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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
Complications of testicular torsion
Infertility | Loss of testis
26
Difference between testicular appendage torsion and testicular torsion?
Appendage: Small part above testis is twisted Less serious Treat conservatively (rest, lying down, etc.)
27
What is the hydrated of Morgagni?
A small embryological remnant of the Müllerian duct at the upper pole of the testis
28
How to differentiate between hydatid of morgagni torsion and testicular torsion?
Less severe pain Often a longer history Palpable/visible through scrotal wall Can see a blue dot on transillumination
29
Treatment for hydatid of Morgagni torsion?
Analgesia - you know I think this may be the same as appendage torsion (as in they may be the same condition)
30
What are risk factors for BPH?
Old age | Ethnicity: black > white > asian
31
Symptoms of BPH?
``` LUTS: Voiding symptoms (obstructive) Storage symptoms (irritative) Complications such as UTI, retention, obstructive uropathy ```
32
What are obstructive voiding symptoms?
``` Weak/intermittent urinary flow Straining Hesitancy Terminal dribbling Incomplete emptying ```
33
What are storage symptoms (irritative)
Urgency Frequency Urgency incontinence Nocturia
34
How do we manage BPH?
Watchful waiting Medications - alpha 1 antagonists, 5 alpha reductase inhibitors Surgical - TURP
35
Examples of alpha 1 antagonists and their MOA
Tamsulosin, alfuzosin These decrease smooth muscle tone (prostate + bladder)
36
5 alpha-reductase inhibitor examples and MOA?
Finasteride Blocks conversion of testosterone into dihydrotestosterone These can slow down progression of condition (shrink the prostate)
37
Risk factors for bladder cancer?
``` Male gender 4:1 Increasing age Smoking Schistosomiasis Occupational carcinogens ```
38
Protective factors for bladder cancer?
Water consumption | Cruciferous legume consumption
39
Symptoms of bladder cancer
Haematuria Irritative lower urinary tract symptoms Pain
40
What is another name for transitional cell carcinoma?
Urothelial carcinoma
41
What are the different bladder cancer subtypes?
Transitional cell carcinoma (90%) Squamous cell carcinoma Adenocarcinoma Small cell carcinoma
42
What sort of bladder cancer is linked to schistosomiasis?
Squamous cell carcinoma
43
How do you diagnose bladder cancer?
White light cytoscopy (gold standard) | Fluoroscopy cytoscopy as an alternative
44
How do we treat a bladder cancer?
TURBT (if superficial) If higher grade/risk - intravesical chemotherapy Occasionally cystectomy
45
Which staging system is used for bladder cancer?
TNM
46
Risk factors for prostate cancer
Increasing age Obesity Afro-Caribbean ethnicity FHx
47
Clinical features of prostate cancer
Bladder outlet obstruction (hesitancy, urinary retention) Haematuria, haematospermia Pain - perineal, back, testicular
48
DRE findings in prostate cancer
Asymmetrical Hard Nodular enlergement Loss of median sulcus
49
How common is prostate cancer?
It is the second most common cancer in men worldwide | 1 in 6 men will get diagnosed with it
50
What is the main prostate cancer subtype?
Adenocarcinoma (95%)
51
What is the grading system for prostate cancer?
Gleason score - 2 is the best prognosis, 10 is the worst
52
What investigations can we do for prostate cancer?
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
Treatment of prostate cancer T1/T2 (localised)?
Conservative: active monitoring + watchful waiting Radical prostatectomy Radiotherapy
54
Treatment of localised advanced prostate cancer (T3/T4)
Hormonal therapy: Goserelin, cyproterone Radical prostatectomy Radiotherapy
55
Common complication of prostatectomy?
Erectile dysfunction
56
What type of drug is goserelin?
GnRH (gonadotrophin-releasing hormone) agonist
57
What type of drug is cyproterone?
Anti-androgen
58
Treatment for metastatic prostate cancer?
``` Hormonal therapy (goserelin, cyproterone) Orchidectomy (to lower testosterone levels) ```
59
What age group are most likely to get testicular cancer?
20-35 year olds
60
Subtypes of testicular cancer
Germ cell (95%): Seminomas Non-seminomas (embryonal, yolk sac, teratoma, choriocarcinoma) Non-germ cell (5%): Leydig Sarcomas
61
At what age do you get a peak in teratomas?
25
62
At what age do you get a peak in seminoma?
35
63
What are risk factors for testicular cancer?
``` Infertility (3x risk) Cryptorchidism (congenital non-descent) FHx Klinefelter's Mumps ```
64
Features of testicular cancer?
Painless lump (most common presentation) Pain Hydrocoele Gynaecomastia
65
What bloods may be raised in testicular cancer?
Germ cell: Alpha fetoprotein (60%) LDH (lactate dehydrogenase 40%) hCG (20% in seminomas)
66
How do we diagnose testicular cancer?
US is first-line
67
What is a seminoma?
A tumour originating from the germinal epithelium of the seminferous tubules They comprise 50% of germ-cell testicular tumours
68
Treatment of testicular cancer
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
How does urethritis present?
Dysuria | Urethral discharge
70
How do we usually divide urethritis?
Gonococcal | Non-gonococcal (NGU, also referred to as non-specific urethritis [NSU])
71
What are common causes NSU?
Chlamydia trachomatis Ureaplasma urealyticum Mycoplasma genitalium
72
What are the investigations for urethritis?
``` Urethral swab (gram stained, look for presence of leukocytes/gram -ve diplococci) Urinary nucleic acid amplification tests (for chlamydia) ```
73
What are common complications of urethritis?
Epididymitis Subfertility Reactive arthritis
74
How do we treat urethritis
Doxycycline 7 days OR Single dose of azithromycin
75
How do we treat epididymo-orchitis?
Ceftriaxone (IM), doxycycline
76
What is the main differential to rule out with epididymo-orchitis?
Testicular torsion Similar presentation - unilateral pain, swelling
77
Risk factors for erectile dysfunction?
``` Increasing age Obesity DM HTN Hyperlipidaemia Smoking Alcohol use SSRI Beta-blockers ``` Remember prostectomy can also cause it
78
Erectile dysfunction investigations
Free testosterone in the morning (9-11am) | If low, repeat with FSH, LH and prolactin (if these are abnormal, refer to endo)
79
Management of ED?
PDE-5 inhibitors: Sildenafil (viagra) Vacuum erection devices
80
How to differentiate psychogenic and organic ED?
Organic: Gradual onset Lack of tumescence (swelling of penis) Normal libido Psychogenic: Sudden onset Decreased libido Masturbation is fine
81
What is priapism?
Persistent penile erection, typically longer than 4 hours without sexual stimulation
82
How can we divide causes of priapism?
Ischaemic | Non-ischaemic
83
What is ischaemic priapism caused by?
Impaired vasorelaxation reducing vascular outflow and thus resulting in congestion of de-oxygenated blood within the corpus cavernosa
84
What is non-ischaemic priapism caused by?
High arterial inflow, typically due to a fistula formation
85
Where does priapism affect?
Corpus cavernosa
86
Causes of priapism
``` Haematological dyscrasias (SCD, thalassemia, leukaemia) Meds - sildenafil, others Cocaine, marijuana, alcohol Infection Tumours ```
87
Investigating priapism
Aspiration of corpus cavernosum and then blood gas tests to ascertain whether ischaemic or non-ischaemic Doppler US MRI
88
Management of priapism
``` 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
What is paraphimosis
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
What causes paraphimosis
Retracted foreskin in an uncircumsized male
91
Symptoms of paraphimosis
Retracted forskin that can't be pulled over the glans penis Painful oedema of the glans penis Livid discolouration of the glans penis
92
Treatment of paraphimosis
Analgesia given Manual compression of the distal penis (press down on the oedema) Manual repositioning of the foreskin
93
What are the complications of paraphimosis?
Disrupted blood flow causes: gangrene Tissue necrosis (For these reasons paraphimosis is an urological emergency)
94
What is Fournier's gangrene?
A form of necrotising fasciitis that affects the external genitalia or perineum
95
Risk factors for Fournier's gangrene?
``` Male gender 40:1 Increasing age Diabetics Alcoholics Immunocompromise ```
96
What causes Fournier's gangrene?
Clostridium perfringens Group A. strep Staph aureus
97
Treatment of Fournier's gangrene
CT Scan Resuscitation IV broad-spectrum abx Urgent surgical debridement of dead tissue
98
What is a penile fracture?
Traumatic rupture of the corpus cavernosa and tunica albuginea in an erect penis
99
What causes penile fracture
Generally during penetrative intercourse (usually with female on top)
100
Features of penile fracture
``` Popping sensation/snap Usually during penetrative intercourse Penile swelling Discolouration Rolling sign ```
101
What is rolling sign
A firm immobile haematoma that can be palpated in the shaft (penile fracture)
102
Management of penile fracture
Analgesia Anti-emetics Surgical exploration and repair
103
Inguinal hernia
Can't get above it Cough impulse may be present Can be reducible
104
Testicular tumour
Discrete testicular nodular | Can have associated hydrocoele
105
Epididymal cyst
Painless | Lies above/behind testis
106
Hydrocoele
``` Non-painful Soft fluctuant swelling Can get above it Transilluminates Can be present alongside testicular cancer ```
107
Varicocoele
Typically on left side May be presenting feature of renal cell carcinoma Can affect fertility Feels like worms
108
Treatment of testicular swellings
Malignancy - orchidectomy Varicocoele - conservative Epididymal cyst - excised Hydrocoele - excised/plicated

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