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Pass Medicine > Urology > Flashcards

Urology Flashcards

1
Q

What are the features of acute bacterial prostatitis?

A

Pain in - perineum, penis, rectum or back
Obstructive voiding symptoms
Fever/rigors
DRE - Tender, boggy prostate

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2
Q

What typically causes bacterial prostatitis?

A

E. coli

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3
Q

How do we manage bacterial prostatitis?

A

14 day course of quinolone (floxacins)

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4
Q

What are causes of acute urinary retention?

A 
Men: BPH
Urethral obstruction
Drugs (tricyclic anti., antichol., benzos., antihistamines)
UTI
Neurological
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5
Q

Symptoms of acute urinary retention?

A

Inability to pass urine

Lower abdo. discomfort/pain

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6
Q

Signs of acute urinary retention?

A

Palpable distended urinary bladder
Lower abdo tenderness
(Make sure to do a rectal and neuro exam.)

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7
Q

How do we manage acute urinary retention?

A

US (volume >300cc confirms diagnosis)

Catheterisation

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8
Q

What is balanitis?

A

Inflammation of the glans penis

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9
Q

What causes balanitis?

A

Infection (bacterial, candida)

Can be due to dermatitis

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10
Q

How do we manage balanitis?

A

Hygiene:
Saline washes
Wash under foreskin
1% Hydrocortisone

If candidal in cause:
Topical clotrimazole for 2 weeks
If bacterial: flucloxacillin, clarithromycin

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11
Q

How can we differentiate between different causes of balanitis?

A

Candidiasis - usually after intercourse, itchy, white non-urethral discharge

Dermatitis - itchy, clear non-urethral discharge

Bacterial - yellow non-urethral discharge

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12
Q

What is epidymitis?

A

A condition in which you get pain, swelling and inflammation of the epididymis

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13
Q

Who is affected by epididymitis?

A

Sexually actively men younger than 35

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14
Q

What is the causative organism of epididymitis?

A

It is usually caused by non coliform and nongonococcal urethral infections

2/3rds caused by C. Trachomatis

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15
Q

Features of epididymitis?

A 
Pain
Swelling
Inflammation
Tenderness
(All of epididymis/spermatic cord)
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16
Q

How do we investigate epididymitis?

A

Gram stained:
Urethral smear
MSU

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17
Q

What does n. Gonorrhoea look like on gram staining?

A

Gram negative diplococci

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18
Q

Management of epididymitis

A

Antibiotics if no abscess - fluoroquinolones (ofloxacin, levofloxacin)

Doxycycline adjunct as well if c trachomatis

If abscess develops, surgical drainage

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19
Q

What is testicular torsion

A

Acute rotation of testis and spermatic cord resulting in subsequent reduction or interruption of blood flow

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20
Q

How long do we have to treat in testicular torsion

A

8 hours

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21
Q

What increases risk of testicular torsion?

A 
Cold temperature
Increased testicular volume
Cryptorchidism (failure to descend)
Late descent
Horizontal lie (bell-clap anomaly)
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22
Q

Features of testicular torsion

A

Acute pain in one half of scrotum
Tenderness
Pyuria (pus in the urine)

Nausea
Sweating
Tachycardia

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23
Q

How do we investigate testicular torsion?

A

If low index of suspicious - colour Doppler ultrasound to confirm blood flow to and from testes
Surgical scrotal exploration otherwise

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24
Q

Long-term management of testicular torsion?

A

Orchiopexy (of BOTH testes) to prevent recurrence

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25
Q

Complications of testicular torsion

A

Infertility

Loss of testis

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26
Q

Difference between testicular appendage torsion and testicular torsion?

A

Appendage:
Small part above testis is twisted
Less serious
Treat conservatively (rest, lying down, etc.)

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27
Q

What is the hydrated of Morgagni?

A

A small embryological remnant of the Müllerian duct at the upper pole of the testis

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28
Q

How to differentiate between hydatid of morgagni torsion and testicular torsion?

A

Less severe pain
Often a longer history
Palpable/visible through scrotal wall
Can see a blue dot on transillumination

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29
Q

Treatment for hydatid of Morgagni torsion?

A

Analgesia

  • you know I think this may be the same as appendage torsion (as in they may be the same condition)
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30
Q

What are risk factors for BPH?

A

Old age

Ethnicity: black > white > asian

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31
Q

Symptoms of BPH?

A 
LUTS:
Voiding symptoms (obstructive)
Storage symptoms (irritative)
Complications such as UTI, retention, obstructive uropathy
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32
Q

What are obstructive voiding symptoms?

A 
Weak/intermittent urinary flow
Straining
Hesitancy
Terminal dribbling
Incomplete emptying
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33
Q

What are storage symptoms (irritative)

A

Urgency
Frequency
Urgency incontinence
Nocturia

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34
Q

How do we manage BPH?

A

Watchful waiting
Medications - alpha 1 antagonists, 5 alpha reductase inhibitors
Surgical - TURP

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35
Q

Examples of alpha 1 antagonists and their MOA

A

Tamsulosin, alfuzosin

These decrease smooth muscle tone (prostate + bladder)

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36
Q

5 alpha-reductase inhibitor examples and MOA?

A

Finasteride
Blocks conversion of testosterone into dihydrotestosterone

These can slow down progression of condition (shrink the prostate)

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37
Q

Risk factors for bladder cancer?

A 
Male gender 4:1
Increasing age
Smoking
Schistosomiasis
Occupational carcinogens
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38
Q

Protective factors for bladder cancer?

A

Water consumption

Cruciferous legume consumption

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39
Q

Symptoms of bladder cancer

A

Haematuria
Irritative lower urinary tract symptoms
Pain

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40
Q

What is another name for transitional cell carcinoma?

A

Urothelial carcinoma

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41
Q

What are the different bladder cancer subtypes?

A

Transitional cell carcinoma (90%)
Squamous cell carcinoma
Adenocarcinoma
Small cell carcinoma

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42
Q

What sort of bladder cancer is linked to schistosomiasis?

A

Squamous cell carcinoma

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43
Q

How do you diagnose bladder cancer?

A

White light cytoscopy (gold standard)

Fluoroscopy cytoscopy as an alternative

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44
Q

How do we treat a bladder cancer?

A

TURBT (if superficial)
If higher grade/risk - intravesical chemotherapy
Occasionally cystectomy

45
Q

Which staging system is used for bladder cancer?

A

TNM

46
Q

Risk factors for prostate cancer

A

Increasing age
Obesity
Afro-Caribbean ethnicity
FHx

47
Q

Clinical features of prostate cancer

A

Bladder outlet obstruction (hesitancy, urinary retention)
Haematuria, haematospermia
Pain - perineal, back, testicular

48
Q

DRE findings in prostate cancer

A

Asymmetrical
Hard
Nodular enlergement
Loss of median sulcus

49
Q

How common is prostate cancer?

A

It is the second most common cancer in men worldwide

1 in 6 men will get diagnosed with it

50
Q

What is the main prostate cancer subtype?

A

Adenocarcinoma (95%)

51
Q

What is the grading system for prostate cancer?

A

Gleason score - 2 is the best prognosis, 10 is the worst

52
Q

What investigations can we do for prostate cancer?

A

PSA - this is not that specific though as BPH, prostatitis, UTI etc can all increase this level
DRE
Transrectal ultrasound guided biopsy (used to be first-line)
Multiparametric MRI (first-line)

53
Q

Treatment of prostate cancer T1/T2 (localised)?

A

Conservative: active monitoring + watchful waiting
Radical prostatectomy
Radiotherapy

54
Q

Treatment of localised advanced prostate cancer (T3/T4)

A

Hormonal therapy: Goserelin, cyproterone
Radical prostatectomy
Radiotherapy

55
Q

Common complication of prostatectomy?

A

Erectile dysfunction

56
Q

What type of drug is goserelin?

A

GnRH (gonadotrophin-releasing hormone) agonist

57
Q

What type of drug is cyproterone?

A

Anti-androgen

58
Q

Treatment for metastatic prostate cancer?

A 
Hormonal therapy (goserelin, cyproterone)
Orchidectomy (to lower testosterone levels)
59
Q

What age group are most likely to get testicular cancer?

A

20-35 year olds

60
Q

Subtypes of testicular cancer

A

Germ cell (95%):
Seminomas
Non-seminomas (embryonal, yolk sac, teratoma, choriocarcinoma)

Non-germ cell (5%):
Leydig
Sarcomas

61
Q

At what age do you get a peak in teratomas?

A

25

62
Q

At what age do you get a peak in seminoma?

A

35

63
Q

What are risk factors for testicular cancer?

A 
Infertility (3x risk)
Cryptorchidism (congenital non-descent)
FHx
Klinefelter's
Mumps
64
Q

Features of testicular cancer?

A

Painless lump (most common presentation)
Pain
Hydrocoele
Gynaecomastia

65
Q

What bloods may be raised in testicular cancer?

A

Germ cell:
Alpha fetoprotein (60%)
LDH (lactate dehydrogenase 40%)
hCG (20% in seminomas)

66
Q

How do we diagnose testicular cancer?

A

US is first-line

67
Q

What is a seminoma?

A

A tumour originating from the germinal epithelium of the seminferous tubules
They comprise 50% of germ-cell testicular tumours

68
Q

Treatment of testicular cancer

A

Sperm bank prior?

Depends on type, but usually:
Radical orchidectomy
Chemotherapy (specific type depends on type/grading)
Seminomas have a 95% 5 year survival rate, 85% for teratoma

69
Q

How does urethritis present?

A

Dysuria

Urethral discharge

70
Q

How do we usually divide urethritis?

A

Gonococcal

Non-gonococcal (NGU, also referred to as non-specific urethritis [NSU])

71
Q

What are common causes NSU?

A

Chlamydia trachomatis
Ureaplasma urealyticum
Mycoplasma genitalium

72
Q

What are the investigations for urethritis?

A 
Urethral swab (gram stained, look for presence of leukocytes/gram -ve diplococci)
Urinary nucleic acid amplification tests (for chlamydia)
73
Q

What are common complications of urethritis?

A

Epididymitis
Subfertility
Reactive arthritis

74
Q

How do we treat urethritis

A

Doxycycline 7 days
OR
Single dose of azithromycin

75
Q

How do we treat epididymo-orchitis?

A

Ceftriaxone (IM), doxycycline

76
Q

What is the main differential to rule out with epididymo-orchitis?

A

Testicular torsion

Similar presentation - unilateral pain, swelling

77
Q

Risk factors for erectile dysfunction?

A 
Increasing age
Obesity
DM
HTN
Hyperlipidaemia
Smoking
Alcohol use
SSRI
Beta-blockers

Remember prostectomy can also cause it

78
Q

Erectile dysfunction investigations

A

Free testosterone in the morning (9-11am)

If low, repeat with FSH, LH and prolactin (if these are abnormal, refer to endo)

79
Q

Management of ED?

A

PDE-5 inhibitors:
Sildenafil (viagra)
Vacuum erection devices

80
Q

How to differentiate psychogenic and organic ED?

A

Organic:
Gradual onset
Lack of tumescence (swelling of penis)
Normal libido

Psychogenic:
Sudden onset
Decreased libido
Masturbation is fine

81
Q

What is priapism?

A

Persistent penile erection, typically longer than 4 hours without sexual stimulation

82
Q

How can we divide causes of priapism?

A

Ischaemic

Non-ischaemic

83
Q

What is ischaemic priapism caused by?

A

Impaired vasorelaxation reducing vascular outflow and thus resulting in congestion of de-oxygenated blood within the corpus cavernosa

84
Q

What is non-ischaemic priapism caused by?

A

High arterial inflow, typically due to a fistula formation

85
Q

Where does priapism affect?

A

Corpus cavernosa

86
Q

Causes of priapism

A 
Haematological dyscrasias (SCD, thalassemia, leukaemia)
Meds - sildenafil, others
Cocaine, marijuana, alcohol
Infection
Tumours
87
Q

Investigating priapism

A

Aspiration of corpus cavernosum and then blood gas tests to ascertain whether ischaemic or non-ischaemic
Doppler US
MRI

88
Q

Management of priapism

A 
Non-ischaemic (high flow)
Clinical observation (most self-resolve)

Ischaemic (low flow)
Corporal blood aspiration of at least 200ml
Sympathomimetic drug injection - gold standard (e.g. phenylephrine)

89
Q

What is paraphimosis

A

Tight constrictive band of oedema and swelling of the glans penis due to lymphatic and venous congestion, stopping you from being able to put the foreskin back over the head of penis

90
Q

What causes paraphimosis

A

Retracted foreskin in an uncircumsized male

91
Q

Symptoms of paraphimosis

A

Retracted forskin that can’t be pulled over the glans penis
Painful oedema of the glans penis
Livid discolouration of the glans penis

92
Q

Treatment of paraphimosis

A

Analgesia given
Manual compression of the distal penis (press down on the oedema)
Manual repositioning of the foreskin

93
Q

What are the complications of paraphimosis?

A

Disrupted blood flow causes:
gangrene
Tissue necrosis

(For these reasons paraphimosis is an urological emergency)

94
Q

What is Fournier’s gangrene?

A

A form of necrotising fasciitis that affects the external genitalia or perineum

95
Q

Risk factors for Fournier’s gangrene?

A 
Male gender 40:1
Increasing age
Diabetics
Alcoholics
Immunocompromise
96
Q

What causes Fournier’s gangrene?

A

Clostridium perfringens
Group A. strep
Staph aureus

97
Q

Treatment of Fournier’s gangrene

A

CT Scan

Resuscitation
IV broad-spectrum abx
Urgent surgical debridement of dead tissue

98
Q

What is a penile fracture?

A

Traumatic rupture of the corpus cavernosa and tunica albuginea in an erect penis

99
Q

What causes penile fracture

A

Generally during penetrative intercourse (usually with female on top)

100
Q

Features of penile fracture

A 
Popping sensation/snap
Usually during penetrative intercourse
Penile swelling
Discolouration
Rolling sign
101
Q

What is rolling sign

A

A firm immobile haematoma that can be palpated in the shaft (penile fracture)

102
Q

Management of penile fracture

A

Analgesia
Anti-emetics
Surgical exploration and repair

103
Q

Inguinal hernia

A

Can’t get above it
Cough impulse may be present
Can be reducible

104
Q

Testicular tumour

A

Discrete testicular nodular

Can have associated hydrocoele

105
Q

Epididymal cyst

A

Painless

Lies above/behind testis

106
Q

Hydrocoele

A 
Non-painful
Soft fluctuant swelling
Can get above it
Transilluminates
Can be present alongside testicular cancer
107
Q

Varicocoele

A

Typically on left side
May be presenting feature of renal cell carcinoma
Can affect fertility
Feels like worms

108
Q

Treatment of testicular swellings

A

Malignancy - orchidectomy
Varicocoele - conservative
Epididymal cyst - excised
Hydrocoele - excised/plicated

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