Urology Flashcards
What are storage urinary symptoms
FUND
Frequency
Urgency
Nocturia
Dysuria
What are voiding/obstructive urinary symptoms
HIPS
Hesitancy Incomplete emptying Poor stream Straining Others: terminal dribbling, overflow incontinence
Mx of BPH (medical 2 and surgical 2)
Medical
a-blockers to relax smooth muscle of internal urinary sphincter (e.g. tamsulosin)
5a-reductase inhibitors to prevent conversion of testosterone to dihydrotestosterone (more potent androgen) (e.g. finasteride)
Surgical
Transurethral resection of the prostate (TURP)
Open prostatectomy
1st line Ix for suspected prostate cancer
MRI – FIRST LINE
Ix for prostate cancer (4)
PSA – low specificity
MRI – FIRST LINE
Transrectal Ultrasound-guided Biopsy
LFTs/bone profile – check for metastatic effects
What are most bladder cancers
Transitional cell carcinomas
RF for bladder cancer (5)
Dye stuffs Pelvic irradiation Smoking Chronic UTIs Schistosomiasis
Symptoms of bladder cancer
Painless macroscopic haematuria
FUND (not HIPS)
FLAWS
Ix for bladder cancer (2)
Cystoscopy with biopsy
CT/MRI for staging
What is RF of stress related urinary incontinence
Childbirth
What is stress related urinary incontinence down to
Poor closure of the bladder
What is urge related urinary incontinence down to
Detrusor overactivity
What are rare causes of urinary incontinence (2)
Normal pressure hydrocephalus
Cord compression
What is functional incontinence
individual is aware of the need to urinate, but are unable to get to the bathroom in time due to physical/mental reasons
What is overflow incontinence
involuntary release of urine from an overfull bladder, in the absence of any need to urinate
What should you always consider as a DDx of nephrolithiasis
leaking AAA
4 types of urinary stone
CALCIUM OXALATE – most common
Magnesium ammonium phosphate
Urate
Cysteine
What is the most common type of kidney stone
CALCIUM OXALATE – most common
RF of nephrolithiasis (2)
Low fluid intake
Structural urinary tract abnormalities
Gold standard Ix for urinary tract calculi
Non-contrast CT-KUB
Ix for urinary tract calculi (4)
Urine dipstick (microscopic haematuria)
Non-contrast CT-KUB – GOLD STANDARD
Ultrasound
U&Es – check renal function
Mx of nephrolithiasis
ANALGESIA
< 5 mm diameter – allow to pass spontaneously
> 5 mm diameter – SURGERY
Ureteroscopic lithotripsy
Extracorporeal Shockwave Lithotripsy (ESWL)
Percutaneous Nephrolithotomy (PCNL)
What is percutaneous nephrolithotomy and under what circumstances is it performed
Percutaneous Nephrolithotomy (PCNL) – performed for large, complex stones (e.g staghorm calculus). After making a nephrostomy tract, a nephroscope is inserted which allows the disintegration and removal of stones.
Presentation of testicular torsion (3)
Sudden-onset severe hemiscrotal pain
Nausea and vomiting
Swollen and erythematous scrotum
What is the first step in Mx of suspected testicular torsion
Exploratory surgery
Epidemiology of hydrocoele
Very young boys (< 1 yr)
Older men
Causes of hydrocoele (4)
Idiopathic
Infection
Trauma
Tumour
Can the swelling be seperated from testicle in a hydrocoele
No
Ix for hydrocoele (3)
Ultrasound - exclude tumour
Testicular tumour markers
Urine dipstick/MSU – check for infection
Varicocele is caused by which dilated veins
dilated veins of the pampiniform plexus forming a scrotal mass
Why are varicoceles more common on the lef (3)t
Reasons for being more common on the left:
Angle at which the left testicular vein meets the left renal vein
Lack of effective valves between the left testicular vein and the left renal vein
Increased reflux from compression of the left renal vein
Causes of epididimitis/orchitis under 35
<35 yrs: Chlamydia and Gonococcus
Causes of epididimitis/orchitis over 35
> 35 yrs: Coliforms (e.g. Enterobacter, Klebsiella)
How to differentiate epididimitis/orchitis from torsion
NOTE: less acute onset than torsion
Where do testicular tumours metastasise
Para-aortic nodes
Which tumour marker is never raised in seminomatous testicular cancer
AFP
Which type of testicular tumours and what % is AFP raised in
• AFP is a marker for 50-70% of nonseminomatous tumours
Which type of testicular tumours and what % is BHCG raised in
• ΒHCG is raised in 40% of nonseminomatous tumours
and 10% of seminomatous tumours
What is lactate dehydrogenase a marker of
Testicular tumour burden
Which tumour markers are involved in testicular cancer (3)
a-fetoprotein
b-hCG
Lactate Dehydrogenase
What is a scrotal mass separate from the testes that transilluminates likely to be
Epididymal cyst
What is a scrotal mass not separate from the testes that transilluminates likely to be
Hydrocoele
