Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

CP3 Surgery > Urology > Flashcards

Urology Flashcards

1
Q

What are the symptoms of Lower UTI?

A 
Frequency and nocturia 
Dysuria 
Urgency 
Haematuria 
Smelly urine 
Suprapubic pain / tenderness
Stranguary: painful, frequent urination of small volume, expelled only by straining despite a severe sense of urgency
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the predisposing factors to lower UTI?

A

Female sex: due to short urethra
pregnancy: dip during and treat due to risk of premature Labour
Menopause
Obstruction / tract malformation
Catheter: always infected, do not investigate unless symptomatic
Diabetes: glycosuria, reduced host defences

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What investigations should be done for a patient with a suspected infection?

A

Urine dipstick: double positive: nitrates and leucocytes
Midstream urine MCS (confirms diagnosis if >10^5 pathogenic organisms/ml
Urine dip is very often double positive in a hospital population

MSU
?ask about discharge

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are the causes of sterile pyuria? (raised WBC but no organisms grown)

A 
Recently treated UTI
Appendicitis
TB
chlamydia
Bladder cancer
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What circumstances should prompt further investigations for UTI?

A

Males, children, treatment resistant UTI, recurrent UTI, if pyelonephritis suspected or if an unusual organism is grown:

USS: to assess for renal scarring or obstruction (hydronephrosis)
CT/IV urography: to exclude small stones, tumours or bladder diverticula

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is the most common organism causing UTI?

A

E.Coli (75%)

Others: Proteus, Staphylococcus, streptococcus, Klebsiella, Pseudomonas

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is the treatment of UTI?

A

Advice: drink plenty of fluids and urinate often
Empirical: Nitrofurantoin 100mg BD for 3 days (review when MCS comes back)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is the treatment of pyelonephritis?

A

IV tazocin 4.5g TDS )review when MCS comes back)

therapy continued for at least 7 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

How is a UTI / asymptomatic bacteriuria in pregnant women treated?

A

Treat - follow local guideline / speak to microbiology

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

How is recurrent UTI managed?

A

Advice on high fluid intake, frequent voiding (after sex)
avoidance of spermicidal jellies and avoidance of constipation

If this fails, prophylaxis with trimethoprim / nitrofurantoin at night may be started

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are the treatment outcomes for UTIs

A

Eradication: no further infection
Relapse: recurrence of the same infection within 7 days due to inadequate eradication of infection
Reinfection: bacteriuria absent for at least 14 days, but recurs due to susceptible tract

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What does acute ureteric obstruction cause?

A

Enlargement of the urinary tract, superior to the obstruction
Dilation of the renal pelvis is known as hydronephrosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are the causes of ureteric obstruction?

A

Luminal, mural, extramural

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are the luminal causes of ureteric obstruction?

A 
Calculus (stone)
sloughed renal papilla (in diabetes / long term NSAID use)
Blood clot 
TCC of the renal pelvis / ureter 
Bladder tumour
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are the mural causes of ureteric obstruction?

A 
Ureteric stricture (TB, post-calculus, post-surgery) 
Congenital pelviureteric neuromuscular dysfunction 
Congenital megaureter
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are the extramural causes of ureteric obstruction?

A

Pelviureteric compression (due to external tumours, diverticulitis, AAA, retroperitoneal fibrosis)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What are the symptoms / signs of ureteric obstruction?

A

Varying loin pain to groin pain - greater when urine volume increases (alcohol / diuretics)

Anuria (if complete bilateral obstruction) / polyuria (if partial blockage causes renal impairment) due to post-renal AKI

Loin tenderness and palpable hydrfonephrotic kidney

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What investigations should be done for ureteric obstruction?

A

Urine MCS
USS to confirm upper tract dilation
Abdominal plain film
CT to outline detailed cause of obstruction

Retrograde pyelogram may be used at cystoscopy to further outline ureteric abnormalities (e.g. TCC)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is the management of ureteric obstruction?

A

Analgesia - rectal diclofenac
Nephrostomy may be required to decompress the pelvicalyceal system, preserving the kidney function and preventing infection from developing

Surgical management: e.g. stenting may be required depending on the cause

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Where do renal calculi form?

A

In the collecting ducts - may be deposited anywhere from the renal pelvis to the urethra

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Where are the classic sites of renal calculi deposition?

A

Pelviureteric junction, pelvic brim and vesicoureteric junction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What are renal stones most commonly made of?

A

Calcium oxalate (75%) with other being magnesium ammonium phosphate or urate based

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Describe the lifetime risk of kidney stones?

A

15% lifetime risk, peak age 20-40 years, M:F 3:1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

How do patients with kidney stones present?

A

Renal colic: excruciating loin to groin spasms, with nausea and vomiting, patient often cannot lie still
Occurs if stone is impacted in the ureter

Dull loin pain: if the stone is in a major/minor calyx

UTI: secondary to the partial / complete obstruction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
What are the risk factors for kidney stones?
Obesity, Dehydration / low fluid intake Family history, personal history of stone disease Anatomical abnormalities
26
What are the investigations for kidney stones?
Bloods: include calcium, phosphate, glucose, bicarbonate and urate levels Urine dip: 95% positive for blood, rule out infection bHCG is vital Urine MCS Imaging: AXR - 80% visible Non-contrast CT: 99% visible, can exclude abdominal ddx
27
What is the acute management of renal stones?
``` A-E + fluids 75mg diclofenac PR (post renal Aki beware) IV metaclopramide IV abx if signs of infection Assess whether admission is required ```
28
What are the requirements for admission with a stone?
If there is still severe pain at 1 hour If there is a risk of AKI If there are signs of shock / infection If there is uncertainty over diagnosis
29
What are the indications for active treatment of renal stones?
``` Low chance of spontaneous passage (>10mm) Persistent pain Ongoing obstruction Signs of infection Renal insufficiency ```
30
What are the active treatments of renal stones?
Extracorporeal shockwave lithotripsy (ESWL) - shock waves to break the stone Uretoscopy Percutaneous nephrolithotomy
31
What is ESWL?
Outpatient procedure that focuses shock waves on the stone to break it up, and it can then be passed spontaneously If there is a hydronephrosis present, they may need a percutaneous nephrostomy to decompress the pelvicalyceal system prior to outpatient ESWL
32
What is uretoscopy?
Small telescope passed into the ureter - basket retrieval or laser / shock waves / electrical energy to fragment
33
What is percutaneous nephrolithotomy used for?
Renal (NOT ureteric calculi) that do not respond to ESWL Scope inserted through small incision in the back to remove kidney stones
34
What are the medical treatments for renal stones?
Tamsulosin (first line / alpha blocker) or nifedipine increase the rate of spontaneous expulsion Advice for home: 80% pass naturally High fluid intake Advise to return if there is any increase in pain, or signs of infection First time stone formers - pass urine through a sieve to try and collect the stone for analysis Refer the patient to urology within 1 week
35
What are the causes of bladder calculi?
Bladder outflow obstruction Presence of a foreign body (prolonged catheterisation_ Upper urinary tract stone passing down
36
What is the presentation of bladder calculi?
Symptoms of UTI as there is often significant bacteriuria (frequency, pain and haematuria) Haematuria and pain generally occur at the END of micturition as the bladder contracts IN males, the pain can be felt at the tip of the penis, rather than a general burning There also may be perineal pain if there is trigonitis and anuria / bladder distension if the stone is obstructing
37
What are the investigations / managements for bladder calculi?
Investigation = same as upper urinary tract stone Bloods: include calcium, phosphate, glucose, bicarbonate and urate levels Urine dip: 95% positive for blood, rule out infection bHCG is vital Urine MCS Imaging: AXR - 80% visible Non-contrast CT: 99% visible, can exclude abdominal ddx - CTKUB MX: medical expulsive / ESWL if the stone is large
38
What are the complications of bladder stones?
Can predispose to SCC
39
What does a renal cell carcinoma arise from?
Proximal tubular epithelium | Accounts for 90% renal tumours
40
What is the main risk factor for renal cell carcinoma?
Prolonged harm-dialysis (15% develop this)
41
What is the presentation of renal cell carcinoma?
50% incidental 10% = classic triad of haematuria, loin pain and an abdominal mass plus vague B symptoms Rarely, invasion of the left renal vein leads to a varicocele May be signs of polycythaemia / HTN (if renin / EPO secretion)
42
What investigations can be done for renal cell carcinoma?
Urine cytology USS can differentiate solid from cystic mass CT/MRI to assess tumour CXR: cannon ball metastases Renal angiography (if considering partial nephrectomy)
43
What is the management of renal cell carcinoma?
Radical nephrectomy Partial nephrectomy: If perineal tumour smaller than 5cm or if bilateral tumours / poor kidney function Post-operative chemotherapy
44
What is prognosis like for RCC?
65% 5 year survival if N0, 25% if nodal involvement, 5% if distant mets
45
What % of childhood malignancies are Wilm's tumours?
20% childhood malignancies
46
What Is a Wilm's tumour?
Undifferentiated mesodermal tumour Generally presents at 3.5 years with flank pain and an abdominal mass Should not be biopsied Treatment is with nephrectomy, with pre-operative chemotherapy
47
Who gets renal cysts?
Elderly - 50% will have a renal cyst by the age of 50 Often asymptomatic, or can cause haematuria / pain PKD is a common cause, with other causes being medullary cystic disease (childhood disease leading to ESRF) or medullary sponge kidney
48
What type of epithelium lines the calyces, renal pelvis, ureter, bladder and urethra?
Transitional cell epithelium | therefore get transitional cell carcinoma
49
What are the risk factors for transitional cell carcinoma
smoking aromatic amines: rubber / plastic / dye industry workers chronic cystitis pelvic irradiation
50
What is the presentation of transitional cell carcinoma?
Painless haematuria +/- clots: most common presentation recurrent UTI Voiding symptoms Pain from invasion of local structures
51
What investigations should be done for TCC?
Urine MCS / cytology (cancers can cause sterile pyuria) cystoscopy and biopsy (gold standard) CT/MRI or lymphangiography to assess spread
52
What is the treatment of TCC?
Carcinoma in situ, or T1 bladder carcinoma: transurethral resection of bladder tumour (TURBT) at cystoscopy with intravesical chemotherapy 5 year survival = 95% T2/T3 / high grade: radical cystectomy is gold standard with pre-operative chemotherapy ileal conduit is used to leave an urostoma T4: invasion beyond the bladder: treated palliatively Long-term follow up with cystoscopy is then required
53
What other types of bladder cancer are there?
SCC of the bladder (more rare), however presents similarly Risk factors are anything that irritates the lining of the bladder leading to squamous metaplasia e.g. schistomiasis or bladder calculi
54
What is the management of trauma to the bladder?
Intraperitoneal bladder rupture - treated with laparotomy and suturing of the bladder Extraperitoneal bladder rupture: treated conservatively with prolonged urethral or suprapubic catheterisation
55
What are the causes of bladder outlet obstruction?
Luminal Mural extramural
56
What are the luminal causes of bladder outlet obstruction?
bladder tumour
57
What are the mural causes of bladder outlet obstruction?
urethral stricture (post calculus / infection) congenital abnormalities neuropathic bladder
58
What are the extramural causes of bladder outlet obstruction?
BPH / Prostatic carcinoma | Phimosis / paraphimosis
59
What are the clinical features of bladder outlet obstruction?
Suprapubic pain Hesitancy and diminished force of the stream Terminal dribbling Overflow incontinence (retention with overflow, leakage of small amounts) Signs of infection due to stasis of urine
60
What are the signs of bladder outlet obstruction?
Palpable full bladder Loin tenderness / palpable hydronephrotic kidney Enlarged prostate on PR (poor sensitivity for prostatic obstruction)
61
What investigations can be done for bladder outlet obstruction?
Bloods: FBC (infection), U+Es Urine: Dip, MCS USS: hydronephrosis CT/MRI
62
What is the management of bladder outlet obstruction?
Catheterisation (suprapubic, urethral) Beware of large diuresis following relief of obstruction Find and treat underlying cause
63
What is BPH?
Benign nodular / diffuse proliferation of glandular layers of the prostate, leading to enlargement of the inner transitional zone affects 70% of those over 70
64
What are the symptoms of BPH?
Filling symptoms: due to bladder overactivity Frequency, first noticed as nocturia Urgency / stranguary Voiding symptoms: due to bladder outlet obstruction: hesitancy, poor/intermittent stream, post-void dribbling, stranguary symptoms due to complications: occasionally haematuria (rupture of veins into the cyst) Symptoms of associated UTI
65
What investigations are done for BPH?
``` PR: typically sulcus = still palpable Frequency / volume chart Bloods: FBC, U&Es, PSA Urinalysis / MCS Uroflowmetry Bladder USS (pre/post-void) Transrectal USS +/- biopsy to rule out carcinoma ```
66
What is PSA?
Prostate cancer marker, concentrations below 4.0ng/mL are deemed normal Can be adjusted 'normal' tased on age and prostate size
67
What are the positive findings for BPH from uroflowmetry
Requires >150ml to be voided | Flow rate <12ml/sec suggests obstruction or weak bladder contractility
68
What are the complications of BPH?
``` UTI overflow incontinence Bladder calculi Bladder diverticulae Bilateral hydronephrosis and renal failure ```
69
What is the acute management for BPH?
(acute retention): attempt urethral catheter drainage | Suprapubic drainage if urethral catheterisation not possible
70
What lifestyle modifications can be told to treat non-acute BPH?
Avoid alcohol / caffeine Relax when voiding Void twice in a row to help emptying Bladder retraining therapy Watchful waiting, if more troublesome, medical therapy
71
What medical treatments can be given for BPH urinary relief?
Alpha-blockers e.g. doxasosin / tamsulosin reduce smooth muscle tone SE: drowsiness, dizziness, depression, hypotension 5-alpha-reductase inhibitors e.g. finasteride Stop conversation of testosterone to dihydrotestosterone, thus decreasing enlargement but effects are slow. SE: impotence and reduced libido and it is excreted in semen so condoms should be used
72
What are the surgical options for BPH?
transurethral resection of the prostate: Holmium laser prostatectomy (HoLEP) - endoscopic, used for very large prostates
73
What are the long term effects of TURP?
10% risk of impotence and 20% will need a repeat within 10 years retrograde ejaculation almost universal after procedure other Risks are bleeding / and rarely TURP syndrome absorption of washout leads to hyponatremia and fits
74
What are the long term effects of HoLEP?
Urinary incontinence if too much gland is removed
75
What kind of cancers are prostate carcinomas?
Adenocarcinomas, arising in the peripheral prostate thus, biopsy must be transrectal
76
How does prostate cancer spread?
Local (seminal vesicles, bladder, rectum), lymphatic or haematogenous, classically to bone Risk factors: family history and raised testosterone levels
77
What is the presentation of prostate cancer?
Often asymptomatic, found on PR / histology of BPH resection May present with filling, voiding or complication symptoms, as per BPH Weight loss / bone pain suggest metastatic disease On examination - hard and craggy prostate
78
What investigations should be done for prostate cancer?
PR: vital to give clinical T stage PSA: rises >10ng are highly suggestive of tumour Affected by many factors, thus not a reliable screening method Mountain biking, infection, recent intercourse (48h), cystoscopy Transrectal USS/biopsy Vital for Gleason grading Bone XR / scan and contrast enhanced MRI for staging
79
What is the Gleason grade? how is it done?
2 areas of tissue are graded out of 5 to give a combined score out of 10 Gleason grade is vital for prognosis; scores of 6 or less considered 'low risk' and 8 or more 'high risk'
80
What is the D'amico risk stratification?
Gleason score + clinical score + PSA to give a more accurate prognostic score than using Gleason alone
81
What is the management for localised prostate cancer (T1/T2)
Active surveillance: regular PSA / DRE / re-biopsy monitoring Radiotherapy / brachytherapy Surgery: radical prostatectomy is tx of choice BUT risks of impotence / incontinence
82
What is the management for advanced prostate cancer (T3/T4)
Active surveillance not recommended Choice between radiotherapy and surgery No difference in outcomes between the two
83
How is metastatic prostate cancer managed?
Hormonal therapy, GnRH agonists e.g. goserelin / buserelin Can be palliative or used in high-risk disease as an adjunct to a curative treatment First stimulate, then inhibit pituitary LH release, thus reducing testosterone production An anti-androgen such as cytoproterone acetate is co-prescribed initially to prevent the early rise in testosterone

CP3 Surgery (12 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions