Urology Flashcards
What is the most common type of renal cancer?
Renal clear cell carcinoma
What metastases are commonly associated with renal cell carcinoma?
Cannon ball mets in lungs
What is the clinical triad which is suggestive of renal cancer?
Haematuria
Loin pain
Abdominal mass
What are risk factors for the development of renal cancer?
Smoking Obesity HTN LT dialysis Von-Hippel-Lindau disease
Why does renal cancer cause a varicocele?
Compression of the renal artery causes back pressure on there testicular vessels
What are the different subtypes of renal cancer?
Clear cell Papillary Chromophobe Collecting duct carcinoma Wilms Tumour - children <5
How can renal cancer be managed?
Surgery - partial/radical nephrectomy
+/- chemotherapy/radiotherapy
What paraneoplastic features are associated with renal cancer?
Polycythaemia - RCC secretes EPO
Hypercalcaemia - RCC secretes a hormone which mimics PTH
Stauffer syndrome
What is Stauffer syndrome?
Abnormal LFTs indicating an obstructive jaundice without any localised hepatic/biliary metastasis
What are the two main types of bladder cancer?
90% transitional
10% squamous cell
What are the main risk factors for transitional cell?
Smoking
Aromatic amines
Polycyclic aromatic hydrocarbons
Arsenic
(Hair dye, industrial paint, rubber)
What are the main risk factors for squamous cell carcinoma of the bladder?
Smoking
Schistosomiasis
How do bladder cancers present?
Painless haematuria
How are bladder cancers diagnosed?
Cystoscopy and biospy
Following a neobladder reconstruction, what type of cancer are people most at risk of?
Adenocarcinoma
How can a bladder cancer that does not invade the muscle be treated?
Transurethral Resection of Bladder Tumour (TURBT)
Chemo into bladder
Weekly treatments of BCG vaccine into bladder via catheter for 6 weeks, then every 6 months for 3 years
How can a bladder cancer that invades into the detrusor muscle be managed?
Radical cystectomy with ileal conduits
Radiotherapy
Chemotherapy
What is BPH?
Hyperplasia of stromal and epithelial cells of the prostate
How should BPH be investigated?
Urine dipstick
PSA prior to DRE
DRE - size, shape, characteristics of prostate
How can BPH be managed?
Reassurance and monitoring
Meds:
alpha blockers - tamsulosin
5a reducase inhibitors - finasteride
Surgery:
TURP (transurethral resection of prostate)
Open prostatectomy via abdo/perineal
What is a TURP, and what complications are associated with a TURP?
Shave off part of the prostate to create a wider space for urine to flow
Bleeding Infection Incontinence Retrograde ejaculation Urethral strictures Erectile dysfunction Failure to resolve symptoms
What is TURP syndrome?
Irrigation fluid enters systemic circulation causing:
- Dilutional hyponatraemia
- Fluid overload
- Glycine toxicity
What can cause PSA levels to be elevated?
BPH Prostatis and UTI Ejaculation Vigorous exercise Urinary retention
What is the most common type of prostate cancer?
Adenocarcinoma
How can BPH present?
Lower Urinary Tract Symptoms (LUTS) Hesitancy Frequency Dribbling Incomplete voiding Nocturia
How can prostate cancer present?
Similar to BPH
+ Haematuria
+ Erectile dysfunction
+ General signs of cancer
How might a malignant prostate feel on DRE?
Firm/hard
Asymmetrical
Craggy/irregular
Loss of central sulcus
How is a prostate cancer graded?
Gleason Score - assess the most dominant and 2nd most dominant biopsies
Grade 1: well differentiated
Grade 2/3: moderately differentiated
Grade 4: poor differentiated
Grade 5: anaplastic
Gives an overall score out of 10
How can prostate cancer be managed?
Watchful waiting
Radiotherapy
Brachytherapy - radioactive seeds implanted into prostate to deliver target, constant radiotherapy
Hormonal - block androgens to slow/stop growth of prostate cancer
- Bilateral orchidectomy - gold standard
- LHRH agonists - causes chemical castration
- Androgen receptor blockers
Surgery - total prostectomy
What are complications of radical treatment of prostate cancer?
Erectile dysfunction
Urinary incontinence
Radiation induced enteropathy
Urethral strictures
If starting a patient on anti-androgen therapy, what else needs to be co-prescribed and why?
Flutamide - a synthetic anti-androgen
Anti-androgen drugs cause a transient increase in symptoms of prostate cancer the ‘flare effect’ due to the initial increase in LH production prior to receptor down regulation
What are causes of epididymo-orchitis?
E.coli
Chlamdyia trachomatis
Neisseria gonorrhoea
Mumps
How does a patient present with epididymo-orchitis?
Gradual onset over minutes/hours Usually unilateral Testicular pain/tenderness Dragging/heavy sensation Urethral discharge (chlamdyia/gonorrohea) Tender on palpation Swelling of testicles and epididymus Erythema to scrotum
How should epididymo-orchitis be managed?
Admit if septic 2 weeks Abx - ciprofloxacin Tight underwear for scrotal support Abstain from intercourse during illness USS to exclude torsion and tumours
Describe testicular torsion
Urological emergency
Sudden onset unilateral testicular pain
Often triggered by activity
How long do you generally have to sort out a testicular torsion before the damage from ischaemia is irreversible?
6 hours
What is a major complication of testicular torsion?
Sub-fertility
infertility
What are the anticipated examination findings in a patient with testicular torsion?
Acutely tender testicle Firm testicle Absent cremastic reflex Abnormal lie (Horizontal lie, epididymus not in normal posterior position, testicle may be retracted)
What is a Bell-Clapper deformity?
Testicle should be fixed posteriorly to the tunica vaginalis
In bell-clapper deformity, the fixation is absent, so testicles can rotate within tunica
As the testicle rotates, it twists the vessels cutting off the blood supply
How should a testicular torsion be managed?
Emergency urological review
Immediate surgical scrotal exploration
(untwist the testicle, fix both testicles in correct position - orchiplexy, orchidectomy if delayed surgery/necrotic tissue)
Describe how a testicular cancer may feel
Non-tender Arises from testicle Hard without fluctuance Doesn't transilluminate Irregular
Commonly between 15-40
What is a hydrocele?
Build up of fluid in tunica vaginalis
How does a hydrocele feel?
Soft, fluctuant, transilluminates
Irreducible with no bowel sounds
What side do hydroceles commonly present on?
Left side
What is a varicoele?
Swollen pampiniform plexus
How can a varicole present?
Dragging/sore
Describe a epididymal cyst
Soft, fluctuant lump at top of testicle
Describe how an inguinal hernia presents as a testicular lump
Separated from hernia
Can’t get above it
Bowel sounds
Reducible
What are the main types of testicular cancer?
Seminoma (average age 25)
Teratoma (average age 35)
What tumour markers can be used in testicular cancer?
AFP - raised in teratomas
beta-HCG - raised in termatomas and seminoma
Lactate dehydrogenase
Where can a testicular cancer metastasis to?
Lymphatics
Lungs
Liver
Brain
How is testicular cancer managed?
Orchidectomy +/- prosthesis
Chemo/radiotherapy
Monitor with tumour markers and imaging
What organisms can be responsible for pyelonephritis?
E.coli
Klebsiella
Enterococcus
Pseudomonas
How can pyelonephritis present?
High fever + rigors Loin to groin pain Dysuria and urinary frequency Haematuria Pain on palpation of renal angle
What might be seen on dipstick in a patient with pyelonephritis?
Haematuria
Proteinuria
Leucocytes
Nitrites
How can pyelonephritis be investigated?
CT-KUB
MSSU - cultures
DMSA scan - assess for renal scarring
How can pyelonephritis be managed?
Blood and urinary cultures Broad spectrum abx (co-amoxiclav) IVF Analgesia Anti-pyretics
What can be the result of chronic pyelonephritis?
Scarring
Can cause CKD
Can cause abscess formation
? Prophylactic abx
