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Surgery > Urology > Flashcards

Urology Flashcards

1
Q

what are the common causes of LUTS in men?

A

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

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2
Q

what are the common causes of LUTS in women?

A

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

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3
Q

lifestyle factors that affect LUTS?

A

drinking fluids late at night

excess alcohol intake

excess caffeine intake

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4
Q

which LUTS are storage symtpoms?

A

inc urinary frequency

nocturia

urgency

urge incontinence

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5
Q

which LUTS are voiding symptoms?

A

hesistancy

poor flow

terminal dribble

feeling of incomplete emptying

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6
Q

which medicatiosn are known to exacerbate LUTS?

A

anticholinergics

antihistamines

bronchodilators

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7
Q

investigations for LUTS?

A

urinalysis

post void bladder screening and flow rate

FBC, U&E and PSA

urodynamic studies

cystoscopy

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8
Q

what conservative measures are available to manage LUTS?

A

regulating fluid intake

pelvic floor exercises

bladder training techniques

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9
Q

pharmacological management options in LUTS?

A

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

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10
Q

acute urinary retention is most prevelant in which patient population?

A

elderly men

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11
Q

common cause of acute urinary retention?

A

BPH

urethral strictures, prostate cancer

UTI- can cause urethral sphincter to close

constipation- compression to urethra

medications e.g. anti-muscarinics

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12
Q

presentation of a patient with acute urinary retention?

A

acute suprapubic pain

inability to micturate

palpable distended bladder

associated fevers/ rigors may indicate infective cause

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13
Q

which exam is always done when investigating acute urinary retnetion in elderly men?

A

PR exam to assess any prostate enlargement or constipation

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14
Q

which investigatiosn are avaible for acute urinary retention?

A

post voidal bladder scan- reveal vol of retained urine

routine bloods: FBC, U&Es, CRP

CSU (if post catheterisation)

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15
Q

what can happen following acute urinary retention that causes high intra-vesicular pressure?

A

hydronephrosis- urine backs up from baldder and ureters into kidneys, impairing kidnet clearance level

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16
Q

what management is available for acute urinary retention?

A

immediate urethral cathetirisation

treat underlying cause i.e. BPH

check CSU for infection and treat w antibiotics if necessary

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17
Q

what complication can occur in patients following acute-on-chronic retention resolved through cathetierisation?

(large retnetion volume >1000ml)

A

post-obstructive diuresis

kidneys can over diurese due to loss of their medullary concentration gradient which can take time to re-equilibrate

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18
Q

post-obstructuve diuresis can cause which further complication?

A

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

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19
Q

what is TWOC?

A

Trial without catheter

following retention- if patient can void with minimal residual volume considered succesfull

if patient re-enters retention they require re-catheterisation

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20
Q

main complications of urinary retention?

A

AKI which can lead to chronic kidney injury

inc risk of UTI

renal stones due to stasis

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21
Q

common causes of chronic urinary retention?

A

BPH in men

pelvic prolapse/ pelvic masses in women

neuoroligcal causes e.g. MS, parkinsons

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22
Q

how do patients in chronic urinary retention present?

A

painless urinary retention

may have assoc voiding LUTS such as poor flow, hesitancy

overflow incontinence may be present

palpable distended bladder on examination

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23
Q

what management is required following chronic urinary retention?

A

catheterisation

monitor for post-obstructive diuresis

TWOC

Intermittent self catheterisation

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24
Q

Haematuria can be classified into which categories?

A

Visible haematuria (macroscopic or gross)

Non-visible haematuria (microscopic or dipstick +ve)

can be symptomatic non visible (s-NVH) or asymptomatic (a-NVH)

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25
Q

what is pseudohaematuria?

A

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

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26
Q

what are urological causes of haematuria?

A

infection (pyelonephritis, cystitis, prostatis)

malignancy (urothelial carcinoma, prostate adenocarcinoma)

renal calculi

trauma/ recent surgery

radiation cystitis

parasitic (schistosomiasis)

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27
Q

what is the difference in total and terminal haematuria?

A

total- suggest bladder/ upper tract source

terminal suggests bladder irratation

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28
Q

which examination is essential in a patient presenting with haematuria?

A

abdo exam

PR exam

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29
Q

which investigations should be carried out following haematuria?

A

urinalysis- nitrites/ leukocytes may indicate infectious cause

Baseline bloods: FBC, U&Es, clotting, PSA

ACR in those with deranged renal fucntion

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30
Q

when do the NICE guidelines reccomend urgent referral to urological service for specialist haematuria investigation?

A

>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

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31
Q

what special investigations are available to assess haematuria cause?

A

flexible cystoscopy (gold standard)

urine cytology

US KUB imaging (typically cases of NV haematuria)

CT urogram (typically cases of V haematuria)

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32
Q

what % of patients with visible haematuria are found to have an underlyign malignancy?

A

20%

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33
Q

what are the 6 S’s when inspecting a scrotal lump?

A

Site

Size

Shape

Symmetry

Skin changes

Scars

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34
Q

what investigations are carreid out for scrotal lumps?

A

US of scrotum (first line)

blood tests/ further imaging

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35
Q

why are biopsies not carried out for suspected testiculat cancer?

A

risk of seeding cancer

instead diagnosis made purley on clinical features, US and histopathological exam of testis following orchidectomy

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36
Q

blood tests for which tumour markers can be carried in suspected testicular cancer?

A

lactate dehydrogenase (LDH)

alpha-fetoprotein (AFP)

beta-human chorionic gonadotrophn (beta-hCG)

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37
Q

how are scrotal lumps classified in origin?

A

testicuar

extra-testicular

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38
Q

what are extra-testicular causes of scrotal lumps? (5)

A

hydrocele

varicocele

epididymal cysts

epididymitis

inguinal hernia

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39
Q

what extra-testicular patholgy presents as an abnormal collection of fluid between the parietal and visceral layers of the tunica vaginalis enveloping the testis?

A

hydrocele

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40
Q

using a torch to shine light from behind a scrotal lesion is useful in diagnosing which pathology?

A

detects whether mass is fluid filled or not

hydroceles and epididymal cysts will classically illuminate

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41
Q

what is a varicocele?

A

abnormal dilation of the pampiniform venous plexus within spermatic cord

often described as ‘dragging’ or ‘bag of worms’

dissapears when lying flat

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42
Q

90% of varicoceles are found on which side?

A

Left- spermatic vein drains directly into left renal vein

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43
Q

what are the red flag signs for varicoceles?

A

acute onset

right-sided

remain when lying flat

(associated with infertility)

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44
Q

which common condition present with unilateral acute onest scrotal pain?

A

epididymitis

may be assoc swelling, erythematous overlying skin, fever

most commonly bacterial in origin

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45
Q

inguinal hernia pass into the scrotum via what structure?

A

external inguinal ring

enter the inguinal cancal initially at teh interal ring (indirect) ot through hesselbachs triangle (direct)

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46
Q

how are testicular lumps classically described?

A

painless lump arising in testis

firm irregular mass

mass does not transilluminate

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47
Q

testicular cancer is the most common malignancy in which pt population?

A

men aged 20-40yrs

urgent US for diagnosis

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48
Q

which condition presents suddenly with very severe unilateral scrotal pain often assoc with N/V?

A

testicular torsion

surgical emergency requiring scrotal exploration within 6 hours

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49
Q

lsit some benign testicular lesions?

A

leydig cell tumours

sertoli cell tumours

lipomas

fibromas

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50
Q

inflammaiton of the testis is known as?

A

orchitis

commonly following mumps virus

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51
Q

what are the subtypes of urinary incontinence?

A

stress incontinence

urge incontinence

mixed incontinence

overflow incontinence

continous incontinence

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52
Q

all patients presetnign with incontinence should have which investigation?

A

mid stream urine dipstick

post void bladder scans are useful in those with overflow UI

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53
Q

in cases of urinary incontinence with unclear cause what investigation can be useful?

A

urodynamic assessment

outflow urodynamics

cystoscopy

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54
Q

what lifestyle changes are encouraged in the first instance to manage UI?

A

wgt loss

reducing caffeine intake

avoid excessive fluid intake

smoking cessation

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55
Q

what are the conservative management options in urinary incontinece?

A

pelvic floor exercises

anti-muscarincs i.e. oxybutynin, tolterodine

bladder training (min 6 weeks)

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56
Q

what surgical managemtn options are considered in urinary incontinence?

A

for urge UI, botulinum toxin A injections, augmentation cystoplasty

for stress UI, tension-free vaginal tape, open colposuspension

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57
Q

bladder cancer is more common in which sex?

A

male >80yrs

M:F = 3:1

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58
Q

what are the subtypes of bladder cancer?

A

transitional cell carcinma (80-90% cases)

sqaumous cell carcinoma

adeconcarcinoma and sarcoma (rare)

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59
Q

bladder cancers can be further classified following cell type- what are these classifcations?

A

non-muscle invasive bladder cancer (70-80% cases)

muscle invasive bladder cancer

locally advanced or metastatic bladder cancer

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60
Q

what are the four layers of the bladder wall?

A

inner layer- transitional epithelium (urothelium)

connective tissue layer- lamina propria

muscular layer- muscularis propria

outer layer- fatty connective tissues

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61
Q

what are the 2 most important risk factors for bladder cancer?

A

smoking

increasing age

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62
Q

what is the most common presentation of bladder cancer?

A

painless visible/non-visible haematuria

may also present with recurrent UTIs/ LUTS

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63
Q

what are the T stages of bladder cancer?

A

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

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64
Q

what investigations are carreid out in those with suspected bladder cancer?

A

urgent cystoscopy

biospy (rigid cystoscopy)

CT imaging

TURBT (transurehtral resection of bladder tumour)

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65
Q

how are Tis and T1 bladder tumours typically managed?

A

resected via TURBT

adjuvant intravesical therapy may be required in higher risk cases

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66
Q

how are muscel invasive bladder cancer managed?

A

radical cystectomy +/- neoadjuvamt chemotherapy (typically cisplatin)

require follow up with CT imaging

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67
Q

how common is bladder cancer recurrence?

A

70% within 3 years for superficial bladder cancers

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68
Q

followin radical cystectomy how is urinary diversion acheived?

A

ilieal conduit formation- urine drains via urostomy

bladder reconstruction- segment of small bowel, urine drains urethrally or via catheter

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69
Q

why are B12 and folate checked alongside routine bloods following bladder reconstruction?

A

part of the ileum is resected during urinary diversion procedure

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70
Q

patients with locally advanced or metastatic bladder cancer are treated with which typical chemo regimes?

A

cisplatin- based regime

carboplatin + gemcitabne based regime

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71
Q

pyelonephritis (inflammation of kidney parenchyma) most commonly affects which patient populaiton?

A

women aged 15-29 yrs

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72
Q

what is meant by umcomplicated/ complicated pyelonephritis?

A

uncomplicated occurs in a structurally/ functionally normal urinary tract in a non-immunocomprimised host

complicated is the opposite (complicated in males by definition)

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73
Q

what is the most common caustitive organism of pyelonephritis?

A

E coli

others include: Klebsiella, proteua, enterococcus faecalis, S. aureus, pseudomonas

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74
Q

how do bacteria reach the kidney in pyelonephritis?

A

ascending from lower urinary tract

directly from blood stream

lymphatics (rarely)

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75
Q

which cell type infllltrate teh tubues and interstitium to cause supparitive inflammation in pyelonephritis?

A

neutrophils

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76
Q

what are the risk factors for developing pyelonephritis?

A

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)

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77
Q

what triad is classically seen in pyelonephritis?

A

fever, unilateral loin pain, N&V

(typically develops over 24/48 hrs)

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78
Q

what diagnosis when suspect of pyelonephritis is important to exlcude?

A

potential AAA rupture

(back pain/ tachy/ hypotension)

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79
Q

what investigations should be carried out to confirm diangosis of pyelonephritis?

A

urinalysis

urine culture

FBC, U&Es, CRP

renal US scan (for evidence of obstruction)

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80
Q

if renal US scan shows evidince of obstruction what should next be performed?

A

non-contrast CT imaging (CT KUB)

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81
Q

how is pyelonephritis managed?

A

systemically unwell use A-E approach

start empirical antibiotics

IV fluids

consider admission in those who are more at risk of complication

82
Q

what complications can occur following pyelonephritis?

A

severe sepsis

multi-organ failure

renal scarring → CKD

pyonephrosis

83
Q

repeated infections can lead to chronc pyelonephritis. What will be seen on imaging?

A

small, scarred shrunken kidney

84
Q

how does emphysematous pyelonephritis differ from acute pyelonephritis?

A

rare and severe form of pyelonephritis, caused by gas-forming bacteria

wil fail to responf to empirical antibiotics

85
Q

emphysematous pyelonephritis is most common in which patient population?

A

diabetic patients

(high glucose allows CO2 production from fermentation by enterobacteria)

86
Q

how are cases of empyhsematous pyelonephritis treated?

A

mild cases treated with broad-spectrum anti-microbial cover

severe cases may warrant nephrostomy insertion or percutaneous drainage

87
Q

what is pyonephrosis?

A

complication of pyelonephritis- infeected, obstructed kidney

88
Q

how are renal cysts classified?

A

simple or complex

89
Q

what are the charactersitics of simple renal cysts?

A

well defined outline and homogenous features

common in elderly- 50% in >50yrs

develop from renal tubule epithelium

90
Q

what are the characteristics of complex renal cysts?

A

thick walls, septations, calcification, heterogenous enhancement on imaging

higher risk of malignancy

91
Q

what system is used to classify complex cysts?

A

Bosniak classification

92
Q

risk factors for developing renal cysts?

A

increasing age, smoking, hypertension, male gender

genetics: PCKD, tuberous sclerosis, von hippel-lindau disease

93
Q

what pattern of inheritance does polycystic kidney disease follow?

A

Autosomal dominant (ADPKD)

autosomal recessive (ARPKD) v rare- usually diagnosed in-utero, 60% neonates will not survive >1 month

94
Q

which genes are effected in ADPKD?

A

PKD1, PKD2 genes

causes multiple renal cysts to form

95
Q

in addition to renal cysts which pathology is assoc with ADPKD?

A

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

96
Q

clinical features of renal cysts?

A

often found incidentally as typically asymtpomatic

can include: flank pain, haematuria

may present with uncontrolled hypertension or flank mass

97
Q

what is the main differntial for any renal cyst?

A

renal cell carcinoma

imaging to investigate

98
Q

how are renal cysts investigated?

A

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)

99
Q

what should be checked in the patients blood when investigating renal cysts?

A

serum U&Es for renal function

100
Q

when is MRI favoured over CT when investigating renal cysts?

A

those with a known genetic risk and in younger patients

101
Q

what are the Bosniak stages?

A

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

102
Q

what is the suggested management for wach Bosniak stage?

A
  • I- No follow up
  • II- No follow up
  • II F- CT scan at 3, 6, & 12 months
  • III- Surveillance or surgical
  • IV- Surgical
103
Q

what are the management options for symptomatic simple renal cysts?

A

simple analgesia

needle aspiration

cyst deroofing*

*usually done laparoscopically- cyst aspirated and part of the wall excised to discourage cyst recurrence

104
Q

although rare what are the possible complications of renal cysts?

A

infection, haemorrhage and rupture

105
Q

what is the most common form of adult renal tumour?

A

Renal Cell Carcinoma

(accounts for 85% of all renal malignancies)

106
Q

other than RCC what renal malignacies can occur?

A

transitional cell carcinoma (urothelial)

nephroblastoma in children (Wilms tumour)

squamous cell carcinomas (chronic inflammation second to renal calculi, infection)

107
Q

where in the kidney do renal cell carcinomas occur?

A

renal cortex, arise predominatnly from proximal convoluted tubules most often appearing in upper pole of the kidney

108
Q

what can be seen microscopically when concerned with renal cell carcinoma?

A

polyhedral clear cells

dark stainign nuclei and cytoplasm rich with lipid and glycogen granules

109
Q

how do renal cell carcinomas spread?

A

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

110
Q

what is meant by ‘tumour thrombosis’ a feature distinct to RCCs?

A

invasion through the renal vein and into the lumen

111
Q

what is teh most common risk factor for renal cell carcinoma?

A

smoking- doubles the risk

112
Q

which genetic disorders can predispose to RCCs?

A

von Hippel-Lindau disease

BAP1 mutant disease

Birt-Hogg-Dube syndrome

113
Q

what is the most common presenting complaint for RCCs?

A

haematuria, either visible or non-visible

may also report flank pain, flank mass, wgt loss/ lethargy

114
Q

left sided renal masses such as RCC may also present with what left sided feature in males?

A

varicocele due to compression of left testicular vein as it joins the left renal vein

115
Q

which investigations should be carried out in cases where RCC is suspected?

A

routine bloods: FBC, U&Es, Ca, LFTs, CRP

urinalysis

CT imaging with IV contrast (gold standard) + chest for staging

116
Q

what is the management for renal cell carcinoma in localalised disease?

A

surgical management

partial nephrectomy (smaller masses)

radical nephrectomy (larger)

117
Q

what management options are available for RCC in those pts not fit enough for surgery?

A

percutaenous radiofrequency ablation

cryotherapy

renal artery embolisation for haemorrhaging disease/ unresectable paliative cases

118
Q

what is the management for renal cell carcinoma in metastatic disease?

A

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

119
Q

what % of pts with renal cell carcinoma have metastatic disease at presentation?

A

25%

120
Q

what are urinary tract stones most commonly made of?

A

80% are made of calcium as either calcium oxalate (35%), calcium phosphate (10%) or mixed (35%)

121
Q

other than calcium urianry tract stones can be made of what?

A

struvite

urate

cystiene

122
Q

which urinary tract stone is the only radiolucent stone?

A

urate stones

123
Q

which stone is largely responsible for staghorn calculi?

A

struvite stones- they are large and soft so will fill teh renal pelvis

124
Q

high levels of what cause the formation of urate stones?

A

high levels of purine in the blood- red meat in diet, haematological disorders i.e myeloproliferative disease

125
Q

what results in cysteine stones?

A

homocystinuria- inheritede defect affesting the absorptiona nd transport of cystiene in the bowel and kidneys

126
Q

what points are most likely to be affected by renal stones?

A

pelviureteric junction- renal pelvis becomes the ureter

crossing pelvic brim- iliac vessels travel across ureter in pelvis

vesicoureteric junction- ureter enters bladder

127
Q

what is the most common presenting symptom of renal stones?

A

pain- ureteric colic

sudden, severe, radiates from flank to pelvis and N&V

haematuria also occurs in 90% of cases (NV)

128
Q

what are the differentials for flank pain?

A

ureteric stone

pyelonephritis

ruptured AAA

biliary pathology

bowel obstruction

lower lobe pneumonia

MSK pain

129
Q

which investigations should be carried out ot confrim daignosis of ureteric stones?

A

urinalysis and routine bloods

urate and calcium levels

non-contrast CT KUB (gold standard)

AXR and US

130
Q

how are patients with renal stones managed?

A

adequate fluid resecitation

sufficient analgesia

IV antibiiotic therapy if infection evident

131
Q

what is the criteria for inpatient admission of renal stones?

A

post-obstructive acute kidney injury

pain ncontrolled with simple analgesia

evidence of infected stone(s)

large stones (>5mm)

132
Q

when are patients with renal stones considered for stent insertion or nephrostomy?

A

obstructive nephropathy or significant infection

133
Q

Extracorpeal Shock Wave Lithotripsy (ESWL) is reserved for which stones?

A

small stones <2cm

134
Q

which definitive management is reserved for renal stones only, particulary larger stones i.e. staghorn calculi?

A

percutaenous nephrolithotomy (PCNL)

135
Q

which renal stone management involves passing a scope retrograde up into the ureter?

A

flexible uretero- renoscopy (URS)

136
Q

what complications can follow ureteric stones?

A

infection

post renal AKI

recurrent stones can lead to renal scarring and loss of kidney function

137
Q

if someone present with recurrent calcium stone formation what test should be performed?

A

PTH levels checked to exclude primary hyperparathyroididm

138
Q

bladder stones are commonly seen on patients with which condition?

A

chronic urinary retention

can also occur secondary to infections (classically schistosmiasis)

139
Q

what is the definitive managemnt of bladder stones?

A

cystoscopy

140
Q

chronic irritation of bladder epithelium following multiple bladder stones can predispose to what?

A

SCC bladder cancer

141
Q

BPH is a histological diagnosis characterised by what tissue?

A

non-cancerous hyperplasia of glandular-epithelial and stromal tissue

142
Q

the prostate converts testosterone to dihydrotestosterone (DHT)using what enzyme?

A

5a-reductase

143
Q

risk factors for developing BPH?

A

increasing age

family history

afro carribean ethnicity

obesity

144
Q

how do patients with BPH generally present?

A

LUTS either voiding (hesitancy, poor flow, dribbling),

or storage symtpoms (frequency, nocturia, UI)

145
Q

Whch examination is necessary when investigating BPH?

A

Dgitial Rectal Exam (PR)

distinguishes from prostate cancer

146
Q

as part of teh inital assessment for BPH patients should complete which questionnaire?

A

International Prostate Symtpom Score (IPSS)

each question rated 0-5:

0-7 mild

8-19 moderate

20+ severe

147
Q

differential diagnoses for BPH?

A

prostate cancer

UTI

overactive bladder

bladder cancer

148
Q

which investigations should be carried out follwoing suspect BPH?

A

urine frequency and volume chart

PSA

US of renal tract

urodynamic studies

149
Q

how are patients with BPH managed medically?

A

a-adrenoreceptor antagonist (a-blocker) i.e. tamsulosin

5a-reductase inhibitors i.e. finasteride

150
Q

how are patients with BPH managed surgically?

A

Transurethral Resection of the Prostate (TURP)-

151
Q

what are the potential complications of BPH?

A

high-pressure retention where urianry retention can reault in post-renal kidney injury

UTIs

haematuria

152
Q

what is TURP syndrome?

A

rare complication of TURP- fluid overload and hyponatraemia

presentation: confusion, nausea, agitation, visual changes

153
Q

the majority of prostate cancers are which type of patholgy? Where do these typically arise?

A

adenocarcinomas (>95%)- peripheral zone

can be multifocal

154
Q

what two types can prostate cancer be categorised into?

A

Acinar adenocarcinoma- glandular cells that line prostate

Ductal adeoncarcinoma- cells that line the ducts of the prostate

155
Q

which type of prostate cancer is more likely to metastasiise?

A

ductal adeonocarcinoma grows and metastasises faster than acinar though less common type

156
Q

what risk factors are there for prostate cancer?

A

Increasing age

Black african or carribean ethnicity

family history

(obesity, diabetes, smoking)

157
Q

how is prostate cancer investigated?

A

PSA

biopsies of prostatic tissue

mulit-parametric MRI

158
Q

what are the two current methods available for prostate biospy?

A

transperineal (template) biopsy

Transrectal US guided (TRUS) biopsy

159
Q

which system is used to grade prostate cancers?

A

Gleason Grading system

higher score = poorer prognosis

160
Q

how is prostate cancer staged?

A

abdomino-pelvic CT

bone scan

161
Q

what three parameters are used to determine the level of risk in prostate cancer?

A

PSA

Gleason Score

Clinical stage (T from TNM)

162
Q

what is the difference in watchful waiting and active surveillance of low risk prostate cancer pts?

A

watchful waiting- symtpom guided

active surveillance- monitor pts 3-monthly PSA, 6 month/yrly PR and re-biopsy at 1-3yrs

163
Q

how can prostate cancer be managed surgically?

A

radical prostectomy

removal of prostate gland, seminal vesicles, surroundign tissue +/- dissection of pelvic lymph nodes

164
Q

other than surgery what therapies are available for prostate cancer?

A

radiotherapy

chemotherapy i.e. docetaxel, cabazitaxel

androgen deprivation therapy i.e enzalutamide, abiraterone (reserved for metastatic disease)

165
Q

what are the common causitive organisms of prostatis?

A

E.coli

enterobacter

serratia

pseudomonas

proteus

166
Q

what are risk factors for prostatis?

A

indwelling catheter

phimosis/ urethral stricture

recent surgery/ cystoscopy

immunocompromised

167
Q

a very tender and boggy prostate is classically seen in which condition?

A

prostatis

168
Q

chronic prostatis can be diagnosed after experiencing symtpoms for how long?

A

3 months

169
Q

what investigation is first line in prostitis?

A

urine culture

consider STI screen and routine bloods

170
Q

if pts with prostatis fail to respond to antibitoic therapy what needs to be rule out?

A

prostate abscess- rule out using transrectal prostatic ultrasound (TRUS) or CT

171
Q

how is prostatis managed?

A

prolonged antibiotic treatment

typically quinolone

172
Q

who is most commonly affected by epididymitis?

A

males aged 15-30yrs and again in >60yrs

173
Q

which is rarer to occur on its own, epididymitis or orchitis?

A

orchitis

(usually occur together)

174
Q

what is the msot likely mode of infection in epididymitis?

A

Sexual transmission in <35yrs

local extension of infection from bladder/ urethra

175
Q

orchitis can occur as a complication follwoing which viral infection?

A

mumps

176
Q

what are the clinical features of epididymitis?

A

unilateral scrotal pain

red and swollen

cremasteric reflex intact

Prehns sign +ve

177
Q

differentials of epididymitis?

A

testicular torsion

testicular trauma

testicular abscess

epididymal cyst

hydrocele

178
Q

how is epididymitis investigated?

A

urine dipstick

STI screen

routine bloods- assess infective cause

US doppler imaging

179
Q

how are epsiodes of epididymitis managed?

A

antibiotic therapy- ofloxacin for enteric organsisms, ceftriaxone for STI organisms

sufficient analgesia

abstain from sexua activity

180
Q

males with which deformity are more prone to developing testicular torsion?

A

bell-clapper deformity

(horizontal lie to their testes- more mobile)

181
Q

is the cremasteric reflex present in testicular torsion?

A

NO- reflex absent

Prehns sign also -ve

182
Q

the ‘blue dot’ sign occurs in which urological condition?

A

torsion of hyatid of morgagni- visible infarcted hyatid

(remnant of mullerian duct)

183
Q

testicular cancer is msot common in which age group?

A

20-40yrs

184
Q

testicular tumours are categorised in which types?

A

germ cell tumous

Non-germ cell: Seminomas or non-seminomatous GCTs

185
Q

Non-germ cell tumours comprise of which cells?

A

Leydig cells

Sertoli cells

Benign tumours

186
Q

non-seminmatous germ cell tumours (NSGCTs) inculde which tumour types?

A

yolk sac tumours

choriocarcinoma

embryonal carcinoma

teratoma

187
Q

are seminomas or non-seminomatous GCTs more likely to have a poorer prognosis?

A

non-seminomatous CGTs- metastasise early

seminomas stay localised

188
Q

risk factors for testicular cancer?

A

cryptorchidism (undescended testes)

prev. testicular malignancy

+ve family history

klienfelters syndrome (XXY)

189
Q

how are testicular cancers investigated?

A

tumour markers: BHCG, AFP

scrotal US

CT imaging with contrast of chest/abdo/pelvis to stage

190
Q

what system is used to stage testicular cancer?

A

Royal Marsden Classification (I-IV)

191
Q

what are the main treatment options for testicular cancer?

A

surgery, radiotherapy and chemotherapy

192
Q

urethritis cause can be classified into one of which two types?

A

gonococcal (N. gonorrhoeae) or non-gonococcal (C. trachomatis, M. genitalium)

193
Q

Risk facotrs for urethritis?

A

<25yrs

MSM

previous STI

multiple sexual partners

194
Q

typical presenting symptoms of urethritis?

A

dysuria, penile irritation, discharge

195
Q

differentials for urethritis?

A

balanitis

acute prostatis

cystitis

196
Q

how is urethritis investigated?

A

urethral gram stain from urethral swabs

first void urine sent for NAAT

urine dipstick

197
Q

what can be seen microscopically if gonococcal infection is causitive organism?

A

gram negative diplococci

198
Q

how is urethritis treated?

A

gonococcal- ceftriaxone + azithromycon

non-gonococcal- Doxycycline or azithromycine

199
Q

what is priaprism?

A

unwated painful erection no assoc w sexual desire lasting >4hrs

200
Q

what is paraphimosis?

A

inability to pull forward retracted foreskin over teh glans

201
Q

penile cancer has a strong association with which virus?

A

HPV subtypes 16, 6 and 18

202
Q

how does penile cancer typically present?

A

palpable or ulcerating lesion on the penis- most commonly the glans

Surgery (3 decks)

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