Urology Flashcards
What is BPH?
Which areas enlarge?
Benign, nodular or diffuse proliferation of musculofibrous and glandular layers of the prostate
Enlarged inner TZ
LUTS from BPH are caused by what 2 components?
Static - increased tissue bulk –> narrow urethral lumen
Dynamic –> prostate smooth muscle tone increased
What are LUTS?
Storage = FUN
Frequency, urgency, nocturia
Voiding = HIP
Hesitancy, incomplete emptying, poor-flow
Ix in BPH?
DRE, TRUSS +/- biopsy, PSA
Urinalysis, USS KUB
Scoring system for BPH?
IPSS - International prostate symptom score (/35)
Behavioural mx for BPH?
Avoid caffeine, alcohol
Void twice
Bladder training
Limit fuilds
Mx in BPH?
W+W
Pharma mx in BPH?
Alpha-blocker (tamsulosin, doxazosin)
5-alpha reductase inhibitor (finasteride)
Mechanism of alpha-blocker?
SEs?
Smooth muscle relaxation
Post hypo, dry mouth
Mechanism of 5-a reductase inhibitors?
Reduced conversion of testosterone to dihydrotestosterone
Mx of abnormal DRE / PSA?
Surgical referral
If prostate small - TURP / TUVP
If big - open prostatectomy
Comps of BPH
Progression
Sexual dysfunction
Urinary retention
TURP
Causes of urinary retention?
BPH / Ca Calculi Bladder cancer Faecal impaction Infection Anticholinergics Alcohol Neurological
Ix in acute urinary retention?
USS bladder (post-voidal) Urinalysis CT abdo pelvis
Mx of acute urinary retention
Immediate bladder decompression –> catheter
What type of Ca is prostate?
adenocarcinoma
Spread of prostate cancer?
Haematogenous [bone, lung, liver]
Local [seminal vesicles, bladder, rectum]
Lymph nodes
Prostate Ca grading?
Gleason score [level of differentiation]
Screening for prostate Ca?
PSA
look this up*
Pres of prostate Ca?
LUTS, haematuria
if mets –> bone pain, wt loss, anorexia, lethargy
Ix in prostate cancer?
PSA
DRE
TRUSS + biopsy
MRI / CT for staging
Mx for prostate Ca?
Radiotherapy (external or brachy)
Prostatectomy
Mx of mets in prostate Ca?
Androgen deprivation therapy –> goserelin, castration
Bisphosphonates
Palliative radio
Usual ca in bladder?
Transitional cell carcinoma (90%)
RFs for bladder Ca?
Smoking
Occupational (rubber + dye)
Age
HNPCC
Ix in bladder ca?
Urine dip, MC+S
KUB USS
Cystoscopy
CT urogram
Comps of bladder ca?
Hydronephrosis
Spread
Retention
Recurrence
Mx of bladder ca?
Cystectomy + chemo
Causes of haematuria?
UTI Warfarin Coagulopathy Menstruation contamination Pyelonephritis Trauma
Stones
Malignancy
BPH
Ix in haematuria?
Urine dip, MC+S
DRE
Bloods [FBC, coag, PSA]
Imaging [USS KUB,
Causes of UTI?
E.coli
Staph. saprophyticus
Abx in UTI?
Women –> Trimethoprim/nitrofurantoin
Men –> ciprofloxacin
When is UTI complicated?
Functional impairment Structural impairment Kidney involved Pregnancy Catheter Immunosuppressed
Complicated hospital admission UTI mx?
IV gentamicin
Prostatitis causative organism?
E. coli
o/e prostatitis?
Warm, soft, exquisitely boggy
ix in prostatitis?
Urinalysis, MC+S
PSA
STI screen
TRUSS
Mx of prostatitis?
Ciprofloxacin + NSAID + relieve obstruction
Urethritis cause?
Post unprotected sex –> N. gonorrhoea, C. trachomatis
If urethritis untreated?
Reactive arthritis, meningitis, IE
DDx in epididymo-orchitis that you must r/o!
torsion
ix in epididymo orchitis
USS
First catch urine for NAAT + gram stain
Mx of epididymo orchitis?
STI - Ceftriaxone IM + doxycycline
UTI - levofloxacin
Most common types of renal stone?
Calcium oxalate
Ix for nephrolithiasis?
NCCT Urinalysis FBC (?infection) U+Es KUB USS
Mx of nephrolithiasis?
Medical [Hydration, Pain relief, Anti emetic]
Surgical [ESWL, nephrostolithotomy]
Epididymal cyst Pres? Ix? Assos w? Mx?
Small painless cyst, b/l
USS - transilluminates
CF
Benign, needs no mx
Varicocele?
Pres?
Ix?
Mx?
Abnormal dilation of internal spermatic veins and pampniform plexus
Painless mass ‘bag of worms’
Examination, USS
Reassurance, if large –> surgery
Hydrocele?
Pres?
Ix?
Mx?
Collection of serous fluid between layers of tunica vaginalis/spermatic cord
Testicular swelling, enlarged post activity. Not separate to testis and will transilluminate.
USS
W+W
Testicular Ca?
Pres?
Ix?
Mx?
Seminoma (30-65yo) Teratoma (20-30yo)
Painless nodule. Haemospermia.
BALUC B-HCG AFP LDH USS CT
Radical orchidectomy +/- chemo / radio
Mx of stress incontinence?
Pelvic floor
Physio
Surgery
Sling (TVT, TOT)
Male –> artificial sphincter, male sling
Mx of urge incontinence?
Behavioural [F/V chart, avoid caffeine + alcohol]
Drugs [antichoinergics (oxybutinin), B3 agonists (mirabegron), botulinum toxin]
Bladder augmentation [detrusor myectomy, cystoplasty (from small bowel)]
Neurogenic bladder
Pathophys?
Leads to..?
Pres?
Peripheral nerve/spinal nerve damage at S2-4
Leads to hypotonic bladder; high residual volume, predisposes to infection and overflow
Overflow incontinence (can be flaccid or spastic); increased UTI + calculi; hydronephrosis
Aims of mx of neurogenic bladder?
Bladder safety –> protect the kidneys
Continence control
Preserve body image
Complications of transurethral resection of prostate?
TURP
TUR syndrome
Urethral stricture/UTI
Retrograde ejaculation
Perforation of prostate
Features of TUR sydnrome?
Hyponatraemia: dilutional
Fluid overload
Glycine toxicity
How does rhabdomyolysis cause AKI?
Acute tubular necrosis
Causes of raised PSA?
BPH / Ca
Prostatitis / UTI
Ejaculation
Urinary retention
Gold standard ix for stones?
Non-contrast CT
Gold standard ix for bladder Ca?
flexible cystoscopy
Mx of acute upper urinary tract obstruction due to stone?
Nephrostomy
ESWL for smaller stones
Causes of hydronephrosis?
u/l
b/l
Uni - PACT [Pelvic uereteric obstruction, Aberrant renal vessels, Calculi, Tumours]
Bilat - SUPER [Stenosis of urethra, Urethral valve, Prostatic enlartgement, Extensive bladder tumour, Retro-peritoneal fibrosis]
Mx of chronic urinary tract obstruction?
Ureteric stent or pyeloplasty
RCC usual pres?
Paraneoplastic features?
Haematuria
HTN + polycythaemia
Nephroblastoma vs neuroblastoma on imaging?
Neuroblastoma is usually calcified
CI to circumcision?
Hypospadias
Most common renal malignancy?
Renal adenocarcinoma
DDx of testicular torsion?
What test can you do o/e to differentiate?
Torsion of testicular appendage –> cremasteric reflex is preserved when torsion affects the appendage ONLY
