Urology Flashcards
What is Phimosis
When prepuce cannot be fully retracted
Risk of Phimosis
Poor hygiene, balanitis, pain during sex, urinary retention, posthitis
What is paraphimosis
Constriction of glans penis by retraction of prepuce proximal to corona.
What causes paraphimosis
Phimosis, catheterisation, penile cancer
Treatment for phimosis
Circumcision
Treatment for paraphimosis
Reduction manually or dorsal slit
Penile cancer- Squamous cell risk factors
Phimosis, smegma, HPV 16&18
Causes of acute scrotal pain
Torsion, epididymitis, orchitis, epididymo-orchitis, trauma
History of torsion
<30years, sudden onset, unilateral
History of epididymo-orchitis
STI if young, UTI if other (chlamydia or E.coli), gradual onset, unilateral
Examination of epididymo-orchitis
Pyrexial, erythematous, enlarged and tender, fluctuant represents abscess. +/- hydrocoele.
What is fournier’s gangrene
Necrotic area of scrotal tissue- high mortality
Treatment of epididymo-orchitis
Abxx, drain abscess, debride if necrotic.
Painless scrotal lump
Tumour, cyst, hydrocoele, reducible inguinoscrotal hernia.
Aching scrotal lump
Varicocoele
Painful scrotal lump
Epididymitis, epididymo-orchitis, strangulated inguinoscrotal hernia
Presentation of testicular tumour
Painless, Germ cell if <45, if older could be lymphoma,, body of testis abnormal and you can get above.
Presentation of hydrocoele
Slow onset, uni or bi swelling, testes not palpable separately, transilluminates
What is a hydrocoele
Fluid production and reabsorption imbalance between albuginea and vaginalis.
Presentation of epididymal cyst
Painless, seperate from tesis, can get above, transilluminates.
Presentation of varicocele
Dull ache, L>R, feel like bag of worms
Why L>R for varicocele
Left, the angel at which vein enters renal and lack of effective valves.
What is the lymphatic drainage of testis and scrotum
T= Paraortic. S= Inguinal.
Causes of urinary retension
Prostate enlargement, constipation, phimosis, overdistension, neurological
Presentation of acute retension
Painful, residual volume <1000ml, no kidney insult
Treatment of acute retension
TWOC after treating exacerbating factor
Presentation of chronic retension
Painless/less painful. Residual volume >300ml. May be kidney insult.
Treatment of chronic retension
Self catheterise
Presentation of acute on chronic retension
Residual volume >1000ml, kidney insult present
Treatment of acute on chronic retension
TWOC or LT catheter or surgical intervention
Voiding symptoms
Hesitancy, poor flow, dribbling
Storage symptoms
Nocturia, urgency, frequency
Causes of LUTS
Irritative, Overactive bladder, Low compliance, Polyuria
Causes of voiding symptoms
Physical, dynamic, neurological, reduced contractibility
Dynamic cause of bladder outflow obstruction
Sympathetic smooth muscle tone
What receptor mediates the sympathetic smooth muscular tone
Alpha 1
What tool to use with prostate issues
International prostate symptom score
When not to do PSA
<45
Lifestyle management of BPH
Reduce caffeine, avoid fizzy drinks, 2.5L/day
Alpha blockers
Tamsulosin- relax smooth muscle within prostate and bladder neck
5a reductase inhibitor
Finasteride, shrink prostate by androgen depletion
Surgical for BPH
TURP
