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Yr3 - General Surgery > Urology > Flashcards

Urology Flashcards

1
Q

Define a scrotal lump

A

Abnormal mass or swelling within the scrotum

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2
Q

6 stages of inspection of a scrotal lump

A 
Site
Size
Shape
Symmetry
Skin changes
Scars present
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3
Q

Palpation techniques of a scrotal lump

A 
Tenderness
Temperature
Transillumination
Consistency
Attachments 
Mobility
Pulsation
Fluctuation
Irreducibly
Regional lymph nodes
Edge
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4
Q

Investigations for a scrotal lump

A

USS of scrotum

Blood tests - lactate dehydrogenase, alpha-fetoprotein and beta-hCG

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5
Q

Differential diagnosis for a scrotal lump

A 
Extra-testicular
- hydrocoele
- varicocoele
- epididymal cysts
- epididymitis
- inguinal hernia
Testicular
- testicular tumour
- orchitis
- testicular torsion
- benign testicular lesions
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6
Q

Define a hydrocoele

A

Abnormal collection of peritoneal fluid between the parietal and visceral layers of the tunica vaginalis

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7
Q

Presentation of a hydrocoele

A

Painless fluctuant swelling - transluminates

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8
Q

Treatment of congenital hydrocoeles

A

No treatment - resolve spontaneously

Patent processus vaginalis - ligation to prevent recurrence

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9
Q

Causes of hydrocoeles in older males

A 
Primary - idiopathic
Secondary
- trauma
- infection
- malignancy
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10
Q

Define a varicocoele

A

Abnormal dilation of the pampiniform venous plexus within the spermatic cord

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11
Q

Presentation of a varicocoele

A

Lump - bag of worms

Disappear on lying flat

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12
Q

Complications of a varicocoele

A

Infertility

Testicular atrophy

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13
Q

Red flag signs with a varicocoele

A

Acute onset
Right-sided
Remain when lying flat

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14
Q

Treatment for a varicocoele

A

No treatment if asymptomatic
Embolisation
Ligation of spermatic veins

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15
Q

Define an epididymal cyst

A

Benign fluid-filled sacs arsing from the epididymis

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16
Q

Presentation of an epididymal cyst

A

Smooth fluctuant nodule
Found above and separate from the testis
Transilluminate

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17
Q

Define epididymitis

A

Inflammation of the epididymis

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18
Q

Presentation of epididymitis

A 
Unilateral acute onset scrotal pain
Associated swelling, erythematous overlying skin 
Systemic symptoms - fever
Tender on examination
Pain relieved by elevation
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19
Q

Treatment of epididymitis

A

Oral antibiotics

Analgesia

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20
Q

Examination findings of an inguinal hernia

A

Cannot get above
Cough may exacerbate swelling
Disappear upon lying flat

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21
Q

Presentation of testicular tumour

A

Painless
Firm irregular mass
Does not transilluminate

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22
Q

Treatment for testicular tumour

A

Radical inguinal orchidectomy

Chemotherapy

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23
Q

Define orchitis

A

Inflammation of the testis

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24
Q

Causes of orchitis

A

Mumps virus

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25
Define testicular torsion
Twisting of the testis
26
Presentation of testicular torsion
Sudden-onset very severe unilateral scrotal pain Associated N+V Extremely tender, raised and swollen testis Loss of cremasteric reflex
27
Treatment for testicular torsion
Surgical emergency | - scrotal exploration and fixation
28
Benign testicular lesions
Leydig cell tumours Sertoli cell tumours Lipomas Fibromas
29
Define acute urinary retention
New onset inability to pass urine | Leads to pain and discomfort with significant residual volume
30
Define acute-on-chronic urinary retention
Patients with chronic retention can also enter acute retention Due to an acute deterioration of underlying pathology or new aetiology
31
Causes of acute urinary retention
BPH UTI Constipation Severe pain Medications - anti-muscarinics, spinal or epidural anaesthesia Neurological - peipheral neuropathy, iatrogenic nerve damage, MS, Parkinson's disease
32
Clinical features of acute urinary retention
Acute suprapubic pain Inability to micturate Palpable distended bladder Suprapubic tenderness
33
Investigations for acute urinary retention
DRE - assess for prostate enlargement and constipation Post-void bladder scan - volume of retained urine Catheterised specimen of urine (CSU) - infection USS of urinary tract - hydronephrosis
34
Define high pressure urinary retention
Urinary retention causing high intra-vesicular pressures which overcome anti-reflux mechanism Hydroureter and hydronephrosis Impairs kidneys clearance ability
35
Management of acute urinary retention
Immediate urethral catheterisation - measure volume Treat underlying causes Check for evidence of infection TWOC Those with large retention volume need to be monitored for evidence of post-obstructive diuresis
36
Complications of acute urinary retention
AKI Chronic kidney injury UTI Renal stones
37
Define chronic urinary retention
Painless inability to pass urine - long standing retention - bladder distension - bladder desensitisation
38
Common causes of chronic urinary retention
``` BPH Urethral strictures Prostate cancer Pelvic prolapse Pelvic mass - fibroids MS Parkinson's disease ```
39
Clinical features of chronic urinary retention
Painless urinary retention Voiding LUTS - weak stream and hesitancy Overflow incontinence - worse at night Palpable distended bladder
40
Investigations for chronic urinary retention
Post-void bladder scan Routine bloods USS of urinary tract
41
Management of chronic urinary retention
TWOC Long term catheterisation Monitor urine for post-obstructive diuresis Treat underlying cause
42
Complications of chronic urinary retention
UTI Bladder calculi Chronic kidney disease
43
Define haematuria
Presence of blood in urine | Classed as visible or non-visible
44
Define pseudohaematuria
Red or brown urine that is not secondary to the presence of haemoglobin - medication - rifampicin or methyldopa - hyperbilirubinuria - myoglobinuria - certain foods
45
Common causes of haematuria
``` UTI Urothelial carcinoma Renal calculi Adenocarcinoma of prostate BPH Trauma Radiation cystitis ```
46
Investigations for haematuria
``` Urinalysis - nitrites/leukocytes = infection Baseline bloods PSA Flexible cystoscopy US KUB CT urogram ```
47
Define LUTS
Lower urinary tract symptoms | Array of symptoms affecting the control and quality of micturition in the lower urinary tract
48
Common causes of LUTS in men
``` BPH UTI Urological malignancy Detrusor muscle weakness of instability Chronic prostatitis Urethral stricture External compression - pelvic tumour, faecal impaction Neurological disease - MS, spinal cord injury ```
49
Common causes of LUTS in females
UTI Menopause Urological malignancy Detrusor muscle weakness or instability Urethral stricture External compression - pelvic tumour, faecal impaction Neurological disease - MS, spinal cord injury
50
State some LUTS storage symptoms
Increased urinary frequency Nocutria Increased sense of urgency to urinate Urge incontinence
51
State some LUTS voiding symptoms
Hesitancy in micturition Poor flow Terminal dribble Feeling of incomplete emptying
52
Investigations for LUTS
``` Post-void bladder scanning and flow rate Urinary frequency and volume chart Urinalysis Urine culture PSA Urodynamic studies Cystocopy US KUB CT urogram ```
53
Conservative management of LUTS
Treat underlying pathology Regulating fluid intake - reduce caffeinated and alcoholic beverages Urethral milking - manually emptying bulbar urethra of residual urine Double voiding - passing urine and then remaining for a short time before passing urine again Pelvic floor exercises Bladder training techniques
54
Pharmacological management of LUTS
``` Anticholinergics - oxybutynin, tolterodine - relax bladder Alpha blockers - alfuzosin, tamsulosin - reduce prostate size 5α-reductase inhibitors - finasteride - reduce prostate size in BPH Loop diuretics - furosemide, butetanide - prevent nocturia ```
55
Complications of LUTS
``` UTI Renal and bladder calculi Bladder wall muscle hypertrophy - overflow incontinence Renal failure Bilateral hydronephrosis Acute urinary retention ```
56
Define urinary incontinence
Involuntary leakage of urine
57
State the subtypes of urinary incontinence
``` Stress Urge Mixed Overflow Continuous ```
58
Pathophysiology of stress UI
Intra-abdominal pressure exceeds the urethral pressure | - coughing, straining, laughing or lifting
59
Causes of stress UI
``` Weakness of pelvic floor muscles - post-partum Constipation Obesity Post-menopausal Pelvic surgery ```
60
Pathophysiology of urge UI
Overactive bladder (detrousor hyperactivity) leads to uninhibited bladder contraction leading to rise in intravesical pressure
61
Causes of urge UI
``` Neurogenic - previous stroke Infection Malignancy Idiopathic Medication - cholinesterase inhibitors ```
62
Define mixed UI
Combination of stress UI and urge UI
63
Pathophysiology of overflow UI
Normally complication of chronic urinary retention - progressive stretching of bladder wall leads to damage of efferent fibres of sacral reflex - loss of bladder sensation - bladder becomes grossly distended - constant dribbling urine
64
Causes of overflow UI
BPH Spinal cord injury Congenital defects
65
Define continuous UI
Constant leakage of urine
66
Causes of continuous UI
Anatomical abnormality - ectopic ureter Bladder fistulae Severe overflow incontinence
67
Investigations for UI
Midstream urine dipstick Post void bladder scan Urodynamic assessment Cystoscopy
68
Management of UI
``` Lifestyle advice - weight loss - reduced caffeine and alcohol intake - smoking cessation Conservative - pelvic floor muscle training - anti-muscarinic drugs - urge UI - bladder training Surgical - botulinum toxin A injections - tension-free vaginal tape - stress UI ```
69
Define epididymitis
Inflammation of the epididymis
70
Pathophysiology of epididymitis
Local extension of infection - most likely sexual transmission in < 35 years - N. gonorrhoeae - C. trachomatis - most likely enteric organism from UTI in > 35 years - E. coli - Klebsiella pneumoniae - Pseudomonas aeruginosa
71
Presentation of mumps orchitis
Uni or bilateral orchitis Accompanied fever 4-8 days after onset of mumps parotitis
72
Management of mumps orchitis
Self-resolves within a week | Supportive management
73
Complications of mumps orchitis
Testicular atrophy | Infertility
74
Risk factors for epididymitis
``` Non-enteric causes - males who have sex with males - multiple sexual partners - known contact of gonorrhea Enteric causes - recent instrumentation or catheterisation - bladder outlet obstruction - immunocompromised state ```
75
Clinical features of epididymitis
``` Unilateral scrotal pain and swelling Red and swollen Tender on palpation Cremasteric reflex intact Positive Prehn's sign - pain relief on elevation of testicle ```
76
Investigations for epididymitis
``` Urine dipstick First-void urine collection and Nucleic Acid Amplification Test - assess STI STI screening Blood cultures USS ```
77
Management of epididymitis
Appropriate antibiotic therapy Sufficient analgesia Abstain from sexual activity
78
Complications of epididymitis
Reactive hydrocele formation Abscess formation Testicular infarction
79
Risk factors for testicular cancer
``` 20-40 years Caucasian and Northern European descent Cryptorchidism Previous testicular malignacy Positive family history Kleinfelter's syndrome ```
80
Clinical features of testicular cancer
``` Unilateral painless testicular lump - irregular, firm, fixed and does not transilluminate Evidence of metastasis - wight loss - back pain - retroperitoneal metastases - dyspnoea - lung metastases ```
81
Investigations for testicular cancer
Tumour markers - βhCG - NSGCT and seminomas - AFP - NSGCTs - LDH - surrogate marker for tumour volume Scrotal USS CT chest-abdo-pelvis with contrast - staging
82
Management of NSGCTs
``` Stage 1 - orchidectomy - surveillance - adjuvant chemotherapy Metastatic - chemotherapy ```
83
Management of seminomas
Stage 1 - orchidectomy and surveillance - chemotherapy - radiotherapy
84
Define testicular torsion
Spermatic cord and contents twists within the tunica vaginalis - compromising blood supply to testicle Surgical emergency - infarct within hours
85
Risk factors for testicular torsion
``` Age - 12-25 years Previous testicular torsion Family history of testicular torsion Undescended testes Bell-clapper deformity ```
86
Clinical features of testicular torsion
Sudden onset severe unilateral testicular pain N+V secondary to pain Testis has high position with horizontal lie Cremasteric reflex absent Negative Prehn's sign
87
Investigations for testicular torsion
Clinical diagnosis - Straight to theatre for scrotal exploration Doppler ultrasound Urine dipstick
88
Management of testicular torsion
Urgent surgical exploration - bilateral orchidopexy - ochidectomy Analgesia and anti-emetics
89
Complications of testicular torsion
Testicular infarction Atrophy Chronic pain
90
Define urethritis
Inflammation of the urethra Often due to infection - gonococcal urethritis - N.gonorrhoeae - non-gonococcal urethritis - C.trachomatis, T.vagninalis
91
Risk factors for urethritis
< 25 years Men who have sex with men Previous STI Recent new sexual partner
92
Clinical features of urethritis
Dysuria Penile irritation Discharge from urethral meatus Sexual health screen
93
Investigations for urethritis
Urethral swabs - gram stain under microscopy First-void urine - NAAT Mid-stream urine dipstick STI screening
94
Management of urethritis
Antibiotic management - gonococcal - ceftriaxone 1g IM + azithromycin 1g PO single dose - non-gonococcal - doxycycline 100mg PO BD for 7 days Abstain for sexual activity for 7 days after antibiotics finished Consel on condom use and notifying sexual partners
95
Define pyelonephritis
Inflammation of the kidney parenchyma and the renal pelvis | - typically due to bacterial infection
96
Types of pyelonephritis
Uncomplicated - structurally or functionally normally urinary tract in a non-compromised host Complicated
97
Pathophysiology of pyelonephritis
``` Bacterial infection - ascending from the lower urinary tract - blood stream - lymphatics Neutrophils infiltrate tubules and interstitium and cause suppurative inflammation ```
98
Most common causative organisms of pyelonephritis
Escherichia coli ``` Catherters - enterococcus faecalis - staphylococcus aureus - pseudomonas Commensal - staphylococcus saprophyticus ```
99
Risk factors for pyelonephritis
Factors reducing antegrade flow of urine - obstructed urinary tract - BPH - spinal cord injury -> neuropathic bladder Factors promoting retrograde ascent of bacteria - female gender - short urethra - indwelling catheter or ureteric stents - structural renal abnormalities - vesico-ureteric reflux (VUR) Factors predisposing infection or immuncompromise - diabetes mellitus - corticosteriod use - HIV infection Factors promoting bacterial colonisation - renal calculi - sexual intercourse - oestrogen depletion
100
Clinical features of pyelonephritis
``` Fever Unilateral loin pain N+V On examination - pyrexia - costovertebral angle tenderness ```
101
Investigations for pyelonephritis
``` Urinalysis Urine culture Routine bloods Renal US scan Non-contrast CT KUB - if obstruction suspected ```
102
Management of pyelonephritis
Resuscitaiton Empirical antibiotics IV fluids as appropriate
103
Complications of pyelonephritis
``` Severe sepsis Multi-organ failure Renal scarring -> chronic kidney disease Pyonephrosis Chronic pyelonephritis Emphysematous pyelonephritis ```
104
Types of renal cancer
Renal cell carcinoma Transitional cell carcinoma Squamous cell carcinomas - chronic inflammation secondary to renal calculi, infection and schistosomiasis
105
Pathophysiology of RCC
Adenocarcinoma of the renal cortex - most commonly upper pole of kidney Spread through - direct invasion to perinephric tissues, adrenal gland, renal vein or IVC - lymphatic system to pre-arotic and hilar nodes - haematogenous spread to bones, liver, brain and lung
106
Risk factors for RCC
``` Smoking Industrial exposure to carcinogens Dialysis Hypertension Obesity Anatomical abnormalities Genetic disorders ```
107
Clinical features of RCC
``` Haematuria - visible or non-visible Flank pain Flank mass Non-specific symptoms - lethargy or weight loss Incidental finding on abdo imagine Left varicocoele Paraneoplastic syndrome Clinical features of metastasis ```
108
Investigations for RCC
``` Routine blood tests Urinalysis USS CT abdo-pelvis Biopsy of renal lesions ```
109
Staging of renal cancers
Stage 1 - Tumour < 7cm and confined to renal capsule Stage 2 - Tumour > 7cm or invading renal capsule Stage 3 - Tumour extending into renal vein, vena cava or spread to 1 lymph node Stage 4 - Tumour extending beyond Gerota's fascia, >1 lymph node, involvement of ipsilateral adrenal gland or perinephric fat or distant metastases
110
Management of renal cancer
``` Partial or radical nephrectomy Percutaneous radiofrequency ablation Cryotherapy Renal artery embolism Surveillance Immunotherapy Biological agents Metastasectomy Chemotherapy ineffective ```
111
Define a simple renal cyst
Well-defined outline and homogenous features | Common in older patients
112
Pathophysiology of simple renal cysts
Develop from renal tubule epithelium in response to previous ischaemia
113
Define a complicated renal cyst
Complicated structures, including thick walls, septations, calcificiation or heterogeneous enhancement on imaging Risk of malignancy
114
Risk factors for renal cysts
``` Increasing age Smoking Hypertension Male gender Genetic conditions - polycystic kidney disease - tuberous sclerosis ```
115
Aetiology of polycystic kidney disease
Autosomal dominant | Mutations in PKD1 or PKD2 gene
116
Associated features of polycystic kidney disease
Berry aneurysm formation -> subarachnoid haemorrhage Mitral valve disease Liver cysts End stage renal failure - dialysis or renal transplant
117
Clinical features of renal cysts
``` Usually asymptomatic - found incidentally on imaging Flank pain Haematuria PKD - uncontrolled hypertension - flank mass ```
118
Investigations for renal cysts
CT or MRI imaging with IV contrast USS Serum U&Es - ensuring no impact on renal function
119
Scoring systems for renal cysts
Bosniak stage Stage 1 - simple cyst - <1% malignancy risk - no follow up Stage 2 - complex cyst - <3% malignancy risk - no follow up Stage 2F - complex - 5% malignancy risk - CT scan and 3,6,12 months Stage 3 - complex - 50-70% malignancy risk - surveillance or surgery Stage 4 - complex - 90-100% malignancy risk - surgery
120
Management of renal cysts
``` Asymptomatic - no follow-up or treatment Symptomatic simple - simple analgesia - needle aspiration - cyst deroofing Complex cysts - continued surveillance - surgical intervention ```
121
Complications of renal cysts
Infection Haemorrhage Rupture
122
Composition of renal stones
``` Calcium - 80% - calcium oxalate - 35% - calcium phosphate - 10% - calcium oxalte and phosphate - 35% Struvite - magnesium ammonium phosphate Urate Cystine ```
123
How are renal stones formed?
Over-saturation of urine | Specific pathology
124
Name 3 locations where ureteric stones are likely to impact
PUJ Crossing pelvic brim VUJ
125
Clinical features of ureteric stones
``` Pain - colic - sudden onset - flank to pelvis Haematuria Tenderness in flank ```
126
Investigations for ureteric stones
Urine dip Urate and calcium levels Non-contrast CT KUB USS - hydronephrosis
127
Management of ureteric stones
``` Adequate fluid resuscitation Sufficient analgesia IV antibiotic therapy - evidence of significant infection Retrograde stent insertion Nephrostomy Extracorporeal Shock Wave Lithotripsy (ESWL) Percutaneous nephrolithotomy (PCNL) Flexible uretero-renoscopy ```
128
Complications of ureteric stones
Infection AKI Scarring Loss of kidney function
129
Causes of bladder stones
Chronic urinary retention Secondary to infections - schistosomiasis Passed ureteric stones
130
Presentation of bladder stones
LUTS
131
Management of bladder stones
Cystoscopy
132
Complications of bladder stones
TCC - chronic irritation of bladder epithelium
133
Define Fournier's gangrene
Necrotising fascitis that affects the perineum | Urological emergency
134
Risk factors for Fournier's gangrene
``` Diabetes mellitus Excess alcohol Poor nutritional state Steroid use Haematologial malignancies Recent trauma to region ```
135
Clinical features of Fournier's gangrene
``` Sever pain Pyrexia Crepitus Skin necrosis Haemorrhagic bullae Patients will rapidly deteriorate and become septic ```
136
Management of Fournier's gangrene
Urgent surgical debridement Parital or total orchiectomy Broad spectrum antibiotics
137
Define paraphimosis
Inability to pull forward a retracted foreskin over glans penis
138
Pathophysiology of paraphimosis
Tight contricting band as part of foreskin prevents retraction over the glans Glands becomes oedematous to due reduced venous return
139
Complications of paraphimosis
Penile ischaemia | Worsening infection - Fournier's gangrene
140
Risk factors for paraphimosis
Phimosis Indwelling catheter Poor hygiene Prior paraphimosis
141
Clinical features of paraphimosis
Progressive pain and swelling in glans | Unable to retract foreskin
142
Management of paraphimosis
``` Reduced ASAP - manual pressure - dextrose soaked gauze - dundee technique - needle punctures Suitable anaglesia - penile block with LA Doral slit ```
143
Define priapism
Unwanted painful erection of penis - not associated with sexual desire - lasting more than 4 hours
144
Pathophysiology of priapism
``` High flow - unregulated cavernous arterial inflow - often associated with trauma Low flow - veno-occlusive - blockage of venous drainage of corpus cavernosusm - urological emergency ```
145
Causes of priapism
``` Idiopathic Non-ischaemic - damage to vasculature causes arterial-sinusoidal shunt - penile or perineal trauma - spinal cord injury Ischaemic - iatrogenic - sickle cell - haemoatological disorders - leukaemia, thalassaemia - pelvic malginancy ```
146
Investigations for priapism
Corporeal blood gas - determine whether ischaemic or non-ischaemic Routine bloods Potential spinal injury
147
Management of priapism
Corporeal aspiration Intracavernosal injection of sympathomimetic agent Surgical shunt
148
Define a penile fracture
Traumatic rupture of corpus cavernosa and tunica albuginea
149
Clinical features of a penile fracture
Popping sensation or snap during intercourse Immediate pain, swelling and detumescence Penile swelling and discoluration Firm immobile haematoma
150
Management of a penile fracture
Analgesia Anti-emetics Surgical exploration and repair abstinence for 6-8 weeks
151
Complications of a penile fracture
Penile curvature during erection Penile paraesthesia Dyspareunia Painful erection
152
Types of bladder cancer
Transitional cell carcinoma Squamous cell carcinoma Adenocarcinoma Sarcoma
153
Classification of bladder cancers
Non-muscle invasive Muscle-invasive Locally advanced Metastatic
154
Layers of the bladder wall
Urothelium - transitional epithelium Lamina propria - connective tissue Muscularis propria - muscle Fatty connective tissues
155
Risk factors for bladder cancer
``` Male Smoking Increasing age Aeromatic hydrocarbons - industrial dyes or rubbers Schistosomiasis infection - SCC Previous radition ```
156
Clinical features of bladder cancer
Painless haematuria - visible or non-visible Recurrent UTIs or LUTS Clinical exam unremarkable Locally advanced disease -> localised symptoms (pelvic pain) Metastatic disease -> systemic symptoms (lethargy and weight loss
157
Investigations for bladder cancer
Urgent cystoscopy - biopsy Transurethral resection of bladder (TURBT) CT staging Urine cytology
158
Management of bladder cancer
``` TURBT - carcinoma in-situ or T1 Adjuvant intravesical therapy - BCG or mitomycin C Radical cystectomy - ileal conduit formation - bladder reconstruction Chemotherapy - cisplatin, gemcitabine ```
159
Pathophysiology of BPH
Exact mechanism unknown | Prostate converts testosterone to dihydrotestosterone (DHT)
160
Risk factors for BPH
Age Family history - first degree relative Afro Caribbean ethnicity Obesity
161
Clinical features of LUTS
LUTS - voiding or storage | Firm smooth symmetrical prostate on DRE
162
Investigations of BPH
``` Urinary frequency and volume chart Bedside urinalysis Post-void bladder scan PSA levels USS of renal tract Urodynamic studies ```
163
Management of BPH
α-adrenoreceptor antagonis - tamsulosin - relax prostatic smooth muscle 5α-reductase inhibitors - finasteride - prevent conversion of testosterone to DHT reducing prostatic volume Transurethral resection of prostate (TURP) - endoscopic removal of obstructive prostate tissue
164
Complications of BPH
High-pressure retention -> kidney injury TURP syndrome - fluid overload and hyponaturaemia - confusion, nausea, agitation or visual changes
165
Pathophysiology of prostate cancer
Adenocarcinoma - arise in peripheral zone - acinar - originates in the glandular cells that line the prostate gland - ductal - originates in the cells that line the ducts Mulitfocial
166
Risk factors for prostate cancer
Age Ethnicity - black African or Caribbean Family history of prostate cancer Genetic predisposition - BRCA 1 or 2
167
Clinical features of prostate cancer
``` LUTS - weak urinary stream - increased urinary frequency - urgency More advanced disease - haematuria - dysuria - incontinence - suprapubic and loin pain Metastatic disease - bone pain - weight loss - lethargy ```
168
Investigations for prostate cancer
``` PSA elevated Transperineal biopsy Transrectal ultrasound guided (TRUS) biopsy MRI CT abdo-pelvis - staging ```
169
Management of prostate cancer
``` Active surveillance Radical prostatectomy - open, laparoscopic or robotic External beam radiotherapy Brachytherapy Chemotherapy - docetaxel - cabazitaxel - androgen deprivation therapies ```
170
Define prostatitis
Inflammation of prostate gland
171
Pathophysiology of prostatitis
``` Acute bacterial - ascending urethral infection - E.coli, Enterobacter, Pseudomonas Chronic bacterial - sequelae of inadequately treated acute prostatitis ```
172
Risk factors for prostatitis
``` Acute bacterial - indwelling catheters - phimosis or urethral stricture - recent surgery - cystoscopy or transurethral prostate biopsy - immunocompromised Chronic - intraprostatic ductal reflex - neuroendocrine dysfunction - dysfunctional bladder ```
173
Clinical features of prostatitis
``` Acute - LUTS - systemic infection - perineal or suprapubic pain - tender and boggy prostate on DRE - inguinal lymphadenopathy Chronic - pelvic pain/discomfort for 3 months - LUTS - perineum pain ```
174
Investigations for prostitis
Urine culture - sensitivities STI screen Routine bloods
175
Management of prostatitis
``` Prolonged antibiotic treatment Suitable analgesia Admission for severely ill or prostatic abscess Alpha blocker Chronic pain specialist ```

Yr3 - General Surgery (17 decks)

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