Urology Flashcards
Stress incontinence aetiology
Detrusor pressure > Closing pressure of urethra
Obesity
Menopause - Lack of oestrogen
Pelvic radiation
Childbirth / pregnancy
Stress incontinence presentation and investigations
Involuntary passage of urine with increase in intra-abdominal pressure
- Coughing
- Sneezing
- Laughing
Urine dip / MC&S - Infection?
F/V chart - Normal
Urodynamics - Pre-surgery
Stress incontinence management
Conservative
- Lose weight
- Stop smoking
- Pelvic floor exercises - 3 months
- Decrease caffeine
- Reduce fluid intake
SSRI - Duloxetine
Surgery - TVT
Urge incontinence aetiology
Overactive bladder
Overactive detrusor muscle
Obesity
Neuro disease
- MS
- Stroke
- Parkinson’s
Urge incontinence presentation and investigations
Key in door syndrome!
- Urgency
- Frequency
- Nocturia
Investigations
- Urine dip / MC&S - Infection?
- F/V chart - Increased frequency
- Urodynamics - Pre-surgery
Urge incontinence management
Conservative - Bladder retraining!
- Lose weight
- Stop smoking
- Pelvic floor exercises - 3 months
- Decrease caffeine intake
- Reduce fluid intake
Ach antagonist - Oxybutynin - Falls risk!
M3 agonist - Mirabegron
Botox injections
BPH aetiology
5a reductase converts testosterone into dihydrotestosterone
Hypertrophy of cells in transitional zone
Narrowing of urethra
Increase in smooth muscle contractility
50% of men aged 50 - 30% symptomatic
80% of men aged 80
BPH presentation
Voiding symptoms - Obstructive
- Weak / intermittent flow
- Straining
- Hesitancy
- Terminal dribbling
- Incomplete emptying
Storage symptoms - Irritative
- Urgency
- Frequency
- Urgency incontinence
- Nocturia
BPH investigations
- PSA - Prostate cancer?
- DRE
- TRUS
Scoring system - International Prostate Scoring System
Urine dip / MC&S
USS-KUB
F/V chart
BPH management
Behavioural - E.g. fluid restriction at night
A-blocker - Tamsulosin / Doxasozin
- Postural hypotension
- Sexual dysfunction
5a reductase inhibitor
- Finasteride
- Gynaecomastia
Surgery - TURP
BPH complications
Urinary retention
Hydronephrosis
Stones
Infection
TURP syndrome!
- Aetiology - Long surgery / Large blood loss
- Clinical features - Fluid overload, hyponatraemia, headache
- Management - Supporting, correct hyponatraemia
Prostate cancer aetiology
Peripheral zone
Adenocarcinoma
Family history Black ethnicity Dietary fat BRCA HPC-1
Prostate cancer presentation
Bladder outlet obstruction
- Nocturia
- Frequency
- Hesitancy
Haematuria
Pain
- Perineal
- Testicular
- Back - Secondary to metastases
Weight loss
Prostate cancer investigations
- PSA
- TRUS + Biopsy
- DRE - Asymmetrical, hard, nodular, loss of median sulcus
+ MRI
+ CT/PET staging
Urine dip / MC&S
+ Markers
- Serum - PSMA
- Urinary - PCA3
Prostate cancer metastases and staging
Bone
Lung
Liver
Staging
- Non-palpable / non-visible
- Palpable / visible
- Beyond capsule
- Beyond seminal vesicles
Prostate cancer management
T1/2
- Active monitoring
- Brachytherapy
- Prostatectomy
T3/4
- Hormonal
- Brachytherapy
- Prostatectomy
Metastatic
- Synthetic GnRH
- Anti-androgen
- Orchidectomy