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UROLOGY Flashcards

1
Q

What is the first line investigation for scrotal lumps?

A

Ultrasound scan (assess for cancer)

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2
Q

What are the tumour makers for testicular cancer?

A

Lactate dehydrogenase
AFP
beta-HCG

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3
Q

Where is the fluid in hydrocoele?

A

Peritoneal fluid between parietal and visceral layers of tunica vaginalis

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4
Q

What is a varicocoele?

A

Dilatation of the pampiniform plexus

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5
Q

What are the consequences of a varicocoele?

A

Infertility and testicular atrophy

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6
Q

How is a varicocoele managed?

A

Embolisation (examine abdo for renal cancer)

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7
Q

What are epididymal cysts?

A

Benign fluid filled sac

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8
Q

How is the pain on epididymitis relieved?

A

Elevation of the testes

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9
Q

How is a testicular lymph caused by inguinal hernia presenting?

A

Cannot ‘get above’

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10
Q

What is the most common malignancy in men 20-40?

A

Testicular cancer

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11
Q

How does testicular torsion present?

A

•Tender
•Raised
•Swollen

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12
Q

What is the main cause of orchitis?

A

Mumps

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13
Q

What causes acute urinary retention?

A

BPH
Constipation (compresses urethra)
Anti-muscarinics

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14
Q

What are the clinical features of acute urinary retention?

A

Suprapubic pain

  • *Palpable** bladder
  • *PR** for prostate / constipation
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15
Q

What are the investigations for acute urinary retention?

A

Post-void bedside bladder scan

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16
Q

What is high pressure urinary retention?

A

Back up into the renal tract

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17
Q

What is the management of acute retention?

A

Urethral catheterisation
Treat underlying cause

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18
Q

What causes chronic urinary retention?

A

BPH
Pelvic prolapse
Upper motor neurone disease (MS or Parkinson’s)

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19
Q

How does chronic urinary retention present?

A
  • Painless urinary retention
  • Weak stream
  • Hesitancy
  • Overflow incontinence (worse at night- nocturnal enuresis)
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20
Q

What are the investigations for urinary retention?

A

Post coid bladder scan showing retained urine

Bloods: FBC, U&Es, CRP

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21
Q

What is the management of chronic retention?

A
  • Catheterisation (>1L)
  • NO TWOC (long term catheter till definitive management)
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22
Q

What are some complications of chronic urinary retention?

A

UTI

Bladder calculi

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23
Q

What is pseudohaematuria?

A

Red/brown urine not secondary to haaemoglobin

Causes incl. rifampicin, hyperbilirubinuria, myoglobinuria

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24
Q

What are some urology differentials for haematuria?

A
  • Infection (pyelonephritis, cystitis or prostatitis)
  • Malignancy (prostate adenocarcinoma)
  • Renal calculi
  • Trauma / recent surgery
  • Radiation cystitis
  • Parasitic, commonly schistosomiasis
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25
Q

What does terminal haematuria suggest?

A

Severe bladder irritation

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26
Q

Why are work/travel questions added for haematuria?

A

Work (dye industry)

Travel = schistosomiasis

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27
Q

What are the investigations for haematemesis?

A
  • Urinalysis (nitrites/leukocytes = infection)
  • Bloods (FBC, U&Es, clotting)
  • Prostate specific antigen (PSA)

(1+ blood on dipstick is required for certainty - not trace)

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28
Q

When should haematuria be referred for urgent referral?

A

Aged > 45 with unexplained visible haematuria

Aged > 60 with unexplained non-visible haematuria (with dysuria/ raised WCC)

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29
Q

What is the gold standard for assessing lower urinary tract?

A

Flexible cystoscopy (local anaesthetic)

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30
Q

What are common causes of LUTS in men and women?

A

Men = BPH, UTI, malignancy, detrusor muscle weakness

Women = UTI, menopause, malignancy, stricture

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31
Q

What are the two categories of LUTS?

A

Storage = urgency, frequency, nocturia, urgency incontinence

Voiding = hesitancy, intermittency, straining, terminal dribbling

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32
Q

What associated questions can be added about LUTS?

A
  • Visible haematuria
  • Suprapubic discomfort
  • Colicky pain

Digital rectal exam

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33
Q

What specialist investigations are there for LUTS?

A

Urodynamic studies

Upper urinary tract imaging (ultrasound / CT scanning)

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34
Q

What conservative options are there for LUTS?

A
  • Regulate fluid intake (no caffeine/alcohol)
  • Urethral milking (mabually empty bulbar urethra)
  • Double voiding (voiding immediately again after)
  • Pelvic floor exercises
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35
Q

What medication can be used for over active bladder?

A

Anticholinergics (e.g. oxybutynin, tolterodine)

B3 andrenic agonist (e.g. mirabegron)

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36
Q

What medication can be used for BPH?

A

Alpha blockers (tamsulosin)

5α-reductase inhibitors (finasteride)

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37
Q

What can be used to aid reducing nocturia?

A

Desmopressin

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38
Q

What is a complicated (vs uncomplicated) pylonephritis?

A

Uncomplicated = structurally / functionally normal urinary tract in non-immunocompromised host (complicated when opposite is true)

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39
Q

What are the top 3 organisms for pyelonephritis?

A

Escherichia coli

Klebsiella

Proteus

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40
Q

What are some risk factors of pyelonephritis?

A

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

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41
Q

What is the classical triad for pyelonephritis?

A
  • Fever
  • Loin pain
  • Nausea and vomiting
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42
Q

What are some differentials for back pain?

A
  • Pyelonephritis
  • Renal calculi
  • Acute cholecystitis
  • Ecopic pregnancy
  • Pelvic inflammatory disease
  • Lower lobe pneumonia
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43
Q

What are the investigations for pyelonephritis?

A
  • Urinalysis (nitrites and leucocytes)
  • Urinary beta-hCG

- Urine culture

  • FBC, CRP (inflammation)
  • U&Es
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44
Q

What is the management of pyelonephritis?

A

A-E

IV fluids

Analgesia

Antiemetics

Catheterisation

Early CT

SEVERE = NEPHROSTOMY INSERTION / PERCUTANEOUS DRAINAGE

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45
Q

What are some complications of pyelonephritis?

A
  • Sepsis
  • Renal scarring
  • Pyonephritis
  • Preterm labour
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46
Q

What is the most common form of adult renal tumour?

A

Renal cell carcinoma (<15% incl TCC)

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47
Q

What are the risk factors of renal cell carinoma?

A
  • Smoking
  • Dialysis
  • HTN
  • Obesity
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48
Q

How does RCC present?

A
  • Haematuria
  • Flank pain / mass
  • Lethargy
  • Weight loss
  • Left varicocoele
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49
Q

What are some paraneoplastic syndromes caused by ectopic secretion of hormones by RCC?

A

Polycythaemia due to erythropoetin

Hypercalcaemia due to parathyroid hormone

Hypertension due to renin

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50
Q

What is the imaging for suspected RCC?

A

Ultrasound or CT with IV contrast is gold standard

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51
Q

What are some risk factors for developing renal cysts?

A

Increasing age

Smoking

HTN

Male

ADPCD

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52
Q

What is ADPKD associated with in the head? (and elsewhere)

A

Berry aneurysm formation (subarachnoid haemorrhage), mitral valve disease, liver cysts

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53
Q

What are the features of renal cysts?

A

Incidentally on abdo imaging

Flank pain (infected/rupture)

Haematuria

Uncontrolled hypertension (ADPKD)

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54
Q

What is the imaging for renal cysts?

A

CT or MRI imaging (pre and post enhancement scans)

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55
Q

How are cysts managed?

A

Simple = no further follow up

Complicated = analgesia or needle aspiration

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56
Q

What is the only radiolucent stone?

A

Urate stones

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57
Q

What causes urate stones?

A

High levels of purine in the blood (red meats)

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58
Q

What are the location where ureteric stones lodge?

A

PUJ

Crossing pelvic brim

VUJ (vesicoureteric junction)

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59
Q

How do renal stones present?

A
  • Ureteric colic
  • Haematuria
  • Flank tenderness
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60
Q

What are differentials for flank pain?

A
  • Renal stone
  • Pyelonephritis
  • Ruptured AAA
  • Biliary pathology
  • Bowel obstruction
  • Lower lobe pneumonia
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61
Q

What are some investigations for renal stone?

A
  • Urine dip (haematuria)
  • Bloods (FBC, CRP - infection)
  • U&Es (renal function)
  • Urate and calcium levels

NON CONTRAST CT KUB

Ultrasound scan for hydronephritis

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62
Q

How to manage patients with renal stones?

A

Fluid resus (patients are often dehydrated)

Stones normally pass spontaneously

ANALGESIA (NSAIDs per rectum)

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63
Q

When should a patient with a stone be admitted?

A
  • AKI
  • Uncontrolled pain
  • Evidence of infected stone
  • Large stone >5mm
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64
Q

How are patients with obstruction and renal calculi managed?

A

Nephrostomy (temporarily drain) or retrograde stent insertion

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65
Q

What are some definitive treatments of stones?

A
  • Extracorrporeal Shock Wave Lithotripsy (ESWL) (contraindications are pregnancy or stone over bony landmark)
  • Percutaneous nephrolithotomy (PCNL) (larger stones)

-

66
Q

What are some complicatins from urteric stones?

A

Infection and post renal AKI

67
Q

What foods should patients who get oxolate stones be warned against?

A

High oxalate foods (nuts, rubarb and sesame)

68
Q

When can bladder stones be seen?

A

Chronic urinary retention

Schistosomiasis

69
Q

What is the definitive treatment of bladder stones?

A

Cytoscopy allowing stones to drain/lithotripsy

70
Q

What are some risk factors for SCC of the bladder?

A

Schistosomiasis

Bladder stones

71
Q

What epithelium lines the bladder?

A

Urothelium (transitional)

72
Q

What are the biggest risk factors for bladder cancer?

A

- Smoking

- Increasing age

  • Industrial dyes
  • Schistosomiasis infection
73
Q

How does bladder cancer present?

A

Painless haematuria

Recurrent UTIs

74
Q

What is the investigation for bladder cancer?

A

Urgent cytoscopy

(initally flexible under local then rigid under general - if suspicious, with biopsy taken)

75
Q

What is the surgery for bladder cancer?

A

TURBT (transurethral resection of carcinoma in situ)

Radical cystectomy (high risk disease)

76
Q

What are the different types of incontinence?

A

Stress (intraabdominal presure increases - weak pelvic floor)

Urge (overactive detrusor - neurogenic i.e. stroke, infection, malignancy)

Mixed

Overflow (from chronic urinary retention)

77
Q

What are some risk factors for stress urge incontinence?

A
  • Post partum
  • Constipation
  • Obesity
  • Post-menopausal
78
Q

What are the investigations for incontinence?

A
  • Midstream urine dip (infection/haematuria)
  • Post void bladder scan
  • Cytoscopy
79
Q

What are the non-surgical options for urge incontinence?

A
  • Weight loss
  • Reduce caffeine intake
  • Avoid drinking excessive fluid volumes
  • Smoking cessation
80
Q

What are the managment options for stress UI?

A
  • Pelvic floor muscle training (3 months)
  • Duloxetine (SSRI) to cause stronger urethral contractions
81
Q

What are the treatment options for urge urinary incontinence?

A

Anti-muscarinic drugs e.g. oxybutynin or tolterodine and bladder training

82
Q

What are the surgical options for urinary incontinence?

A

Urge = botulinum toxin A injection

Stress = tension free vaginal tape

83
Q

What does the prostate do?

A

Converts testosterone to dihydrotestosterone (DHT) using 5α-reductase.

MECHANISM OF BPH IS NOT UNDERSTOOD

84
Q

What are the risk factors for BPH?

A

Age

Family history

Afro-caribbean

85
Q

How do patients with BPH present?

A
  • Hesitancy
  • Weak steam
  • Terminal dribbling
  • Urinary frequency
  • Nocturia
  • Nocturnal enuresis
86
Q

What scoring system is used to evaluate LUTS in BPH

87
Q

What are the investigations for BPH?

A
  • Dipstick
  • Post-void bladder scan
  • PSA
  • Ultrasound scan (for hydronephrosis)
88
Q

What are the medical options for BPH? How do they work and any side effects?

A

α-blockers (e.g. tamsulosin) - relax prostatic smooth muscle (postural hypotension, retrograde ejaculation)

5α-reductase inhibitors (e.g. finasteride) - prevent conversion to DHT, decresing volume of prostate

89
Q

What is the surgical management of prostate enlargement? What are some complications?

A

Transurethral resection of the prostate

Haemorrhage, sexual dysfunction, retrograde ejaculation

90
Q

What is the main complication for BPH?

A

High-pressure retention

Recurrent UTIs

Significant haematuria

91
Q

What type of cancer affects the prostate?

A

Adenocarcinoma

92
Q

Where do prostate cancers typically affect?

A

Peripheral zone

93
Q

What are the main risk factors for prostate cancer?

A

Age

Ethnicity (black / caribbean men are twice as likely to get it)

FH

94
Q

What are some modifiable risk factors for prostate cancer?

A
  • Obesity
  • Diabetes
  • Smoking
95
Q

How does prostate cancer present?

A
  • LUTs
  • Haematuria
  • Dysuria
  • Incontinence
  • Haematospermia
96
Q

What are the differentials for enlarged prostate with LUTs?

A
  • BPH
  • Prostate cancer
  • Prostatitis
97
Q

What investigations are there for prostate cancer?

A
  • PSA

- DRE

-

98
Q

When can the PSA be artifically raised?

A
  • BPH
  • Prostatitis
  • Vigorous exercise
  • Ejaculation
  • Recent DRE
99
Q

How is prostate cancer diagnosed?

A

Biopsies of tissue

100
Q

What scoring system is used for prostate cancers?

A

Gleason grading system

101
Q

What is the surgical treatment for prostate cancer?

A

Radical prostatectomy

102
Q

What are the side effects of radical prostatectomy?

A
  • Erectile dysfunction
  • Stress incontinence
  • Bladder neck stenosis
103
Q

What are the common organisms in prostatitis?

A

E. Coli

Enterobacter

Proteus

Chlamydia/gonorrhoea

104
Q

What are risk factors for acute bacterial prostatitis?

A
  • Indwelling catheters
  • Phimosis
  • Recent transrectal biopsy
  • Immunoscompromised
105
Q

How does acute bacterial prostatis present?

A
  • LUTs
  • Pyrexia
  • Perineal pain
  • Tender prostate
  • Inguinal lymphadenopathy
106
Q

What is the 1st line investigation for prostatitis?

A

Urine culture

107
Q

What are some other investigations for prostatitis?

A
  • STI screen
  • Routine bloods
  • Prostate abscess ruled out by transrectal prostatic ultrasound
108
Q

What is the management of acute bacterial prostatitis?

A
  • Prolonged antibiotic therapy (normally quinolone)
  • Analgesia
  • Medications used for BPH
109
Q

What are the organisms in epididymitis on <35 and >35?

A

<35 = N. gonorrhoeae and C. trachomatis

>35 = E. Coli, proteus spp, Klebsiella pneumoniae

110
Q

What typically causes orchitis?

A

Viral cause - mumps

111
Q

What is the disease course of mumps?

A

Parotitis then orchitis

Self-resolving disease (can lead to testicular atrophy)

112
Q

What are some risk factors for epididymitis?

A
  • MSM
  • Multiple sexual partners
  • Catheterisation
  • BPH
113
Q

How does epididymitis present?

A
  • Dysuria
  • Red and swollen
  • Tender to palpate
  • Associated hydrocoele
  • Intact cremasteric reflex
  • Prehn’s sign (pain in alleviated by raising)
114
Q

What are the differentials for a painful and swollen testicle?

A
  • Testicular torsion (pain is sudden)
  • Epididymitis
  • Testicualr abscess
  • Epididymal cyst

-

115
Q

What are the investigations for epididymitis?

A
  • Urine dipstick
  • First-void urine for STIs
  • FBC and CRP for infection
116
Q

What imaging for epididymitis?

A

Normally clinical diagnosis however ultrasound imaging can be used

117
Q

What is the management for epididymitis?

A

Abx

Abstinence from sex until abx complete

118
Q

What are the types of testicular cancer?

A

Germ cell tumours (95%)

Non germ cell tumours (seminomas/non-seminomas)

119
Q

What cells comprise NGCT?

A

Leydig/sertoli cells.

USUALLY BENIGN

120
Q

What is a teratoma an example of?

A

Non-seminomatous GCT (along with yolk sac, choriocarcinoma, etc)

121
Q

What are some risk factors for testicular cancer?

A

Cryptorchidism (undescended testis)

Previous testicular malignancy

Positive family history

122
Q

How does a testicular tumour appear?

A

Unilateral painless testicular lump

Irregular, firm and fixed

123
Q

Where is the lump drainage from the testes?

A

Para-aortic nodes

124
Q

Name some differentials for a scrotal lump?

A
  • Epididymal cyst
  • Haematoma
  • Epididymitis
  • Hydrocoele
  • Testicular cancer
125
Q

What are the investigations for testicular cancer? Incl. tumour markers

A

Tumour markers = bHCG, AFP, LDH

Scrotal ultrasound

Staging with CT

No trans-scrotal percutaneous biopsy as can cause seeding

126
Q

What is the surgery option for testicular cancer?

A

Inguinal radical orchidectomy

127
Q

What is testicular torsion?

A

Spermatic cord and contents twists within the tunica vaginalis

128
Q

What deformity leads to an increased risk of torsion?

A

Males with horizontal lie of testes aka bell-clapper deformity

129
Q

What are the risk factors for torsion?

A

Age

Previous testicular torsion

FH

Undescended testes

130
Q

How does the testes appear with torsion?

A

Unilateral testicular pain

High lying postion with absent cremasteric reflex

Negative prehns sign (pain doesnt go away)

131
Q

What are the investigations for torsion?

A

Normally clinical diagnosis (urgent surgical exploration)

Doppler ultrasound can be used to investigate blood flow to the testis

132
Q

What term is used for the fixing of testes after torsion?

A

Bilateral orchidopexy

133
Q

What are the main risk factors for urethritis?

A

< 25 years old

MSM

Previous STIs

Recent new sexual partner

More than 1 partner in past year

134
Q

How does urethritis present?

A
  • Dysuria
  • Penile irritation
  • Discharge
135
Q

What is reactive arthritis?

A

Sterile inflammatory arthritis caused by autoimmune response to distant joints

136
Q

What is reactive arthritis commonly caused by?

A

Clamydia Teachomatis

Campylobacter spp

Shigella

137
Q

What is the triad in reactive arthritis?

A

Conjunctivits

Arthritis

Urethritis

138
Q

What are some differentials for dysuria?

A

Balanitis (inflammation of glans penis)

Acute prostatitis (ejaculatory pain, LUTs)

Cystitis (dysuria / freqency)

139
Q

What are the investigations for urethritis?

A

Culture of urethral swabs

Gold standard is first-void urine sent for nucleic acid amplification test

140
Q

What is the treatment for urethritis?

A

Gonococcal = ceftriaxone

Non-gonococcal = Doxy or Azithromycin

141
Q

What is Fournier’s gangrene?

A

Necrotising fasciitis affecting the perineum

142
Q

Where does necrotising fasciitis infect?

A
  • Subcut tissue
  • Fascia
143
Q

What are the alpha-haemolytic and beta haemolytic streps?

A

Alpha = S. pneumoniae, S. Viridans

Beta:

  • Group A = S. Pyogenes
  • Group B = S. Agalactiae (harmlessly colonises)
144
Q

Name 2 risk factors for Fournier’s gangrene?

A
  • Diabetes
  • Excess alcohol
  • Poor nutritional state
145
Q

How does Fourn’ers Gangrene present?

A

Severe pain, out of proportion

Pyrexia

Skin necrosis

146
Q

What organisms typically cause Fournier’s gangrene?

A

E. Coli

S. Pyogenes

147
Q

What is the management for Founier’s gangrene?

A

Urgent surgical debridgement

148
Q

What is paraphimosis?

A

Inability to pull forward a retracted foreskin

149
Q

What are some risk factors for paraphimosis?

A
  • Phimosis
  • Urethral catheter
  • Poor hygiene
150
Q

What are the management options of paraphimosis?

A
  • Analgesia
  • Manual pressure on glans to reduce oedema then reduction
  • Dorsal slit/emergency circumcision
151
Q

What virus is penile cancer associated with?

A

HPV 16, 6 and 18

152
Q

What is the most common penil malignancy?

A

Squamous cell carcinoma

153
Q

Name some risk factors for penile cancer?

A

HPV infection 6, 16, 18

Phimosis

Smoking

Lichen sclerosis

154
Q

How does penile cancer present?

A

Ulcerating lesion on the penis (painless)

Inguinal lymphadenopathy

155
Q

What are the differentials for ulcerations on the penis?

A

Infection: Herpes simplx / Syphilis

Inflammation: Psoriasis, balanitis

156
Q

How is penile cancer diagnosed?

A

Penile biopsy

157
Q

What is priapism?

A

Unwanted painful erection for more than 4 hours

158
Q

What are the two forms of priapism?

A

High flow: blood enters corpus cavernosum more quickly than it can be drained (through trauma usually)

Low flow (ischaemic): veno-occlusive caused by blocking of the venous drainage

159
Q

What is a penile fracture?

A

Traumatic rupture of corpus cavernosa and tunica albuginea

160
Q

How does a penis fracture present?

A
  • Snap followed by pain and cessation of erection
  • Pain and swelling, deviation to opposite side
161
Q

What is the management of penile fractures?

A

Analgesia

Anti-emetics

Surgical exploration and repair

Surgery - DONE (9 decks)

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