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MSRA > Urology > Flashcards

Urology Flashcards

1
Q

What are the risk factors for renal calculi?

A
  1. Dehydration - concentrated urine more likely to form stones
  2. Recurrent UTI
  3. Metabolic abnormalities (particularly hypercalcemia which leads to hypercalcuria)
  4. Urinary tract abnormalities
  5. Foreign bodies
  6. Drugs
  7. Family history

MORE COMMON IN CAUCASIAN MALES

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2
Q

Which urinary tract abnormalities may predispose to renal calculi?

A

Hydronephrosis, hotshot kidney, ureterocele, vesicoureteric reflux, stricture

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3
Q

What is the main type of renal calculus and how do they appear on imaging?

A

Calcium oxalate - spiky, radio-opaque on x-ray

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4
Q

Where do renal calculi typically deposit?

A

Stones form in collecting ducts and are classically deposited in:

  1. Pelviureteric junction
  2. Pelvic brim
  3. Vesicoureteric junction
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5
Q

How do renal stones present (6 presentations)?

A
  1. Renal colic - loin to groin pain, nausea and vomiting, cant lie still
  2. Renal obstruction - felt in loin between rib 12 and lumbar muscles, not colicky, worsened by particular movements
  3. Mid ureteric obstruction - mimics appendicitis/diverticulitis
  4. Lower ureteric obstruction - bladder irritability, penile/labial pain
  5. Obstruction in bladder/urethra - pelvic pain, dysuria, interrupted flow
  6. Pyelonephritis/UTI - pain, dysuria, haematuria
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6
Q

What examination findings may be present in renal calculi?

A

Often no tenderness on palpation, may have renal angle tenderness especially to percussion (indicates retroperitoneal inflammation)

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7
Q

What investigations should be done in suspected renal calculi?

A

BEDSIDE: obs, urinalysis (blood), MC&S, pregnancy test. 24hr urine monitoring for calcium/oxalate/urate/citrate

BLOODS: FBC, U&E, LFT, CRP, calcium, phosphate, glucose, urate

IMAGING: spiral non-contrast CT KUB (consider US for hydronephrosis/ KUB xray)

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8
Q

What are some predisposing factors for kidney stone formation?

A
  • Hypercalciruia
  • Drugs (loop diuretics, antacids, glucocorticoids, theophylline, vitamin D)
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9
Q

What symptoms indicate urgent intervention in renal stones?

A

Urosepsis, intractable pain or vomiting, obstruction in a solitary kidney, bilateral stones

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10
Q

What is the ongoing management for renal calculi?

A

Pain management
- NSAIDS and paracetamol
- Alpha blockers for distal ureteric stones <10mm

Antibiotics:
- As per UTI
- IV abx if unwell

Renal stones:
- Watchful waiting if <5mm
- Shockwave lithotripsy if 5-10mm (contraindicated if pregnant)
- Shockwave lithotripsy or ureteroscopy if 10-20mm
- Percutaneous nephrolithotomy if >20mm

Ureteric stones:
- Shockwave lithotripsy +/- alpha blockers if <10mm
- Ureteropscy if 10-20mm

Ureteric obstruction:
- + infection = emergency, needs urgent decompression with nephrostomy tube, insertion of ureteric catheters and ureteric stent placement

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11
Q

What are the main causes of urinary tract obstruction ?

A

Luminal:
- Calculus
- Blood clot
- Sloughed papilla
- Tumour

Mural:
- Congenital/acquired stricture
- Neuromuscular dysfunction
- Neuropathic bladder

Extra mural:
- Mass/tumour
- Retroperitoneal fibrosis
- Post surgery
- Diverticulitis
- AAA
- Prostatic obstruction

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12
Q

How does urinary tract obstruction affect the kidney?

A
  1. Continuing urine formation leads to rise in intraluminal pressure
  2. Dilatation proximal to the site of obstruction
  3. Compression and thinning of renal parenchyma
  4. Decreased size of kidney and renal damage

When kidney function is affected, it is determined obstructive neuropathy

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13
Q

What is hydronephrosis?

A

Dilation of the renal pelvis, with or without obstruction

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14
Q

What are the symptoms of acute urinary tract obstruction?

A

UPPER - loin to groin pain, infection, enlarged kidney, anuria

LOWER - severe suprapubic pain, urinary obstructive symptoms, palpable bladder , anuria , polyuria (if unilateral, compensation)

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15
Q

What are the symptoms of chronic urinary tract obstruction?

A

UPPER - flank pain, renal failure, infection, polyuria

LOWER - urinary frequency, hesitancy, poor stream , overflow incontience, distended bladder (think symptoms of BPH)

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16
Q

What investigations should be done in urinary obstruction?

A

BEDSIDE: urinalysis, MC&S

BLOODS: FBC, U&E, creatinine, PSA, specific tumour markers

IMAGING: renal USS, CT abdo pelvis (determines level of obstruction), radionuclide imaging

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17
Q

How is urinary obstruction not due to calculi managed?

A

UNILATERAL - stent, analgesia, antibiotics, treat underlying cause

BILATERAL - catheter, antibiotics, alpha blockers, treat underlying cause

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18
Q

What is retroperitoneal fibrosis?

A

Ureters get embedded in dense, fibrous tissue resulting in progressive bilateral ureteric obstruction.

May be idiopathic, autoimmune.

Required stent placement to relieve obstruction and ureterolysis

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19
Q

What is PUJ obstruction?

A

Disturbance of peristalsis of collecting system WITHOUT mechanical obstruction

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20
Q

What is the definition of acute and chronic urinary retention?

A

Acute - Sudden, painful inability to void despite having a full bladder. Medical emergency.

Chronic - Gradual development of painless retention, characterised by residual bladder volume >1L or associated with presence of distended or palpable bladder

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21
Q

What causes urinary retention?

A

Obstruction
* BPH (most likely men)
* Strictures
* Constipation
* Malignancy
* Bladder stone
* Pelvic prolapse
Drug treatment
* Antimuscarinics
* Sympathomimetics
* Tricyclic antidepressants
* Anaesthetic agents
* Morphine
Reduced detrusor contraction
* Neurogenic (cauda equina, MS)
* Postpartum/postoperative
Bladder over-distension
* Alcohol
* Post-operative pain

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22
Q

What investigations should be done in urinary retention?

A

BEDSIDE: urinalysis, C&S
BLOODS: FBC, U&E, PSA (if chronic)
IMAGING: flow analysis, bladder post-void residual volume, renal US, MRI spine

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23
Q

Why is PSA not useful in acute urinary retention?

A

It will give a false positive - defer by 2 weeks

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24
Q

How is acute urinary retention managed?

A
  1. Immediate catheterisation (urethral/suprapubic)
  2. Alpha-adrenoreceptor blocker (eg. tamsulosin) for at least 2 days before catheter removal (TWOC)
  3. If TWOC is unsuccesful (no void), further TWOCs can be attempted but failure may warrant long-term catheter
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25
Q

How is chronic urinary retention managed?

A

CONSERVATIVE – treat cause, voiding tips
MEDICAL – alpha-adrenoreceptor blocker and review after 4-6 weeks then every 6-12 months, consider finasteride
OTHER – indwelling catheter

NB - do not TWOC for chronic retention, either discharge with catheter until TURP or discharge with long term catheter

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26
Q

What is a contraindication for suprapubic catheter?

A

Suspected bladder cancer - there is a risk of seeding and spreading

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27
Q

What are the indications for an indwelling catheter?

A

Incontinence, repeated infection, renal dysfunction, no surgical solution

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28
Q

What is post obstructive diuresis?

A

Severe dehydration, postural hypotension and deranged U&Es following relief of urinary retention.

Patients may pass as much as 8-20L/day. Be aware in pts with renal/cardiac failure

(aiming for <200ml/hour)

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29
Q

What is the pathophysiology of BPH?

A
  1. Proliferation of musculofibrous and glandular layer of the prostate
  2. Inner transitional zone of prostate enlarges
  3. Enlargement of gland distorts the urethra, obstructing bladder outflow
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30
Q

What is the function of the prostate?

A

Secretion of alkaline fluid that comprises 70% of seminal volume

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31
Q

What are the symptoms of BPH?

A

Storage sx - frequency, urgency, nocturne, incontinence

Voiding sx - weak stream, dribbling, dysuria, straining

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32
Q

What is the normal size of the prostate? What is the normal PSA value?

A

<30g (size of a walnut).

PSA changes as you age, usually below 3ng/ml.

Before a PSA test men should not have had a UTI or urological intervention in past 6 weeks, ejaculated or exercised in last 48h
Also must wait 2 week post UTI and 1 month post prostatitis

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33
Q

How is BPH managed?

A

Mild-moderate - watchful waiting, avoid caffeine/alcohol, voiding tips, bladder training
Use IPSS to classify severity of LUTS

Moderate (IPSS >= 8)
1st line - alpha blockers (tamsulosin) - work by relaxing smooth muscle
2nd line, enlarged prostate - 4 alpha reductase inhibitors (finasteride) - work by shrinking the prostate
3rd line - tolterodine, darifenacin (antimuscarinics) use if persistent storage/voiding sx after treatment with alpha blocker alone

Surgery:
Transurethral resection of prostate
Transurethral incision of prostate
Retropubic prostatectomy
TULIP

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34
Q

How do alpha blockers work?

A

Relax smooth muscle in prostate and bladder neck

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35
Q

How do 5a reductase inhibitors work and what are the side effects?

A

Decrease conversion of testosterone to dihydrotestosterone so shrink the prostate itself

SE: ED, reduced libido, ejaculation issues, gynaecomastia

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36
Q

What are the differences between TURP, TUIP and TULIP?

A

TURP - moderately invasive, lots of unwanted sexual side effects (impotence) and bleeding

TUIP - less destruction, relieves pressure on urethra, fewer side effects

TULIP - uses lasers to ablate tissue, less bleeding, fewer side effects

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37
Q

When should prostatectomy be considered?

A

Prostate >80g, good surgical candidates.

This isn’t used much as the other options are better!!

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38
Q

What is prostatitis? What are the symptoms?

A

Acute or chronic (>3 months) inflammation of the prostate, usually due to s.faecalis or e.coli, or chlamydia

Causes UTI, retention, pain, haematospermia, fever, swollen/boggy prostate

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39
Q

What investigations should be ordered in prostatitis?

A

BEDSIDE: urinalysis, culture, prostatic secretion culture

BLOODS: FBC, CRP, blood cultures, PSA

IMAGING: cystoscopy, transracial US, 4-glass test

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40
Q

How is prostatitis managed?

A

Oral ciprofloxacin/levofloxacin

If pain - NSAIDS
If obstruction - catheter
If abscess - aspiration, IV abx

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41
Q

What are the symptoms of prostate cancer?

A

Prostatism (nocturia, urinary frequency, hesitancy, dysuria, terminal dribbling)

Systemic (weight loss, night sweats, bone pain ) - suggests mets

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42
Q

What are the RF for prostate cancer?

A
  • Positive family history
  • Age
  • Increased testosterone
  • African american ethnicity
  • High levels dietary fat
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43
Q

What is the histopathology of prostate cancer?

A

ADENOCARCINOMAS arising in peripheral prostate.

Can spread locally via lymph or haematogenously, causing sclerotic bony lesions

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44
Q

What investigations are done for suspected prostate cancer?

A

BEDSIDE: obs, urinalysis, DRE exam

BLOODS: FBC, testosterone PSA, calcium, CRP, U&E, LFT (looking for mets)

IMAGING: 1st line is multiparametric MRI, if Likert scale >3 offer biopsy

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45
Q

How is diagnosis of prostate cancer confirmed?

A

Prostatic biopsy or MRI

If clinical suspicion of prostate cancer is high, only do MRI

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46
Q

How is prostate cancer staged and graded?

A

Staging - TNM

Grading - Gleason score from 1 to 5

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47
Q

How is the Gleason score calculated?

A

Pathologist analyses histology from two areas of tumour and adds together to get a total score from 2-10.

2-4 - indolent
5-7 - intermediate
8-10 - aggressive

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48
Q

How is prostate cancer managed (no mets)?

A
  • Radical prostatectomy
  • Radical radiotherapy (with hormonal therapy)
  • Hormone therapy alone (not curative - elderly patients with high risk disease)
  • Active surveillance (if >70yo, low risk, review PSA yearly)
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49
Q

How is prostate cancer managed (mets)?

A
  • Hormonal therapy - LHRH agonists eg. goserelin and antagonists eg. degarelix
  • Orchidectomy (testicular removal)
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50
Q

What is multi parametric MRI?

A

Pre-biopsy imaging, aims to accurately locate clinically significant prostate cancer and facilitate targeted biopsy

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51
Q

What is androgen deprivation therapy? How can you managed the side effects?

A

Hormone therapy used to reduce androgen levels and shrink the cancer. Used if surgery/radiation not possible. Can give LHRH agonists or antagonists.

Hot flushes - medroxyprogesterone

Sexual dysfunction - PDE5 inhibitors

Osteoporosis - bisphosphonates

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52
Q

What is Wilms tumour?

A

A childhood tumour (<3yo) of the renal tubules and mesenchymal cells - presents with abdo mass and haematuria

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53
Q

How is Wilms tumour managed?

A

Nephrectomy, radiotherapy and chemotherapy - 5 year survival is 90%

54
Q

What is the most common type of bladder cancer?

A

Transitional cell carcinoma

55
Q

How does bladder cancer present?

A

Painless haematuria
Recurrent UTIs
Voiding irritability

56
Q

What are the RF for bladder cancer?

A
  • Smoking
  • Aromatic amines (rubber industry)
  • Chronic cystitis
  • Schistosomiasis (more likely squamous cell carcinoma)
  • Pelvic irradiation
57
Q

Which investigations should be done in suspected bladder cancer?

A

BEDSIDE: urinalysis (although asymptomatic haematuria is not v helpful), c&s (may cause sterile pyuria)
BLOODS:
IMAGING: cystoscopy with biopsy (diagnostic), CT urogram (staging), bimanual EUA (assess spread), MRI (nodes)

58
Q

How is bladder cancer staged?

A 
TNM staging 
Tis - in situ
Ta - epithelium
T1 - lamina propria
T2 - superficial muscle
T3 - deep muscle
T4 - invasion beyond bladder
  • nothing felt at EUA (exam under anaesthetic) until T2, when superficial muscle becomes involved
59
Q

Describe the histology of bladder cancer?

A

Grade 1 - differentiated
Grade 2 - intermediate
Grade 3 - poorly differentiated

60
Q

How is bladder TCC managed?

A

Tis/Ta/T1 - diathermy, transthurethral resection of bladder tumour. Good 5 year survival!!! (95%)

T2-3 - radical/partial cystectomy with pelvic lymph node dissection (consider adjuvant radiotherapy and chemotherapy)

T4 - palliative chemo/radio

61
Q

What does radical cystectomy involve?

A

Male - removal of bladder, prostate and seminal vesicles
Female - removal of bladder, uterus, ovaries and part of the vagina

The surgeon will then do either a:

  1. Ileal conduit - uses small intestine to create a tube that attaches to ureters and forms stoma
  2. Neobladder reconstruction - using small intestine
  3. Continent urinary reservoir - needs a catheter to drain
62
Q

What is the follow up for bladder cancer?

A

Regular cystoscopy
Low risk tumours - once after 9 months then yearly
High risk tumours - every 3 months for 2 yrs then every 6 months

63
Q

What causes urinary incontinence in males?

A
  • Prostate enlargement
  • Overflow in urinary retention (palpate bladder!)
  • Pelvic surgery
  • Bladder neck obstruction
  • Urethral stricture (eg after gonorrhoea)
64
Q

What are the 4 types of incontinence in women?

A
  1. Functional
  2. Stress
  3. Urge/overactive bladder
  4. Overflow
65
Q

How much urine can our bladders store?

A

500mL - urge to void starts at around 200mL

66
Q

How does the micturition reflex work?

A

Distention of the bladder wall causes contraction of the detrusor muscle via parasympathetic nerve fibres, controlled by the pons.

67
Q

When does micturition occur, in terms of pressure?

A

Bladder pressure > urethral pressure

This occurs because:

  1. Detrusor muscle causes increased bladder pressure
  2. Pelvic floor relaxation causes decreased urethral pressure
68
Q

What is functional incontinence?

A

Incontinence due to inability to get to the toilet - due to disability or environmental factors

69
Q

What is stress incontinence? What causes it?

A

Increased intra-abdominal pressure (eg when coughing or sneezing) is transmitted to the bladder but not the urethra.

Usually due to weakened pelvic floor muscles, incompetent sphincter or urethral stricture. Common after pregnancy and elderly women, prolapse.

70
Q

What is urge incontinence? What causes it?

A

Uncontrolled increases in detrusor pressure due to overactive bladder.

Usually due to neurogenic mechanisms or bladder muscle problem, may be due to organic brain damage. May be due to infection, diabetes, diuretics, vaginitis or urethritis

71
Q

How can you distinguish between stress and urge incontinence in the history?

A

Stress - small but frequent amounts of urine lost when sneezing/coughing/exercising.

Urge - precipitated by cold, cold, caffeine, sound of running water.

72
Q

What is overflow incontinence? What causes it?

A

Leakage of urine from a full distended bladder.

Usually due to prostatic obstruction and urinary retention, following surgery or spinal cord injury.

73
Q

What investigations should be done in suspected incontinence?

A

BEDSIDE: urinalysis, MC&S

BLOODS: FBC, U&E, CRP

IMAGING: cough stress test, urodynamic studies, post-void bladder US, cystoscopy, CT (look at ureter and dye test)

74
Q

How does urodynamics (cystometry) work?

A

Uses catheters to look at:

  • bladder pressure on coughing with a full bladder
  • abdo pressure using a pressure transducer in the rectum

If there is an involuntary detrusor contraction during test = URGE/OVERRACTIVE

If leakage during test = STRESS

75
Q

Which acute causes of incontinence should be excluded?

A 
UTI
DM
Diuretic use
Faecal impaction
Palpable bladder
76
Q

How is stress incontinence managed?

A

CONSERVATIVE - pelvic floor exercises, vaginal cones

MEDICAL - pseudoephedrine, duloxetine

SURGICAL - tapes/pessaries, colposuspension (lift up bladder neck)

OTHER - intravaginal electrical stimulation

77
Q

How is urge incontinence managed?

A

CONSERVATIVE - incontinence chart, reduce fluid intake, medication review, bladder training

MEDICAL - oxybutynin (anticholinergic), oestrogen (if post menopausal), botox (risk of retention)

SURGERY - clam ileocystoplasty (aka bladder augmentation - bisect bladder and sew in ileum, makes it larger)

OTHER - neuromodulation/sacral nerve stimulation (improves ability to suppress detrusor contractions)

78
Q

What 3 columns of tissue is the penis made up of?

A
  1. Corpora cavernosa (x2) - spaces get filled with blood and lead to erections
  2. Corpus spongiosum - contains male urethra
79
Q

What is the function of the scrotum?

A
  • Protects testis
  • Maintains testicular temperature at 2-3C lower than body temp to allow spermatogenesis
  • Contains many blood vessels and nerves
80
Q

What is the cremaster muscle?

A

A muscle in the scrotum that contracts and pulls the scrotum closer to the body when temperature falls too low

81
Q

What is the function of the testis?

A
  1. Production of male gametes

2. Production of testosterone

82
Q

What are the two coverings of the testes?

A

Tunica vaginalis - extension of peritoneum

Tunica albufeira - dense connective tissue, divides testes into lobules of semineforous tubules

83
Q

What are the different cell types present in the testes?

A
  1. Leydig cells - produce testosterone
  2. Sertoli cells - protect and provide growth to developing germ cells
  3. Germ cells - gametes
84
Q

What is the epididymis?

A

A highly coiled tube like structure connecting the testis to vas deferens.

Immature sperm passes through here as matures - gain motility and fertility

85
Q

What is the vas deferens?

A

30cm long tube connecting the epididymis to the ejactulatory duct.

86
Q

What is epididymo-orchitis and how is it managed?

A

Cetriaxone 500mg IM STAT + oral dyxocycline 100mg BD for 10-14 days

This covers gonorrhea and chlamydial infection

If suspecting enteric organism - send MSU and treat empirically with oral quinolone for 2 weeks

87
Q

What is an epididymal cyst? How is it managed?

A

Cyst lying above and behind the testis - contains clear or milky fluid.

Can remove if symptomatic but can leave.

88
Q

What is a hydrocele? How is it managed?

A

Fluid within the tunica vaginalis of the testis. Can be:

  1. Primary (patent processus vaginalis, self-resolving)
  2. Secondary (tumour, infection, trauma)

Located superior and anterior to the testes, can transilluminate on examination, may be uncomfortable.
Surgical repair (Lords/Jaboulay) - can leave if asymptomatic but need to US to exclude tumour

89
Q

What is epididymis-orchitis? How is it managed?

A

Inflammation of the epididymis and/or testis. Usually due to UTI/STI. May have systemic features and discharge.

Treat STI (doxycycline and add ceftriazone if gonorrhoea suspected) or UTI (ciprofloxacin) for 2-4 weeks - warn of possible infertility! Give analgesia and scrotal support.

90
Q

What is a varicocele? How is it managed?

A

Dilated veins of the pam-uniform plexus, commonly affecting the left side due to anatomy of the venous drainage system - due to incompetent valves. Looks like a bag of worms and may be dull pain!

Repair via surgery/embolization or risk of subfertility. If aged over 50 dip urine for haematuria as renal cancer can present like this!

91
Q

What is a haematocele? How is it managed?

A

Blood in the tunica vaginalis, often due to trauma.

Drainage/excision

92
Q

What is a spermatocele? How is it managed?

A

Located superior and posterior to the testis, milky fluid on aspiration

93
Q

What is the most common type of testicular tumour?

A

Seminoma (30-65yrs) - from seminiferous tubules

Non-seminomatous germ cell (20-30yrs) - from germ cells

94
Q

What are the symptoms of testicular cancer?

A

Painless lump

May have haematospermia, secondary hydrocele, pain, systemic symptoms

95
Q

How is testicular cancer staged?

A

1 - no mets
2 - infradiaphragmatic nodes
3 - supadiaphragmatic nodes
4 - lungs

96
Q

Which tumour markers are used in testicular cancer?

How is the cancer diagnosed?

A

aFP - teratoma
bHCG - seminoma
LDH

Diagnosis by ultrasound

97
Q

How is testicular cancer managed?

A

Radical orchidectomy and radiotherapy (seminomas)

Radical orchidectomy and chemotherapy (NSGCT)

Highly curable if diagnosed early! Good prognosis. May need testicular prosthesis or sperm banking.

98
Q

What are the symptoms of testicular torsion?

A

Sudden onset unilateral testicular pain

Abdo pain, N&V

99
Q

What are the signs of testicular torsion?

A

Inflamed, red, affected testis may lie high and transversely

100
Q

What age groups does testicular torsion commonly affect?

A
  • Babies

- 11-30yo

101
Q

What is a blue spot sign?

A

Due to torsion of the hydatid of morgagni which is an embryological remnant of the Mullerian duct - may tort aged 7-12yrs due to gonadotrophin surge in puberty. Less painful.

Treat as testicular torsion.

102
Q

What are the DDs for testicular torsion?

A
  • Epidiymo-orchitis
  • Tumour
  • Trauma
  • Acute hydrocele
  • Idiopathic scrotal oedema (no pain!!)
103
Q

How is testicular torsion investigated?

A

Doppler US - shows lack of blood flow

Often investigation not necessary - if any doubt SURGERY !!!

104
Q

How is testicular torsion managed?

A

Surgery - expose and untwist testis within 6 hours. Usually will do bilateral orchidopexy (fix each tumour to the tunica vaginalus to prevent recurrence)

Explain possibility or orchidectomy and bilateral fixation

105
Q

What other lumps can be found in the groin?

A
  • Testicular lumps
  • Psoas abscess
  • Femoral artery aneurysm
  • Hernia (femoral/inguinal)
  • Lymph node
  • Cryptorchidism
106
Q

What are the different types of undescended testes?

A

CRYPTORCHIDISM - Complete absence of testicle from scrotum

RETRACTILE TESTES - excessive cremasteric reflex

MALDESCENDED TESTS - can be found from abdomen to groin

ECTOPIC TESTES - found in superior inguinal pouch

107
Q

How is undescended tested treated?

A
  1. Orchidopexy - bring forward testicle through a hole made in the dartos muscle
  2. Hormone therapy if in inguinal cancel (hcg)
108
Q

What are the complications of undescended testes?

A
  • Infertility
  • Testicular cancer
  • Trauma/torsion
  • Hernias
109
Q

What is Fournier’s gangrene?

A

Necrotiscing fascitis of the genitals, perineal and perianal region.

Syngerstic infection of 3 or more anaerobes - likely in immunocompromised/homeless/alcoholics

110
Q

How is Fournier’s gangrene managed?

A
  • Broad spectrum IV abx
  • Fluid resuscitation
  • Aggressive surgical debridement and reconstructive surgery

THIS HAS A REALLY HIGH MORBIDITY AND MORTALITY!!

111
Q

What is hypospadias?

A

A congenital condition in males in which the opening of the urethra (meatus) is on the underside of the penis

112
Q

What is phimosis?

A

Tightening of the foreskin

113
Q

What is paraphimosis?

A

Tightening of the foreskin to the extent that the foreskin can no longer be pulled over the glans penis so remains retracted. Can be iatrogenic after catheterisation.

114
Q

How do you manage paraphimosis?

A
  • Compress affected area to reduce oedema then pull back

- If ineffective may need penile block

115
Q

How effective is vasectomy? What are the complications?

A

Very - need to perform semen analysis twice (16, 20 weeks) before unprotected sex

Complications include bruising, sperm granuloma and chronic testicular pain

116
Q

What causes unilateral hydronephrosis?

A 
PACT:
Pelvic-ureteric obstruction
Aberrant renal vessels
Calculi
Tumours of renal pelvis
117
Q

What causes bilateral hydronephrosis?

A 
SUPER:
Stenosis of the urethra
Urethral valve
Prostatic enlargement
Extensive bladder tumour
Retro-peritoneal fibrosis
118
Q

What is the 1st line investigation in hydronephrosis?

A

USS

119
Q

How is hydronephrosis managed?

A
  1. Remove obstruction and drain urine (catheter)

If acute obstruction - nephrostomy tube
If chronic obstruction - ureteric stent, pyeloplasty

120
Q

What is TURP syndrome?

A

Complication of prostate surgery, due to irrigation with large volumes of glycine

Causes hyponatremia, hyperammonia, visual disturbances and CNS, respiratory, systemic symptoms

121
Q

What is priapism? What are the sub-types?

A

Persistent penile erection >4h which is not associated with sexual stimulation

Types:
Ischaemic - impaired vasorelaxation and reduced vascular outflow causing congestion and trapping of de-oxygenated blood within the corpus cavernosa

Non-ischaemic - due to high arterial inflow, typically due to fistula formation as a result of congenital or traumatic mechanisms

122
Q

What causes priapism?

A
  • Idiopathic
  • Sickle cell and other haemoglobinopathies
  • ED meds eg. sildenafil and other PDE-5 inhibitors
  • Pharmacological eg. anti-hypertensives, anticoagulants, antidepressants
  • Recreational eg. cocaine, cannabis, ecstasy
  • Trauma
123
Q

How do you differentiate symptoms of ischaemic and non-ischaemic priapism?

A

Non-ischaemic tends to be non-painful and not fully rigid

124
Q

How is priapism investigated?

A

1st line is cavernosal blood gas - in ischaemic priapism p02 and pH would be reduced whilst pC02 would be increased (as blood is de-oxygenated)

Also:
- doppler USS
- FBC/toxicology

125
Q

How is ischaemic priapism managed?

A

MEDICAL EMERGENCY!!! TREATMENT DELAY > PERMANENT DAMAGE > LONG TERM ED

1st line treatment is aspiration of blood combined with injection of saline flush to help clear viscous blood
If this fails, intracaversonal injection of vasoconstrictor eg. phenyl epinephrine, repeat at 5 minute intervals
If both fail > surgery

126
Q

How is non-ischaemic priapism managed?

A

Observation

127
Q

What are the features of renal cell cancer?

A
  • Usually clear cell, arises from proximal tubular epithelium
  • RF include tuberous sclerosis, smoking, VHL syndrome
  • Triad of haematuria, loin pain and abdominal mass
  • Often have varicocele or endocrine effects
128
Q

What is Stauffer syndrome?

A
  • Paraneoplastic disorder associated with renal cell cancer
  • Typically presents as cholestasis/hepatosplenomegaly
  • Thought to be secondary to increased levels of IL-6
129
Q

What are the features of penile fracture?

A
  • Traumatic rupture of the corpus cavernosum
  • May occur due to sexual intercourse or sudden balunt trauma
  • Patient describe a dnapping sound with immediate tumescence
  • ‘Eggplant’ deformity
  • Diagnose clinically or on MRI
  • Manage with retrograde urethorgraphy and surgical therapy involveing evacuation of haematoma, correcting defect in tunica and repairing urethral injury
130
Q

Which drugs may cause erectile dysfunction?

A
  • Antihypertensives (thiazides and beta blockers)
  • Phenothiazines
  • Benzodiazepines
  • TCAs/MAOIs
  • Finaseteride
  • Cimetidine
  • Oestrogens
  • Antiandrogens
131
Q

What are the features of urethral injury?

A

Anterior:
- Located distal to the membranous urethra
- Due to blunt trauma to perineum
- May appear years later as a stricture

Posterior:
- Located in the membranous and prostatic urethra
- Related to major blunt trauma such as RTA/falls and often associated with pelvic fractures

Present with perineal bruising, blood at meatus, abnormally high riding prostate or inability to palpate the prostate

DO NOT ATTEMPT URETHRAL CATHETERISATION - REFER TO UROLOGY ASAP

MSRA (24 decks)

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