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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
Q

Define testicular torsion

A

Twisting of the testis

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26
Q

Presentation of testicular torsion

A

Sudden-onset very severe unilateral scrotal pain
Associated N+V
Extremely tender, raised and swollen testis
Loss of cremasteric reflex

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27
Q

Treatment for testicular torsion

A

Surgical emergency

- scrotal exploration and fixation

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28
Q

Benign testicular lesions

A

Leydig cell tumours
Sertoli cell tumours
Lipomas
Fibromas

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29
Q

Define acute urinary retention

A

New onset inability to pass urine

Leads to pain and discomfort with significant residual volume

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30
Q

Define acute-on-chronic urinary retention

A

Patients with chronic retention can also enter acute retention
Due to an acute deterioration of underlying pathology or new aetiology

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31
Q

Causes of acute urinary retention

A

BPH
UTI
Constipation
Severe pain
Medications - anti-muscarinics, spinal or epidural anaesthesia
Neurological - peipheral neuropathy, iatrogenic nerve damage, MS, Parkinson’s disease

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32
Q

Clinical features of acute urinary retention

A

Acute suprapubic pain
Inability to micturate
Palpable distended bladder
Suprapubic tenderness

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33
Q

Investigations for acute urinary retention

A

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

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34
Q

Define high pressure urinary retention

A

Urinary retention causing high intra-vesicular pressures which overcome anti-reflux mechanism
Hydroureter and hydronephrosis
Impairs kidneys clearance ability

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35
Q

Management of acute urinary retention

A

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

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36
Q

Complications of acute urinary retention

A

AKI
Chronic kidney injury
UTI
Renal stones

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37
Q

Define chronic urinary retention

A

Painless inability to pass urine

  • long standing retention
  • bladder distension
  • bladder desensitisation
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38
Q

Common causes of chronic urinary retention

A 
BPH
Urethral strictures
Prostate cancer
Pelvic prolapse
Pelvic mass - fibroids
MS
Parkinson's disease
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39
Q

Clinical features of chronic urinary retention

A

Painless urinary retention
Voiding LUTS - weak stream and hesitancy
Overflow incontinence - worse at night
Palpable distended bladder

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40
Q

Investigations for chronic urinary retention

A

Post-void bladder scan
Routine bloods
USS of urinary tract

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41
Q

Management of chronic urinary retention

A

TWOC
Long term catheterisation
Monitor urine for post-obstructive diuresis
Treat underlying cause

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42
Q

Complications of chronic urinary retention

A

UTI
Bladder calculi
Chronic kidney disease

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43
Q

Define haematuria

A

Presence of blood in urine

Classed as visible or non-visible

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44
Q

Define pseudohaematuria

A

Red or brown urine that is not secondary to the presence of haemoglobin

  • medication - rifampicin or methyldopa
  • hyperbilirubinuria
  • myoglobinuria
  • certain foods
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45
Q

Common causes of haematuria

A 
UTI
Urothelial carcinoma
Renal calculi
Adenocarcinoma of prostate
BPH
Trauma
Radiation cystitis
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46
Q

Investigations for haematuria

A 
Urinalysis - nitrites/leukocytes = infection
Baseline bloods 
PSA
Flexible cystoscopy
US KUB
CT urogram
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47
Q

Define LUTS

A

Lower urinary tract symptoms

Array of symptoms affecting the control and quality of micturition in the lower urinary tract

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48
Q

Common causes of LUTS in men

A 
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
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49
Q

Common causes of LUTS in females

A

UTI
Menopause
Urological malignancy
Detrusor muscle weakness or instability
Urethral stricture
External compression - pelvic tumour, faecal impaction
Neurological disease - MS, spinal cord injury

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50
Q

State some LUTS storage symptoms

A

Increased urinary frequency
Nocutria
Increased sense of urgency to urinate
Urge incontinence

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51
Q

State some LUTS voiding symptoms

A

Hesitancy in micturition
Poor flow
Terminal dribble
Feeling of incomplete emptying

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52
Q

Investigations for LUTS

A 
Post-void bladder scanning and flow rate
Urinary frequency and volume chart
Urinalysis
Urine culture
PSA
Urodynamic studies
Cystocopy
US KUB
CT urogram
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53
Q

Conservative management of LUTS

A

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

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54
Q

Pharmacological management of LUTS

A 
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
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55
Q

Complications of LUTS

A 
UTI
Renal and bladder calculi
Bladder wall muscle hypertrophy - overflow incontinence
Renal failure
Bilateral hydronephrosis
Acute urinary retention
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56
Q

Define urinary incontinence

A

Involuntary leakage of urine

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57
Q

State the subtypes of urinary incontinence

A 
Stress
Urge
Mixed
Overflow
Continuous
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58
Q

Pathophysiology of stress UI

A

Intra-abdominal pressure exceeds the urethral pressure

- coughing, straining, laughing or lifting

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59
Q

Causes of stress UI

A 
Weakness of pelvic floor muscles
- post-partum
Constipation
Obesity
Post-menopausal
Pelvic surgery
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60
Q

Pathophysiology of urge UI

A

Overactive bladder (detrousor hyperactivity) leads to uninhibited bladder contraction leading to rise in intravesical pressure

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61
Q

Causes of urge UI

A 
Neurogenic
- previous stroke
Infection
Malignancy
Idiopathic
Medication
- cholinesterase inhibitors
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62
Q

Define mixed UI

A

Combination of stress UI and urge UI

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63
Q

Pathophysiology of overflow UI

A

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
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64
Q

Causes of overflow UI

A

BPH
Spinal cord injury
Congenital defects

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65
Q

Define continuous UI

A

Constant leakage of urine

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66
Q

Causes of continuous UI

A

Anatomical abnormality
- ectopic ureter
Bladder fistulae
Severe overflow incontinence

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67
Q

Investigations for UI

A

Midstream urine dipstick
Post void bladder scan
Urodynamic assessment
Cystoscopy

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68
Q

Management of UI

A 
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
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69
Q

Define epididymitis

A

Inflammation of the epididymis

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70
Q

Pathophysiology of epididymitis

A

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
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71
Q

Presentation of mumps orchitis

A

Uni or bilateral orchitis
Accompanied fever
4-8 days after onset of mumps parotitis

72
Q

Management of mumps orchitis

A

Self-resolves within a week

Supportive management

73
Q

Complications of mumps orchitis

A

Testicular atrophy

Infertility

74
Q

Risk factors for epididymitis

A 
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
Q

Clinical features of epididymitis

A 
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
Q

Investigations for epididymitis

A 
Urine dipstick
First-void urine collection and Nucleic Acid Amplification Test - assess STI
STI screening
Blood cultures
USS
77
Q

Management of epididymitis

A

Appropriate antibiotic therapy
Sufficient analgesia
Abstain from sexual activity

78
Q

Complications of epididymitis

A

Reactive hydrocele formation
Abscess formation
Testicular infarction

79
Q

Risk factors for testicular cancer

A 
20-40 years
Caucasian and Northern European descent
Cryptorchidism
Previous testicular malignacy
Positive family history
Kleinfelter's syndrome
80
Q

Clinical features of testicular cancer

A 
Unilateral painless testicular lump
- irregular, firm, fixed and does not transilluminate
Evidence of metastasis
- wight loss
- back pain - retroperitoneal metastases
- dyspnoea - lung metastases
81
Q

Investigations for testicular cancer

A

Tumour markers
- βhCG - NSGCT and seminomas
- AFP - NSGCTs
- LDH - surrogate marker for tumour volume
Scrotal USS
CT chest-abdo-pelvis with contrast - staging

82
Q

Management of NSGCTs

A 
Stage 1 - orchidectomy
- surveillance
- adjuvant chemotherapy
Metastatic
- chemotherapy
83
Q

Management of seminomas

A

Stage 1 - orchidectomy and surveillance

  • chemotherapy
  • radiotherapy
84
Q

Define testicular torsion

A

Spermatic cord and contents twists within the tunica vaginalis
- compromising blood supply to testicle
Surgical emergency - infarct within hours

85
Q

Risk factors for testicular torsion

A 
Age - 12-25 years
Previous testicular torsion
Family history of testicular torsion
Undescended testes
Bell-clapper deformity
86
Q

Clinical features of testicular torsion

A

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
Q

Investigations for testicular torsion

A

Clinical diagnosis - Straight to theatre for scrotal exploration
Doppler ultrasound
Urine dipstick

88
Q

Management of testicular torsion

A

Urgent surgical exploration
- bilateral orchidopexy
- ochidectomy
Analgesia and anti-emetics

89
Q

Complications of testicular torsion

A

Testicular infarction
Atrophy
Chronic pain

90
Q

Define urethritis

A

Inflammation of the urethra
Often due to infection
- gonococcal urethritis - N.gonorrhoeae
- non-gonococcal urethritis - C.trachomatis, T.vagninalis

91
Q

Risk factors for urethritis

A

< 25 years
Men who have sex with men
Previous STI
Recent new sexual partner

92
Q

Clinical features of urethritis

A

Dysuria
Penile irritation
Discharge from urethral meatus
Sexual health screen

93
Q

Investigations for urethritis

A

Urethral swabs - gram stain under microscopy
First-void urine - NAAT
Mid-stream urine dipstick
STI screening

94
Q

Management of urethritis

A

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
Q

Define pyelonephritis

A

Inflammation of the kidney parenchyma and the renal pelvis

- typically due to bacterial infection

96
Q

Types of pyelonephritis

A

Uncomplicated - structurally or functionally normally urinary tract in a non-compromised host
Complicated

97
Q

Pathophysiology of pyelonephritis

A 
Bacterial infection
- ascending from the lower urinary tract
- blood stream
- lymphatics
Neutrophils infiltrate tubules and interstitium and cause suppurative inflammation
98
Q

Most common causative organisms of pyelonephritis

A

Escherichia coli

Catherters
- enterococcus faecalis
- staphylococcus aureus
- pseudomonas
Commensal
- staphylococcus saprophyticus
99
Q

Risk factors for pyelonephritis

A

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
Q

Clinical features of pyelonephritis

A 
Fever
Unilateral loin pain
N+V
On examination
- pyrexia
- costovertebral angle tenderness
101
Q

Investigations for pyelonephritis

A 
Urinalysis
Urine culture
Routine bloods
Renal US scan
Non-contrast CT KUB - if obstruction suspected
102
Q

Management of pyelonephritis

A

Resuscitaiton
Empirical antibiotics
IV fluids as appropriate

103
Q

Complications of pyelonephritis

A 
Severe sepsis
Multi-organ failure
Renal scarring -> chronic kidney disease
Pyonephrosis
Chronic pyelonephritis
Emphysematous pyelonephritis
104
Q

Types of renal cancer

A

Renal cell carcinoma
Transitional cell carcinoma
Squamous cell carcinomas - chronic inflammation secondary to renal calculi, infection and schistosomiasis

105
Q

Pathophysiology of RCC

A

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
Q

Risk factors for RCC

A 
Smoking
Industrial exposure to carcinogens
Dialysis
Hypertension
Obesity
Anatomical abnormalities
Genetic disorders
107
Q

Clinical features of RCC

A 
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
Q

Investigations for RCC

A 
Routine blood tests
Urinalysis
USS
CT abdo-pelvis
Biopsy of renal lesions
109
Q

Staging of renal cancers

A

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
Q

Management of renal cancer

A 
Partial or radical nephrectomy
Percutaneous radiofrequency ablation
Cryotherapy
Renal artery embolism
Surveillance
Immunotherapy
Biological agents
Metastasectomy
Chemotherapy ineffective
111
Q

Define a simple renal cyst

A

Well-defined outline and homogenous features

Common in older patients

112
Q

Pathophysiology of simple renal cysts

A

Develop from renal tubule epithelium in response to previous ischaemia

113
Q

Define a complicated renal cyst

A

Complicated structures, including thick walls, septations, calcificiation or heterogeneous enhancement on imaging
Risk of malignancy

114
Q

Risk factors for renal cysts

A 
Increasing age
Smoking
Hypertension
Male gender
Genetic conditions
- polycystic kidney disease
- tuberous sclerosis
115
Q

Aetiology of polycystic kidney disease

A

Autosomal dominant

Mutations in PKD1 or PKD2 gene

116
Q

Associated features of polycystic kidney disease

A

Berry aneurysm formation -> subarachnoid haemorrhage
Mitral valve disease
Liver cysts
End stage renal failure - dialysis or renal transplant

117
Q

Clinical features of renal cysts

A 
Usually asymptomatic - found incidentally on imaging
Flank pain
Haematuria
PKD 
- uncontrolled hypertension
- flank mass
118
Q

Investigations for renal cysts

A

CT or MRI imaging with IV contrast
USS
Serum U&Es - ensuring no impact on renal function

119
Q

Scoring systems for renal cysts

A

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
Q

Management of renal cysts

A 
Asymptomatic - no follow-up or treatment
Symptomatic simple
- simple analgesia
- needle aspiration
- cyst deroofing
Complex cysts
- continued surveillance
- surgical intervention
121
Q

Complications of renal cysts

A

Infection
Haemorrhage
Rupture

122
Q

Composition of renal stones

A 
Calcium - 80%
- calcium oxalate - 35%
- calcium phosphate - 10%
- calcium oxalte and phosphate - 35%
Struvite - magnesium ammonium phosphate
Urate
Cystine
123
Q

How are renal stones formed?

A

Over-saturation of urine

Specific pathology

124
Q

Name 3 locations where ureteric stones are likely to impact

A

PUJ
Crossing pelvic brim
VUJ

125
Q

Clinical features of ureteric stones

A 
Pain 
- colic
- sudden onset
- flank to pelvis
Haematuria
Tenderness in flank
126
Q

Investigations for ureteric stones

A

Urine dip
Urate and calcium levels
Non-contrast CT KUB
USS - hydronephrosis

127
Q

Management of ureteric stones

A 
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
Q

Complications of ureteric stones

A

Infection
AKI
Scarring
Loss of kidney function

129
Q

Causes of bladder stones

A

Chronic urinary retention
Secondary to infections - schistosomiasis
Passed ureteric stones

130
Q

Presentation of bladder stones

A

LUTS

131
Q

Management of bladder stones

A

Cystoscopy

132
Q

Complications of bladder stones

A

TCC - chronic irritation of bladder epithelium

133
Q

Define Fournier’s gangrene

A

Necrotising fascitis that affects the perineum

Urological emergency

134
Q

Risk factors for Fournier’s gangrene

A 
Diabetes mellitus
Excess alcohol
Poor nutritional state
Steroid use
Haematologial malignancies
Recent trauma to region
135
Q

Clinical features of Fournier’s gangrene

A 
Sever pain
Pyrexia
Crepitus
Skin necrosis
Haemorrhagic bullae
Patients will rapidly deteriorate and become septic
136
Q

Management of Fournier’s gangrene

A

Urgent surgical debridement
Parital or total orchiectomy
Broad spectrum antibiotics

137
Q

Define paraphimosis

A

Inability to pull forward a retracted foreskin over glans penis

138
Q

Pathophysiology of paraphimosis

A

Tight contricting band as part of foreskin prevents retraction over the glans
Glands becomes oedematous to due reduced venous return

139
Q

Complications of paraphimosis

A

Penile ischaemia

Worsening infection - Fournier’s gangrene

140
Q

Risk factors for paraphimosis

A

Phimosis
Indwelling catheter
Poor hygiene
Prior paraphimosis

141
Q

Clinical features of paraphimosis

A

Progressive pain and swelling in glans

Unable to retract foreskin

142
Q

Management of paraphimosis

A 
Reduced ASAP
- manual pressure
- dextrose soaked gauze
- dundee technique - needle punctures
Suitable anaglesia - penile block with LA
Doral slit
143
Q

Define priapism

A

Unwanted painful erection of penis

  • not associated with sexual desire
  • lasting more than 4 hours
144
Q

Pathophysiology of priapism

A 
High flow
- unregulated cavernous arterial inflow
- often associated with trauma
Low flow
- veno-occlusive - blockage of venous drainage of corpus cavernosusm
- urological emergency
145
Q

Causes of priapism

A 
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
Q

Investigations for priapism

A

Corporeal blood gas - determine whether ischaemic or non-ischaemic
Routine bloods
Potential spinal injury

147
Q

Management of priapism

A

Corporeal aspiration
Intracavernosal injection of sympathomimetic agent
Surgical shunt

148
Q

Define a penile fracture

A

Traumatic rupture of corpus cavernosa and tunica albuginea

149
Q

Clinical features of a penile fracture

A

Popping sensation or snap during intercourse
Immediate pain, swelling and detumescence
Penile swelling and discoluration
Firm immobile haematoma

150
Q

Management of a penile fracture

A

Analgesia
Anti-emetics
Surgical exploration and repair
abstinence for 6-8 weeks

151
Q

Complications of a penile fracture

A

Penile curvature during erection
Penile paraesthesia
Dyspareunia
Painful erection

152
Q

Types of bladder cancer

A

Transitional cell carcinoma
Squamous cell carcinoma
Adenocarcinoma
Sarcoma

153
Q

Classification of bladder cancers

A

Non-muscle invasive
Muscle-invasive
Locally advanced
Metastatic

154
Q

Layers of the bladder wall

A

Urothelium - transitional epithelium
Lamina propria - connective tissue
Muscularis propria - muscle
Fatty connective tissues

155
Q

Risk factors for bladder cancer

A 
Male
Smoking
Increasing age
Aeromatic hydrocarbons - industrial dyes or rubbers
Schistosomiasis infection - SCC
Previous radition
156
Q

Clinical features of bladder cancer

A

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
Q

Investigations for bladder cancer

A

Urgent cystoscopy - biopsy
Transurethral resection of bladder (TURBT)
CT staging
Urine cytology

158
Q

Management of bladder cancer

A 
TURBT - carcinoma in-situ or T1
Adjuvant intravesical therapy - BCG or mitomycin C
Radical cystectomy
- ileal conduit formation 
- bladder reconstruction
Chemotherapy - cisplatin, gemcitabine
159
Q

Pathophysiology of BPH

A

Exact mechanism unknown

Prostate converts testosterone to dihydrotestosterone (DHT)

160
Q

Risk factors for BPH

A

Age
Family history - first degree relative
Afro Caribbean ethnicity
Obesity

161
Q

Clinical features of LUTS

A

LUTS - voiding or storage

Firm smooth symmetrical prostate on DRE

162
Q

Investigations of BPH

A 
Urinary frequency and volume chart
Bedside urinalysis
Post-void bladder scan
PSA levels
USS of renal tract
Urodynamic studies
163
Q

Management of BPH

A

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
Q

Complications of BPH

A

High-pressure retention -> kidney injury
TURP syndrome
- fluid overload and hyponaturaemia
- confusion, nausea, agitation or visual changes

165
Q

Pathophysiology of prostate cancer

A

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
Q

Risk factors for prostate cancer

A

Age
Ethnicity - black African or Caribbean
Family history of prostate cancer
Genetic predisposition - BRCA 1 or 2

167
Q

Clinical features of prostate cancer

A 
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
Q

Investigations for prostate cancer

A 
PSA elevated
Transperineal biopsy
Transrectal ultrasound guided (TRUS) biopsy
MRI
CT abdo-pelvis - staging
169
Q

Management of prostate cancer

A 
Active surveillance
Radical prostatectomy - open, laparoscopic or robotic
External beam radiotherapy
Brachytherapy
Chemotherapy
- docetaxel
- cabazitaxel
- androgen deprivation therapies
170
Q

Define prostatitis

A

Inflammation of prostate gland

171
Q

Pathophysiology of prostatitis

A 
Acute bacterial
- ascending urethral infection
- E.coli, Enterobacter, Pseudomonas
Chronic bacterial
- sequelae of inadequately treated acute prostatitis
172
Q

Risk factors for prostatitis

A 
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
Q

Clinical features of prostatitis

A 
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
Q

Investigations for prostitis

A

Urine culture - sensitivities
STI screen
Routine bloods

175
Q

Management of prostatitis

A 
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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