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Integration for Clinical Application > Urology > Flashcards

Urology Flashcards

1
Q

What is phimosis?

A

The inability to retract the foreskin over the glans

Incidence: 1% of non-circumcised population

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2
Q

What is physiological phimosis?

A

Phimosis that is normal up to adolescence

  • 50% at 1 year
  • 10% at 3 years
  • 1% at 17 years
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3
Q

What are some of the consequences of phimosis?

A
  • Poor hygeine - increased STDs
  • Pain on intercourse - splitting/ bleeding of foreskin
  • Balanitis (inflamed glans)
  • Posthisis (inflamed foreskin/ prepuce)
  • Balanitis Xerotica Obliterans (BXO)
  • Parphimosis - when trying to retract forekin and it gets stuck
  • Urinary retention
  • Penile cancer
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4
Q

What is balanitis xerotica obliterans? (BXO)?

A

Whitening of the tip of the glans caused by scar tissue

Can cause urethral strictures

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5
Q

What is paraphimosis?

A

The painful constriction of the gland penis by the retracted prepuce

(retracted foreskin that can’t be pulled back)

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6
Q

What are the commonest causes of paraphimosis?

A
  • Phimosis
  • Catheterisation (esp in elderly) - the most common
  • Penile cancer- if there’s a lump underneath
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7
Q

How is paraphimosis treated?

A
  • Need reduction
  • can be achieved manually under local anaesthetic
  • Occasional a dorsal slit may be necessary
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8
Q

How common is penile cancer?

A

Rare- c. 350 cases/ year UK

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9
Q

What type of cancer is penile cancer?

A

Squamous cell carcinoma

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10
Q

What are some risk factors for developing penile cancer?

A
  • Phimosis - hygeine and smegma (build up of sebaceous secretion in folds of skin)
  • HPV 16 & 18
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11
Q

What is the mortality of penile cancer if left untreated?

A
  • Most die within 2 years
  • Almost all within less than 5 years
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12
Q

What are some reasons for circumcision?

A

Peadiatric:

  • Religious
  • Recurrent balanitis/ UTI

Adult:

  • Reccurrent balanitis
  • Phimosis
  • Recurrent paraphimosis
  • Balanitis Xerotica Obliterans
  • Penile cancer
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13
Q

What are some of the causes of acute scrotal pain?

A
  • Testicular torsion
  • Epididymtitis/ Orchitis (inflamed testes), epididymo-orchitis
    • UTI
    • STI
    • Mumps (can be 1st presentation of mumps)
  • Torsion of hydatid of Morgagni (top of testis)
  • Trauma
  • Uretetic Calculi (rare) - get referred pain to testicle
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14
Q

What is the typical history of testicular torsion?

A
  • Usually a younger patient (<30 years)
  • Sudden onset (e.g. woke from sleep)
  • Unilateral pain
  • May have nausea/ vomiting
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15
Q

What would you find on examination if someone presents with testicular torsion?

A
  • Testis is very tender
  • Lying high in the scromtum with horizonal lie
  • Needs emergency scrotal exploration within 6 hours
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16
Q

What is epididymo-orchitis?

A

Epididymo-orchitis is an inflammation of the epididymis and/or testicle (testis) usually due to infection

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17
Q

What is the typical history of someone with epididymo-orchitis?

A
  • Age:
    • 20-40/50- STI (esp Chlaymdia)
    • 40-50 - UTI (esp E.Coli)
  • Gradual onset
  • Usually unilateral
  • Recent history of
    • UTI
    • Unprotected sex
    • Catheter/ urethral instrumentation
    • Check for mumps history
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18
Q

What might you find on examination of a patient with epididymo-orchitis?

A
  • May be pyrexial (can be septic)
  • Scrotum erythematous (red)
  • Testis/ epididymis enlarged and tender
  • Fluctuant areas (fluid filled) may represent abscess
  • May have reactive hydrocele
  • Rarely necrotic (Fournier’s Gangrene) - high mortality rate!
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19
Q

What investigations should you do if you suspect epididymo-orchitis?

A
  • Bloods
    • FBC, U&E, Cultures (if septic)
  • Urine
    • midstream specimen of urine for
  • Radiology
    • Scrotal ultrasound is suspected abscess
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20
Q

How do you treat epididymo-orchitis?

A
  • Epididymo-orchitis: antibiotics
  • Abscess: surgical drainage and antibiotics
  • Fournier’s gangrene: emergency debridement and antibiotics
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21
Q

What key questions should you ask in the history of someone presenting with scrotal lumps?

A
  • Is it painful?
  • How quickly has it appeared?
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22
Q

What should establish on examination of a patient who presents with a scrotal lump?

A
  • Can i get above it?
    • if not its likely to a hernia
  • Is it in the body of the testis?
    • if yes this could be a testicular tumour
  • Is is separate to the testis?
  • Does it fluctuate and transilluminate?
23
Q

What are some of the differential diagnosis of a painless scrotal lump? (non tender)

A
  • Testis tumour (90% are painless)
  • Epididymal cyst
  • Hydrocele
  • Reducible inguino-scrotal hernia
24
Q

What is the likely diagnosis of a scrotal lump that is painless but aches at the end of the day

A

Varicocele (bag of worms)

25
Q

What are the differential diagnosis of a painful, tender, acute presentation of a scrotal lump?

A
  • Epididymtitis
  • Epididymo-orchitis
  • Strangulated inguino-scrotal hernia (emergency!)
26
Q

What history is typical of testicular tumour?

A
  • Usually painless
  • Germ cell tumours (seminoma/ teratoma) usually in men <45 years
  • Older men could be lymphoma
  • On examination - can get above the lump
27
Q

What are the testis tumour markers?

A
  • aFP (alpha feto protein)
  • hCG
  • LDH

If abnormal high usually indicitive

If normal it doesn’t rule out testicular tumour!

28
Q

What is a hydrocele?

A

An imbalance of fluid production and resorption between the tunica albuginea and tunica vaginalis

Presents as slow/sudden onset uni/bilateral scrotal swelling

29
Q

What do you find on examination of a man with hydrocele?

A
  • Testis is not separately palpable
  • Can usually get above it
  • Transilluminates
30
Q

What do you find on examination of an epididymal cyst?

A
  • Usually painless
  • Separate from testis
  • Can get above it
  • Transilluminates
31
Q

How does varicocele present?

A
  • Dull ache at end of the day
  • May be associated with reduced fertility (if bilateral)
  • Bag of worms
  • non-tender
  • May have palpable abdominal/ renal mass
  • Will leave alone in most adults- can treat in young men
32
Q

What is the treatment for testicular tumours?

A
  • Inguinal orchidectomy
  • Remove the nearest lymph nodes (inguinal lymph nodes)
33
Q

How do you treat an epididymal cyst?

A
  • Reassure
  • Excise if large
34
Q

How do you treat an adult hydrocele?

A
  • If testis are normal on ultrasound:
  • reassure
  • Surgical removal if large/ symptomatic
35
Q

How do you treat a varicocele?

A
  • Reassure
  • Radiological embolisation if symptomatic, infertile, affecting growth of testis in adolescent
36
Q

What is urinary retention?

A

The inability to pass urine (rather than the inability to make urine)

Common in males, rare in females

37
Q

What are some of the causes of urinary retention?

A
  • Prostatic enlargement
    • BPH
    • Cancer
  • Phimosis/ urethral stricture/ meatal stenosis
  • Constipation
  • UTI
  • Drugs (anticholinergic drugs given for overactive bladder can go opposite way)
  • Over-distension (too much fluid and not urinating stretches bladder)
  • Post surgical
  • Neurological e.g. cauda equina
38
Q

How do you treat acute, painful urinary retention?

A
  • Pain relieved by drainage (catheter)
  • Residual volume <1,000 ml
  • No kidney insult
39
Q

How do you treat chronic urinary retention?

A
  • May have kidney insult
  • Residual volume >300 ml
  • Learn to self catheterise
40
Q

How do you treat acute on chronic urinary retention?

A
  • Usualyl have kidney insults
  • Residual volume >1,000 ml
  • Long term catheterisation or surgical intervention
41
Q

What is the cause of nocturnal enuresis in older men? (until proven otherwise)

A

Chronic retention with overflow incontinence

42
Q

What symtpoms sugests a voiding issue in men?

A
  • Hesitancy
  • Poor flow
  • Post micturition dribbling
  • Suggestive of ladder outflow obstruction
43
Q

What symptoms suggest an issue with urine storage?

A
  • Increased frequency
  • Increased urgency
  • Nocturia (bedwetting)
44
Q

What are some of the causes of a bladder storage issue?

A
  • Irritative
    • e.g. infection, inflammation, bladder stone, bladder cancer
  • Overactive bladder
    • idiopathic or neuropathic e.g. CVA, Parkinson’s, MS
  • Low bladder compliance (scarred)
    • e.g. after TB, Schistosomiasis, Pelvic Radiotherapy
  • Polyuria (making too much urine)
    • Gobal - uncontrolled diabetes
    • Nocturnal - venous stasis, sleep apnoea
45
Q

What type of things can cause Bladder Outflow Obstruction?

A

Physical:

  • Urethra - phimosis, stricture
  • Postate - benign, malignant, bladder neck

Dynamic:

  • tone of muscle in bladder neck, prostate

Neurological:

  • lack of coordination between bladder and urinary sphincter
  • Upper Motor Neurone
46
Q

What sort of things cause reduced bladder contractility?

A
  • Physical problem
  • Neurological
    • lower motor neurone
    • Cauda equina
    • Extreme B12 deficiency
47
Q

What may spraying of urine suggest?

A

Urethral stricture

48
Q

Which receptors are responsible for maintaining sympathetic smooth muscular tone?

A

Principally alpha 1 receptors in the prostate and bladder neck

49
Q

What factors are assessed on the international prostate symptom score?

A
  • Incomplete Emptying
  • Frequency
  • Intermittency
  • Urgency
  • Weak Stream
  • Straining
  • Nocturia

Mild: 0-7
Moderate: 8-19
Severe: 20-35

50
Q

Why can you not perform prostate specific antigen tests if patient has a UTI?

A

Must treat UTI first - wait 4-6 weeks

UTI’s spike PSA levels

51
Q

What lifestyle factors can you modify in management of BPH?

A
  • Reduce caffeine intake
  • Avoid fizzy drinks
  • Don’t drink more than 2.5L p/day
52
Q

What drugs can you give to treat BPH?

A

1. TAMSULOSIN

An alpha blocker

Works by relaxing smooth muscle within the prostate and the bladder for rapid symptom relief

2. 5a- REDUCTASE INHIBITORS

FINASTERIDE or DUTASTERIDE

Act by shrinking the prostate by androgen deprivation. Slower symptoms relief than alpha blocker, slows progression and reduces risk of retention

53
Q

What do the green, yellow and red lines of this flow rate chart suggest?

A

Green: normal

Yellow: suggestive of urethral stricture

Red: Suggestive of prostatic obstruction

Integration for Clinical Application (8 decks)

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