Urology Flashcards
What are the lower urinary tract infection symptoms?
What are the 2 broad categories?
Storage:
- Frequency
- Urgency
- Nocturia
- Dysuria
Voidance:
- Hesitancey
- Incomplete emptying
- Poor stream
- Straining
Benign prostate hyperplasia
definition
Epidemiology
Examination
Symptoms:
Investigation
What is the treatment for BPH(conservative, medical and Surgical)?
definition: slowly progressive hyperplasia of the periurethral (transitional) zone of the prostate gland
Epidemiology: •VERY COMMON – most common cause of LUTS in men
Examination: DRE smooth enlarged prostate with ridge palpable (periurthral growth)
Symptoms:
- FUND HIPS
- Severe pain (if ACUTE retention)
- DRE - smoothly enlarged prostate with a palpable midline groove
Investigation: DRE, PSA
- Usually unnecessary
- U&Es – check for ↓ renal function
- Ultrasound of urinary tract
What is the treatment for BPH?
- Emergency: Catherise
- Conservative: watchful waiting
- Medical: alpha blocker (tamsulosin), Alpha 5 reductase inhibitor (finasteride)
- Surgical: TURP OR open prostectomy
bladder cancer
Background
Risk factors:
Symptoms and signs:
Investigation:
Background:
- Most bladder cancers are transitional cell carcinomas
- Rarely, they can be squamous cell carcinomas
Risk factors:
- naphtelamyne (dye stuff)
- Schistosomiasis
- chronic UTI
- smoking
- pelvic iradiation
Symptoms: painless, macroscopic haematuria
- FUND (not HIPS)
- FLAWS
Investigation: cystoscopy with biopsy and CT (staging)
prostate cancer
Examination:
Symptoms and signs:
Investigation:
prostate cancer
Examination: asymmetrical hard nodular prostate
Symptoms:
- FUND HIPS
- Symptoms of malignancy
- Bone pain
- Cord compression
- FLAWS
- Paraneoplastic (e.g. hypercalcaemia)
Investigation: MRI (firts line)
- PSA – low specificity
- Transrectal Ultrasound-guided Biopsy
- •LFTs/bone profile – check for metastatic effects
What are the different types of urinary incontinence and what are their symptoms?
- stress incontinence: poor bladder closure - stress on bladder through increased abdominal pressure through movement -RF: childbrith
- urge incontinence: overactive detrussor muscle, symptoms include sudden urge to pee
- Functional: due to stroke or dissabilty can’t get to the toilet in time
- Overflow: involuntary release of urine from an overfull bladder, in the absence of any need to urinate (ussualy not aware)
Niche ones:
- Normal pressure hydrocephalus
- Cord compression
Urinary tract calculi
Causes
Risk factors
Symptoms:
Investigation:
Management:
Causes:
- idiopathic
- metabolic (e.g. hypercalcaemia, hyperuricaemia)
Risk factors:
- low fluid intake
- structural abnormalities
Symptoms:
- often asymptomatic
- severe loin to groin pain
- nausea and vomitting
Investigation:
- urine dip, blood
- non contrast CT KUB
- Ultrasound
- U&E- check for renla function
Management:
- EMERGENCY- infected and obstructed - emergency nephrostomy
- NOT EMERGENCY
- <5mm- pass sponteously (drink plenty of water, tamsulosin)
- >5mm- uteroscope lithotripsy, extrocoreal shockwave lithotripsy, percutaneus nephrolithotom
Testicular torsion
Definition:
Causes
Risk factors
Symptoms:
Investigation:
Management:
Testicular torsion
Definition:twisting or torsion of the spermatic cord results in disruption of the blood supply to the testicle. A SURGICAL EMERGENCY
Causes: cremaster muscle contract and twists the testicle
Risk factors: young boys
Symptoms:
- Sudden-onset severe hemiscrotal pain
- Nausea and vomiting
- Swollen and erythematous scrotum
Investigation: exploratory surgery (within 6 hours) OR if not that acute do an duplex ultrasound
Management:
- EXPLORATORY SURGERY (within 6 hours)
- Both testicles are fixed in place
- Necrotic tissue may need removal
- Duplex Ultrasound
Varicocele:
Background:
Causes:
Symptoms:
Background:
- More common on the LEFT (80-90%)
- Associated with infertility
Causes: dilation of the pampiniform plexus due to venius obstruction froming a mass
Symptoms and Signs:
- Usually asymptomatic
- Scrotum feels like a ‘bag of worms’
- Swelling may reduce when lying down
hydrocele:
Causes
Risk factors
Symptoms:
Investigation:
Management:
FLUID IN THE TUNICA VAGINALIS
Causes: infection, trauma, idiopathic, tumour
Risk factors: young boys and very old
Symptoms: heavy testicle but otherwise asymptomatic
- Can get above the swelling
- Transilluminates
- Swelling cannot be separated from testicle
Investigation:
- transillumination
- ultrasound
- tumour markers
- urine dipstick/MSU- check for infectoin
Management: drain or in kids just wait
A 67-year-old man has been urinating around 12-14 times per day over the past 6 months. His stream is ‘weak’ and often takes a long time to get going. After he has finished urinating, he does not feel fully empty and often dribbles a little bit. DRE reveals a smoothly enlarged prostate gland with a palpable midline sulcus. A diagnosis of benign prostatic hyperplasia is made. He is eager to avoid surgery if possible. Which treatment would be best for him?
A Oxybutynin
B Solifenacin
C Tamsulosin
D Nitrofurantoin
E Co-trimoxazole
C Tamsulosin
What are the different types of renal calculi?
- CALCIUM OXALATE – most common
- Magnesium ammonium phosphate
- Urate
- Cysteine
A 75-year-old owner of a dye factory has experienced 4 episodes of ‘bright red’ blood in his urine over the past 2 weeks. He does not feel any pain when urinating. He has also noticed that he has lost some weight recently despite not changing his eating habits or exercise levels. What is the most likely diagnosis?
A Pyelonephritis
B Glomerulonephritis
C Bladder Cancer
D Prostate Cancer
E Ureteric Stone
C Bladder Cancer
An 80-year-old man has had considerable difficulty urinating. He goes about 10-12 times per day, including at night, and has described his stream as being very poor. He has also experienced lower back pain over the last 6 weeks. On digital rectal examination, an asymmetrically enlarged, nodular prostate gland is palpated. Which first-line investigation should be used to confirm the diagnosis?
A PSA
B Acid phosphatase
C MRI Scan
D Transrectal ultrasound guided biopsy
E Isotope bone scan
C MRI Scan
A 43-year-old woman presents to her GP having wet herself several times since the birth of her third child, 4 months ago. Whenever she laughs or coughs, a little bit of urine leaks out without her control. Which type of incontinence does she have?
A Functional incontinence
B Stress incontinence
C Urge incontinence
D Overflow incontinence
E Double incontinence
B Stress incontinence
A 65-year-old woman has wet herself several times over the past 3 months. She says that she will be going about her usual daily activities and will suddenly become overwhelmed by the feeling of needing to urinate. Before she can even think about finding a toilet, she has wet herself. Which type of incontinence is this?
A Functional incontinence
B Stress incontinence
C Urge incontinence
D Overflow incontinence
E Double incontinence
C Urge incontinence
A 42-year-old man presents with severe pain in his right flank. He adds that the pain moves towards his right groin. Although he is writhing around in pain, no abnormalities are detected on abdominal examination.
Urine Dipstick: + blood
Which investigation would you do next?
A Renal ultrasound
B Cystoscopy
C CT-KUB
D MRI
E Urine MC&S
C CT-KUB
Which type of urinary tract stone is most common?
A Magnesium ammonium phosphate
B Calcium oxalate
C Cysteine
D Urate
E Hydroxyapatite
B Calcium oxalate
A 13-year-old boy is brought to A&E with sudden-onset pain and swelling in his scrotum, which began an hour ago whilst playing a football match. After arriving at hospital, he begins to vomit. On examination, his right hemiscrotum is red and swollen. What is the most appropriate first step in his management?
A Doppler ultrasound of the testes
B CT Scan
C Exploratory surgery
D Empirical antibiotics
E Abdominal X-ray
C Exploratory surgery
A 50-year-old man has developed a swollen scrotum that has been bothering him for the past 2 weeks. The swelling is uncomfortable but not painful. On examination, the left hemiscrotum is enlarged, fluctuant and non-tender. It is possible to get above the swelling, however, the left testicle cannot be distinguished from the swelling. When a pen torch is shone on the swelling, it illuminates brightly. What is the most likely diagnosis?
A Varicocoele
B Hydrocoele
C Testicular tumour
D Epididymal cyst
E Indirect inguinal hernia
B Hydrocoele
A 30-year-old man has developed a swollen scrotum that he first noticed a week ago. He adds that the swelling feels like a ‘bag of worms’, and is uncomfortable but not painful. On examination, the patient’s scrotum looks normal when lying down, however, the left hemiscrotum becomes swollen when he stands up. The GP can get above the swelling and distinguish it from the testicle. What is the most likely diagnosis?
A Indirect inguinal hernia
B Direct inguinal hernia
C Hydrocoele
D Varicocoele
E Epididymal cyst
D Varicocoele
A 21-year-old man visits his GP complaining that his scrotum feels ‘heavier than usual’. On examination, a firm, non-tender lump can be palpated at the base of the right testicle. The patient had an undescended testicle as a child, which was corrected with orchidopexy. Testicular cancer is suspected and a CT scan is requested to assess for spread. Which group of lymph nodes does testicular cancer spread to?
A Inguinal
B Femoral
C Para-aortic
D Iliac
E Mesenteric
C Para-aortic
A 32-year-old man presents with a 2-week history of frequent urination and excessive thirst. He has also noticed that he feels much weaker than usual, and is struggling to complete his usual gym routine. He has been to see his GP once before because his blood pressure was high on multiple occasions, however, he did not return to receive treatment. His blood pressure is measured again and it is 184/94 mm Hg. What would you expect to see on the ECG of this patient?
A Tented T waves
B Absent P waves
C ST elevation
D J waves
E U waves
E U waves
Why are varicoecele more common on the left?
Reasons for being more common on the left:
- Angle at which the left testicular vein meets the left renal vein
- Lack of effective valves between the left testicular vein and the left renal vein
- Increased reflux from compression of the left renal vein
Epididymitis and Orchitis
- Definition
- Epidemiology
- Causes
- Symptoms and signs
- Investigations
Definition: inflammation of the epididymis or testes
Epidemiology: •Most common in 20-30 yr olds
Causes:
- < 35 yrs: Chlamydia and Gonococcus
- > 35 yrs: Coliforms (e.g. Enterobacter, Klebsiella)
- Others: mumps, Candida
Symptoms and signs:
- Painful, swollen and tender testis/epididymis
- NOTE: less acute onset than torsion
- Penile discharge (if STI)
- Fever
- Enquire about sexual history
Investigations:
- Urine dipstick
- Urine MC&S
- Bloods (FBC, CRP)
