Urology Flashcards
what are the common causes of LUTS in men?
BPH
UTI
Urological malignancy
detrusor muscle weakness/ instability
chronic prostatis
urethral stricture
external compression e.g. pelvic tumour, faecal impaction
neurological disease e.g. MS, spinal cord injury
what are the common causes of LUTS in women?
UTI
menopause
urologicla malignancy
detrusor muscle weakness or instability
urethral stricture
external compression e.g. pelvic tumour
neurological diesase e.g. MS, spinal cord injury
lifestyle factors that affect LUTS?
drinking fluids late at night
excess alcohol intake
excess caffeine intake
which LUTS are storage symtpoms?
inc urinary frequency
nocturia
urgency
urge incontinence
which LUTS are voiding symptoms?
hesistancy
poor flow
terminal dribble
feeling of incomplete emptying
which medicatiosn are known to exacerbate LUTS?
anticholinergics
antihistamines
bronchodilators
investigations for LUTS?
urinalysis
post void bladder screening and flow rate
FBC, U&E and PSA
urodynamic studies
cystoscopy
what conservative measures are available to manage LUTS?
regulating fluid intake
pelvic floor exercises
bladder training techniques
pharmacological management options in LUTS?
anticholinergics (oxybutin, tolterodone) for overactive bladder
B3 adrenergic agonist (finasteride) for overactive
alpha blockers (alfuzosin tamsulosin) for BPH
5a-reductase inhibitors (finasteride) for BPH
Loop diuretics (furosemide, bumetanide) for nocturia
acute urinary retention is most prevelant in which patient population?
elderly men
common cause of acute urinary retention?
BPH
urethral strictures, prostate cancer
UTI- can cause urethral sphincter to close
constipation- compression to urethra
medications e.g. anti-muscarinics
presentation of a patient with acute urinary retention?
acute suprapubic pain
inability to micturate
palpable distended bladder
associated fevers/ rigors may indicate infective cause
which exam is always done when investigating acute urinary retnetion in elderly men?
PR exam to assess any prostate enlargement or constipation
which investigatiosn are avaible for acute urinary retention?
post voidal bladder scan- reveal vol of retained urine
routine bloods: FBC, U&Es, CRP
CSU (if post catheterisation)
what can happen following acute urinary retention that causes high intra-vesicular pressure?
hydronephrosis- urine backs up from baldder and ureters into kidneys, impairing kidnet clearance level
what management is available for acute urinary retention?
immediate urethral cathetirisation
treat underlying cause i.e. BPH
check CSU for infection and treat w antibiotics if necessary
what complication can occur in patients following acute-on-chronic retention resolved through cathetierisation?
(large retnetion volume >1000ml)
post-obstructive diuresis
kidneys can over diurese due to loss of their medullary concentration gradient which can take time to re-equilibrate
post-obstructuve diuresis can cause which further complication?
worsening AKI
patients should have urine ouput monitored 24hrs post-catheterisation. If producing >200ml/hr should have 50% or urine output replaced with IV fluids
what is TWOC?
Trial without catheter
following retention- if patient can void with minimal residual volume considered succesfull
if patient re-enters retention they require re-catheterisation
main complications of urinary retention?
AKI which can lead to chronic kidney injury
inc risk of UTI
renal stones due to stasis
common causes of chronic urinary retention?
BPH in men
pelvic prolapse/ pelvic masses in women
neuoroligcal causes e.g. MS, parkinsons
how do patients in chronic urinary retention present?
painless urinary retention
may have assoc voiding LUTS such as poor flow, hesitancy
overflow incontinence may be present
palpable distended bladder on examination
what management is required following chronic urinary retention?
catheterisation
monitor for post-obstructive diuresis
TWOC
Intermittent self catheterisation
Haematuria can be classified into which categories?
Visible haematuria (macroscopic or gross)
Non-visible haematuria (microscopic or dipstick +ve)
can be symptomatic non visible (s-NVH) or asymptomatic (a-NVH)
what is pseudohaematuria?
red or brown urine not secondary to presence of haemoglobin
can be caused by medication e.g. rifampicin/methyldopa, hyperbilirubinuria, certain foods e.g. beetroot
what are urological causes of haematuria?
infection (pyelonephritis, cystitis, prostatis)
malignancy (urothelial carcinoma, prostate adenocarcinoma)
renal calculi
trauma/ recent surgery
radiation cystitis
parasitic (schistosomiasis)
what is the difference in total and terminal haematuria?
total- suggest bladder/ upper tract source
terminal suggests bladder irratation
which examination is essential in a patient presenting with haematuria?
abdo exam
PR exam
which investigations should be carried out following haematuria?
urinalysis- nitrites/ leukocytes may indicate infectious cause
Baseline bloods: FBC, U&Es, clotting, PSA
ACR in those with deranged renal fucntion
when do the NICE guidelines reccomend urgent referral to urological service for specialist haematuria investigation?
>45yrs with visible haematuria and no UTI
>45yrs with visible haematuria that persits following successful treatment of UTI
>60yrs with unexplained NV haematuria +/- dysuria or a raised white cell count
what special investigations are available to assess haematuria cause?
flexible cystoscopy (gold standard)
urine cytology
US KUB imaging (typically cases of NV haematuria)
CT urogram (typically cases of V haematuria)
what % of patients with visible haematuria are found to have an underlyign malignancy?
20%
what are the 6 S’s when inspecting a scrotal lump?
Site
Size
Shape
Symmetry
Skin changes
Scars
what investigations are carreid out for scrotal lumps?
US of scrotum (first line)
blood tests/ further imaging
why are biopsies not carried out for suspected testiculat cancer?
risk of seeding cancer
instead diagnosis made purley on clinical features, US and histopathological exam of testis following orchidectomy
blood tests for which tumour markers can be carried in suspected testicular cancer?
lactate dehydrogenase (LDH)
alpha-fetoprotein (AFP)
beta-human chorionic gonadotrophn (beta-hCG)
how are scrotal lumps classified in origin?
testicuar
extra-testicular
what are extra-testicular causes of scrotal lumps? (5)
hydrocele
varicocele
epididymal cysts
epididymitis
inguinal hernia
what extra-testicular patholgy presents as an abnormal collection of fluid between the parietal and visceral layers of the tunica vaginalis enveloping the testis?
hydrocele
using a torch to shine light from behind a scrotal lesion is useful in diagnosing which pathology?
detects whether mass is fluid filled or not
hydroceles and epididymal cysts will classically illuminate
what is a varicocele?
abnormal dilation of the pampiniform venous plexus within spermatic cord
often described as ‘dragging’ or ‘bag of worms’
dissapears when lying flat
90% of varicoceles are found on which side?
Left- spermatic vein drains directly into left renal vein
what are the red flag signs for varicoceles?
acute onset
right-sided
remain when lying flat
(associated with infertility)
which common condition present with unilateral acute onest scrotal pain?
epididymitis
may be assoc swelling, erythematous overlying skin, fever
most commonly bacterial in origin
inguinal hernia pass into the scrotum via what structure?
external inguinal ring
enter the inguinal cancal initially at teh interal ring (indirect) ot through hesselbachs triangle (direct)
how are testicular lumps classically described?
painless lump arising in testis
firm irregular mass
mass does not transilluminate
testicular cancer is the most common malignancy in which pt population?
men aged 20-40yrs
urgent US for diagnosis
which condition presents suddenly with very severe unilateral scrotal pain often assoc with N/V?
testicular torsion
surgical emergency requiring scrotal exploration within 6 hours
lsit some benign testicular lesions?
leydig cell tumours
sertoli cell tumours
lipomas
fibromas
inflammaiton of the testis is known as?
orchitis
commonly following mumps virus
what are the subtypes of urinary incontinence?
stress incontinence
urge incontinence
mixed incontinence
overflow incontinence
continous incontinence
all patients presetnign with incontinence should have which investigation?
mid stream urine dipstick
post void bladder scans are useful in those with overflow UI
in cases of urinary incontinence with unclear cause what investigation can be useful?
urodynamic assessment
outflow urodynamics
cystoscopy
what lifestyle changes are encouraged in the first instance to manage UI?
wgt loss
reducing caffeine intake
avoid excessive fluid intake
smoking cessation
what are the conservative management options in urinary incontinece?
pelvic floor exercises
anti-muscarincs i.e. oxybutynin, tolterodine
bladder training (min 6 weeks)
what surgical managemtn options are considered in urinary incontinence?
for urge UI, botulinum toxin A injections, augmentation cystoplasty
for stress UI, tension-free vaginal tape, open colposuspension
bladder cancer is more common in which sex?
male >80yrs
M:F = 3:1
what are the subtypes of bladder cancer?
transitional cell carcinma (80-90% cases)
sqaumous cell carcinoma
adeconcarcinoma and sarcoma (rare)
bladder cancers can be further classified following cell type- what are these classifcations?
non-muscle invasive bladder cancer (70-80% cases)
muscle invasive bladder cancer
locally advanced or metastatic bladder cancer
what are the four layers of the bladder wall?
inner layer- transitional epithelium (urothelium)
connective tissue layer- lamina propria
muscular layer- muscularis propria
outer layer- fatty connective tissues
what are the 2 most important risk factors for bladder cancer?
smoking
increasing age
what is the most common presentation of bladder cancer?
painless visible/non-visible haematuria
may also present with recurrent UTIs/ LUTS
what are the T stages of bladder cancer?
Tis- in situ, contained within BM
T1- through lamina propria into sub-epithelial connective tissues
T2- into muscularis propria layer
T3- invasion into perivesical tissues
T4 direct invasion into adjacent loose structures
what investigations are carreid out in those with suspected bladder cancer?
urgent cystoscopy
biospy (rigid cystoscopy)
CT imaging
TURBT (transurehtral resection of bladder tumour)
how are Tis and T1 bladder tumours typically managed?
resected via TURBT
adjuvant intravesical therapy may be required in higher risk cases
how are muscel invasive bladder cancer managed?
radical cystectomy +/- neoadjuvamt chemotherapy (typically cisplatin)
require follow up with CT imaging
how common is bladder cancer recurrence?
70% within 3 years for superficial bladder cancers
followin radical cystectomy how is urinary diversion acheived?
ilieal conduit formation- urine drains via urostomy
bladder reconstruction- segment of small bowel, urine drains urethrally or via catheter
why are B12 and folate checked alongside routine bloods following bladder reconstruction?
part of the ileum is resected during urinary diversion procedure
patients with locally advanced or metastatic bladder cancer are treated with which typical chemo regimes?
cisplatin- based regime
carboplatin + gemcitabne based regime
pyelonephritis (inflammation of kidney parenchyma) most commonly affects which patient populaiton?
women aged 15-29 yrs
what is meant by umcomplicated/ complicated pyelonephritis?
uncomplicated occurs in a structurally/ functionally normal urinary tract in a non-immunocomprimised host
complicated is the opposite (complicated in males by definition)
what is the most common caustitive organism of pyelonephritis?
E coli
others include: Klebsiella, proteua, enterococcus faecalis, S. aureus, pseudomonas
how do bacteria reach the kidney in pyelonephritis?
ascending from lower urinary tract
directly from blood stream
lymphatics (rarely)
which cell type infllltrate teh tubues and interstitium to cause supparitive inflammation in pyelonephritis?
neutrophils
what are the risk factors for developing pyelonephritis?
factors reducing anterograde flow of urine (obstruction i.e. BPH)
factors promoting retrograde ascent of bacteria (indwelling catheter/stent, structural abnormalities, female shorter urethra)
factors predisposing to infection (diabetes, corticosteroids, untreated HIV infection)
factors promoting bacterial colonisation (renal calculi, intercourse, menopause)
what triad is classically seen in pyelonephritis?
fever, unilateral loin pain, N&V
(typically develops over 24/48 hrs)
what diagnosis when suspect of pyelonephritis is important to exlcude?
potential AAA rupture
(back pain/ tachy/ hypotension)
what investigations should be carried out to confirm diangosis of pyelonephritis?
urinalysis
urine culture
FBC, U&Es, CRP
renal US scan (for evidence of obstruction)
if renal US scan shows evidince of obstruction what should next be performed?
non-contrast CT imaging (CT KUB)
how is pyelonephritis managed?
systemically unwell use A-E approach
start empirical antibiotics
IV fluids
consider admission in those who are more at risk of complication
what complications can occur following pyelonephritis?
severe sepsis
multi-organ failure
renal scarring → CKD
pyonephrosis
repeated infections can lead to chronc pyelonephritis. What will be seen on imaging?
small, scarred shrunken kidney
how does emphysematous pyelonephritis differ from acute pyelonephritis?
rare and severe form of pyelonephritis, caused by gas-forming bacteria
wil fail to responf to empirical antibiotics
emphysematous pyelonephritis is most common in which patient population?
diabetic patients
(high glucose allows CO2 production from fermentation by enterobacteria)
how are cases of empyhsematous pyelonephritis treated?
mild cases treated with broad-spectrum anti-microbial cover
severe cases may warrant nephrostomy insertion or percutaneous drainage
what is pyonephrosis?
complication of pyelonephritis- infeected, obstructed kidney
how are renal cysts classified?
simple or complex
what are the charactersitics of simple renal cysts?
well defined outline and homogenous features
common in elderly- 50% in >50yrs
develop from renal tubule epithelium
what are the characteristics of complex renal cysts?
thick walls, septations, calcification, heterogenous enhancement on imaging
higher risk of malignancy
what system is used to classify complex cysts?
Bosniak classification
risk factors for developing renal cysts?
increasing age, smoking, hypertension, male gender
genetics: PCKD, tuberous sclerosis, von hippel-lindau disease
what pattern of inheritance does polycystic kidney disease follow?
Autosomal dominant (ADPKD)
autosomal recessive (ARPKD) v rare- usually diagnosed in-utero, 60% neonates will not survive >1 month
which genes are effected in ADPKD?
PKD1, PKD2 genes
causes multiple renal cysts to form
in addition to renal cysts which pathology is assoc with ADPKD?
berry aneurysm formation (leads to subarachnoid haemorrhage), mitral valve disease, liver cysts
patients will eventually develop end-stage renal failure and may require dialysis/ renal transplant
clinical features of renal cysts?
often found incidentally as typically asymtpomatic
can include: flank pain, haematuria
may present with uncontrolled hypertension or flank mass
what is the main differntial for any renal cyst?
renal cell carcinoma
imaging to investigate
how are renal cysts investigated?
CT or MRI imaging with pre- and post- enhancment scnas with IV contrast
(ultrasound can pick up incidentally but requires CT/MRI for definitive diagnosis)
what should be checked in the patients blood when investigating renal cysts?
serum U&Es for renal function
when is MRI favoured over CT when investigating renal cysts?
those with a known genetic risk and in younger patients
what are the Bosniak stages?
I- Simple <1% malignancy risk
II- Complex, <3% malignancy risk
II F- Complex, 5% malignancy risk
III- Complex, 50-70& malignancy risk
IV- Complex 90-100% malignancy risk
what is the suggested management for wach Bosniak stage?
- I- No follow up
- II- No follow up
- II F- CT scan at 3, 6, & 12 months
- III- Surveillance or surgical
- IV- Surgical
what are the management options for symptomatic simple renal cysts?
simple analgesia
needle aspiration
cyst deroofing*
*usually done laparoscopically- cyst aspirated and part of the wall excised to discourage cyst recurrence
although rare what are the possible complications of renal cysts?
infection, haemorrhage and rupture
what is the most common form of adult renal tumour?
Renal Cell Carcinoma
(accounts for 85% of all renal malignancies)
other than RCC what renal malignacies can occur?
transitional cell carcinoma (urothelial)
nephroblastoma in children (Wilms tumour)
squamous cell carcinomas (chronic inflammation second to renal calculi, infection)
where in the kidney do renal cell carcinomas occur?
renal cortex, arise predominatnly from proximal convoluted tubules most often appearing in upper pole of the kidney
what can be seen microscopically when concerned with renal cell carcinoma?
polyhedral clear cells
dark stainign nuclei and cytoplasm rich with lipid and glycogen granules
how do renal cell carcinomas spread?
direct invasion into perinephric tissue, adrenal gland, renal vein ot IVC
lymphatic system to pre-aortic and hilar nodes
haematogenous spread to liver, bones, brain and lung
what is meant by ‘tumour thrombosis’ a feature distinct to RCCs?
invasion through the renal vein and into the lumen
what is teh most common risk factor for renal cell carcinoma?
smoking- doubles the risk
which genetic disorders can predispose to RCCs?
von Hippel-Lindau disease
BAP1 mutant disease
Birt-Hogg-Dube syndrome
what is the most common presenting complaint for RCCs?
haematuria, either visible or non-visible
may also report flank pain, flank mass, wgt loss/ lethargy
left sided renal masses such as RCC may also present with what left sided feature in males?
varicocele due to compression of left testicular vein as it joins the left renal vein
which investigations should be carried out in cases where RCC is suspected?
routine bloods: FBC, U&Es, Ca, LFTs, CRP
urinalysis
CT imaging with IV contrast (gold standard) + chest for staging
what is the management for renal cell carcinoma in localalised disease?
surgical management
partial nephrectomy (smaller masses)
radical nephrectomy (larger)
what management options are available for RCC in those pts not fit enough for surgery?
percutaenous radiofrequency ablation
cryotherapy
renal artery embolisation for haemorrhaging disease/ unresectable paliative cases
what is the management for renal cell carcinoma in metastatic disease?
nephrectomy in combination with immunotherapy such as IFN-a or IL-2 agents
biological agents i.e. sunitinib or pazopanib (tyrosine kinase inhibitors)
metastasectomy surgical resection of resectable mets
what % of pts with renal cell carcinoma have metastatic disease at presentation?
25%
what are urinary tract stones most commonly made of?
80% are made of calcium as either calcium oxalate (35%), calcium phosphate (10%) or mixed (35%)
other than calcium urianry tract stones can be made of what?
struvite
urate
cystiene
which urinary tract stone is the only radiolucent stone?
urate stones
which stone is largely responsible for staghorn calculi?
struvite stones- they are large and soft so will fill teh renal pelvis
high levels of what cause the formation of urate stones?
high levels of purine in the blood- red meat in diet, haematological disorders i.e myeloproliferative disease
what results in cysteine stones?
homocystinuria- inheritede defect affesting the absorptiona nd transport of cystiene in the bowel and kidneys
what points are most likely to be affected by renal stones?
pelviureteric junction- renal pelvis becomes the ureter
crossing pelvic brim- iliac vessels travel across ureter in pelvis
vesicoureteric junction- ureter enters bladder
what is the most common presenting symptom of renal stones?
pain- ureteric colic
sudden, severe, radiates from flank to pelvis and N&V
haematuria also occurs in 90% of cases (NV)
what are the differentials for flank pain?
ureteric stone
pyelonephritis
ruptured AAA
biliary pathology
bowel obstruction
lower lobe pneumonia
MSK pain
which investigations should be carried out ot confrim daignosis of ureteric stones?
urinalysis and routine bloods
urate and calcium levels
non-contrast CT KUB (gold standard)
AXR and US
how are patients with renal stones managed?
adequate fluid resecitation
sufficient analgesia
IV antibiiotic therapy if infection evident
what is the criteria for inpatient admission of renal stones?
post-obstructive acute kidney injury
pain ncontrolled with simple analgesia
evidence of infected stone(s)
large stones (>5mm)
when are patients with renal stones considered for stent insertion or nephrostomy?
obstructive nephropathy or significant infection
Extracorpeal Shock Wave Lithotripsy (ESWL) is reserved for which stones?
small stones <2cm
which definitive management is reserved for renal stones only, particulary larger stones i.e. staghorn calculi?
percutaenous nephrolithotomy (PCNL)
which renal stone management involves passing a scope retrograde up into the ureter?
flexible uretero- renoscopy (URS)
what complications can follow ureteric stones?
infection
post renal AKI
recurrent stones can lead to renal scarring and loss of kidney function
if someone present with recurrent calcium stone formation what test should be performed?
PTH levels checked to exclude primary hyperparathyroididm
bladder stones are commonly seen on patients with which condition?
chronic urinary retention
can also occur secondary to infections (classically schistosmiasis)
what is the definitive managemnt of bladder stones?
cystoscopy
chronic irritation of bladder epithelium following multiple bladder stones can predispose to what?
SCC bladder cancer
BPH is a histological diagnosis characterised by what tissue?
non-cancerous hyperplasia of glandular-epithelial and stromal tissue
the prostate converts testosterone to dihydrotestosterone (DHT)using what enzyme?
5a-reductase
risk factors for developing BPH?
increasing age
family history
afro carribean ethnicity
obesity
how do patients with BPH generally present?
LUTS either voiding (hesitancy, poor flow, dribbling),
or storage symtpoms (frequency, nocturia, UI)
Whch examination is necessary when investigating BPH?
Dgitial Rectal Exam (PR)
distinguishes from prostate cancer
as part of teh inital assessment for BPH patients should complete which questionnaire?
International Prostate Symtpom Score (IPSS)
each question rated 0-5:
0-7 mild
8-19 moderate
20+ severe
differential diagnoses for BPH?
prostate cancer
UTI
overactive bladder
bladder cancer
which investigations should be carried out follwoing suspect BPH?
urine frequency and volume chart
PSA
US of renal tract
urodynamic studies
how are patients with BPH managed medically?
a-adrenoreceptor antagonist (a-blocker) i.e. tamsulosin
5a-reductase inhibitors i.e. finasteride
how are patients with BPH managed surgically?
Transurethral Resection of the Prostate (TURP)-
what are the potential complications of BPH?
high-pressure retention where urianry retention can reault in post-renal kidney injury
UTIs
haematuria
what is TURP syndrome?
rare complication of TURP- fluid overload and hyponatraemia
presentation: confusion, nausea, agitation, visual changes
the majority of prostate cancers are which type of patholgy? Where do these typically arise?
adenocarcinomas (>95%)- peripheral zone
can be multifocal
what two types can prostate cancer be categorised into?
Acinar adenocarcinoma- glandular cells that line prostate
Ductal adeoncarcinoma- cells that line the ducts of the prostate
which type of prostate cancer is more likely to metastasiise?
ductal adeonocarcinoma grows and metastasises faster than acinar though less common type
what risk factors are there for prostate cancer?
Increasing age
Black african or carribean ethnicity
family history
(obesity, diabetes, smoking)
how is prostate cancer investigated?
PSA
biopsies of prostatic tissue
mulit-parametric MRI
what are the two current methods available for prostate biospy?
transperineal (template) biopsy
Transrectal US guided (TRUS) biopsy
which system is used to grade prostate cancers?
Gleason Grading system
higher score = poorer prognosis
how is prostate cancer staged?
abdomino-pelvic CT
bone scan
what three parameters are used to determine the level of risk in prostate cancer?
PSA
Gleason Score
Clinical stage (T from TNM)
what is the difference in watchful waiting and active surveillance of low risk prostate cancer pts?
watchful waiting- symtpom guided
active surveillance- monitor pts 3-monthly PSA, 6 month/yrly PR and re-biopsy at 1-3yrs
how can prostate cancer be managed surgically?
radical prostectomy
removal of prostate gland, seminal vesicles, surroundign tissue +/- dissection of pelvic lymph nodes
other than surgery what therapies are available for prostate cancer?
radiotherapy
chemotherapy i.e. docetaxel, cabazitaxel
androgen deprivation therapy i.e enzalutamide, abiraterone (reserved for metastatic disease)
what are the common causitive organisms of prostatis?
E.coli
enterobacter
serratia
pseudomonas
proteus
what are risk factors for prostatis?
indwelling catheter
phimosis/ urethral stricture
recent surgery/ cystoscopy
immunocompromised
a very tender and boggy prostate is classically seen in which condition?
prostatis
chronic prostatis can be diagnosed after experiencing symtpoms for how long?
3 months
what investigation is first line in prostitis?
urine culture
consider STI screen and routine bloods
if pts with prostatis fail to respond to antibitoic therapy what needs to be rule out?
prostate abscess- rule out using transrectal prostatic ultrasound (TRUS) or CT
how is prostatis managed?
prolonged antibiotic treatment
typically quinolone
who is most commonly affected by epididymitis?
males aged 15-30yrs and again in >60yrs
which is rarer to occur on its own, epididymitis or orchitis?
orchitis
(usually occur together)
what is the msot likely mode of infection in epididymitis?
Sexual transmission in <35yrs
local extension of infection from bladder/ urethra
orchitis can occur as a complication follwoing which viral infection?
mumps
what are the clinical features of epididymitis?
unilateral scrotal pain
red and swollen
cremasteric reflex intact
Prehns sign +ve
differentials of epididymitis?
testicular torsion
testicular trauma
testicular abscess
epididymal cyst
hydrocele
how is epididymitis investigated?
urine dipstick
STI screen
routine bloods- assess infective cause
US doppler imaging
how are epsiodes of epididymitis managed?
antibiotic therapy- ofloxacin for enteric organsisms, ceftriaxone for STI organisms
sufficient analgesia
abstain from sexua activity
males with which deformity are more prone to developing testicular torsion?
bell-clapper deformity
(horizontal lie to their testes- more mobile)
is the cremasteric reflex present in testicular torsion?
NO- reflex absent
Prehns sign also -ve
the ‘blue dot’ sign occurs in which urological condition?
torsion of hyatid of morgagni- visible infarcted hyatid
(remnant of mullerian duct)
testicular cancer is msot common in which age group?
20-40yrs
testicular tumours are categorised in which types?
germ cell tumous
Non-germ cell: Seminomas or non-seminomatous GCTs
Non-germ cell tumours comprise of which cells?
Leydig cells
Sertoli cells
Benign tumours
non-seminmatous germ cell tumours (NSGCTs) inculde which tumour types?
yolk sac tumours
choriocarcinoma
embryonal carcinoma
teratoma
are seminomas or non-seminomatous GCTs more likely to have a poorer prognosis?
non-seminomatous CGTs- metastasise early
seminomas stay localised
risk factors for testicular cancer?
cryptorchidism (undescended testes)
prev. testicular malignancy
+ve family history
klienfelters syndrome (XXY)
how are testicular cancers investigated?
tumour markers: BHCG, AFP
scrotal US
CT imaging with contrast of chest/abdo/pelvis to stage
what system is used to stage testicular cancer?
Royal Marsden Classification (I-IV)
what are the main treatment options for testicular cancer?
surgery, radiotherapy and chemotherapy
urethritis cause can be classified into one of which two types?
gonococcal (N. gonorrhoeae) or non-gonococcal (C. trachomatis, M. genitalium)
Risk facotrs for urethritis?
<25yrs
MSM
previous STI
multiple sexual partners
typical presenting symptoms of urethritis?
dysuria, penile irritation, discharge
differentials for urethritis?
balanitis
acute prostatis
cystitis
how is urethritis investigated?
urethral gram stain from urethral swabs
first void urine sent for NAAT
urine dipstick
what can be seen microscopically if gonococcal infection is causitive organism?
gram negative diplococci
how is urethritis treated?
gonococcal- ceftriaxone + azithromycon
non-gonococcal- Doxycycline or azithromycine
what is priaprism?
unwated painful erection no assoc w sexual desire lasting >4hrs
what is paraphimosis?
inability to pull forward retracted foreskin over teh glans
penile cancer has a strong association with which virus?
HPV subtypes 16, 6 and 18
how does penile cancer typically present?
palpable or ulcerating lesion on the penis- most commonly the glans
