Urology Flashcards
What are symptoms of BPH?
Presents with both storage symptoms (frequency, urgency, nocturia, and incontinence) and voiding symptoms (weak stream, dribbling, dysuria, straining).
What is BPH?
Lower urinary tract symptoms (LUTS) caused by bladder outlet obstruction due to benign prostatic hyperplasia (BPH), also known as benign prostatic enlargement (BPE), are predominantly due to 2 components: a static component related to an increase in benign prostatic tissue narrowing the urethral lumen and a dynamic component related to an increase in prostatic smooth muscle tone mediated by alpha-adrenergic receptors.
What are the first line investigation for suspected BPH?
urinalysis, PSA, international prostate symptom score, volume charting
What is the international prostate symptom score (IPSS)?
The IPSS questionnaire allows your urologist to better understand
the severity of your water work symptoms. It is used for men who
are having problems that are likely to be related to an enlarged
prostate. It is helpful in determining which treatment option is best
for you and then monitoring any improvement.
There are 7 questions relating to different symptoms you might be
experiencing and one question relating to your overall quality of
life. Once you have scored each question the values are added
together to give an indication of the severity of your symptoms.
What is 1st line treatment for BPH causing bothersome symptoms?
alpha blocker and behavioural management
OR
5-alpha-reductase inhibitors
How do alpha receptor blockers work?
Alpha-blockers work through smooth muscle relaxation in the prostate and bladder neck. The predominant receptor type in the prostate and bladder is the alpha-1A receptor. Alpha-blockers are efficacious within a matter of a few days and are usually well tolerated.
5-alpha-reductase inhibitors work through reduction of serum dihydrotestosterone (DHT), via inhibition of DHT formation, reducing prostate volume by 20% to 25%.[8] They require several months of use to improve symptoms.
In patients with larger prostates over 30 grams, initial therapy with 5-alpha-reductase inhibitors should be considered as they are effective in larger prostates at reducing prostate size, decreasing the short-term risk for acute urinary retention and invasive surgery.
What are some examples of alpha blockers used in BPH?
Long-acting alpha-1 blockers include terazosin and doxazosin. Terazosin and doxazosin are titrated to avoid first-dose hypotension and syncope from first-dose effect.
What are complications of BPH?`
UTI, bladder stones, renal insuffiency, sexual dysfunction
80% of renal stones are…
calcium oxalate
What type of renal stone are not visible on an Xray?
uric acid
What is the presentation of renal stones?
can be asymptomatic
loin to groin pain
renal colic (fluctuating in pain as the stone moves)
may have haematuria, nausea, vomiting and oliguria
What is the gold standard test for diagnosing renal stones?
CT KUB - kidey urethra bladder
What is usually the most effective analgesia for renal stones?
NSAIDs - PR diclofeac
Explain the management of renal stones
Antiemetic if nausea and vomiting
Fluids
Antibiotics if infection is present
Stones less than 6mm have greater than 50% chance of passing without intervention
Spontaneous passage can take several weeks
Tamsulosin (an alpha-blocker) can be used to help aid spontaneous passage of stones
Surgical Interventions in large stones or stones that do not pass
What are the 4 surgical interventions for renal stones?
- Extracorporeal Shock Wave Lithotripsy
An external machine generates shock waves and directs them at the stone under xray guidance.
Breaks the stone to smaller parts to make them easier to pass. - Ureteroscopy and Laser Lithotripsy
Camera inserted via urethra, bladder and ureter
Stone identified
The stone is broken up by targeted lasers
The smaller parts are easier to pass - Percutaneous Nephrolithotomy
Performed in theatres under anaesthetic
A nephroscope (small camera on a stick) is inserted via a small incision at the patient’s back
The scope is inserted through the kidney to assess the ureter
Stones can either be removed or broken up to small stones - Open Surgery
What does renal stones predispose the patient to?
further renal stones
What is some advice that can be given to patients suffering from renal stones?
Increase oral fluids
Reduce dietary salt intake
Reduce intake of oxalate-rich foods for calcium stones (e.g. spinach, nuts, rhubarb, tea)
Reduce intake of urate- rich foods for uric acid stones (e.g. kidney, liver, sardines)
Limit dietary protein
What is the area in the brain responsible for urination control?
pontine storage centre
What is pyelonephritis?
Acute pyelonephritis is an infection of one or both kidneys usually caused by bacteria travelling up from the bladder – the most common causative pathogen is Escherichia coli, which is responsible for 60-80% of uncomplicated infections.
What are some acute complications of pyelonephritis?
Sepsis. Parenchyma renal scarring. Recurrent urinary tract infections. Renal abscess formation. Preterm labour in pregnancy. Emphysematous pyelonephritis.
When should a urine dipstick not be used to diagnosis UTI’s?
in people with an indwelling catheter, or aged over 65 years.
What is the treatment on pyelonephritis?
eople with severe symptoms, or signs or symptoms which suggest a more serious illness or condition should be admitted to hospital.
All other people should be offered an antibiotic.
An antibiotic can be started once a midstream or catheter specimen of urine has been obtained for culture and sensitivity.
For women who are not pregnant, men, and people with an indwelling catheter – ciprofloxacin 500 mg twice a day for 7 days;
Potential signs of prostate cancer include…
Any lower urinary tract symptoms, such as nocturia, urinary frequency, hesitancy, urgency or retention or
Erectile dysfunction or
Visible haematuria
What is the main symptom of bladder cancer?
Haematuria
In which demographic is pyelonephritis more common?
older women
What is the difference between cystitis and pyelonephritis?
cystitis is a lower UTI
pyelonephritis is an upper UTI
How may prostatitis present?
flu-like symptoms. with low backache, LUTS
What is the treatment of acute prostatitis?
Men suspected of having acute bacterial prostatitis should be prescribed an oral antibiotic for 14 days: ciprofloxacin 500 mg twice daily
How should I manage acute lower urinary tract infection without haematuria in a woman who is not pregnant or catheterized?
Consider the need for antibiotics depending on severity of symptoms, risk of complications, and previous urine culture results and antibiotic use.
If prescribing an immediate antibiotic — treat according to sensitivities from recent urine culture (if available), otherwise treat empirically taking account of local antimicrobial resistance patterns:
For first choice, consider prescribing:
Nitrofurantoin 100mg modified-release twice a day for 3 days (if eGFR ≥45ml/minute) or
Trimethoprim 200mg twice a day for 3 days (if low risk of resistance).
What are some differential diagnoses for visible haematuria?
BPH, UTI, pyelonephritis, bladder cancer, urethra trauma
Which demographic is the prevalence of non visible haematuria the highest?
men over 60 that smoke
What are some differential diagnoses for non-visible haematuria?
menstruation, cystitis, pyelonephritis, Nephrolithiasis (kidney stones)
What is the most common malignancy in young adult men (20 to 34 years of age), and highly curable when diagnosed early?
testicular cancer
What is the 1st investigation to order for suspected testicular cancer?
ultrasound
What is the treatment of balanitis?
For suspected non-specific dermatitis, application of topical hydrocortisone and imidazole.
For suspected or confirmed bacterial balanitis, oral flucloxacillin or clarithromycin (if there is penicillin allergy).
What are associated symptoms of epididymo-orchitis?
Nausea or vomiting (common with torsion, may occur with epididymo-orchitis). Symptoms of a lower urinary tract infection, or urethral discharge (suggesting epididymo-orchitis). Parotid swelling (suggesting mumps orchitis). Back pain, breathlessness, or weight loss (may occur in metastatic testicular cancer).
What is the Prehn sign?
relief of pain with elevation of the testes — may suggest epididymitis, but does not rule out testicular torsion.
How does a varicocele change when lying down?
it disappears and reappears when standing
What can be described as a bag of worms consistency?
varicocele of the testes
In which demographic are hydroceles most common?
neonatal ad usually disappears within 1-2 years
What is a Valsalva-type manoeuvre used for?
to excentuate an inguinal hernia
