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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
Q

Bladder Cancer

Signs + symptoms (3)

A

Painless haematuria
Recurrent UTIs
Voiding irritability

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26
Q

Bladder Cancer

Investigations (3)

A

Cystoscopy + biopsy: diagnostic
Urine microscopy/cytology: cancers may cause sterile pyuria
CT urogram: diagnostic + staging

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27
Q

Bladder Cancer

Spread (3)

A

Local to pelvic structures
Lymphatic to iliac and para-aortic nodes
Haematogenous to liver + lungs

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28
Q 
Bladder Cancer
TNM Staging (6)
A 
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
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29
Q

Bladder Cancer

Treatment (3)

A

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

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30
Q

Bladder Cancer

Survival (4)

A

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
Q 
Renal Cell Cancer
Risk factors (3)
A

Mean age 55
Male
Haemodialysis

32
Q

Renal Cell Cancer

Signs + symptoms (8)

A 
1/2 incidental findings 
Haematuria 
Loin pain 
Abdominal mass 
Anorexia 
Malaise 
Weight loss 
Pyrexia of unknown origin
33
Q

Renal Cell Cancer

Spread (3)

A

Direct (renal vein)
Lymphatic
Blood (bone, liver, lungs)

34
Q

Renal Cell Cancer

Investigations (5)

A

FBC (polycythaemia from erythropoietin secretion)
ESR
U&E
Urine: RBCs, cytology
Imaging: ultrasound, CT/MRI, IV urogram (filling defect +/- calcification), CXR (mets)

35
Q

Renal Cell Cancer

Treatment (3)

A

Radical nephrectomy
Often chemo/radio resistant
Biological therapies

36
Q 
Testicular Lumps 
Epididymal cysts (3)
A

Usually develop in adulthood and contain clear/milky (spermatocele) fluid
Lie above and behind testis
Separate from testis

37
Q

Testicular Lumps

Hydroceles (2)

A

Fluid within tunica vaginalis

Associated with patent processus vaginalis

38
Q

Testicular Lumps

Epididymo-Orchitis (3)

A

Sudden onset tender swelling, dysuria, sweats/fever
Caused by chlamydia, E.coli, gonorrhoea
Antibiotics and STI treatment

39
Q

Testicular Lumps

Varicocele (2)

A

Dilated veins of pampiniform plexus

Distended scrotal blood vessels that feel like a ‘bag of worms’

40
Q

Testicular Cancer

Epidemiology (1)

A

Commonest malignancy in males aged 15-44

41
Q

Testicular Cancer

Aetiology (5)

A 
Undescended testes, even after orchidopexy 
Seminoma most common histology 
Non-seminomatous germ cell tumour 
Mixed germ cell tumour
Lymphoma
42
Q

Testicular Cancer

Signs + symptoms (5)

A 
Typically painless testis lump 
Haematospermia 
Secondary hydrocele 
Dyspnoea (lung mets) 
Abdominal mass (enlarged nodes)
43
Q

Testicular Cancer

Staging (4)

A

1: no evidence of mets
2: infradiaphragmatic nodes
3: supradiaphragmatic nodes
4: lung involvement

44
Q

Testicular Cancer

Investigations (4)

A

CXR
CT
Excision biopsy
Alpha-FP and B-hCG are tumour markers and help monitor treatment

45
Q

Testicular Cancer

Treatment (2)

A

Radical orchidectomy

Seminomas very radiosensitive

46
Q

Testicular Cancer

Survival (1)

A

> 90% in all groups (5 year)

47
Q

Penile Cancer

Epidemiology (2)

A

Rare in UK

V rare if circumcised

48
Q 
Penile Cancer
Risk factors (3)
A

Chronic irritation
Viruses
Smegma

49
Q

Penile Cancer

Signs + symptoms (3)

A

Chronic fungating ulcer
Bloody/purulent discharge
50% spread to lymph at presentation

50
Q

Penile Cancer

Treatment (2)

A

Radiotherapy and irridium wires if early

Amputation and lymph node dissection if late

51
Q

Acute Urinary Retention

Aetiology (4)

A

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
Q 
Acute Urinary Retention 
Risk factors (5)
A 
BPH 
Constipation 
Medications 
Urolithiasis
Neurological disease
53
Q

Acute Urinary Retention

Signs + symptoms (5)

A 
Inability to pass urine 
Lower abdominal discomfort/pain 
Acute on chronic urinary retention: overflow incontinence 
Palpable and percussible bladder 
Enlarged prostate on DRE
54
Q

Acute Urinary Retention

Investigations (3)

A

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
Q

Acute Urinary Retention

Treatment (4)

A

IV fluids + antibiotics if sepsis
Analgesia
RRT may be required
Urethral or suprapubic catheterisation

56
Q

Acute Urinary Retention

Complications (5)

A 
UTI 
AKI 
Metabolic acidosis + hyperkalaemia 
Sepsis 
Post obstructive diuresis (loss of salt and water)
57
Q

Acute Upper Tract Obstruction

Aetiology (4)

A

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
Q

Acute Upper Tract Obstruction

Signs + symptoms (7)

A 
Flank pain: dull, sharp or colicky, intermittent or persistent, restless, radiation to iliac fossa 
N&amp;V
Anuria (bilateral complete obstruction) 
Loin tenderness
UTI 
Sepsis 
Rarely, an enlarged kidney
59
Q

Acute Upper Tract Obstruction

Investigations (4)

A

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
Q

Acute Upper Tract Obstruction

Treatment (3)

A

Treat underlying cause
Nephrostomy
Ureteric stents

61
Q

Chronic Urinary Retention

Aetiology (3)

A

Detrusor inactivity
Bladder outflow obstruction: BPH, prostate cancer, urethral stenosis/stricture
Neurological: spinal cord injury, pelvic surgery, herniated disc

62
Q

Chronic Urinary Retention

Pathology (2)

A

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
Q

Chronic Urinary Retention

Signs + symptoms (5)

A

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
Q

Chronic Urinary Retention

Investigations (5)

A

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
Q

Chronic Urinary Retention

Treatment (2)

A

Treat underlying cause

Clean intermittent self-catherisation

66
Q

Chronic Urinary Retention

Complications (4)

A

Acute on chronic urinary retention
Detrusor hypertrophy
Hydronephrosis leading to AKI/CKD
Overflow incontinence

67
Q

Nephrolithiasis

Epidemiology (3)

A

Lifetime incidence 15%
M:F 3:1
Peak age 20-40

68
Q

Nephrolithiasis

Aetiology (5)

A

Metabolic abnormalities (high Ca, high urate)
Dehydration
Renal tubular acidosis
Polycystic kidney disease
Drugs (diuretics, steroids, theophylline)

69
Q

Nephrolithiasis

Pathology (4)

A

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
Q

Nephrolithiasis

Types (4)

A 
Calcium oxalate (75%, low urine vol, hypercalcuria, high urine pH) 
Uric acid stone (low urine pH) 
Struvite stones (infection) 
Cystine stones (rare, genetic)
71
Q

Nephrolithiasis

Signs + symptoms (8)

A

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
Q

Nephrolithiasis

Investigations (5)

A

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
Q

Nephrolithiasis

Treatment (6)

A

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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