpha blockers

260
Q

What is priapism?

A

-Prolonged erection
>4 hours = risk of permanent ischaemic damage to the corpora
>needs aspiration with a 19 gauge needle or inject phenylephrine

261
Q

Define haematuria?

A

-Presence of blood in the urine

>can be visible, non-visible, symptomatic or asymptomatic

262
Q

What are the causes of transient non-visible haematuria?

A
  • UTI
  • Menstruation
  • Vigorius exercise
  • Sex
263
Q

Causes of persistent non-visible haematuria?

A
  • Cancer: renal, bladder, prostate
  • Stones
  • BPH
  • Prostatits
  • Urethritis
  • Renal causes ie IGA nephropathy

Phase 3B (14 decks)

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