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Renal/GU > Urology > Flashcards

Urology Flashcards

1
Q

List the common anatomical sites with urolithiasis occur

A
  1. Pelviureteric junction
  2. Pelvic brim
  3. Vesicoureteric junction
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2
Q

Types of stones that causes urolithiasis

A
  1. Calcium oxadate stones (spikey or smooth opaque stones)
  2. Struvite stones (staghorn stones, linked to infection)
  3. Urate stones (smooth brown stones)
  4. Cystine stones (yellow crystal stones)
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3
Q

Factors that predispose patients to developing stones

A 
Dehydration 
Hypercalcaemia (1 PTH)
Increased oxalate excretion 
UTIs
 Hyperuricaemia 
Anatomical abnormalities 
Drugs: furosomide
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4
Q

Presentation of urolithiasis

A 
Acute severe flank pain Pt cannot lie still 
- renal colic 
- loin to groin 
- unilateral 
\+ n/v 
\+ worse on fluids
\+ microscopic haematuria
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5
Q

Investigation for suspected urolithiasis

A
  1. Spiral non contrast CT of the kidneys , gold standard
  2. Urinalysis
    - dip and Mc+s: microhaematuria, leukocytes, nitrates
  3. Bloods
    - FBC, raised WCC
    - U+E, hypercalcaemia, gout
  4. Pregnancy test
  5. KUB USS (hydronephrosis)

Watch out for signs of sepsis

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6
Q

Treatment of urolithiasis

A

ACUTE

  • Hydration
  • Pain control
  • Anti-emetics
  • Rectal diclofenac

Stone with no obstruction

  • +bacteriuria (trimethoprim/nitrofurantoin)
  • <10mm: medical explosion therapy (alpha blockers or CCB
  • > 10mm : Extracorporeal shock wave lithotripsy + ureteroscopy

Stone with obstruction
- as above + surgical decompression

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7
Q

Define BPH and discuss why the lower urinary tract symptoms occur

A

Proliferation of musculofibrous and glandular layers
Enlargement of inner transition zone

LUTRS due to bladder outlet obstruction

  1. Static component: increase in the tissue bulk
  2. Dyanamic component: increase in the prostatic smooth muscle (alpha adrenergic receptors)
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8
Q

List the symptoms of BPH

A 
Frequency 
Urgency 
Nocturia 
Hesitancy 
Intermittent emptying 
Poor flow 
Post voiding dribble
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9
Q

Investigations for BPH

A
  1. PR examination
  2. TRUSS +/- biopsy
  3. PSA

Urinalysis
- rule out UTI

Volume chart

Urodynamics

USS KUB

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10
Q

Treatment of BPH

A

MILD
- Watch and wait

MILD + symptomatic

  • Alpha blocker (tamulosisn)
  • 5 alpha reductase inhibitor (finasteride)
  • NSAID

Abnormal DRE + elevated SA

  • surgical referral
  • Prostate <80g TURP/TUVP
  • Prostate > 80g radical prostectomy
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11
Q

Complications of BPH

A
  1. Progression
  2. Sexual dysfunction
  3. Acute urinary retention
  4. TURP syndrome: absorption of irrigating fluids into prostatic venous sinuses
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12
Q

Causes of urinary retention

A 
OBSTRUCTIVE 
- Mechanical 
BPH 
Clots 
Strictures 
Stone 
Constipation
  • Dynamic
    Drugs
    Post operative pain
NEURO 
- Interruption of sensory or motor innervation 
Pelvic surgery 
MS 
DM

MYOGENIC
- Over distension of the bladder
High alcohol intakes

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13
Q

Clinical features of acute urinary retention

A 
Suprapubic tendernes 
Palpable bladder 
- Dull to percussion 
Large prostate on PR 
<1L on catheterisation
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14
Q

Investigations in acute urinary retention

A

Blood

  • FBC
  • U&E
  • PSA

Urine
- Mc&s

Imaging

  • US bladder volume
  • Hydronephrosis
  • Pelvic XR
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15
Q

Management of acute urinary retention

A

Conservative

  • Analgesia
  • Walking
  • Running water or bath
Catheterise 
- + stat gent cover 
- hourly UO 
- Tamulosin, decreased the risk of recatherterisation after retention 
- TWOC 24-72hr
if failed TWOC will need TURP
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16
Q

Organisms that cause prostatitis

A

S.faecalis
E.coli
Chlamydia

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17
Q

Clinical features associated with prostatitis

A 
UTI 
Pain 
- low backache 
- pain on ejaculation 
Haematospermia 
Fevers 
Rigors 
Retention 
Malaise

O/E
Pyrexia
Swollen/boggy/tender prostate on PR

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18
Q

Treatment of prostatitis

A

Sepsis

  • IV taz
  • IV gent
  • NSAIDs
  • SPC

No sepsis

  • Fluoroquinolone oral 2-4 weeks
  • Ciprofloxacin 500mg PO BD

Chronic
- 4/6 weeks of ciprofloxacin + alpha blocker + NSAIDS

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19
Q

Causes of false haematuria

A

Beetroot
Rifampicin
Porphyria
PV bleed

20
Q

Outline the presentation of acute epididymo-orchitis

A 
Unilateral pain and swelling (develops over days) 
Discharge 
Fever 
LUTS 
(must rule out torsion)
21
Q

List the causes of epididymo-orchitis

A

<35

  • STI
  • N.Gonorrhoeae

> 35

  • UTI
  • Enteric pathogens (E.coli)

Retrograde ascent of urinary pathogens

22
Q

A 24yr old male presents to A&E complain of pain and swelling in his testicles. It is sore and hot to touch.
On questioning further he mentions that he has had some LUTS symptoms in the last few days as well as some discharge.
What are you ddx?
What investigations would you perform?
How will you manage this patient?

A

A) Acute epididymo-orchits from a STI
B) Acute epididymo-orchitis from a UTI

Ix

  • First catch urine or NAAT for STI check
  • Gram stain of urethral secretions
  • Urine dip +ve leucocyte esterase
  • Urine culture
  • Urine microscopy
  • Colour duplex USS
  • May require surgical exploration

Rx

  • STI : Single dose of ceftriaxone (IM) + doxycycline (100mg)
  • UTI levofloxacin 100mg
23
Q

Presentation of testicular torsion

A

Surgical emergency
Tender, swollen, hot, high and transverse lie
Morel likely in bell clapper deformity

24
Q

Treatment of testicular torsion

A

Ordidopexy (bilateral fixation)

Must also consent for an orchidectomy

25
Q

Define erectile dysfunction

A

ED is difficulty in attaining, maintaining an erection or a marked decrease in rigidity

Importnat Q’s

  1. Early morning erection
  2. Foreplay
  3. Masturbation
26
Q

List the causes of ED

A 
Age 
Pain 
Vascular 
Neurological ( Spinal cord injury) 
Horomonal (increased prolactin, low androgens) 
Psychological (anxiety, depression) 
Surgical 
Drugs (SSRI, B-blockers)
27
Q

Investigations for erectile dysfunction

A 
Nocturnal rigiscan 
Penile doppler USS 
Testosterone 
Prolactin 
Cholesterol 
BP 
Fasting glucose 
HbA1c
FSH/LH
TSH
28
Q

Outline the possible treatment options for men with erectile dysfunction

A

Rx underlying cause

  1. PDE5 inhibitor: sildenafil
  2. Alprostadil:
  3. Vacum pump
  4. Constriction ring
  5. Penile implant
  6. Psychosexual therapy
29
Q

Outline the pathology of prostate cancer

A

Commonest male Ca
Adenocarcinoma
Peripheral zone of prostate

30
Q

Clinical features of prostate cancer

A 
Asymptomatic 
Urinary 
- Nocturia 
- Frequency 
- Hesitancy 
- Poor stream 
- Dribbling 
Weight loss 
Fatigue 
Bone pain from mets
31
Q

Outline the types of spread expected in prostate cancer

A

Local: seminal vesicles, bladder, rectum
Lymph: para-aortic nodes
Haem: Sclerotic bony lesions

32
Q

Investigations in suspected prostate cancer

A

Bloods

  • PSA
  • U&Es
  • FBC
  • ALP-
  • Ca

Imaging

  • XR chest and spine
  • Transrectal USS guided biopsy
  • Bone scan
  • Staging MRI
33
Q

Outline the issues in relation to PSA

A

Proteolytic enzyme that is not specific to prostate Ca

Increases with age, RP, TURP and prostatitis

34
Q

Name the grading system used for prostate cancer

A

Gleason

35
Q

Outline the treatment of prostate cancer

A

VERY LOW RISK

  • Active surveillance
  • +/- brachytherapy or external beam radiotherapy
  • Check PSA/DRE/BIopsy

LOW RISK
- As above

HIGH RISK

  • Radiacal prostectomy plus pelvic LN dissection
  • External beam radiotherapy + androgen deprivation therapy
36
Q

Outline the management of metastatic disease

A

80% are androgen sensitive: castration leads to remission

  • Goserelin (GnRH analogue) may initially make things worse and will then improve.
  • Tamoxifen
  • Anti-androgen ( flutamide)

If castration resistant

  • Bisphosphonates/ denosumab for bone pain and hypercalcaemia
  • Palliative radiotherapy
37
Q

Complications of prostate cancer

A

Erectile dysfunction
Hormone induced gynaecomastia
Hormone induced flush
Radiation induced LUTS

38
Q

Define a varicocele

A

Abnormal dilatation of internal spermatic veins and paminiform plexus
Possible due to absent valves

39
Q

Management of a varicocele

A

Reassurance and observation

High grade: surgical repair

40
Q

Define a hydrocele

A

Collection of serous fluid between layers of the tunica vaginalis
Types: Communicating or non-communicating

41
Q

Management of a hydrocele

A

May resolve spontaneously
Surgical repair
- Lord’s repair

42
Q

Define neurogenic bladder

A

Bladder function that is either flaccid or spastic and is caused by neurological damage.
Main feature: OVERFLOW INCONTIENCE

43
Q

Outline the innervation of the bladder

A

Detrusor contraction: PSNS (cholinergic) S2,3,4, pelvic splanchnic
Urethral Contraction and inhibition of the detrusor: SNS T11-L2 (hypogastric)
Somatic: S2,3,4 external sphincter muscle

44
Q

Outline the causes of neurogenic bladder

A

CNS

  • Spinal injury
  • ALS

PNS

  • Diabetes
  • Alcohol
  • VItB12 neuropathy

Mixed

  • Parkinsons
  • MS
  • Syphillis
  • Tumour
45
Q

Classify the different types of neurogenic bladder

A

Flaccid (hypotonic)

  • Areflexic bladder
  • Bladder volume is large, press sure is low
  • Absent contractions

Spastic bladder

  • Brain or spinal cord damage
  • Detrusor-sphincter dyssynergia
  • Involuntary urination/defecation
46
Q

Complications of neuropathic bladder

A

Reduced quality of life
Increased UTI and calculi
Hydronephrosis (problematic kidney damage)
Acute bladder distension

Renal/GU (2 decks)

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