Urology Flashcards
Name 3 storage LUTS and 4 voiding LUTS.
Storage= frequency, urgency, urge incontinence, nocturia Voiding= hesitancy, slow flow, terminal dribbling, haematuria, dysuria, incomplete voiding
Following taking a history of LUTS, name 3 important parts of the examination.
Abdominal examination- importantly noting bladder distension/palpable
Examine external genitalia- e.g. looking for phimosis or meatus stenosis
DRE
Give 3 investigations that may be used to investigate LUTS.
Uroflowmetry Bladder scan for post-void residual volume Urine dipstick MUS for culture and sensitivities PSA and renal function bloods Frequency volume chart Urodynamic testing US of kidney for hydronephrosis if renal function impaired or residual volume is high
Give 2 common causes of storage LUTS
and 2 common causes of voiding LUTS
Storage= overactive bladder, cystitis, bladder tumour, bladder calculi Voiding= BPE, prostate cancer, urethral stricutre, meatal stenosis, phimosis
What zone of the prostate does BPH usually arise?
Transitional zone
What does BPE feel like on DRE?
Soft enlarged gland
Which enzyme converts testosterone to its more potent form, DHT?
5-alpha reductase
How is testosterone linked to BPE?
DHT binds to receptors in the prostate gland, increasing secretions and possibly cell division, resulting in gland enlargement
What is first line medical therapy for BPE? Give an example drug and how it works.
Alpha blocker e.g. Tamsulosin.
Alpha 1 adrenoceptor antagonist, relaxes smooth muscle
What is second line medical therapy for BPE? Give example drug and how it works.
5-alpha reductase inhibitors e.g. Finasteride
Inhibits conversion of testosterone to dihydrotestosterone
What are 2 surgical management options for BPE?
TURP, laser prostatectomy, open prostatectomy, aquablation
Give 4 causes of a raised PSA.
Prostate cancer, BPE, UTI, prostatitis, urinary retention, catheterisation, ejaculation, exercise e.g. cycling
What is the most common type of prostate cancer?
Adenocarcinoma
75% of the time, prostate adenocarcinoma originates from what zone of the prostate?
Peripheral zone
True/false: adenocarcinoma of the prostate is multifocal 80% of the time.
True
What does prostate cancer feel like on DRE?
Craggy, hard, irregular gland
What investigations are used to further investigate prostate cancer following a raised PSA?
MRI, transrectal US guided biopsy, bone scan if bone mets suspected
What grading system is used for prostate cancer? What does it use to grade the cancer?
Gleason grading
Uses histology from prostatic biopsy
Where are the likely metastatic sites of prostate cancer?
Most frequently bone, then lung and liver
What is the management of low risk or intermediate risk localised prostate cancer?
Active surveillance or
Radical prostatectomy
Other than radical prostatectomy and active surveillance, outline other treatment options for prostate cancer.
Radiotherapy (brachytherapy and/or external beam radiation
Androgen deprivation therapy
Symptomatic e.g. bisphosphonates, ureter stent
What types of drugs are used in androgen deprivation therapy in prostate cancer?
LHRH antagonists or LHRH agonists
What risk prostate cancers is androgen deprivation therapy suitable for?
Intermediate, high risk and metastatic cancers
Give 3 risk factors for prostate cancer.
Age, family history, ethnicity (Afro-Caribbean), diet (high animal fat) and obesity, UV radiation
What does PSA do?
It’s a protease which prevents the coagulation of seminal fluid
Give 3 risks of a transrectal US guided biopsy of the prostate.
Infection Bleeding Discomfort Acute retention False negatives
What is taken out in a radical prostatectomy?
The prostate and seminal vesicles
Should an MRI for investigating prostate cancer be performed pre- or post-biopsy?
Pre. Can reduce the number of biopsies you perform and can increase accuracy of biopsies.
How do you get the Gleason score?
Histologically from biopsy. Add together the two most common scores e.g. 3+3= 6
How might prostatectomy affect the Gleason score?
There is a 30-40% risk of upgrading
How are Gleason grades now reported?
Gleason grade groups
True/false: a T1 stage prostate cancer is palpable?
False, it’s not palpable but picked up on PSA/MRI/biopsy
Who is active surveillance of prostate cancer for?
Men who want to defer radical treatment, those who have a low risk (sometimes intermediate risk) localised cancer.
Gleason grade 6 and 7 (grade group 1 and 2)
What investigations are involved in active surveillance of prostate cancer and how often?
3 monthly PSA
6 monthly DRE
TRUS and biopsy at 1 year
Who is watchful waiting of prostate cancer for?
What does it consist of?
Men who don’t wish to have radical treatment or who aren’t suitable for radical treatment
Observation and then deferred androgen deprivation therapy (if they develop symptoms or metastatic disease)
What are the 3 main side effects of external beam radiotherapy for prostate therapy?
LUTS, GI symptoms e.g. rectal discomfort/bleeding, ED
What are 2 CI to brachytherapy for prostate cancer?
Previous TURP (due to increased risk of incontinence)
Large prostate
Moderate to severe LUTS
Where in the body does androgen deprivation therapy medications act?
Anterior pituitary
Outline the treatment of metastatic prostate cancer.
Initially= androgen deprivation therapy
If good performance status, Docetaxel chemotherapy
Bone-targeted therapies e.g. zolendronic acid, denosumab, alpharadin
Palliative radiotherapy
Give 3 complications of metastatic prostate cancer.
Bone pain Fractures Hypercalcaemia Spinal cord compression Urinary retention Obstructive uropathy
How is spinal cord compression due to prostate cancer mets treated?
Dexamethasone + Omeprazole
Bed rest
Degarelix (LHRH antagonist)/Radiotherapy (if already on ADT)
May need to call neurosurgeons (if one level of compression)
How is obstructive uropathy caused by prostate cancer managed?
Nephrostomy or internal stents
If potassium is abnormal, correct medically
What causes bladder calculi to form?
Urinary stasis
Give 3 causes of bladder calculi
BPE, prostate cancer, weak detrusor muscle, long-term catheter
Bladder stones are most commonly made up of?
Calcium
Name 3 investigations that can be used to investigate bladder calculi.
US, X-ray, or flexible cystoscopy
Name 2 management options for bladder calculi.
Endoscopic e.g. cystolitholapaxy, laser fragmentation, pneumatic lithotripsy
Cystolithotomy (open removal of stone)
What is the most common histological subtype of bladder cancer?
Transitional cell carcinoma of the bladder
True/false: you can get adenocarcinoma of the bladder.
True- squamous cell carcinoma, adenocarcinoma and TCC
Name 4 risk factors for bladder cancer.
Age (50-80), male (2.5:1), Caucasian, exposure to dyes/paint/rubber/leather/textiles (aromatic amines are carcinogenic), smoking, FH, genetic conditions (HNPCC), Cyclophosphamide, previous pelvic radiotherapy.
Name 3 risk factors for squamous cell carcinoma of the bladder.
Smoking Schistosomiasis Chronic cystitis Long term catheter Intermittent self-catheterisation
What is the NICE 2WW referral guidelines for patients presenting with visible/invisible haematuria?
Patients >45 with visible haematuria and no UTI, or persists/recurs following proper treatment of UTI.
Or patient >60 with unexplained non-visible haematuria and either dysuria or raised WCC.
Give 3 blood tests you would request to investigate haematuria
FBC, clotting, U&Es, (Group and save if severe haematuria)
After bloods, what 2 investigations will all patients with haematuria require?
Imaging of the upper tracts (either US-KUB or CT with contrast)
Flexible cystoscopy
Give 2 reasons US-KUB is preferred in investigating haematuria compared to CT.
Give 1 disadvantage of US-KUB vs CT.
- Quick to do
- Doesn’t require contrast so can be done no matter the renal function
- No radiation exposure
DISADVANTAGE= user-dependent, so may miss small stones or tumours
What is the most common management method for bladder cancer?
TURBT
Chemotherapy for bladder cancer can be intra-vesical or systemic. Give 2 examples of drugs used intra-vesically.
BCG
Mitomycin C
Other than TURBT, what 2 surgical options are there for bladder cancer?
Cystodiathermy or laser
Cystectomy
A patient with haematuria needs continuous irrigation and bladder washouts. What type of catheter should you insert?
3-way catheter
Name 4 congenital abnormalities of the renal tract.
Pelvic ureteric junction obstruction Horseshoe kidney Renal agenesis and dysplasia Renal cysts Adult polycystic kidneys Ectopic kidney
PUJO increases the risk of what 3 things?
Infections, stones and renal failure
Patients with adult polycystic kidneys are at increased risk of a number of conditions. Name 3
Hypertension
Hepatic and pancreatic cysts
Intracranial aneurysms
Valve abnormalities (especially mitral valve prolapse)
What is the commonest renal tumour?
Renal cell carcinoma (adenocarcinoma)
What is the name of the cancer that arises from urothelial cells along the urinary tract?
Transitional cell carcinoma
What tumour is the commonest intra-abdominal tumour in children?
Wilms tumour/nephroblastoma.
Give 4 risk factors for renal cancer.
Smoking Age Male Obesity HTN CKD and dialysis Genetic e.g. von Hippel Lindau, HNPCC, HPRCC
How do most renal tumours present?
What is the classic triad?
Majority identified incidentally on imaging
Mass, haematuria and pain (fewer than 10% present with this)
Renal cancer may cause a left varicocele but wouldn’t cause a right varicocele. Why?
Left testicular vein drains into left renal vein, so involvement of the left renal vein would cause obstruction of the left testicular vein.
The right testicular vein drains directly into the IVC
What paraneoplastic syndromes might occur with renal carcinoma and why?
Polycythemia, due to paraneoplastic EPO production
Hypercalcaemia, due to excretion of PTH related hormone
Stauffer’s syndrome (abnormal LFTs)
Hypertension
Anaemia
Which renal tumour is radio-resistant?
Renal cell carcinoma
Surgical options for renal tumours can be full or partial nephrectomy.
What type of renal cancer would you perform a nephrouretectomy for?
When would you do renal artery embolisation?
Transitional cell carcinoma (because want to remove the ureters as well)
If unfit for surgery and refractory haematuria
Why is X-ray not the first line investigation of choice for kidney stones?
60-70% of stones are radio opaque
Large body habitus and overlying bowel gas can decrease image quality
What is the gold standard investigation to assess first presentation of kidney stones?
CT-KUB non-contrast
How would you detect on a scan that the stone has caused obstruction e.g. of the ureter or bladder?
It would present as hydronephrosis due to the backlog of fluid
In patients presenting acutely with loin/groin/back/abdo pain, what condition is very important to rule out?
Abdominal aortic aneurysm rupture
What is the stone composition of 80-85% of renal stones?
Calcium oxalate
Why do calcium oxalate and uric acid calculi form?
Acidic urine
Which type of renal stones is associated with kidney infections?
Struvite
Which renal stone is typically described as radiolucent?
Uric acid
What rare type of renal stones have a genetic cause?
Cystine
Caused by a AR inherited condition called cystinuria
What is the brief pathophysiology of why renal stones form?
Supersaturation of solutes in the urine
Stones precipitate out of the urine
What are two examples of stone inhibitor factors?
Citric acid, magnesium, pyrophosphate, zinc
Are males or females more susceptible to calcium oxalate stones? Give 2 reasons.
Males
Testosterone increases oxalate production
Females have higher urinary citrate which inhibits calcium oxalate stone formation
Give 3 risk factors for developing renal stones
Genetics- FH, Caucasian and Asian, cystinuria, hyperuricaemia
Anatomical abnormalities- horseshoe kidney, PUJO
UTIs
Medications- diuretics, steroids, chemotherapy (hyperuricaemia), antiepileptics (e.g. topiramate)
Hot climates
Dehydration/low fluid intake
Sedentary lifestyle
Diet- high salt, high protein
Many renal stones can be managed on an elective basis. Give 2 indications for emergency management.
- Signs of infection
- A single functioning kidney
- Renal impairment
- Obstruction of the kidney
- Other patient factors e.g. prev ITU admission due to stones
What are the 3 most common sites of obstruction of stones?
PUJ
Mid-ureter, at crossing of iliac vessels
VUJ
Which two patient groups would receive a USS-KUB rather than a CT-KUB when investigating kidney stones?
Pregnant women and those <16 years old
What imaging is used for follow up of renal stones?
XR-KUB
Outline the management of ureteric colic caused by stones, dividing it into conservative, medical and surgical management.
Conservative= modify RFs, patient information and safety netting Medical= ANALGESIA (PR Diclofenac, paracetamol), antiemetics, medical expulsion therapy (Tamsulosin) Surgical= ESWL, ureteroscopy + stone removal (most commonly with lasers), PCNL, ureteric stenting
Give 2 indications for surgical management of ureteric colic.
- Severe pain >48h
- Renal dysfunction
- Previous renal disease
- Bilateral stones
What % of stones <5mm will pass spontaneously?
~70%
Renal calculi can be silent and still kill kidney cells. Outline surgical management options for a renal calculus
- ESWL
- Ureteroscopy and stone removal
- Percutaneous nephrolithotomy
- Nephrectomy (if very large/staghorn calculus)
Which bacteria is associated with formation of a staghorn calculus?
Proteus
Outline the initial management of a patient with an infected obstructed kidney.
This is a urological emergency, the patient might die!
- ABCDE (including IV access) and sepsis 6
- Bloods: blood cultures, lactate, FBC, U&E, CRP, urate, calcium
- Fluid resuscitation and maintenance
- Urine dipstick and sample sent for C&S. Pregnancy test
- Urine output and fluid status
- Start Abx
- Admit patient and inform senior
- Keep NBM
- Imaging (CT-KUB unless CI)
What temporary management options are there for managing an infected obstructed kidney?
JJ stent or percutaneous nephrostomy
Then once kidney is drained would treat the stone
What is the most common solid tumour cancer in men aged 20-45?
Testicular cancer
True/false: a testicular cancer lump is not transilluminable.
True
Give 4 risk factors for testicular cancer.
Undescended testes HIV Age 20-45 Prev testicular cancer Family history Caucasian
Testicular tumours are broadly categorised into what two categories? Which category is more common?
Germ cell tumours- 90%
Non-germ cell tumours
Name 3 types of germ cell testicular tumour.
Seminoma
Teratoma
Choriocarcinoma
Yolk Sac tumour
Name 3 types of non-germ cell testicular tumour
Sertoli
Leydig
Lymphoma
Mesenchymal
What is the investigation of choice when investigating a possible testicular tumour?
Urgent US of the testes
Name 3 tumour markers for testicular cancer.
What are they used for?
alpha-FP, hCG, LDH
Not diagnostic, but useful for monitoring response before vs after surgery
Which lymphnodes would testicular cancer first spread to?
Para-aortic lymphnodes
Outline the management of non-metastatic testicular cancer.
- Semen cryopreservation (if uncompleted family)
- Radical inguinal orchidectomy
- Testicular prothesis (patient choice)
Outline the management of metastatic testicular cancer.
- Surgical resection + lymph node dissection
- Chemotherapy
- Radiotherapy
Apart from the para-aortic lymph nodes, what is another common site for testicular cancer metastases and how would you investigate for this?
Lungs
CXR
Untreated undescended testes increases a patient’s risk of what 3 conditions?
Infertility
Testicular torsion
Testicular cancer (because less likely to pick it up)
Undescended testes are described anatomically as either maldescended or…?
Ectopic
What is a retractile testis?
One that can be easily brought down into the scrotum on examination
Clinically, undescended testes can be described as palpable or impalpable. Give 3 locations impalpable may be found, and which is the commonest location?
40% in the abdomen
30% the vessels and vas end blindly near the deep inguinal ring
20% the vessels and vas end blindly in the inguinal canal
10% testis exists within the inguinal canal
What is the most likely cause of the vessels and vas ending blindly, with no testis on the end?
Intrauterine testicular torsion
What is the management of palpable undescended testis?
Orchidopexy
Management of impalpable undescended testis?
Laparoscopy to identify testis and bring it down into scrotum if viable
Give 5 things to ask when taking a history of a scrotal lump/bump.
Give 4 differential diagnoses.
When did you notice it? Has it changed? Pain? Fever? Dysuria? LUTS? Penile discharge? Unprotected sexual intercourse Trauma history History of subfertility Red flag symptoms PMH: Prev testicular cancer, undescended testes, HIV FH of testicular cancer
DDx= testicular cancer, hydrocele, varicocele, epididymal cyst, secabeous cyst of scrotum
A hydrocele is an accumulation of fluid in what part of the scrotum?
Tunica vaginalis
A non-communicating hydrocele is more typical in adults or children?
Adults
What causes a communicating hydrocele?
Patent processus vaginalis
Describe 2 features of a hydrocele swelling.
Fluctuant
Transilluminable
Can get above it (compared to a hernia)
What are the treatment options for a hydrocele?
Conservative management, surgical repair, or aspiration
What is a varicocele? How does it present and what investigation confirms the diagnosis?
Dilated testicular veins
‘Bag of worms’; dragging sensation; can cause aching
US scan of the testes
Why should a new left varicocele in adults raise suspicion and of what underlying pathology?
Renal carcinoma
Renal cancers that involve the left renal vein may obstruct the left testicular vein and cause a varicocele.
What management options are there for varicocele?
Conservative, surgical ligation, embolisation
How is an epididymal cyst diagnosed?
What are the management options?
US of the testes
Conservative management or surgical excision if large/symptomatic
Describe 3 features of a sebaceous scrotal cyst
Hard/rubbery Tethered to skin and separate to testis and epididymis Contain white/yellow substance Non-transilluminable Often multiple cysts
Give 3 common causative organisms of epididymo-orchitis
E. coli
Chlamydia trachomatis
Neisseria gonorrhoeae
What used to be a common cause of orchitis but is now rare? And why?
Mumps
Now rare due to MMR vaccination. (Should still check parotids for signs of parotitis)
Give 3 complications of epididymo-orchitis?
Sepsis
Abscess
Testicular pain
Testis necrosis
Epididymo-orchitis is difficult to distinguish clinically from what other condition?
Testicular torsion
What investigation can differentiate testicular torsion from epididymo orchitis and what are the different findings?
What examination finding may differentiate the two?
Doppler US to evaluate blood flow to the scrotum.
Blood flow to scrotum is increased in epididymo orchitis, whereas it is decreased in testicular torsion
Cremasteric reflex is absent in testicular torsion
Note- testicular torsion is a clinical diagnosis and urological emergency, so if suspected needs immediate surgical exploration, don’t delay with Ix!
How is epididymo orchitis managed:
a) if STI source suspected
b) if UTI source suspected?
a) Full STI screen and Abx (e.g. ceftriaxone and doxycycline) to cover Chlamydia and Gonorrhoea
b) Abx to cover E.coli and with testicular and epididymal penetrance e.g. Ciprofloxacin
Erectile dysfunction is a multifactorial, often with psychogenic and organic causes. ED that is gradual onset, with no significant loss of libido and in a patient which may have other underlying health conditions is more likely to have a psychogenic or organic cause of ED?
Organic
5 things to examine for a presentation of ED?
1- Cardiovascular examination 2- Neurological examination 3- Abdominal examination 4- External genitalia 5- DRE
5 blood tests for investigating ED?
Testosterone LH and FSH Prolactin Sex hormone binding globulin TFTs Glucose
What special investigation, if positive, might help to diagnose psychogenic ED?
Nocturnal penile tumescence testing
Rings on the penis measure frequency and duration of spontaneous erections overnight
Give 5 organic causes of ED
Endocrine- DM, hyper/hypothyroidism, hyperprolactinaemia, hypogonadism
Vascular- hyperlipidaemia, peripheral vascular disease, HTN
Neuro- Parkinson’s, MS, spinal cord pathology
Medications- antidepressants, Parkinson’s meds, antiandrogens, antihypertensives
Misc- alcohol, smoking, pelvic surgery/radiation, Peyronie’s
What is first line pharmacotherapy for ED?
Phosphodiesterase-5 inhibitors
What are second line treatment options for ED?
Intracavernous injection therapy (alprostadil)
Intra-urethral alprostadil
Other than PDE5 inhibitors and alprostadil, what are some other management options for ED?
Lifestyle modification Vacuum devices Penile prosthesis Psychosexual therapy Testosterone replacement if low
Peyronie’s disease is curvature of the penis caused by the development of fibrotic tissue/plaque(s) on which part of the penis?
Tunica albuginea
Name 3 conditions associated with Peyronie’s?
Diabetes, hypertension, hypercholesterolaemia, Dupuytren’s contracture, plantar fasciitis
True/false: the abnormal curvature present in Peyronie’s is usually only noticeable when erect?
True
What are some medical options for Peyronie’s?
What type of plaques is surgical correction performed on?
Oral pentoxyfiline, verapamil injections, extra-corporeal shockwave therapy (all limited evidence)
Surgical correction only for stable plaques
2 complications associated with phimosis?
Pain during sexual intercourse/erections
Infections of foreskin and glans (balanoposthitis)
What chronic inflammatory condition (seen as male equivalent of lichen sclerosus) can cause phimosis?
What is the management?
Balanitis Xerotica Obliterans- can cause urethral stenosis and is associated with penile cancer
Steroid cream initially, usually circumcision is required
What is physiological phimosis?
Phimosis is normal in childhood, almost all foreskins are retractile by 16 years
Not a problem unless inflamed/infected e.g. balanitis or balanoposthitis
Gold standard treatment for phimosis?
Circumcision
3 causes of urethral stricture disease?
Trauma e.g. straddle injuries
Iatrogenic e.g. catheterisation, instrumentation
Inflammation e.g. urethritis
What type of LUTS would urethral stricture disease cause?
Voiding
What are the two first line management options for urethral stricture disease?
Following this, what might a patient be taught to do in order to prevent the stricture recurring?
Urethral dilatation in theatre or optical urethrotomy (incise the stricture with an endoscopic knife)
Intermittent self-catheterisation
If the stricture recurs following treatment, what may need to be done?
Incision of the stricture and urethroplasty
Give 5 risk factors for incontinence
Female, age, oestrogen deficiency, anatomical disorders (e.g. fistulae), childbirth and pregnancy, diabetes, smoking, obesity, UTIs, poor mobility, neurological disorders (MS, Parkinson’s, spinal cord injury), abdo/pelvic/perineal/prostate surgery
Give 5 things to ask about when taking an incontinence history.
Duration of symptoms and change over time
Timing - continuous/on straining/at the door
LUTS
Use of incontinence pads- if so how many?
Use of catheter?
Bladder diary
Female- obstetric history, post-menopausal
Rule out cauda equina
Bowel function, sexual function
IMPACT ON QOL
PMH: surgeries, radiation, COPD (cough), neuro
DH, FH, SH (drugs, alcohol, smoking)
What is the cause of stress incontinence?
Pelvic floor +/- urethral sphincter deficiency
Mainline management of stress incontinence?
Conservative- weight loss, exercise, smoking cessation
Pelvic floor exercises/physio
What surgical options are there for stress incontinence?
TVT, autologous slings, colposuspension
What is the cause of urge incontinence?
Over-active detrusor muscle
What is overactive bladder syndrome and how is it different to urge incontinence?
Urgency +/- urge incontinence, often with frequency and nocturia.
Urge incontinence is when there is involuntary leakage of urine. OAB may involve this but not necessarily
Outline the conservative measures advised for urge incontinence.
Reduce caffeine intake, reduce alcohol, bladder training
Following conservative measures, what is first line treatment for urge incontinence?
Anti-muscarinic medication e.g. oxybutynin.
This relaxes the detrusor muscle
What are other treatment options for urge incontinence, following conservative measures and oxybutinin.
Mirabegron= B3 adrenoceptor agonist
Neuromodulation= sacral nerve stimulation or percutaneous tibial nerve stimulation
Botox
Name the 4 main types of incontinence.
Stress, urge, mixed urinary incontinence (stress and urge), overflow
How is overflow incontinence managed?
Treat any bladder outflow obstruction. May need either long term catheter or intermittent self-catheterisation
What is:
a) an uncomplicated UTI?
b) a complicated UTI?
a) One occurring in an otherwise normal urinary tract
b) One occurring in an abnormal or male urinary tract
Give 5 symptoms of a UTI.
Frequency, urgency, dysuria, strangury, haematuria, malodorous urine, fever
2 symptoms that would point towards pyelonephritis rather than cystitis?
Loin pain
Rigors
What may be positive on urine dipstick in the case of UTI?
Leucocytes, nitrites, blood
If negative, doesn’t rule out UTI
What Ix should you always send for in the case of suspected UTI?
MSU
True/false: although asymptomatic bacteriuria is common in the elderly, it should always be treated.
False, doesn’t necessarily need treatment. If there’s pyuria (WBCs in urine) that’s a sign of inflammation and is likely to require Abx
What is the commonest causative organism of UTIs? What are the next two most common?
E. coli
Proteus mirabilis and Klebsiella
First line treatment for uncomplicated UTI? How long for?
Nitrofurantoin 100mg modified-release BD for 3 days
Give 4 risk factors for UTI
Female, age, post menopausal, diabetes, previous UTIs, pregnancy, catheters, anatomical abnormality of urinary tract
How many infections are required for someone to be said to have recurrent UTIs?
2 in 6 months or 3 in a year
What are the three main pathophysiological mechanisms of recurrent UTIs?
Bacterial persistence (same bacteria) Bacterial re-infection (infections caused by different bacteria) Unresolved infection (inadequate treatment)
Recurrent UTIs should be investigated for underlying pathology e.g. stones or malignancy with what investigations?
CT/US of the urinary tract and cystoscopy
Give 4 conservative management options for recurrent UTIs.
Adequate fluid intake Control glucose if diabetic Vaginal oestrogens if post-menopausal Avoid constipation Good hygiene Voiding before and after sexual intercourse Avoid bubble baths/bath salts/spermicide D-mannose Cranberry juice/tablets (limited evidence)
What are 3 antibiotic regime options for people with recurrent UTIs?
Self-start Abx, short course to start at home
Post-coital prophylactic Abx if that’s always a trigger
Long-term low dose prophylactic Abx (3-6 months, then see if cleared)
Give 5 differential diagnoses for haematuria
Prerenal- clotting disorders, rhabdomyolsis
Renal- Stones, TCC, glomerulonephritis, ATN, HSP, trauma
Ureter- TCC, stones
Bladder- TCC, other cancers, stones, cystitis/UTI, radiation cystitis
Urethra- TCC, trauma
Prostate- prostate cancer, BPE, prostatitis
Vaginal bleeding?
Pseudohaematuria- beetroot, rifampicin
