Urology Flashcards
What is the sympathetic nerve that innervates the external urethral sphincter?
Hypogastric
What is the voluntary nerve that innervates the external urethral sphincter?
Pudendal
What is the parasympathetic nerve that innervates the bladder?
Pelvic
What is the most common type of renal cancer?
Clear cell carcinoma (75%)
What is the most common type of bladder cancer?
Transitional cell/ urothelial cancer (90%)
Can be papilary/ solid
________________ carcinoma is the second most common type of bladder cancer and is usually invasive, and more common where schistosomiasis is widespread.
Squamous cell carcinoma
What is the most common type of prostate cancer?
Acinar adenocarcinoma
Which region of the prostate is most commonly affected by cancer?
Peripheral zone
Nitrofurantoin should only be used for UTI if the patient’s eGFR is above ____.
30
avoid or use with caution if below 45
A Tis bladder tumour means…..
Bladder carcinoma in situ
A Ta bladder tumour means….
Bladder carcinoma confined to epitheliium
A T1 bladder tumour means….
Bladder carcinoma in submucosa or lamina propria
A T3 bladder tumour means….
Bladder carcinoma extends into perivesical fat
A T4 bladder tumour means….
Bladder carcinoma has invaded adjacent organs
What are the treatment options for non-invasive bladder cancer (Tis-T1)?
- TURBT- Transurethral resection of bladder tumour
- Intravesical BCG
- Intravesical mitomycin
What are the treatment options for invasive bladder cancer (T2-T3)?
- Neoadjuvant/ adjuvant chemo (cisplatin)
- Radiotherapy
- Radical cystectomy
Which lymph nodes do bladder cancer spread to?
Iliac nodes
Para-aortic nodes
When spreading haematogenously where does bladder cancer usually spread to?
- Liver
2. Lungs
What is the first line scan for diagnosing/ staging prostate cancer?
MRI
___________ is acute inflammation of the foreskin and glans, and is associated with staph and strep infections, and diabetes.
Balanitis
________ is when the foreskin occludes the meatus, and can cause balanitis.
Phimosis
________ occurs when a tight foreskin is retracted and then cannot be replaced over the glans. This prevents venous return, leading to oedema and potential ischemia of the glans.
Paraphimosis
Do nephritic conditions usually have proteinuria or haematuria?
Haematuria
Do nephrotic conditions usually have proteinuria or haematuria?
Proteinuria
What triad of features are present in nephrotic syndromes?
- Proteinuria
- Hypoalbuminaemia
- Oedema
Which renal artery crosses the IVC?
Right renal artery
Name 4 or more causes of haematuria.
- Malignancy- bladder, renal, ureters
- UTI
- Renal calculi
- Glomerulonephritis
- Inflammation eg. BPH
- Polycystic kidney disease
- Drugs eg. Cyclophosphamide
- Sickle cell disease
- Trauma
Name 2 examples of nephritic syndromes.
- Post infectious eg. post Strep glomerulonephritis
- Immune complex mediated eg. IgA nephropathy
- Goodpasture’s syndrome
- ANCA associated nephropathy
Alport syndrome is an ____ linked inherited renal disorder, caused by a mutation in the gene for type 4 collagen. Features include haematuria, proteinuria, renal failure, sensorineural hearing loss and anterior lenticonus.
X linked
If the RBCs in haematuria are isomorphic what does this suggest about the source of the bleeding?
Isomorphic-suggests non glomerular source eg. GU tract or external source
If the RBCs in haematuria are dysmorphic what does this suggest about the source of the bleeding?
Dysmorphic- suggests glomerulus as source.
Management: USS and potential renal biopsy
If isomorphic RBCs are found in haemturia how should the patient be managed?
- Flexible cystoscopy
- Ultrasound scan
- CT scan
_______ are cylindrical bodies made of Tamm-Horsfall protein that are seen on urine microscopy, and form in the DCT. They can be made of RBCs, WBCS or granular.
Casts
“Spikes” on silver stain microscopy and a thickening GBM with IgG deposits are suggestive of which type of nephrotic syndrome?
Membranous nephropathy
Name 3 or more causes of proteinuria.
- Glomerular causes- Minimal change disease, membranous nephropathy, Focal segmental glomerulosclerosis
- Diabetes
- Amyloidosis
- SLE/ Lupus nephritis
- Myeloma
- Eclampsia in pregnancy
- CCF
The commonest Glomerulonephritis in developed countries is…..
IgA nephropathy
What are the 4 main features of acute nephritis?
- Haematuria
- Oliguria
- Oedema
- Hypertension
Electron microscopy shows fusion of podocyte foot processes in which type of glomerulonephritis?
Minimal change disease
Name 1 cause of minimal change disease (nephrotic syndrome).
- Idiopathic
- Drugs- NSAIDs or Lithium
- Hodkin’s lymphoma
In nephrotic syndrome the proteinuria will be >____g/24hr. (ACR > ___)
> 3g/24hr
ACR > 350
In nephrotic syndrome the hypoalbuminaemia will be
<30g/l
Mirabegron is a Beta3 agonist used to treat….
Overactive bladder
What are the 7 categories/ questions on the IPSS (International Prostate Symptoms Score)?
- Incomplete emptying
- Frequency
- Intermittency
- Urgency
- Weak stream
- Straining
- Nocturia
A score of up to 7 on the IPSS (International Prostate Symptoms) score is considered _______ symptomatic.
Mildly symptomatic.
Normal peak urinary flow rate is approx ___mls/sec.
15mls/sec
Which zone of the prostate is enlarged in BPH?
Transitional (inner) zone
Oxybutynin, Solifenacin and Tolterodine are ___________ drugs used as 1st line pharmacological therapy to treat ____________.
Antimuscarinic/ anticholinergic
Overactive bladder/ Urge incontinence
Which type of urinary incontinence is usually caused by an incompetent urethral sphincter?
Stress incontinence
What class of drug is Duloxetine, which can be used for stress incontinence?
SNRI
Which drugs are used in the MVAC regimen for bladder cancer?
Methotrexate
Vinblastine
Adriamycin (Doxorubicin)
Cisplatin
Name 3 treatment options for non-muscle invasive bladder cancer.
- TURBT
- Intravesical BCG
- Intravesical Mitomycin
Name 3 treatment options for muscle invasive bladder cancer.
- Radical cystectomy
- Chemotherapy (eg. Cisplatin, Gemcitabine, MVAC)
- Radiotherapy
Adults age ___yrs and over with VISIBLE haematuria and no UTI/treated UTI should be referred to haematuria clinic under the 2 week wait.
45 years
Adults age ___yrs and over with NON-VISIBLE haematuria and raised WCC/dysuria should be referred to haematuria clinic under the 2 week wait.
60 years
Does a CT Urogram involve contrast?
Yes
Does a CT scan to investigate renal calculi usually involve contrast?
No
What should be done as first line investigation for diagnosing prostate cancer; MRI scan or TRUS biopsy?
MRI
List 2 or more sider effects/risks of TRUS biopsy for investigating prostate cancer.
- Rectal bleeding
- Sepsis
- Haematuria
- Urine retention
- Blood in semen
- Fever
- Pain
A separate and cystic testicular swelling is most likely to be…..
Epididymal cyst
A testicular and cystic testicular swelling is most likely to be…..
Hydrocele
A testicular and solid testicular swelling is most likely to be…..
Tumour
Haematocele
Orchitis
A separate and solid testicular swelling is most likely to be…..
Epididymitis/ Varicocele
Varicoceles usually affect which testes?
Left
A varicocele may be a presenting feature of which type of cancer?
Renal cell carcinoma
What is the most common malignancy in men age 20-30yrs?
Testicular cancer
________ are the most common type of testicular cancer and typically present in patients around age 35yrs.
Seminomas
Alpha fetoprotein (AFP) and _____ tumour markers may be present in Non seminomatous germ cell tumours (teratomas and yolk sac tumours).
hCG
Name 2 or more risk factors for testicular cancer.
- Undescended testes
- Klinefelter syndrome
- Infant hernia
- Family history
- Mumps orchitis
- Infertility
Bell Clapper deformity increases the risk of which urological condition?
Testicular torsion
Post TURP syndrome is a rare and life threatening complication of transurethral resection of the prostate, characterised by ___ temperature and ___ sodium levels.
Low temp
Low sodium
The failure rate of male vasectomy is around 1 per _____ patients.
1/2000
Around 33% of men with PSA 4-10 will have prostate cancer, and ___% of men with PSA of 10-20 will have cancer.
60%
The classic triad below are features of which type of cancer?
- Haematuria
- Loin pain
- Abdominal mass
Renal cancer
90-95% of urinary tract stones sized ___mm or less will pass spontaneously, and patients should be encouraged to increase fluid intake.
5mm or less
Which category of analgesia are recommended in initial management of renal colic/ stones?
NSAIDs eg. Diclofenac
Ureteroscopy is used to manage renal calculi in which patient group?
Pregnant women
Around 80% of renal stones are made of calcium ________.
Oxalate
If a renal stone is radiolucent (not visible on Xray) it is most likely to be made of which of the following?
Calcium oxolate
Calcium phosphate
Struvite
Urate
Urate
Which of the surgeries below is suitable for most non complex renal stones?
Shock wave lithotripsy
Ureteroscopy
Percutaneous nephrolithotomy
Shock wave lithotripsy
Name 1 cause of ACUTE urine retention.
- BPH
- Urethral stricture
- Blood clot
- Post surgery
- Constipation
- Cauda equina
- Anticholinergics
- Urinary calculi
Name 1 cause of CHRONIC urine retention.
- Prostatic enlargement
- MS
- Pelvic mass/ tumour
- Diabetes
Which organism usually causes acute bacterial prostatitis?
E coli
Which of the following treatments is used 1st line for stress incontinence?
a-Duloxetine
b- Anticholinergics eg. Oxbutynin, Solifenacin
c- Botox injections
d- Pelvic floor exercises
Pelvic floor exercises
Name 1 side effect of alpha blockers eg. Tamsulosin used for BPH.
- Hypotension/ postural hypotension
- Drowsiness
- Dry mouth
- Extra pyramidal signs
- Ejaculatory failure
What does the appearance of “muddy brown” granular casts on urine microscopy suggest?
a- Glomerulonephritis
b- Acute tubular necrosis
c- Vasculitis
Acute tubular necrosis
What is the most common type of urethral rupture in men; Membranous rupture or bulbar rupture?
Bulbar rupture
Occurs due to straddle type injury eg. Bicycles.
