Urology Flashcards
Management of paraphimosis
Early
- Gentle reduction
- Saline soaked gauze and instillagel for anaesthetic
Intermediate /Middle
- Local anaesthetic penile block
- Hyluronidase injection
- Reduction
Late
- Dorsal slit
- Circumcision
Radiation of urological pain
Kidney: renal angle between lower border of the 12th rib and spine
Ureter: between renal angle and groin “loin to groin”
Bladder: suprapubic region
Prostatic: perineum or along urethra to the tip of the penis
Causes of macroscopic haematuria
Painless = bladder cancer
Painful =
- renal stones
- cystitis / bladder infection
Management of acute renal stones
Analgesia
-100mg Diclofenac PR
Anti-emetic
-10mg Metoclopramide IV
If stones small
<0.5cm = conservative management, will pass
If pain persists or develops obstruction –> percutaneous nephrostomy +/- ureteric stent
Obstructing sites for renal stones (4)
Pelvi-ureteric junction (at the renal pelvis)
Mid-ureter at the pelvic brim
Vesicoureteric junction
Bladder neck
Treatment modalities for renal stones (non-emergency)
Extracorporeal shockwave therapy (ESWL)
Percutaneous nephrolithotomy (PCNL)
Endoscopic-urethroscopy
Open nephrolithotomy / urethrolithotomy
Complications of hydronephrosis
Pyonephrosis (and sepsis)
Hypertension
Renal failure
Causes of unilateral hydronephrosis
Extra-mural
- Aberrant vessels at pelvi-ureteric junction
- Extrinsic tumour
- Idiopathic retroperitoneal fibrosis
- Post-radiation fibrosis
- Retrocaval ureter
- Abdominal aortic aneurysm
Intra-mural
- Urinary calculi
- Transitional cell carcinoma of the renal pelvis
- Ureteric stricture
- Aperistaltic ureteric segment
Causes of bilateral hydronephrosis
ALL CAUSES OF UNILATERAL = causes of bilateral
Congenital posterior urethral valves Congenital urethral structure Acquired urethral stricture Bening enlargement of the prostate Locally advanced prostate cancer Large bladder tumours Gravid uterus
Management of hydronephrosis - emergency
Percutaneous nephrostomy
Retrograde ureteric stent
If renal function cannot be restored, nephrectomy
Differentials for difficulty urinating
Bladder outlet obstruction
- prostatic enlargement (benign or malignant)
- chronic prostatitis
- urethral stricture
- bladder neck stenosis
- faecal impaction
Functional
-bladder neck dysnergia
Neurological
- multiple sclerosis
- diabetic autonomic neuropathy
- spinal cord compression
Investigations for difficulty in urinating
Feel for bladder
DRE
- prostate
- anal tone
Full neurological examination
Feel for bony pain
Bloods: PSA, LFTs
USS KUB and post void volume
Investigations for prostate cancer
PSA
Transrectal USS guided prostate biopsy
CXR
CT for staging, MRI, or PET
Gleason score
Staging of prostate cancer
Predominant and 2nd commonest grade of cells added together
Grade I: normal
Grade V: unrecognisable
2-4: low-grade well differentiated
5-7: moderate grade
8-10: high grade, poorly differentiated
Management of prostate cancer
Conservative (for low grade indolent cancers)
Radical prostatectomy (95% 10 yr survival)
External beam radiotherapy
Hormonal therapy
Risk factors for prostate cancer
Geography
Fix: 2 fold increase if first degree relative affected
Painful haematuria causes
Renal stones
Cystitis
Pyelonephritis
Prostatic
Painless haematuria causes
Frank
- bladder cancer
- renal cancer
Microscopic
-renal parenchymal disease
Risk factors for transitional cell bladder cancer
Amines from textiles
Smoking
Management of bladder cancer
MDT
CT staging
Local
Transurethral resection of bladder tumour (TURBT)
Followed by long-term cystoscopic screening
Intrevesical chemotherapy
T1-T4
Partial cystectomy
Radial cystectomy with pelvic lymphadenectomy and urinary diversion
Or external beam radiotherapy
Or chemotherapy
Metastatic: cisplatin based chemotherapy
Referring for haematuria
Any patient >50 with microscopic haematuria
Any patient with frank haematuria
Staging of bladder cancer
T0: papillary carcinoma
T1: connect tissue
T2: bladder wall, nob breach of surrounding fat
T3: Local invasion (NOT to abdominal or pelvic wall)
T4: Pelvic or abdominal wall invasion
N1 local nodes
M1: lung, liver, bone
