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3b specialties > Urology > Flashcards

Urology Flashcards

1
Q

Name 3 storage LUTS and 4 voiding LUTS.

A 
Storage= frequency, urgency, urge incontinence, nocturia
Voiding= hesitancy, slow flow, terminal dribbling, haematuria, dysuria, incomplete voiding
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2
Q

Following taking a history of LUTS, name 3 important parts of the examination.

A

Abdominal examination- importantly noting bladder distension/palpable
Examine external genitalia- e.g. looking for phimosis or meatus stenosis
DRE

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3
Q

Give 3 investigations that may be used to investigate LUTS.

A 
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
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4
Q

Give 2 common causes of storage LUTS

and 2 common causes of voiding LUTS

A 
Storage= overactive bladder, cystitis, bladder tumour, bladder calculi
Voiding= BPE, prostate cancer, urethral stricutre, meatal stenosis, phimosis
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5
Q

What zone of the prostate does BPH usually arise?

A

Transitional zone

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6
Q

What does BPE feel like on DRE?

A

Soft enlarged gland

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7
Q

Which enzyme converts testosterone to its more potent form, DHT?

A

5-alpha reductase

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8
Q

How is testosterone linked to BPE?

A

DHT binds to receptors in the prostate gland, increasing secretions and possibly cell division, resulting in gland enlargement

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9
Q

What is first line medical therapy for BPE? Give an example drug and how it works.

A

Alpha blocker e.g. Tamsulosin.

Alpha 1 adrenoceptor antagonist, relaxes smooth muscle

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10
Q

What is second line medical therapy for BPE? Give example drug and how it works.

A

5-alpha reductase inhibitors e.g. Finasteride

Inhibits conversion of testosterone to dihydrotestosterone

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11
Q

What are 2 surgical management options for BPE?

A

TURP, laser prostatectomy, open prostatectomy, aquablation

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12
Q

Give 4 causes of a raised PSA.

A

Prostate cancer, BPE, UTI, prostatitis, urinary retention, catheterisation, ejaculation, exercise e.g. cycling

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13
Q

What is the most common type of prostate cancer?

A

Adenocarcinoma

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14
Q

75% of the time, prostate adenocarcinoma originates from what zone of the prostate?

A

Peripheral zone

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15
Q

True/false: adenocarcinoma of the prostate is multifocal 80% of the time.

A

True

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16
Q

What does prostate cancer feel like on DRE?

A

Craggy, hard, irregular gland

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17
Q

What investigations are used to further investigate prostate cancer following a raised PSA?

A

MRI, transrectal US guided biopsy, bone scan if bone mets suspected

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18
Q

What grading system is used for prostate cancer? What does it use to grade the cancer?

A

Gleason grading

Uses histology from prostatic biopsy

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19
Q

Where are the likely metastatic sites of prostate cancer?

A

Most frequently bone, then lung and liver

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20
Q

What is the management of low risk or intermediate risk localised prostate cancer?

A

Active surveillance or

Radical prostatectomy

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21
Q

Other than radical prostatectomy and active surveillance, outline other treatment options for prostate cancer.

A

Radiotherapy (brachytherapy and/or external beam radiation
Androgen deprivation therapy
Symptomatic e.g. bisphosphonates, ureter stent

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22
Q

What types of drugs are used in androgen deprivation therapy in prostate cancer?

A

LHRH antagonists or LHRH agonists

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23
Q

What risk prostate cancers is androgen deprivation therapy suitable for?

A

Intermediate, high risk and metastatic cancers

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24
Q

Give 3 risk factors for prostate cancer.

A

Age, family history, ethnicity (Afro-Caribbean), diet (high animal fat) and obesity, UV radiation

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25
Q

What does PSA do?

A

It’s a protease which prevents the coagulation of seminal fluid

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26
Q

Give 3 risks of a transrectal US guided biopsy of the prostate.

A 
Infection
Bleeding
Discomfort
Acute retention
False negatives
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27
Q

What is taken out in a radical prostatectomy?

A

The prostate and seminal vesicles

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28
Q

Should an MRI for investigating prostate cancer be performed pre- or post-biopsy?

A

Pre. Can reduce the number of biopsies you perform and can increase accuracy of biopsies.

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29
Q

How do you get the Gleason score?

A

Histologically from biopsy. Add together the two most common scores e.g. 3+3= 6

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30
Q

How might prostatectomy affect the Gleason score?

A

There is a 30-40% risk of upgrading

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31
Q

How are Gleason grades now reported?

A

Gleason grade groups

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32
Q

True/false: a T1 stage prostate cancer is palpable?

A

False, it’s not palpable but picked up on PSA/MRI/biopsy

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33
Q

Who is active surveillance of prostate cancer for?

A

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)

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34
Q

What investigations are involved in active surveillance of prostate cancer and how often?

A

3 monthly PSA
6 monthly DRE
TRUS and biopsy at 1 year

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35
Q

Who is watchful waiting of prostate cancer for?

What does it consist of?

A

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)

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36
Q

What are the 3 main side effects of external beam radiotherapy for prostate therapy?

A

LUTS, GI symptoms e.g. rectal discomfort/bleeding, ED

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37
Q

What are 2 CI to brachytherapy for prostate cancer?

A

Previous TURP (due to increased risk of incontinence)
Large prostate
Moderate to severe LUTS

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38
Q

Where in the body does androgen deprivation therapy medications act?

A

Anterior pituitary

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39
Q

Outline the treatment of metastatic prostate cancer.

A

Initially= androgen deprivation therapy
If good performance status, Docetaxel chemotherapy
Bone-targeted therapies e.g. zolendronic acid, denosumab, alpharadin
Palliative radiotherapy

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40
Q

Give 3 complications of metastatic prostate cancer.

A 
Bone pain
Fractures
Hypercalcaemia
Spinal cord compression
Urinary retention
Obstructive uropathy
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41
Q

How is spinal cord compression due to prostate cancer mets treated?

A

Dexamethasone + Omeprazole
Bed rest
Degarelix (LHRH antagonist)/Radiotherapy (if already on ADT)
May need to call neurosurgeons (if one level of compression)

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42
Q

How is obstructive uropathy caused by prostate cancer managed?

A

Nephrostomy or internal stents

If potassium is abnormal, correct medically

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43
Q

What causes bladder calculi to form?

A

Urinary stasis

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44
Q

Give 3 causes of bladder calculi

A

BPE, prostate cancer, weak detrusor muscle, long-term catheter

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45
Q

Bladder stones are most commonly made up of?

A

Calcium

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46
Q

Name 3 investigations that can be used to investigate bladder calculi.

A

US, X-ray, or flexible cystoscopy

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47
Q

Name 2 management options for bladder calculi.

A

Endoscopic e.g. cystolitholapaxy, laser fragmentation, pneumatic lithotripsy
Cystolithotomy (open removal of stone)

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48
Q

What is the most common histological subtype of bladder cancer?

A

Transitional cell carcinoma of the bladder

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49
Q

True/false: you can get adenocarcinoma of the bladder.

A

True- squamous cell carcinoma, adenocarcinoma and TCC

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50
Q

Name 4 risk factors for bladder cancer.

A 
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.
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51
Q

Name 3 risk factors for squamous cell carcinoma of the bladder.

A 
Smoking
Schistosomiasis
Chronic cystitis
Long term catheter
Intermittent self-catheterisation
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52
Q

What is the NICE 2WW referral guidelines for patients presenting with visible/invisible haematuria?

A

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.

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53
Q

Give 3 blood tests you would request to investigate haematuria

A

FBC, clotting, U&Es, (Group and save if severe haematuria)

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54
Q

After bloods, what 2 investigations will all patients with haematuria require?

A

Imaging of the upper tracts (either US-KUB or CT with contrast)
Flexible cystoscopy

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55
Q

Give 2 reasons US-KUB is preferred in investigating haematuria compared to CT.

Give 1 disadvantage of US-KUB vs CT.

A
  • 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

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56
Q

What is the most common management method for bladder cancer?

A

TURBT

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57
Q

Chemotherapy for bladder cancer can be intra-vesical or systemic. Give 2 examples of drugs used intra-vesically.

A

BCG

Mitomycin C

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58
Q

Other than TURBT, what 2 surgical options are there for bladder cancer?

A

Cystodiathermy or laser

Cystectomy

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59
Q

A patient with haematuria needs continuous irrigation and bladder washouts. What type of catheter should you insert?

A

3-way catheter

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60
Q

Name 4 congenital abnormalities of the renal tract.

A 
Pelvic ureteric junction obstruction
Horseshoe kidney
Renal agenesis and dysplasia
Renal cysts 
Adult polycystic kidneys
Ectopic kidney
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61
Q

PUJO increases the risk of what 3 things?

A

Infections, stones and renal failure

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62
Q

Patients with adult polycystic kidneys are at increased risk of a number of conditions. Name 3

A

Hypertension
Hepatic and pancreatic cysts
Intracranial aneurysms
Valve abnormalities (especially mitral valve prolapse)

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63
Q

What is the commonest renal tumour?

A

Renal cell carcinoma (adenocarcinoma)

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64
Q

What is the name of the cancer that arises from urothelial cells along the urinary tract?

A

Transitional cell carcinoma

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65
Q

What tumour is the commonest intra-abdominal tumour in children?

A

Wilms tumour/nephroblastoma.

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66
Q

Give 4 risk factors for renal cancer.

A 
Smoking
Age
Male
Obesity
HTN
CKD and dialysis
Genetic e.g. von Hippel Lindau, HNPCC, HPRCC
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67
Q

How do most renal tumours present?

What is the classic triad?

A

Majority identified incidentally on imaging

Mass, haematuria and pain (fewer than 10% present with this)

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68
Q

Renal cancer may cause a left varicocele but wouldn’t cause a right varicocele. Why?

A

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

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69
Q

What paraneoplastic syndromes might occur with renal carcinoma and why?

A

Polycythemia, due to paraneoplastic EPO production
Hypercalcaemia, due to excretion of PTH related hormone
Stauffer’s syndrome (abnormal LFTs)
Hypertension
Anaemia

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70
Q

Which renal tumour is radio-resistant?

A

Renal cell carcinoma

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71
Q

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?

A

Transitional cell carcinoma (because want to remove the ureters as well)

If unfit for surgery and refractory haematuria

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72
Q

Why is X-ray not the first line investigation of choice for kidney stones?

A

60-70% of stones are radio opaque

Large body habitus and overlying bowel gas can decrease image quality

73
Q

What is the gold standard investigation to assess first presentation of kidney stones?

A

CT-KUB non-contrast

74
Q

How would you detect on a scan that the stone has caused obstruction e.g. of the ureter or bladder?

A

It would present as hydronephrosis due to the backlog of fluid

75
Q

In patients presenting acutely with loin/groin/back/abdo pain, what condition is very important to rule out?

A

Abdominal aortic aneurysm rupture

76
Q

What is the stone composition of 80-85% of renal stones?

A

Calcium oxalate

77
Q

Why do calcium oxalate and uric acid calculi form?

A

Acidic urine

78
Q

Which type of renal stones is associated with kidney infections?

A

Struvite

79
Q

Which renal stone is typically described as radiolucent?

A

Uric acid

80
Q

What rare type of renal stones have a genetic cause?

A

Cystine

Caused by a AR inherited condition called cystinuria

81
Q

What is the brief pathophysiology of why renal stones form?

A

Supersaturation of solutes in the urine

Stones precipitate out of the urine

82
Q

What are two examples of stone inhibitor factors?

A

Citric acid, magnesium, pyrophosphate, zinc

83
Q

Are males or females more susceptible to calcium oxalate stones? Give 2 reasons.

A

Males
Testosterone increases oxalate production
Females have higher urinary citrate which inhibits calcium oxalate stone formation

84
Q

Give 3 risk factors for developing renal stones

A

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

85
Q

Many renal stones can be managed on an elective basis. Give 2 indications for emergency management.

A
  1. Signs of infection
  2. A single functioning kidney
  3. Renal impairment
  4. Obstruction of the kidney
  5. Other patient factors e.g. prev ITU admission due to stones
86
Q

What are the 3 most common sites of obstruction of stones?

A

PUJ
Mid-ureter, at crossing of iliac vessels
VUJ

87
Q

Which two patient groups would receive a USS-KUB rather than a CT-KUB when investigating kidney stones?

A

Pregnant women and those <16 years old

88
Q

What imaging is used for follow up of renal stones?

A

XR-KUB

89
Q

Outline the management of ureteric colic caused by stones, dividing it into conservative, medical and surgical management.

A 
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
90
Q

Give 2 indications for surgical management of ureteric colic.

A
  • Severe pain >48h
  • Renal dysfunction
  • Previous renal disease
  • Bilateral stones
91
Q

What % of stones <5mm will pass spontaneously?

A

~70%

92
Q

Renal calculi can be silent and still kill kidney cells. Outline surgical management options for a renal calculus

A
  • ESWL
  • Ureteroscopy and stone removal
  • Percutaneous nephrolithotomy
  • Nephrectomy (if very large/staghorn calculus)
93
Q

Which bacteria is associated with formation of a staghorn calculus?

A

Proteus

94
Q

Outline the initial management of a patient with an infected obstructed kidney.

A

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)
95
Q

What temporary management options are there for managing an infected obstructed kidney?

A

JJ stent or percutaneous nephrostomy

Then once kidney is drained would treat the stone

96
Q

What is the most common solid tumour cancer in men aged 20-45?

A

Testicular cancer

97
Q

True/false: a testicular cancer lump is not transilluminable.

A

True

98
Q

Give 4 risk factors for testicular cancer.

A 
Undescended testes 
HIV
Age 20-45
Prev testicular cancer
Family history
Caucasian
99
Q

Testicular tumours are broadly categorised into what two categories? Which category is more common?

A

Germ cell tumours- 90%

Non-germ cell tumours

100
Q

Name 3 types of germ cell testicular tumour.

A

Seminoma
Teratoma
Choriocarcinoma
Yolk Sac tumour

101
Q

Name 3 types of non-germ cell testicular tumour

A

Sertoli
Leydig
Lymphoma
Mesenchymal

102
Q

What is the investigation of choice when investigating a possible testicular tumour?

A

Urgent US of the testes

103
Q

Name 3 tumour markers for testicular cancer.

What are they used for?

A

alpha-FP, hCG, LDH

Not diagnostic, but useful for monitoring response before vs after surgery

104
Q

Which lymphnodes would testicular cancer first spread to?

A

Para-aortic lymphnodes

105
Q

Outline the management of non-metastatic testicular cancer.

A
  • Semen cryopreservation (if uncompleted family)
  • Radical inguinal orchidectomy
  • Testicular prothesis (patient choice)
106
Q

Outline the management of metastatic testicular cancer.

A
  • Surgical resection + lymph node dissection
  • Chemotherapy
  • Radiotherapy
107
Q

Apart from the para-aortic lymph nodes, what is another common site for testicular cancer metastases and how would you investigate for this?

A

Lungs

CXR

108
Q

Untreated undescended testes increases a patient’s risk of what 3 conditions?

A

Infertility
Testicular torsion
Testicular cancer (because less likely to pick it up)

109
Q

Undescended testes are described anatomically as either maldescended or…?

A

Ectopic

110
Q

What is a retractile testis?

A

One that can be easily brought down into the scrotum on examination

111
Q

Clinically, undescended testes can be described as palpable or impalpable. Give 3 locations impalpable may be found, and which is the commonest location?

A

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

112
Q

What is the most likely cause of the vessels and vas ending blindly, with no testis on the end?

A

Intrauterine testicular torsion

113
Q

What is the management of palpable undescended testis?

A

Orchidopexy

114
Q

Management of impalpable undescended testis?

A

Laparoscopy to identify testis and bring it down into scrotum if viable

115
Q

Give 5 things to ask when taking a history of a scrotal lump/bump.

Give 4 differential diagnoses.

A 
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

116
Q

A hydrocele is an accumulation of fluid in what part of the scrotum?

A

Tunica vaginalis

117
Q

A non-communicating hydrocele is more typical in adults or children?

A

Adults

118
Q

What causes a communicating hydrocele?

A

Patent processus vaginalis

119
Q

Describe 2 features of a hydrocele swelling.

A

Fluctuant
Transilluminable
Can get above it (compared to a hernia)

120
Q

What are the treatment options for a hydrocele?

A

Conservative management, surgical repair, or aspiration

121
Q

What is a varicocele? How does it present and what investigation confirms the diagnosis?

A

Dilated testicular veins
‘Bag of worms’; dragging sensation; can cause aching
US scan of the testes

122
Q

Why should a new left varicocele in adults raise suspicion and of what underlying pathology?

A

Renal carcinoma

Renal cancers that involve the left renal vein may obstruct the left testicular vein and cause a varicocele.

123
Q

What management options are there for varicocele?

A

Conservative, surgical ligation, embolisation

124
Q

How is an epididymal cyst diagnosed?

What are the management options?

A

US of the testes

Conservative management or surgical excision if large/symptomatic

125
Q

Describe 3 features of a sebaceous scrotal cyst

A 
Hard/rubbery
Tethered to skin and separate to testis and epididymis
Contain white/yellow substance 
Non-transilluminable
Often multiple cysts
126
Q

Give 3 common causative organisms of epididymo-orchitis

A

E. coli
Chlamydia trachomatis
Neisseria gonorrhoeae

127
Q

What used to be a common cause of orchitis but is now rare? And why?

A

Mumps

Now rare due to MMR vaccination. (Should still check parotids for signs of parotitis)

128
Q

Give 3 complications of epididymo-orchitis?

A

Sepsis
Abscess
Testicular pain
Testis necrosis

129
Q

Epididymo-orchitis is difficult to distinguish clinically from what other condition?

A

Testicular torsion

130
Q

What investigation can differentiate testicular torsion from epididymo orchitis and what are the different findings?
What examination finding may differentiate the two?

A

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!

131
Q

How is epididymo orchitis managed:

a) if STI source suspected
b) if UTI source suspected?

A

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

132
Q

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?

A

Organic

133
Q

5 things to examine for a presentation of ED?

A 
1- Cardiovascular examination
2- Neurological examination
3- Abdominal examination
4- External genitalia
5- DRE
134
Q

5 blood tests for investigating ED?

A 
Testosterone
LH and FSH
Prolactin
Sex hormone binding globulin
TFTs
Glucose
135
Q

What special investigation, if positive, might help to diagnose psychogenic ED?

A

Nocturnal penile tumescence testing

Rings on the penis measure frequency and duration of spontaneous erections overnight

136
Q

Give 5 organic causes of ED

A

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

137
Q

What is first line pharmacotherapy for ED?

A

Phosphodiesterase-5 inhibitors

138
Q

What are second line treatment options for ED?

A

Intracavernous injection therapy (alprostadil)

Intra-urethral alprostadil

139
Q

Other than PDE5 inhibitors and alprostadil, what are some other management options for ED?

A 
Lifestyle modification
Vacuum devices
Penile prosthesis
Psychosexual therapy 
Testosterone replacement if low
140
Q

Peyronie’s disease is curvature of the penis caused by the development of fibrotic tissue/plaque(s) on which part of the penis?

A

Tunica albuginea

141
Q

Name 3 conditions associated with Peyronie’s?

A

Diabetes, hypertension, hypercholesterolaemia, Dupuytren’s contracture, plantar fasciitis

142
Q

True/false: the abnormal curvature present in Peyronie’s is usually only noticeable when erect?

A

True

143
Q

What are some medical options for Peyronie’s?

What type of plaques is surgical correction performed on?

A

Oral pentoxyfiline, verapamil injections, extra-corporeal shockwave therapy (all limited evidence)
Surgical correction only for stable plaques

144
Q

2 complications associated with phimosis?

A

Pain during sexual intercourse/erections

Infections of foreskin and glans (balanoposthitis)

145
Q

What chronic inflammatory condition (seen as male equivalent of lichen sclerosus) can cause phimosis?
What is the management?

A

Balanitis Xerotica Obliterans- can cause urethral stenosis and is associated with penile cancer
Steroid cream initially, usually circumcision is required

146
Q

What is physiological phimosis?

A

Phimosis is normal in childhood, almost all foreskins are retractile by 16 years
Not a problem unless inflamed/infected e.g. balanitis or balanoposthitis

147
Q

Gold standard treatment for phimosis?

A

Circumcision

148
Q

3 causes of urethral stricture disease?

A

Trauma e.g. straddle injuries
Iatrogenic e.g. catheterisation, instrumentation
Inflammation e.g. urethritis

149
Q

What type of LUTS would urethral stricture disease cause?

A

Voiding

150
Q

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?

A

Urethral dilatation in theatre or optical urethrotomy (incise the stricture with an endoscopic knife)

Intermittent self-catheterisation

151
Q

If the stricture recurs following treatment, what may need to be done?

A

Incision of the stricture and urethroplasty

152
Q

Give 5 risk factors for incontinence

A

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

153
Q

Give 5 things to ask about when taking an incontinence history.

A

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)

154
Q

What is the cause of stress incontinence?

A

Pelvic floor +/- urethral sphincter deficiency

155
Q

Mainline management of stress incontinence?

A

Conservative- weight loss, exercise, smoking cessation

Pelvic floor exercises/physio

156
Q

What surgical options are there for stress incontinence?

A

TVT, autologous slings, colposuspension

157
Q

What is the cause of urge incontinence?

A

Over-active detrusor muscle

158
Q

What is overactive bladder syndrome and how is it different to urge incontinence?

A

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

159
Q

Outline the conservative measures advised for urge incontinence.

A

Reduce caffeine intake, reduce alcohol, bladder training

160
Q

Following conservative measures, what is first line treatment for urge incontinence?

A

Anti-muscarinic medication e.g. oxybutynin.

This relaxes the detrusor muscle

161
Q

What are other treatment options for urge incontinence, following conservative measures and oxybutinin.

A

Mirabegron= B3 adrenoceptor agonist
Neuromodulation= sacral nerve stimulation or percutaneous tibial nerve stimulation
Botox

162
Q

Name the 4 main types of incontinence.

A

Stress, urge, mixed urinary incontinence (stress and urge), overflow

163
Q

How is overflow incontinence managed?

A

Treat any bladder outflow obstruction. May need either long term catheter or intermittent self-catheterisation

164
Q

What is:

a) an uncomplicated UTI?
b) a complicated UTI?

A

a) One occurring in an otherwise normal urinary tract

b) One occurring in an abnormal or male urinary tract

165
Q

Give 5 symptoms of a UTI.

A

Frequency, urgency, dysuria, strangury, haematuria, malodorous urine, fever

166
Q

2 symptoms that would point towards pyelonephritis rather than cystitis?

A

Loin pain

Rigors

167
Q

What may be positive on urine dipstick in the case of UTI?

A

Leucocytes, nitrites, blood

If negative, doesn’t rule out UTI

168
Q

What Ix should you always send for in the case of suspected UTI?

A

MSU

169
Q

True/false: although asymptomatic bacteriuria is common in the elderly, it should always be treated.

A

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

170
Q

What is the commonest causative organism of UTIs? What are the next two most common?

A

E. coli

Proteus mirabilis and Klebsiella

171
Q

First line treatment for uncomplicated UTI? How long for?

A

Nitrofurantoin 100mg modified-release BD for 3 days

172
Q

Give 4 risk factors for UTI

A

Female, age, post menopausal, diabetes, previous UTIs, pregnancy, catheters, anatomical abnormality of urinary tract

173
Q

How many infections are required for someone to be said to have recurrent UTIs?

A

2 in 6 months or 3 in a year

174
Q

What are the three main pathophysiological mechanisms of recurrent UTIs?

A 
Bacterial persistence (same bacteria) 
Bacterial re-infection (infections caused by different bacteria)
Unresolved infection (inadequate treatment)
175
Q

Recurrent UTIs should be investigated for underlying pathology e.g. stones or malignancy with what investigations?

A

CT/US of the urinary tract and cystoscopy

176
Q

Give 4 conservative management options for recurrent UTIs.

A 
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)
177
Q

What are 3 antibiotic regime options for people with recurrent UTIs?

A

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)

178
Q

Give 5 differential diagnoses for haematuria

A

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

3b specialties (15 decks)

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