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Finals - Surgery > Urology > Flashcards

Urology Flashcards

1
Q

Epididymitis - Definition

A

Inflammation of the epididymis

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2
Q

Epididymitis - Common age group

A

Young adults (average age 25)

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3
Q

Epididymitis - Cause

A
  • Young men: STI > UTI e.g. gonorrhoea

- Older men: UTI > STI e.g. E. coli

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4
Q

Epididymitis - Presentation

A
  • Gradual onset pain
  • Hot, red + swollen testis
  • Low grade fever
  • Urethral discharge + vomiting may present
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5
Q

What is Prehn’s sign

A

Testicular pain is relieved by elevation of scrotum

seen in epididymitis

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6
Q

Epididymitis - Investigations

A
  • Typically a clinical diagnosis
  • Ultrasound: can be used to rule out abscess
  • Surgical exploration if unsure
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7
Q

Epididymitis - Management

A

Antibiotics

  • STI: ciprofloxacin + doxycycline
  • UTI: fluoroquinolone

Scrotal support
Analgesia

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8
Q

Testicular Torsion - Definition

A

Twisting of spermatic cord around testicular artery + vein

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9
Q

Testicular Torsion - Common age groups

A

Two peaks

  • first year of life
  • 13 to 30
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10
Q

Testicular Torsion - Risk factors

A
  • Bell-clapper deformity (biggest risk factor)

- Undescended testicles

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11
Q

Testicular Torsion - Presentation

A
  • Sudden onset severe unilateral pain
  • Nausea + Vomiting
  • Abdominal pain
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12
Q

Testicular Torsion - Examination

A
  • One testicle higher than the other

- Loss of cremasteric reflex

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13
Q

Testicular Torsion - Investigations

A
  • Clinical diagnosis

- Doppler (look at blood flow) not useful

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14
Q

Testicular Torsion - Management

A
  • Immediate surgical exploration

- Fix testes - bilateral orchidopexy

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15
Q

What is the Hydatid of Morgagni

A

Remnant of mullerian duct

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16
Q

Hydatid of Morgagni Torsion - Symptoms

A
  • Sudden onset pain
  • Compared to torsion: younger, less swelling, normal lie
  • Classical sign = ‘blue dot’
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17
Q

Testicular cancer - Common demographic

A

Caucasian men aged 20-40

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18
Q

Testicular cancer - Tumour types

A
  1. Germ Cell Tumours (95%)
    - Seminomas (SGCT)
    - Non-seminomas (NSGCT)
  2. Non-germ cell tumours (NGCT) (5%)
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19
Q

Testicular cancer - Risk factors

A
  • Undescended testes
  • PMH/FH of testicular cancer
  • Klinefelter’s syndrome
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20
Q

Testicular cancer - Clinical features

A
  • Unilateral, painless testicular lump

- Lump: irregular, firm, fixed + doesnt transilluminate

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21
Q

Testicular cancer - Investigations

A
  1. Tumour markers
    - AFP + beta HCG
  2. Scrotal Ultrasound
  3. Contrast CT (for staging)
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22
Q

Testicular cancer - Management

A

NSGCT
- Surgery + chemo (based on risk score)

SGCT
- Orchidectomy + surveillance

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23
Q

Testicular cancer - Fertility

A
  • Chemo/radiotherapy can impair fertility

- Cryopreservation offered

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24
Q

Urethritis - Classification

A
  1. Gonococcal Urethritis

2. Non-gonococcal Urethritis

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25
Q

Urethritis - Risk factors

A
  • Age <25yrs
  • MSM
  • Previous STIs
  • New sexual partner/multiple sexual partners
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26
Q

Urethritis - Clinical features

A
  • Dysuria, penile irritation + discharge

- Complications: reactive arthritis + epididymitis

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27
Q

Urethritis - Investigations

A
  • First-void urine sample for NAAT (gold standard)
  • Urethral swabs
  • Additional STI screening: e.g. HIV, Syphillis
28
Q

Urethritis - Management

A
  1. Antibiotics
    - Gonococcal: ceftriaxone + azithromycin
    - Non-Gonoccocal: doxycycline or azithromycin
  2. Abstinence
    - no sex until 7 days after symptoms + abx finished
29
Q

Bladder Cancer - demographics

A

Men > Women

30
Q

Bladder Cancer - Risk factors

A
  • Smoking + increasing age
  • Exposure to industrial dyes or rubbers
  • Previous pelvic radiation
31
Q

Bladder Cancer - Clinical features

A
  • Painless Haematuria (main symptom)
  • Possibly recurrent UTIs
  • Signs of obstruction
32
Q

Bladder Cancer - Investigations

A
  • Flexible cystoscopy (first line)

- If mass suggested: Rigid cystoscopy (biopsy) + CT KUB

33
Q

Bladder Cancer - Management

A
  1. Confined to bladder
    - Transurethral resection of bladder tumour (TURBT)
    - Higher risk: radical cystectomy
    - Follow up imaging for several years
  2. Muscle invasive
    - Radical cystectomy
    - Regular CT imaging
  3. Locally advanced/Metastatic
    - chemotherapy + symptom relief
    - Palliation discussion
34
Q

BPH - Demographic

A

Older men
>40yrs risk = 50%
>80yrs risk = 90%

35
Q

BPH - Pathophysiology

A
  • Exact mechanism unknown
  • Androgens likely play a role
  • Prostate retains ability to respond to testosterone for life
36
Q

BPH - Risk factors

A

Age (primary risk factor)

FH, afrocaribbean ethnicity, obesity

37
Q

BPH - Clinical features

A
  1. Voiding symptoms
    - hesitancy, weak stream, terminal dribbling, incomplete emptying
  2. Storage symptoms
    - frequency, nocturia, nocturnal enuresis, urge incontinence
  3. Less commonly: haemturia/haematospermia
38
Q

BPH - Examination

A

DRE: enlarged, smooth, symmetrical, firm prostate

39
Q

BPH - Investigations

A
  • Urinary frequency + volume chart
  • Post-void bladder scan (chronic rentention)
  • PSA (exclude malignancy - slightly raised in BPH)
  • Urodynamics (objective measure of symptoms)
40
Q

BPH - Management

A
  1. Conservative
    - lifestyle advice: moderate caffeine + alcohol intake
  2. Medical
    - alpha blocker (tamsulosin) or 5-alpa-reductase inhibitor (Finesteride)
  3. Surgical
    - Trans Urethral Resection of Prostate (TURP)
41
Q

Prostatitis - Classification

A
  1. Acute bacterial
  2. Chronic bacterial
  3. Non-bacterial
  4. Prostatodynia
42
Q

Prostatitis - Cause

A

Acute bacterial caused by ascending UTI

- most commonly E. coli (can also by GI + STI organisms)

43
Q

Prostatitis - Risk factors

A

Acute bacterial
- catheter, recent surgery, immunocompromised, urethral stricture

Chronic

  • Same as acute
  • Plus: structural abnormality, bladder dysfunction
44
Q

Prostatitis - Clinical Features

A

Bacterial

  • Lower urinary tract symptoms
  • Perineal + suprapubic pain
  • Urethral discharge
  • Examination: tender, boggy prostate
45
Q

Prostatitis - Investigations

A
  • Urine culture (first line)
  • Routine bloods
  • STI screen
  • Imaging (if not responding to treatment)
46
Q

Prostatitis - Management

A
  • Prolonged antibiotics (quinolones)
  • Analgesia (paracetamol + NSAIDs)
  • Alpha-blocker/5-ARI (2nd line)
47
Q

Fournier’s Gangrene - Definition

A

Necrotising fasciitis affecting the perineum

48
Q

Fournier’s Gangrene - Cause

A

Causative organisms:

  • Group A strep
  • C. Perfringes
  • E. coli
49
Q

Fournier’s Gangrene - Risk Factors

A
  • Diabetes Mellitus
  • Excess alcohol
  • Poor nutritional state
  • Steroid use
  • Haematological malignancies
  • Recent trauma
50
Q

Fournier’s Gangrene - Clinical Features

A
  • Severe pain out of proportion to findings
  • Pyrexia
  • Progresses to: skin necrosis, haemorrhagic bullae, sensory loss
51
Q

Fournier’s Gangrene - Investigations

A

Clinical Diagnosis

52
Q

Fournier’s Gangrene - Management

A
  • Urgent Surgical Debridement
  • Broad spectrum antibiotics
  • HDU support

Later

  • Further debridement often necessary
  • Secondary closure with skin grafts
53
Q

Paraphimosis - Pathophysiology

A
  • Usually following catheter insertion

- Often presence of tight constricting band

54
Q

Paraphimosis - Risk factors

A
  • Occurs in people with phimosis
  • Previous paraphimosis
  • Poor hygeine
55
Q

Paraphimosis - Clinical features

A
  • Progressive pain + swelling

- Inability to pull foreskin back over glans

56
Q

Paraphimosis - Management

A
  1. Reduction ASAP

2. Definitive management - potentially circumcision

57
Q

Priapism - Pathophysiology

A

Blood stays within corpus cavernosa

58
Q

Priapism - Classification

A
  1. High-flow: arterial blood enters faster than it can be drained
    - does not cause ischaemia
  2. Low-flow: veno-occlusion prevents blood draining
    - can cause ischaemia
59
Q

Priapism - Causes

A
  • Idiopathic (in >50%)
  • Non-ischaemic causes: penile/perineal trauma
  • Ischaemic causes: iatrogenic, sick cell, leukaemia
60
Q

Priapism - Clinical features

A
  • Ongoing, unwanted erections
  • Ischaemic: painful + rigid
  • Non-ischaemic: painless and often not fully rigid
61
Q

Priapism - Investigations

A

After initial management

  • Corporeal blood gas (lactate to see if ischaemic)
  • Routine bloods (look for cause)
62
Q

Priapism - Management

A
  1. Initial - corporeal needle aspiration
  2. Intracavernosal injection of phenylephrine
  3. Surgical - Shunt (cavernosa to glans)
63
Q

Penile Fracture - Pathophysiology

A

Caused by blunt trauma

  • penis violently deviated away from axis
  • Commonly: sex with female on top or forceful masturbation
64
Q

Penile Fracture - Clinical Features

A
  • Reported ‘popping’ sensation
  • Followed by immediate pain, swelling and loss of erection

Examination

  • penile swelling
  • discolouration (aubergine sign)
  • Firm, immobile haematoma
65
Q

Penile Fracture - Investigations

A

Clinical diagnosis

66
Q

Penile Fracture - Management

A

Urgent surgical exploration + repair

Later: abstinence for 6-8 weeks

Finals - Surgery (5 decks)

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