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Med Student Finals > Urology > Flashcards

Urology Flashcards

1
Q

Benign Prostatic Hyperplasia

Pathology (2)

A

Benign nodular or diffuse proliferation of musculofibrous and glandular layers of the prostate
Inner (transitional) zone enlarges in contrast to peripheral layer expansion seen in prostate cancer

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2
Q

Benign Prostatic Hyperplasia

Signs + symptoms (10)

A 
Nocturia 
Frequency 
Urgency 
Post-micturition dribbling 
Poor stream/flow 
Hesitancy 
Overflow incontinence 
Haematuria 
Bladder stones 
UTI
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3
Q

Benign Prostatic Hyperplasia

Investigations (5)

A 
PR exam: smooth but enlarged prostate 
MSU 
U&E
Ultrasound: large residual volume, hydronephrosis (kidney swells due to urine failing to drain from kidney to bladder) 
PSA: rule out cancer
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4
Q

Benign Prostatic Hyperplasia

Treatment (5)

A

Lifestyle: avoid caffeine, alcohol, bladder training
Drugs for mild disease and awaiting surgery: alpha blockers 1st (eg. tamsulosin) which reduces smooth muscle tone, then add 5alpha-reductase inhibitors (eg. finsateride)
TURP surgery
Retropubic prostatectomy
TULIP (transurethral laser-induced prostatectomy) surgery

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5
Q

Prostatitis

Aetiology (3)

A

Usually <35
Acute: S.faecalis, E.coli, chlamydia
Chronic: bacterial or non-bacterial

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6
Q 
Prostatitis 
Risk factors (5)
A 
Recent UTI 
Recent STI 
Urogenital instrumentation 
Intermittent catheterisation 
Recent prostate biopsy
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7
Q

Prostatitis

Signs + symptoms (5)

A 
UTI 
Retention 
Pain 
Haematospermia 
Swollen/boggy/tender prostate on DRE
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8
Q

Prostatitis

Investigations (3)

A

Urinalysis (pyuria)
Microscopy (WCC + bacterial count)
Urine culture

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9
Q

Prostatitis

Treatment (2)

A

Levofloxacin

Analgesia

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10
Q 
Prostate Cancer 
Risk factors (3)
A

Age (80% in men >80)
Family history increases risk by 2-3x
High testosterone

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11
Q

Prostate Cancer

Pathology (1)

A

Adenocarcinomas arising in peripheral prostate

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12
Q

Prostate Cancer

Signs + symptoms (8)

A 
Asymptomatic 
Nocturia 
Hesitancy 
Poor stream 
Terminal dribbling 
Obstruction 
Weight loss/bone pain/cord compression suggest mets 
On DRE: hard irregular prostate
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13
Q

Prostate Cancer

Spread (3)

A

Local (seminal vesicles, bladder, rectum)
Lymphatic
Haematogenous (bone, liver, lung, adrenals)

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14
Q

Prostate Cancer

Investigations (6)

A

PSA (serum prostate enzyme produced by prostate tumour epithelial cells, poor sensitivity and specificity as raised in BPH, prostatitis, UTI, ejaculation)
Other bloods: testosterone, LFTs, FBC, U&E, creatinine
Transrectal ultrasound and biopsy
Bone scan
CT pelvis (regional staging)
MRI for staging

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15
Q

Prostate Cancer

PSA Normal Levels (1)

A

Normal serum range:0-4

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16
Q

Prostate Cancer

PSA Age-Related Range (4)

A

<50: 2.5 upper limit
50-60: 3.5 upper limit
60-70: 4.5 upper limit
>70: 6.5 upper limit

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17
Q

Prostate Cancer

Gleason Pathological Grading System (2)

A 
Score 1-5 of each biopsy (well to poorly differentiated) 
SUM score (combined scores of 2 biggest area) is prognostic
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18
Q

Prostate Cancer

Treatment (5)

A 
Multiple comorbidities/elderly: watch and wait or active surveillance 
Low risk  (PSA <10, GS <6, T1-2a): active surveillance, radical prostatectomy, external beam radiotherapy or brachytherapy 
Intermediate risk (PSA 10-20, GS7 or T2b): radical prostatectomy, external beam radiotherapy +/- brachytherapy +/- hormonal therapy 
Locally advanced: external beam radio + hormonal or prostatectomy + radio + hormonal 
Metastatic: hormonal therapy +/- chemo
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19
Q 
Prostate Cancer 
Hormonal therapy (2)
A

Surgical: bilateral orchidectomy
Chemical: LHRH analogue (inhibits testosterone fuelled tumour growth via -ve feedback), anti-androgen, oestrogen (inhibits LHRH + testosterone)

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20
Q

Haematuria

Non-Visible Haematuria Causes (7)

A 
Transient: UTI, menstruation, vigorous exercise, sexual intercourse 
Bladder, renal, prostate cancer 
Stones 
BPH 
Prostatitis 
Urethritis 
Renal: IgA nephropathy
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21
Q

Haematuria

Visible Haematuria Causes (7)

A

Trauma: blunt renal injury, ureteric trauma, bladder trauma (eg. RTA, pelvic fracture)
Malignancy: bladder TCC, RCC, prostate/renal cancer
Renal: glomerulonephritis
Stones
Drugs: aminoglycosides, chemo, penicillin, NSAIDs, anticoagulants
Gynae: endometriosis
Iatrogenic: catheter, radiation cystitis, cystoscopy

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22
Q

Haematuria

Referral (3)

A

Persistent non-visible haematuria
Urgent if >45 + visible haematuria (unexplained)
Urgent if >60 + unexplained non visible haematuria + dysuria/high WCC

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23
Q

Bladder Cancer

Pathology (6)

A

Most transitional cell carcinomas
Adenocarcinomas + squamous cell cancers are rare, SCC follows schistosomiasis
Grade 1- differentiated
Grade 2- intermediate
Grade 3- poorly differentiated
80% confined to bladder mucosa, only 20% penetrate muscle

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24
Q 
Bladder Cancer
Risk factors (5)
A 
Smoking 
Aromatic amines (rubber industry) 
Chronic cystitis 
Schistosomiasis (SCC) 
Pelvic irradiation
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25
Bladder Cancer | Signs + symptoms (3)
Painless haematuria Recurrent UTIs Voiding irritability
26
Bladder Cancer | Investigations (3)
Cystoscopy + biopsy: diagnostic Urine microscopy/cytology: cancers may cause sterile pyuria CT urogram: diagnostic + staging
27
Bladder Cancer | Spread (3)
Local to pelvic structures Lymphatic to iliac and para-aortic nodes Haematogenous to liver + lungs
28
``` Bladder Cancer TNM Staging (6) ```
``` Tis: carcinoma in situ Ta: tumour confined to epithelium T1: tumour in lamina propria T2: superficial muscle involved T3: deep muscle involved T4: invasion beyond bladder ```
29
Bladder Cancer | Treatment (3)
Tis/Ta/T1: 80% of all patients, diathermy via transurethral cystoscopy/transurethral resection of bladder tumour (TURBT), consider intravesical chemo for multiple small tumours or high grade tumours T2-3: radical cystectomy, radio for bladder preservation, give post-op and neoadjuvant chemo T4: usually palliative chemo/radio
30
Bladder Cancer | Survival (4)
5 year survival 95% for Tis/Ta/T1 For T2-T3, 3 year survival 60% if 65-75, 40% if 75-82 With unilateral node involvement, 6% 5 year survival With bilateral/para-aortic node involvement, 0% 3 year survival
31
``` Renal Cell Cancer Risk factors (3) ```
Mean age 55 Male Haemodialysis
32
Renal Cell Cancer | Signs + symptoms (8)
``` 1/2 incidental findings Haematuria Loin pain Abdominal mass Anorexia Malaise Weight loss Pyrexia of unknown origin ```
33
Renal Cell Cancer | Spread (3)
Direct (renal vein) Lymphatic Blood (bone, liver, lungs)
34
Renal Cell Cancer | Investigations (5)
FBC (polycythaemia from erythropoietin secretion) ESR U&E Urine: RBCs, cytology Imaging: ultrasound, CT/MRI, IV urogram (filling defect +/- calcification), CXR (mets)
35
Renal Cell Cancer | Treatment (3)
Radical nephrectomy Often chemo/radio resistant Biological therapies
36
``` Testicular Lumps Epididymal cysts (3) ```
Usually develop in adulthood and contain clear/milky (spermatocele) fluid Lie above and behind testis Separate from testis
37
Testicular Lumps | Hydroceles (2)
Fluid within tunica vaginalis | Associated with patent processus vaginalis
38
Testicular Lumps | Epididymo-Orchitis (3)
Sudden onset tender swelling, dysuria, sweats/fever Caused by chlamydia, E.coli, gonorrhoea Antibiotics and STI treatment
39
Testicular Lumps | Varicocele (2)
Dilated veins of pampiniform plexus | Distended scrotal blood vessels that feel like a 'bag of worms'
40
Testicular Cancer | Epidemiology (1)
Commonest malignancy in males aged 15-44
41
Testicular Cancer | Aetiology (5)
``` Undescended testes, even after orchidopexy Seminoma most common histology Non-seminomatous germ cell tumour Mixed germ cell tumour Lymphoma ```
42
Testicular Cancer | Signs + symptoms (5)
``` Typically painless testis lump Haematospermia Secondary hydrocele Dyspnoea (lung mets) Abdominal mass (enlarged nodes) ```
43
Testicular Cancer | Staging (4)
1: no evidence of mets 2: infradiaphragmatic nodes 3: supradiaphragmatic nodes 4: lung involvement
44
Testicular Cancer | Investigations (4)
CXR CT Excision biopsy Alpha-FP and B-hCG are tumour markers and help monitor treatment
45
Testicular Cancer | Treatment (2)
Radical orchidectomy | Seminomas very radiosensitive
46
Testicular Cancer | Survival (1)
>90% in all groups (5 year)
47
Penile Cancer | Epidemiology (2)
Rare in UK | V rare if circumcised
48
``` Penile Cancer Risk factors (3) ```
Chronic irritation Viruses Smegma
49
Penile Cancer | Signs + symptoms (3)
Chronic fungating ulcer Bloody/purulent discharge 50% spread to lymph at presentation
50
Penile Cancer | Treatment (2)
Radiotherapy and irridium wires if early | Amputation and lymph node dissection if late
51
Acute Urinary Retention | Aetiology (4)
Intrinsic urinary obstruction: urethral stricture, prolapse, prostatitis, cystitis Extrinsic urinary obstruction: BPH, phimosis Drugs: anti-cholinergic, tricyclics, opioids, benzodiazepines, NSAIDs Neuro: autoimmune neuropathy, DM, spinal cord trauma, stroke, MS, cauda equina, spinal stenosis
52
``` Acute Urinary Retention Risk factors (5) ```
``` BPH Constipation Medications Urolithiasis Neurological disease ```
53
Acute Urinary Retention | Signs + symptoms (5)
``` Inability to pass urine Lower abdominal discomfort/pain Acute on chronic urinary retention: overflow incontinence Palpable and percussible bladder Enlarged prostate on DRE ```
54
Acute Urinary Retention | Investigations (3)
Urinalysis and microscopy to exclude STI Bloods: U&E + creatinine (detect AKI), FBC (leucocytosis in infection, low Hb if bleeding), CRP Bladder USS: volume >300cc confirms diagnosis
55
Acute Urinary Retention | Treatment (4)
IV fluids + antibiotics if sepsis Analgesia RRT may be required Urethral or suprapubic catheterisation
56
Acute Urinary Retention | Complications (5)
``` UTI AKI Metabolic acidosis + hyperkalaemia Sepsis Post obstructive diuresis (loss of salt and water) ```
57
Acute Upper Tract Obstruction | Aetiology (4)
Intrinsic: PUJ obstruction (scar tissue), stone, TCC, clot Extrinsic: PUJ obstruction (crossing vessel), lymph node mets, abdo/pelvic mass (tumour/pregnancy) Unilateral: PACT (Pelvic-ureteric obstruction, Abberent renal vessels, Calculi, Tumour of renal pelvis) Bilateral: SUPER (Stenosis of urethra, Urethral valve, Prostatic enlargement, Extensive bladder tumour, Retroperitoneal fibrosis)
58
Acute Upper Tract Obstruction | Signs + symptoms (7)
``` Flank pain: dull, sharp or colicky, intermittent or persistent, restless, radiation to iliac fossa N&V Anuria (bilateral complete obstruction) Loin tenderness UTI Sepsis Rarely, an enlarged kidney ```
59
Acute Upper Tract Obstruction | Investigations (4)
Bloods: U&E + creatinine (AKI), FBC (anaemia of CKD, infection) Urinalysis and microscopy: RBCs (infection, stones, tumour) Renal USS CT scan (calculi, level of obstruction, renal pathology)
60
Acute Upper Tract Obstruction | Treatment (3)
Treat underlying cause Nephrostomy Ureteric stents
61
Chronic Urinary Retention | Aetiology (3)
Detrusor inactivity Bladder outflow obstruction: BPH, prostate cancer, urethral stenosis/stricture Neurological: spinal cord injury, pelvic surgery, herniated disc
62
Chronic Urinary Retention | Pathology (2)
Void with residual volumes ranging from 400ml to 1 litre | Overflow incontinence and renal failure only occur when bladder capacity reached and bladder pressure is high
63
Chronic Urinary Retention | Signs + symptoms (5)
Storage/voiding lower urinary tract symptoms Acute on chronic urinary retention may occur Painless palpable and percussible bladder after voiding Enlarged kidneys on bimanual palpation Enlarged prostate on DRE
64
Chronic Urinary Retention | Investigations (5)
Urinalysis and microscopy: detect infection, proteinuria, haematuria Bloods: U&E + creatinine, FBC, blood glucose, PSA Urinary tract ultrasound: bilateral hydronephrosis Post-void volumes Urodynamics
65
Chronic Urinary Retention | Treatment (2)
Treat underlying cause | Clean intermittent self-catherisation
66
Chronic Urinary Retention | Complications (4)
Acute on chronic urinary retention Detrusor hypertrophy Hydronephrosis leading to AKI/CKD Overflow incontinence
67
Nephrolithiasis | Epidemiology (3)
Lifetime incidence 15% M:F 3:1 Peak age 20-40
68
Nephrolithiasis | Aetiology (5)
Metabolic abnormalities (high Ca, high urate) Dehydration Renal tubular acidosis Polycystic kidney disease Drugs (diuretics, steroids, theophylline)
69
Nephrolithiasis | Pathology (4)
Microscopic mineral crystal formation in the loop of Henle, distal tubules or collecting duct Urine becomes saturated with salts which form stones Colic is secondary to obstruction of collecting system by the stone Ureter and collecting system are stretched due to an increased intraluminal pressure which stretches the nerve endings
70
Nephrolithiasis | Types (4)
``` Calcium oxalate (75%, low urine vol, hypercalcuria, high urine pH) Uric acid stone (low urine pH) Struvite stones (infection) Cystine stones (rare, genetic) ```
71
Nephrolithiasis | Signs + symptoms (8)
May be asymptomatic Renal colic: excruciating ureteric spasms 'loin to groin', nausea/vomiting Renal obstruction: felt in loin Obstruction of mid-ureter: mimics appendicitis/diverticulitis Obstruction of lower ureter: symptoms of bladder irritability + pain in scrotum/penis/labia Obstruction of bladder/urethra: pelvic pain, dysuria, strangury (desire but inability to void) Haematuria Anuria
72
Nephrolithiasis | Investigations (5)
Bloods: FBC (leucocytosis in UTI), U&E + creatinine (AKI), serum calcium (hyperparathyroidism), serum urate (gout) Urine dipstick: haematuria Urine pH Spiral non-contrast CTKUB Renal USS: hydronephrosis, calcification, dilatation
73
Nephrolithiasis | Treatment (6)
Initially: IV diclofenac as analgesia, IV fluids, antibiotics if infection Stones <5mm in lower ureter usually pass spontaneously with increased fluid intake Nifedipine/alpha-blockers can promote expulsion and reduce analgesic requirements Extracorporeal shockwave lithotripsy Uteroscopy (stents) Percutaneous nephrolithostomy (remove stones)

Med Student Finals (23 decks)

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