UROLOGY Flashcards
What is the first line investigation for scrotal lumps?
Ultrasound scan (assess for cancer)
What are the tumour makers for testicular cancer?
Lactate dehydrogenase
AFP
beta-HCG
Where is the fluid in hydrocoele?
Peritoneal fluid between parietal and visceral layers of tunica vaginalis
What is a varicocoele?
Dilatation of the pampiniform plexus
What are the consequences of a varicocoele?
Infertility and testicular atrophy
How is a varicocoele managed?
Embolisation (examine abdo for renal cancer)
What are epididymal cysts?
Benign fluid filled sac
How is the pain on epididymitis relieved?
Elevation of the testes
How is a testicular lymph caused by inguinal hernia presenting?
Cannot ‘get above’
What is the most common malignancy in men 20-40?
Testicular cancer
How does testicular torsion present?
•Tender
•Raised
•Swollen
What is the main cause of orchitis?
Mumps
What causes acute urinary retention?
BPH
Constipation (compresses urethra)
Anti-muscarinics
What are the clinical features of acute urinary retention?
Suprapubic pain
- *Palpable** bladder
- *PR** for prostate / constipation
What are the investigations for acute urinary retention?
Post-void bedside bladder scan
What is high pressure urinary retention?
Back up into the renal tract
What is the management of acute retention?
Urethral catheterisation
Treat underlying cause
What causes chronic urinary retention?
BPH
Pelvic prolapse
Upper motor neurone disease (MS or Parkinson’s)
How does chronic urinary retention present?
- Painless urinary retention
- Weak stream
- Hesitancy
- Overflow incontinence (worse at night- nocturnal enuresis)
What are the investigations for urinary retention?
Post coid bladder scan showing retained urine
Bloods: FBC, U&Es, CRP
What is the management of chronic retention?
- Catheterisation (>1L)
- NO TWOC (long term catheter till definitive management)
What are some complications of chronic urinary retention?
UTI
Bladder calculi
What is pseudohaematuria?
Red/brown urine not secondary to haaemoglobin
Causes incl. rifampicin, hyperbilirubinuria, myoglobinuria
What are some urology differentials for haematuria?
- Infection (pyelonephritis, cystitis or prostatitis)
- Malignancy (prostate adenocarcinoma)
- Renal calculi
- Trauma / recent surgery
- Radiation cystitis
- Parasitic, commonly schistosomiasis
What does terminal haematuria suggest?
Severe bladder irritation
Why are work/travel questions added for haematuria?
Work (dye industry)
Travel = schistosomiasis
What are the investigations for haematemesis?
- Urinalysis (nitrites/leukocytes = infection)
- Bloods (FBC, U&Es, clotting)
- Prostate specific antigen (PSA)
(1+ blood on dipstick is required for certainty - not trace)
When should haematuria be referred for urgent referral?
Aged > 45 with unexplained visible haematuria
Aged > 60 with unexplained non-visible haematuria (with dysuria/ raised WCC)
What is the gold standard for assessing lower urinary tract?
Flexible cystoscopy (local anaesthetic)
What are common causes of LUTS in men and women?
Men = BPH, UTI, malignancy, detrusor muscle weakness
Women = UTI, menopause, malignancy, stricture
What are the two categories of LUTS?
Storage = urgency, frequency, nocturia, urgency incontinence
Voiding = hesitancy, intermittency, straining, terminal dribbling
What associated questions can be added about LUTS?
- Visible haematuria
- Suprapubic discomfort
- Colicky pain
Digital rectal exam
What specialist investigations are there for LUTS?
Urodynamic studies
Upper urinary tract imaging (ultrasound / CT scanning)
What conservative options are there for LUTS?
- Regulate fluid intake (no caffeine/alcohol)
- Urethral milking (mabually empty bulbar urethra)
- Double voiding (voiding immediately again after)
- Pelvic floor exercises
What medication can be used for over active bladder?
Anticholinergics (e.g. oxybutynin, tolterodine)
B3 andrenic agonist (e.g. mirabegron)
What medication can be used for BPH?
Alpha blockers (tamsulosin)
5α-reductase inhibitors (finasteride)
What can be used to aid reducing nocturia?
Desmopressin
What is a complicated (vs uncomplicated) pylonephritis?
Uncomplicated = structurally / functionally normal urinary tract in non-immunocompromised host (complicated when opposite is true)
What are the top 3 organisms for pyelonephritis?
Escherichia coli
Klebsiella
Proteus
What are some risk factors of pyelonephritis?
Flow obstruction: BPH, neuropathic bladder from spinal cord injury
Bacterial access: Female, indwelling catheter, vesico-ureteric reflux
Immunocompromise: Diabetes, corticosteroid use, HIV infection
Bacterial colonisation: calculi, intercourse
What is the classical triad for pyelonephritis?
- Fever
- Loin pain
- Nausea and vomiting
What are some differentials for back pain?
- Pyelonephritis
- Renal calculi
- Acute cholecystitis
- Ecopic pregnancy
- Pelvic inflammatory disease
- Lower lobe pneumonia
What are the investigations for pyelonephritis?
- Urinalysis (nitrites and leucocytes)
- Urinary beta-hCG
- Urine culture
- FBC, CRP (inflammation)
- U&Es
What is the management of pyelonephritis?
A-E
IV fluids
Analgesia
Antiemetics
Catheterisation
Early CT
SEVERE = NEPHROSTOMY INSERTION / PERCUTANEOUS DRAINAGE
What are some complications of pyelonephritis?
- Sepsis
- Renal scarring
- Pyonephritis
- Preterm labour
What is the most common form of adult renal tumour?
Renal cell carcinoma (<15% incl TCC)
What are the risk factors of renal cell carinoma?
- Smoking
- Dialysis
- HTN
- Obesity
How does RCC present?
- Haematuria
- Flank pain / mass
- Lethargy
- Weight loss
- Left varicocoele
What are some paraneoplastic syndromes caused by ectopic secretion of hormones by RCC?
Polycythaemia due to erythropoetin
Hypercalcaemia due to parathyroid hormone
Hypertension due to renin
What is the imaging for suspected RCC?
Ultrasound or CT with IV contrast is gold standard
What are some risk factors for developing renal cysts?
Increasing age
Smoking
HTN
Male
ADPCD
What is ADPKD associated with in the head? (and elsewhere)
Berry aneurysm formation (subarachnoid haemorrhage), mitral valve disease, liver cysts
What are the features of renal cysts?
Incidentally on abdo imaging
Flank pain (infected/rupture)
Haematuria
Uncontrolled hypertension (ADPKD)
What is the imaging for renal cysts?
CT or MRI imaging (pre and post enhancement scans)
How are cysts managed?
Simple = no further follow up
Complicated = analgesia or needle aspiration
What is the only radiolucent stone?
Urate stones
What causes urate stones?
High levels of purine in the blood (red meats)
What are the location where ureteric stones lodge?
PUJ
Crossing pelvic brim
VUJ (vesicoureteric junction)
How do renal stones present?
- Ureteric colic
- Haematuria
- Flank tenderness
What are differentials for flank pain?
- Renal stone
- Pyelonephritis
- Ruptured AAA
- Biliary pathology
- Bowel obstruction
- Lower lobe pneumonia
What are some investigations for renal stone?
- Urine dip (haematuria)
- Bloods (FBC, CRP - infection)
- U&Es (renal function)
- Urate and calcium levels
NON CONTRAST CT KUB
Ultrasound scan for hydronephritis
How to manage patients with renal stones?
Fluid resus (patients are often dehydrated)
Stones normally pass spontaneously
ANALGESIA (NSAIDs per rectum)
When should a patient with a stone be admitted?
- AKI
- Uncontrolled pain
- Evidence of infected stone
- Large stone >5mm
How are patients with obstruction and renal calculi managed?
Nephrostomy (temporarily drain) or retrograde stent insertion