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4th Year > Urology > Flashcards

Urology Flashcards

1
Q

main conditions covered in urology

A

UTI Incontinence Bladder cancer Stones Testes pathology Prostate pathology

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2
Q

most common cause of UTI

A

ascending infection - bacteria from large bowel colonises up through urethra

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3
Q

presentation of UTI

A

dysuria (pain) polyuria (increased frequency) nocturia (getting up to pee in night) pyelonephritis: fever loin pain rigors

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4
Q

what is pyelonephritis

A

upper uni (of ureters and kidneys)

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5
Q

what is cystitis?

A

inflammation of the bladder - not always infection

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6
Q

investigations for UTI

A

dipstick culture rarely microscopy

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7
Q

what does urine dipstick show in UTI

A

high nitrates -though not with enterococcus, staphylococci and pseudomonas leukocytes

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8
Q

Kass’s criteria for UTI culture

A

>10^5 organisms = significant <10^3 = no infection 10^4 = repeat sample

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9
Q

most common causative organisms for UTI

A

E.coli Proteus Pseudomonas aeruginosa Enterococcus Staphylococcus saprophytic

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10
Q

what type of bacteria is e.coli

A

gram -ve coliform causes fever due to endotoxin

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11
Q

how does a Proteus UTI present

A

FOUL smelling urine -like burnt chocolate? struvite stones increased urinary pH urolithiasis (renal stones)

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12
Q

how does a pseudomonas UTI present

A

gram -ve bacillus associated with catheters resistant to most antibiotics except ciprofloxacin

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13
Q

how does an enterococcus UTI present

A

most commonly hospital required comes from GI tract

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14
Q

how does a staphylococcus saprophyticus UTI present

A

in women of child bearing age gram -ve staph

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15
Q

treatment of female lower UTI

A

nitrofurantoin or trimethoprim 3 days

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16
Q

male UTI - uncatherterised treatment

A

nitrofurantoin or trimethoprim 7 days

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17
Q

complicated UTI/pyelonephritis/urosepsis treatment

A

IV amoxicillin + gentamicin for 3 days

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18
Q

what are the main types of incontinence

A

stress incontinence urge incontinence overflow incontinence

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19
Q

presentation and cause of stress incontinence

A

dribbles of urine on coughing, sneezing or excretion caused by weak pelvic floor causing bladder neck/urethra hyper mobility or neuromuscular defects causing spinster deficiency urine leaks when urethral resistance is exceeded by abdominal pressure

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20
Q

presentation and cause of urge incontinence

A

sudden urge to go - can be triggered by taps, being at front door ect often cant make it to the toilet caused by overactivity of the detrusor muscle

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21
Q

presentation and cause of overflow incontinence

A

caused by bladder outflow obstruction more common in men - caused by BPH constant dribbling

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22
Q

treatment for stress incontinence

A

lifestyle: -reduce caffeine intake -weight loss, stop smoking -pelvic floor exercises drugs: -Duloxetine (SNRI) Surgery -transvaginal tape -colposuspension (bit of bowel wrapped round urethra to keep it up)

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23
Q

treatment for urge incontinence

A

reduce caffeine bladder training antimuscarinics - oxybutynin

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24
Q

incontinence investigations

A

urinalysis - look for UTI/renal impairment bladder chart -record voided volumes, frequencies and incontinence pad test -determines severity urodynamics -records bladder volume and pressure

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25
how to treat overflow incontinence
treat the BPH
26
BPH treatment
alpha blockers (tamsulosin) spironolactone TURPS (transurethral resection of the prostate)
27
what are renal stones made of
80% are calcium oxalate calcium phosphate uric acid struvite
28
what is a staghorn calculus
renal calculus in the shape of a stag horn body sits in the renal pelvis and horns extend into renal calyxes usually composed of struvite
29
renal calculi presentation
can be asymptomatic or severe loin to groin pain -colicky pain fluctuating in severity as the stone moves and settles -haematuria, nausea, vomiting, oliguria
30
how to diagnose renal calculi
urine dipstick bloods for infection and kidney function CT KUB = gold standard
31
medical management of renal calculi
NSAIDs eg. PR diclofenac antiemetic if N&V fluids antibiotics if infection stones \<6mm have a \>50% chance of passing without intervention but spontaneous passage can take weeks tamsulosin - alpha blocker helps with passage of stones
32
surgical management of renal calculi
extracorporeal shock wave lithotripsy -shock waves given under x-ray guidance to break up stone so its easier to pass utereoscopy and laser lithotripsy -camera via urethra, stone broken up by targeted lasers
33
one episode of renal stones makes another more likely, how do you prevent this
increase oral fluids reduce salt intake reduce oxalate rich foods for calcium stones (spinach, nuts, rhubarb, tea) reduce intake of rate (rich foods for uric acid stones) limit dietary protein
34
most common bladder cancers
transitional cell carcinoma (95%) Squamous cell carcinoma (5%)
35
bladder cancer presentation
frank, painless haematuria
36
sites of bladder cancer metastases
local lymph nodes lungs
37
what type of cell lines the bladder and why
transitional epithelium -tight junctions between cells -3-7 layers -constantly renews -prevents toxins passing into body
38
risk factors for transitional cell carcinoma
smoking phenacetin (now banned analgesic) aniline (dye from manufacturing) cyclophosphamide (immunosuppressant)
39
what are the two types of transitional cell carcinoma
papillary - most of them, grow like bushes non-papillary - more dangerous, all malignant, grow flat and invasively
40
when does squamous cell carcinoma of the bladder occur
when theres been a metaplastic change in the epithelium to turn it from transitional to squamous causes: -schistosomiasis -long term catheter -long standing kidney stones -recurrent UTIs all cause inflammation and metaplasia
41
treatment of bladder cancers
resection of the bladder -transurethral resection of bladder tumour Intravesical chemotherapy -localised chemo to the bladder via catheter if severe - cystectomy
42
benign testical lumps/swelligns
hydrocele varicocele spermatocele hernia
43
what is a hydrocele and causes
accumulation of fluid in the tunica vaginalis causes: idiopathic congenital - patent processes vaginalis connecting it to peritoneum infection injury always TRANSILLUMINATES
44
what is a varicocele
dilated veins of venous plexus in testes - like varicose veins
45
worrying presentation of varicocele
new onset on the left side in middle aged men think renal cancer!! left testicular vein drains into the renal vein. If renal cancer occludes renal vein it can cause back pressure down the testicular vein
46
what is a spermatocele
cystic change within the vas of the epidydimus unknown cause can see sperm inside on biopsy
47
how to differentiate between lumps
is it in the testes or separate? can you get above it? - cant get above hernia solid or cystic? is it painful?
48
causes of acute testicular pain
torsion infection
49
what is torsion and whats it's presentation
twisting of the spermatic cord stops blood flowing through the testicular artery EMERGENCY extreme excruciating pain no precipitant can occur in sleep absent cremasteric reflex
50
who gets torsion - causes
adolescent boys bell clapper deformity - tunica vaginalis is sitting in the wrong position and not holding the testes still- therefore they can rotate and even sit laterally
51
how long does it take for the testes to die with torsion and how do you treat it
6 hours emergency surgery to untwist the spermatic cord use non-dissolvable sutures to fix the testes into a safe position MUST do both side - high risk of other side being affected
52
type of testicular cancer and age groups
Seminomatous \>35s Non-seminomatous \<35s
53
how does testicular cancer present
lump IN testicle
54
what des a seminoma look like and how's it treated
cut it open and it looks like a potato most common v responsive to radiotherapy 95% are cured
55
what are the non-seminomatous cancers
much less common far more aggressive and can metastasise - although outcome is reasonable Teratoma Yolk sac Embryonal Trophoblas
56
tumour markers for testicular cancers
alpha-fetoprotein - may be raised in teratomas (not seminomas) beta-hcg - may be raised in teratomas or seminomas (pregnancy test hormone) lactate dehydrogenase
57
where do testicular cancers metastasise to
lungs liver brain
58
what ar the 3 zones of the prostate
transitional central peripheral
59
what zone of the prostate is affected by BPH
60
what zone of the prostate has 70% of prostate cancers
61
what is the verumontanium
where the ejaculatory ducts drain into the urethra
62
presentation of prostate cancer
usually incidental after PSA or PR this is because the cancers are usually in the peripheral zone so need to be v advanced to cause urinary symptoms haematuria haematospermia bone pain, anorecia, weight loss
63
what conditions raised PSA
BPH prostatitis/UTI retention catheterisaion cystoscopy PR cycling on a hard bicycle seat for long time
64
what investigations do you do if abnormal PSA and PR
MRI - usually before biopsy Trans-rectal ultrasound guided biopsy 10 biopsies taken haematospermia and haematuria occur for 2-3 weeks after testing
65
signs of prostate malignancy on PR
Assymetry nodule hard, craggy mass
66
what type of cancer is 95% of prostate cancers
multifocal adenocarcinoma
67
mets sites for prostate cancer
pelvic lymph nodes bones - causes osteo SCLEROSIS bone mets - bone mets are usually lytic
68
management of prostate caner
watchful waiting active surveillance radical surgery radio therapy if locally advanced - radiotherapy + hormonal therapy if metastatic: - androgen depravation therapy (hormonal therapy, bilateral orchidectomy, maximal androgen blockage) - steroids - chemo when prostate cells are deprived of androgens they undergo apoptosis
69
what causes BPH
70
treatment for BPH
alpha blockers - tamulosin 5-alpha reductase inhibitor - finasteride TURP - transurethral resection of the prostate

4th Year (25 decks)

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