Urology Flashcards
Prostate and bladder conditions?
BPH, prostate cancer, bladder cancer
Scrotal masses conditions?
Varicocele, hydrocele, epididymitis and orchitis, testicular cancer
Acute urology conditions?
Testicular torsion and urinary tract calculi
Urinary catherterisation
Causes of post renal obstruction?
Luminal = stones and clots
Mural = malignancy e.g. ureteric, prostae, blader, BPH and strictures
Extrinsic compression = retroperitoneal fibrosis
Post renal obstruction IX and management?
Urine dipstick and MC&S, drug chart review
Bloods = urea, creatnint, serum urea ratio, WCC< RP, cultures
Renal USS< bladder scan and CT KUB if considering stones
Mx: 1) flush catheter or replace and stop medications that could cause
Specific = ureteric stones or malignancy = surgery /chemo
Which bacteria most commonly forms staghorn calculi?
Proteus Miribalis
What are urinary tract calculi and symptoms?
Crystal deposition in the urinary tract AKA nephrolithiasis
Often asymptomatic, ureteric colic, SEVERE loin to groin pain, N+V, might be unable to sit still
Causes of urinary tract calculi?
Idiopathic, metabolic e.g. hypercalcaemia, hyperuircaemi - high cell turnover
RFs = low fluid intake, high salt meat diet and structural urinary tract abnormalities
Types of calculi?
Calcoim oxalate (80%)
Magnesium ammonium phosphate (staghonr/struvite stones) from proteus
Uric acid e.g. tumour lysis syndrome
Cysteine
red flags for urinary tract calculi?
Fever/signs of sepsis, persistent pain, renal impairment, dont forget AAA (CT with contrast)
Ix UTC?
Urine dipstick adn MSU, U&Es
Gold = non-contrast CT-KUB
?USS KUB
24hr urine collection for uric acid stones
Common sites of UTC blockage?
PUJ, ureter at pelvic brim, VUJ
Mx of ureteric colic?
Modify rfs, patient education, stop recurrence <5mm
Med: suppository diclofenac, antiemetics, medical explusion therapy (tamsulosin)
Surg: Indications (renal dysfunction, previous renal disease, infection, sever pain >48hours, bilateral stones)
- Uretoscoy lithotripsy (10-20mm)
- Extracoporeal shockwave lithotripsy
- Percutaenous nephrolithotomy >20mm
Management of infected obstructed system?
ABCDE, sepsis 6
Decompression via stent or nephrostomy +-ITU
Percutaenous nephrostomy
Exam of scrotum?
If you cant get above lump = inguinal hernia
Attached to testicle = hydrocele
Cough for hernia
Transillumination = hydrocele
DDx for scrotal pain and sudden onset?
testicular torsion , torsion of testicular appendix, trauma, incarcerated hernia
DDx for painful gradual onset scrotal?
Acute epididymis, epididymo-orchitis
Haematocele
DDx for painless transilluminates scrotal?
Hydrocele (either communicating or non and reactive or trauma), communicating hydrocele for spermatic cord, indirect hernia (cannot get above), epidydmal cyst (can seperate from testis), spermatocele
DDx for painless, no transillumination scrotal lump?
Varicocele (bag of worms)
Tumour = germ cell seminoma (older), teratoma (younger), or non-germ cell
What is a hydrocoele?
Presence of serous fluid in tunica vaginalis
Primary = patent processus vaginalis (infants)
Secondary = infection/inflammation, trauma or malignancy
Signs and symptoms of hydrocoele and Ix?
Usually asymptomatic swelling, can get above swelling, non-seperate from testis, transilluminates
IX = USS to exclude tumour, testicular tumour markers and dipstick/MSU for infection
What is varicocoele?
Dilated veins of the pampiniform plexus caused by venous reflux from valvular insufficiency
Varicocoele sign/symptoms and Ix?
usually asymptomatic,
Bag of worms
Swelling may reduce lying down
Dragging sensation
Scrotal USS
Colour doppler CT, consider semen analysis
Provide scrotal support nd ligation or radiological embolisation
Causes of epidymitis-orchitis?
Common in 20-30 YO
Sexually active: chlamydia and Gonoccocus
>35YO: colifroms e.g. enterobacter, klebsiella
Mumps orhitis in young
Signs and symptoms of EO?
Acute onset severe pain over days, mild fever +- penile discharge
UTI symptoms
Painful, swollen and tender
Less acute onset that torsion
How to differentiate between epididymitis and orchitis?
Prehns sign +ve = elevation eases epididymitis
Rfs for testicular tumours?
20-40YO, cryptorchidism, klinefelter, hypospadias
Symptoms/signs of testicular tumours?
painless swelling, dull ache, backache (mets to para-aortic nodes)
O/E = painless, hard, irregular mass, LNs
types of testicular tumour?
Germ cell = seminoma (50% fried egg appearance, radiosensitive and 3rd decade)
teratoma (non rad sensitive) chorciocarcinoma (Hcg and blood spread), yolk sac = high AFP, embryonal arcinoma = haem spread
Sex cord tumour = sertoli adn lydig cell tumours
Signs and symptoms of testicular torsion?
Sudden onset severe pain hemiscrotally, N+V, swollen and erythermatous scrotum, high lying testicule, horizontal lie, absent cremasteric reflex
DDx for testicular torsion?
Epididymo-orchtiis
Torsion of appendix testis
strangulated hernia
Mx for testicular torsion?
Clinical diagnosis (maybe doppler)
Urgent urology referral
Analgesia + anti-emetics
Exploratory suregry + contralateral fixation (orchodpexy)
What are the storage LUTS?
Frequency, urgency, nocturia, dysuria
FUND
What are the voiding/obstructive LUTS?
Hesitancy, incomplete emptying, poor stream, straining
HIPS
What are post-micturation LUTS?
Incomplete emptying and terminal dribbling
Symptoms of BPH?
LUTS, severe pain if urinary retention and DRE sows smoothly enlarged prostate with palpable midlien groove
IX for BPH?
Bedisde and bloods
U&Es, bone profile and PSA and USS of urinary tract
Mx for BPH?
Voiding training and limit caffeine and alcohol
Medical = alpha blockers (tamsulosin, doxasozin), 5alphareductase inhibitors e.g. finasteride
Anticholinergics e.g. oxybutynin
oral desmopressin for nocturia
Surg:
Transurethral resection of prostate (TURP)
Symptoms of prostate cancer?
LUTS, malignancy symptoms, bone pain, cord compression flaws, paraneoplastic e.g. hypercalcaemia, DRE = asymettrical hard nodular craggy prostate
Ix for prostate cancer?
Transrectal USS biopsy For gleason score
CXR for mets adn CT abdo and MRI pelvis
Lfts and bone profile
What is bladder cancer and RFS?
Transitional cell carcinomas mainly
RFS: smoking, amine exposure (rbber/airport), chronic cystitis, previosu renal TCC, pelvic irradiation, schistosomiais
Symptoms of bladder cancer?
Painless macroscopic haematuria, voiding symptoms, recurrent UTIs and FLAWS
Ix for bladder cancer?
Cytoscopy with biopsy is diagnostic
CTMRI for staging
Management for bladder cancer?
TURBT
Immunotherapy, radical cystectomy with ileal conduit
What drug can predispose to urinary retention?
Amitriptylline
