Urology Flashcards

1
Q

Risk factors for prostate cancer

A
Increasing age
FHx
Being black
Being tall
Use of anabolic steroids
Genetics - BRCA2 mutation and lynch syndrome
Diet - red meat, fat, diary, calcium
Chemicals - high pesticide exposure
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2
Q

Presentation of prostate cancer

A
Often asymptomatic
Haematuria
Erectile dysfunction
Weight loss
Fatigue
Bone pain
LUTS
- hesitancy
- urgency
- frequency
- intermittency
- straining to void
- terminal dribbling
- incomplete emptying
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3
Q

Features of PSA test

A

Done prior to DRE to avoid stimulating PSA release
Not very sensitive or specific
Most useful in monitoring progression of disease and success of treatment

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4
Q

Features of prostate examination

A

Benign prostate
- feels smooth, symmetrical and slightly soft with a maintained central sulcus
Cancerous prostate
- feel firm/hard, asymmetrical, craggy or irregular with loss of central sulcus

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5
Q

Ix for prostate cancer

A

DRE
PSA
Prostate biopsy
- not particularly sensitive because cancers may be located in areas not biopsied - multiple needle biopsies taken
- Transrectal Ultrasound-Guided Biopsy (TRUS)
- USS inserted into rectum and needle biopsy taken through rectal wall into prostate
- take around 10 biopsies
- Transperineal
- allows more biopsies to be taken
- takes longer than TRUS and requires general anaesthetic

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6
Q

Grading of prostate cancer

A
Gleason Grading System
1 - well differentiated cancer
2 - moderately differentiated
3 - moderately differentiated
4 - poorly differentiated
5 - anaplastic (poorly differentiated)
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7
Q

Mx of prostate cancer

A
Localised
○	Curative intent
■	Active surveillance
■	Radical prostatectomy
■	External beam radiotherapy
■	Brachytherapy 
○	Palliative intent
■	Watchful waiting
Metastatic
○	Surgical castration
○	Medical castration using LHRH agonists (in combination with anti-androgen initially to prevent excess testosterone effects) – patient eventually becomes resistant so add on an antiandrogen
○	Palliation
■	Single dose radiotherapy
■	Zoledronic acid
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8
Q

Side effects of hormonal treatment of prostate cancer

A
Hot flushes
Sexual dysfunction
Gynaecomastia
Fatigue
Osteoporosis
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9
Q

Complications of radical treatment of prostate cancer

A

Erectile dysfunction
Urinary incontinence
Radiation induced enteropathy - gives PR bleeding, pain and incontinence
Urethral strictures

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10
Q

Define BPH

A

Benign Prostate Hyperplasia

  • caused by hyperplasia of the stromal and epithelial cells of the prostate
  • usually present with LUTS in older men
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11
Q

LUTS

A
Hesitancy
Urgency
Frequency
Intermittency
Straining to void
Terminal dribbling
Incomplete emptying
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12
Q

Ix for BPH

A

Urine dipstick - exclude infection
PSA - prior to DRE
Rectal exam to assess prostate size, shape and characteristics

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13
Q

Mx of BPH

A

Reassurance and monitoring
Medical
- alpha-blockers (Tamsulosin) - relax smooth muscle
- 5-alpha reductase inhibitors (finasteride) - block testosterone and reduce size of prostate
Surgery
- Transurethral resection of prostate (TURP)
- Transurethral electrovaporisation of prostate (TUVP)
- Holmium laser enucleation of prostate (HoLEP)
- Open prostatectomy via abdominal or perineal incision

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14
Q

Features of TURP

A

Involves accessing the prostate through the urethra and shaving off prostate tissue using a diathermy
- aims to create a wider space for urine to flow through

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15
Q

Major complications of TURP

A
Bleeding
Infection
Incontinence
Retrograde ejaculation
Urethral strictures
Failure to resolve symptoms
Erectile dysfunction
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16
Q

Alternatives to TURP

A

TUVP - prostate tissue removed using a laser

HoLEP - prostate tissue removed using electrical current

17
Q

Presentation of renal cancer

A

Often asymptomatic
Haematuria
Vague loin pain
Non-specific symptoms of cancer - weight loss, fatigue, anorexia, night sweats

18
Q

Types of renal cancers

A

Tumour of the renal parenchyma

  • Clear cell carcinoma - 75-90%
  • Wilms Tumour in children < 5 years old
19
Q

Risk factors for renal cancer

A
Smoking
Obesity
Hypertension
Long-term dialysis
Von Hippel-Lindau Disease
20
Q

Mx of renal cancer

A
Surgery
- partial nephrectomy
Radiotherapy
Chemotherapy
Biological therapies
21
Q

Paraneoplastic features of renal cancer

A

Polycythaemia - RCC secretes unregulated erythropoietin
Hypercalcaemia - RCC secretes hormone that mimics the action of PTH
Stauffer Syndrome - abnormal liver function tests demonstrating an obstructive jaundice

22
Q

Types of bladder cancer

A

Transitional cell carcinoma - 90%

Squamous cell carcinoma - 10%

23
Q

Pathophysiology of bladder cancer

A

Arise from endothelial lining (urothelium)

24
Q

Clinical features of bladder cancer

A

Painless haematuria

25
Q

Ix for bladder cancer

A

Urinalysis
USS
Cystoscopy + biopsy

26
Q

Staging of bladder cancer

A

TNM

27
Q

Risk factors for bladder cancer

A

Smoking
Carcinogens - hair dyes, industrial pain, rubber, motor, leather and rubber workers
Schistosomiasis - squamous cell carcinoma

28
Q

Mx of bladder cancer

A
Not invading the muscle
- transurethral resection of a bladder (TURBT)
- chemo into bladder post surgery
- weekly treatments for 6 weeks with BCG vaccine into bladder via catheter
Muscle-invasive
- radical cystectomy with ileal conduit
- radiotherapy 
- IV chemotherapy
29
Q

Features of testicular cancer on USS

A
Non tender
Arising from testicle
Hard without fluctuance or transillumination
Irregular
Age 15-40 years
30
Q

Types of testicular cancer

A

Seminoma - 50%

Teratoma - 50%

31
Q

Tumour markers for testicular cancer

A

Alpha-fetoprotein - raised in teratomas
Beta-hCG - raised in teratomas and seminomas
LDH - raised in all

32
Q

Metastasis spread of testicular cancer

A

Lymphatics
Lungs
Liver
Brain

33
Q

Prognosis of testicular cancer

A

Good prognosis unless metastatic - 90% cure rate
Metastatic disease still often curable
Better prognosis for seminomas

34
Q

Mx of testicular cancer

A

Orchidectomy
- testicular prosthesis
Chemotherapy/radiotherapy based on staging
Monitoring post treatment with tumour makers and imaging

35
Q

Common causes of raised PSA

A
Prostate cancer
UTI
Prostatic inflammation (prostatitis)
Enlarged prostate (BPH)
Acute urinary retention
36
Q

Issues for PSA screening

A

Overdiagnosis
Over-treatment
QoL - co-morbidities of establish treatments
Cost-effectiveness

37
Q

Ddx of haematuria

A
Cancer
- RCC
- upper tract TCC
- bladder carcinoma
- advanced prostate carcinoma
Stones
Infection
Inflammation
BPH
Nephrological origin - glomerulonephritis
38
Q

BCG side effects

A
Dysuria, frequency and urgency
UTI
Haematuria
Systemic BCGosis
Bladder contracture/ureteric stenosis