urology and genitourinary Flashcards
Common urological sx
loin pain
infections
uro-sepsis
LUTS/retention or incontinence
haematuria
UTI
scrotal swelling and pain
erectile dysfunction
AKI
common presentation prostate cancer
raised PSA - 2ww
abnormal DRE
wt loss
bone pain
renail failure
LUTS
mx prostate cancer
prostatectomy
ERBT/ADT
brachytherapy
surveillance
serious complication metastatic prostate cancer
cord compression - need MRI and steroids
kidney stones
severe loin to groin pain
need pain relief NCCT, U+Es, Ca, uric acid
exclude sepsis
urological emergencies
testicular torsion
uro sepsis (epididymo-orchitis, pyelonephritis, fourniers gangrene)
ureteric colic
acute retention
haematuria
trauma
paraphimosis
2WW criteria for haematuria
aged over 45 and:
unexplained visible haematuria without UTI
visible haematuria that persists after UTI tx
aged 60 and over and unexplained non visible haematuria and either dysuria or a raised WCC
common causes haematuria
kidneys: transitional cell carcinoma, stones, clotting disorders, glomerulonephritis, acute tubular necrosis, HSP, cancer, trauma
ureters: transitional cell carcinoma, stones
bladder: transitional cell carcinoma, stones, cystitis, UTI
prostate: malignanct, BPH, prostatisi
urethra: cancer, trauma
vagina- need to rule out
pseudo: beetroot, rifampicin
mx signifiant haematuria
A_E
oxygen
IV access and bloods +/- fluids
3 way catheter
mid stream sample
ix haematuria
bloods
urine sample
imaging: USS, contrast CT
flexible cystoscopy
acute vs chronic urinary retention
acute painful, chronic not
chronic v large vol
chronic insidious onset and hx luts
features urinary retention
difficult passing urine
abdo/suprapubic pain
restless
preceding luts
dysuria or haematuria before this
examination: tenderness suprapubically, palpable bladder, enlarged prostate
causes urianry retention
uroloical: BPH, blocked catheter, failed TWOC, clot retention, cancer, urethral stricture
GI: constipation, infection, malignancy, IBD, surgery
systemic: infection, pain
medicationL phenylephrine, anticholinergics
neruo: MS, guillain barre, spinal cord injury, cauda equina
mx acute urinary retention
2 way catheter and record residual vol drained
urine sample
indications high pressure urinary retention
large residual vol urine (>1l)
deranged renal function (high creatinine)
features testicular torsion
sudden onset testicualr pain, may radiate to back/loin
common 10-30y
can be associated with local trauma
nausea and vomiting
examination: tender, fixed and high riding testicle, swelling, absent cremasteric reflex
mx testicualr torsion
surgical exploration
dont USS as wastes time
most common cause obstructed infected kidney
stone - gets stuck comonly at pelvi-ureteric junction, where ureter crosses iliac vessels, vesico-ureteric junction
features infected obstructed kidney
fever
rigors
loin-groin/back/abdo pain
haematuria
tachycardia
tachypnoea
high news
other features sepsis
mx infected obstructed kidney
bloods and fluid resus
urine sample for culture, pregnancy test
assess urine output
abx
CTKUB
drain: ureteric (JJ) stent, nephrostomy
features of renal trauma
suspicious mechanism of injury
possible haematuria
loin or back pain
haemodynamic instability
damage to surrounding structures - ribs, vertebrae, spleen, bowel
features ureteric trauma
suspicious mechanism of injury
insidious onset of generalised sx includin peritonitis, abdo pain, ileus, uronoma, urine leaking from a wound/fistula
features of bladder trauma
suspicious mechanism of injury
pelvic fracture
peritonism
abdo distension
ileus
oliguric/anuric
haematuria
blood at urethral meatus
perineal/scrotal bruising
high riding prostate
mx bladder injury
CT used to diagnise
if extraperitoneal: urethral catheter to allow healing
if intraperitoneal: surgical repair
features penile fracture
feeling of a snap or pop while the penis is erect followed by immediate detumescence
eggplant appearance: swelling, discolouration deformity
mx penile fracture
surgical repair
what is paraphimosis
foreskin retracted behind the glans and cannot be replaced
features paraphimosis
foreskin retracted behind corona of glans penis
penile oedema
discolouration and necrosis
cracks in the skin
may be pain
often in catheterised patients
mx paraphimosis
REDUCTION
methods:
ice: topical lidocaine 5 misn then ice wrapped in gauze
sugar: apply 50% dextrose then ice - not that good
surgical
what is fourniers gangrene
necrotising fascitis of the genitalia and perineum
common causes fourniers gangrene
e.coli, klebsiella, enterococci
clostridium, bacteroids
features fourniers gangrene
acutely unwell
sepsis
erythematous area around external genitalia or perineum
blistering of skin
crepitus
discolourisation as necrosis occurs
RF fourniers gangrene
DM
catheterisation
immunocompromise
post surgery
perineal and peri-anal infections
steroid therapy
mx fourniers gangrene
abx
make ITU aware
debridement necrotic tissue in theatre
what is priapism
persistance of an unwanted erection for more than 4 hrs in the abscense of sexual stimulation
types of priapism
low flow: caused by venous occlusion. rigid and painful
high flow: caused by dysfunction arterial flow. semi rigid and painless
recurrent: stuttering. oftne in sickle cell disease
mx low flow priapism
exercise and cooling
if fails: aspiration
if fails: intracavernosal injection of an alpha q adrenergic agonist (phenylephrine)
if fails: theatre
mx high flow priapism
conservativelt
selective embolisation of arterires
mx recurrent priapism
mx sickle cell disease
analgesia
features pelvic ureteric junction obstruction
narrowing of ureter as it joins renal pelvis
obstructs urine flow from kidney
congenital
increased risk infections and stones
may present with hydronephrosis, loin pain, discomfort
features horseshoe kidney
congenital
kindeys join so 1 big kidney - join=isthmus
risk kidney stones, pyelonephritis, PUJ obstruction
features renal agenesis and dysplasia
unilateral
kidney absent or underdeveopled
features renal cysts
increase with age
rarely affect renal function
if complex need to rule out malignanc
features adult polycystic kidneys
commonly causes CKD
increased risk hepatic and pancreatic cysts, HTN, intracranial aneurisms, valve abnormalitiies
features ectopic kidney
ascends insufficientky
increased risk PUJO
often foudn in pelvis
some are non functioning
common types of renal cancer
renal cell carcinoma: adenocarcinoma
transitional cell carcinoma: originates from urothelial cells
wilms tumour: nephroblastoma, children
RF renal cancer
smoking
CKS and dialysis
HTN
male
obesity
age
genetics: von-hippel lindaue, HNPCC, tuberous sclerosis
features renal cancer
mass
haematuria
loin pain
htn
signs metastatic spread
left sided variocele
paraneoplastic syndromes e.g. polycythaemia, anaemia, hypercalcaemia
classic triad renal cancer
mass, haematuria, pain
however less than 10% present with this
mx renal cancer
support
medical: surveillance, radiotherapy, chemo
surgical: nephrectomy, nephroereterectomy, renal artery embolisation
gold standard ix kidney stones
non contrast CT KUB
features renal colic
loin or loin to groin pain 0 very severe
cannto sit still
nausea, clammy
tachycardia
haematuria
sx infection
kidney stone composition
calcium oxalate - most common, radio-opaque, cause=acidic urine
uric acid: radio-lucent, cause = acidic urine
struvite: radio-opaque, cause=infection
cystine: slightly radio-opaque, cause=genetic
calcium phosphate: radio-opaque, cause=alkaline urine hyperparathyroidism
intrinsic RF for kindey stones
20-50y
males
genetics: caucasiana nd asian, fhx, cystinuria, hypercalcuira, hyperuricaemia
anatomy: horseshoe/duplex kindey, PUJO
UTIs
medication: loop diuretics, steroids, chemo, anti-epileptics
extrinsic RF kidney stones
western lifestyle
hot climae
fluid intake <1.2L/
sednetary lifetyle
working in a hot emvironment
deit: high protein, high salt, low ca, malabsorption
when do renal stones need emergency intervention
signs infection
single funtioning kidney
renal impairment
obstructed kidney
mx renal stones
active surveillance
extracorporeal shockwave lithotripsy
percutaneous nephrolithotomy
flexible uteroscopy
mx proximal ureteric stones
ESWL
rigif uteroscomy
conservative
mx distal ureteric stones
conservative
ESWL
rigid ureteroscopy
causes bladder calculi (stones)
urinary stasis - ibstructing prostate
common composition bladder calculi
calcium based
ix for bladder calculi
USS, XR, flexible cystoscopy
features bladder calculi
pain
luts
haematuria
utis
incidental finding
mx bladder calculi
endoscopic: cystolitholapaxy, laser fragmentation, pneumatic lithotripsy
open: cystolithotomy
bladder cancer types
most common= transitional cell carcinoma
others=squamous cell carcinoma, adenocarcinoma
RF bladder cancer
50-80y
male
caucasian
exposure to aromatic amines (dyes, rubber, leather, paint, textiles)
medications: cyclophosphamide
smoking
fhx
hnpcc
RF bladder squamous cell carcinoma
smoking
schistosomiasis
chronic cystitis
long term catheter
intermittent self catherisation
features bladder cancer
haematuria-often painless and visble
urgency
suprapubic/pelvic mass
suprapubic pain
recurrent uti
sx systemic spread
mx bladder cancer
support
medicalL radiotherpay, chemotherapy
surgical: TURBT most common, cystodiathermy, cystectomy
LUTS
storage: freq, urgency, urge incontience, nocturia, bedwetting
voiding: haematuria, dysuria, hesitancy, poor flow, terminal dribbling, incomplete voiding
ix for cause of luts
uroflowometry
post voidal residual vol
psa and renal function
urine dipstick and culture
freq vol chart
USS
urodynamic testing
causes voiding luts
BPH
prostate cancer
uretheral stricture
meatal stenosis
phimosis
causes storage luts
overactive bladder
cystitis
intravesical pathology - tumour or bladder calculi
what is BPH
increase in number of epithelial and stromal cells
often in transitional zone
presnetation BPH
luts
mx BPH
alpha blockers: tamsulosin
5alpha reductase inhibitors finasteride
TURP, laser prostatecomy
SE tamsulosin
retrogreade ejaculation, dizzy, hypotension
SE finasteride
erectile dysfunction, reduced libido and ejaculation
most common type of prostate cancer
adenocarcinoma - usually originates in the peripheral zone
features prostate canceerq
luts
haematospermia
rasied psa
abnormal dre - hard, nodular, craggy
bone or back pain due to metastases
what is gleason grading
grading of prostate cancer using histology
guides tx
mx prostate cancer
active surveillance: if low risk
radiotherapy: local and locally advanced cancer and bone metastases
hormone therapy
chemo: metastases
surgical - prostatectomy
features testicular cancer
palpable lump
non transilluminable
may be painful
often found on self examination
RF testicular cancer
20-45y
caucasian
cryptorchidism
prev testicular cancer
HIV
fhx
types of testicular cancer
germ cell tumours (90%): seminomas, teratoma, chordiocarcinoma, yolk sac tumour
non germ cell tumours: sertoli, leydig, lymphoma, mesenchymal
ix testicular cancer
USS
CXR if sx for metastases
tumour markers: AFP, hCG, LDH
mx testicular cancer
semen cropreservation
urgent radical inguinal orcidectomy
+/- testicular prosthesis
metastases: resect lymoh nodes, chemo, radiotherapy
what is cryptorchidism
undescended testes
what does untx undescended testes increase risk of
infertility
testicular torsion
testicular cancer as present late as cant examine testes
retractile crptorchidism
can easily be brough into scrotum
variant of normal
does not require surgery
maldescended testes
on normal path of descent
ectopic crptorchidism
often in thigh, perineum, opposite side of scrotum
mx palpable maldescended testes
orchidoplexy
mx impalpabe testes
laparoscopy to find and bring down if viable
sometiems done as a 2 stage procedure
describing a lump
6S: site, size, shape, surface, skin, scar
5C: consistency, contour, colour, can you mobilise it, can you palpate any lymoh nodes
4T: tender, temp, tethering, transillumination
what is hydrocele
accumulation of fluid within tunica vaginalis
causes secondary hydrocele
malignancy, trauma, infectio,n torsion
features of hydrocele
fluctuant scrotal swelling
transilluminable
unable to palpate the testis separate to the swelling
can get above the swelling
mx hydrocele
conservative
surgical
aspiration if not suitbale for anaesthetic
what is variocele
dilatation testicualr veins
features variocele
feels like a bag of worms
dragging sensation
aching
identified on USS
mx variocele
conservative
surgical ligation
embolisation
features epididymal cyst
palpable lumps within epididymis
difficult to transilluminate
may be pain
USS
mx epididymal cyst
conservative
surgical excision if large or sx
features sebaceous cyst of scrotum
hard containing a white/yellow substance
palpable lump within scrotal skin
lumos tethered to skin
rubbery feel
non transilluminable
multiple cysts
usually painless
mx scrotal sebaceous cyst
conservative
surgical excision
what is epididymo-orchitis
infection epididymis/testicle
common causes epididymo-orchitis
e.coli
chlamydia, gonorrhea
mumps if unvaccinated
features epididymo-orchitis
preceding sx uti
luts
penile discharge
painful hemiscrotum - hot and swollen
fever
epididymis tender and cord may feel thickened
mx epididymo-orchitis
rule out torsion
abx depending on cause
what is erectile dysfunction
the recurrent inability to achieve or maintain an erection inhibiting sexual intercourse
ix in erectile dysfunction
examination: CV, neuro, abdo, external genitalia, dre
bloods: testosterone, lh, fsh, prolactin, sex-hormone binding globulin, tfts, glucose
nocturnal penile tumescence testing
MRI - peyonries plaques. doppler USS-vasculature
organic causes erectile dysfunction
endo: DM, thryoid, hyperprolactinaemia, hypogonadism
neuro: spinal cord pathology e.g. compression, MS, parkinsons
vascular: hyperlipidaemia, peripheral vascular disease, htn
medication: antidepresants, parkinsons, anti androgens, anti htn
other: alcohol, smoking, pelvic surgery/radiotherapy, peyronies disease, substance abuse
mx psychogenic erectile dysfunction
therapy
mx organic erectile dysfunction
phosphodiesterase type 5 i: cause vasodilation
intrauretheral prostaglandins: vasodilation
intracavernosal injections
vacuum erection device
testosterone replacement of hypogonadism
penile prothsesis
what is peyronies disease
curvature of the penis caused by the development of fibrotic tissue on the tunica albuginea
cause peyronies disease
repeated minor trauma causes microvascular damage resulting in inflammation and fibrosis
associated with DM, HTN, high cholesterol, dupuytrens contracture, plantar fascitis
features peyronies disease
significant curvature of penis usually only notabel when erect
penile shortening
penile pain
erectily dysfunction
difficulty having penetrative intercourse
palpable fibrous plaque along shaft of penis at site of angular deviation
altered shape- hourglass
mx peyronies disease
medical: oral pentoxiifyline, verapamil injection, extra-corporeal shockwave therapy
surgical: only on stable plaques - nesbits procedure
what is phimosis
tight foreskin unable to retract over the glans
features phimosis
usually asx
ballooning of foreskin on micturition
pain and irritation during intercourse
balanoposthisis - infection
what is balanitis xerotica obliterans
chronic inflammatory condition that can cause phimosis
often with grey/whote discolouration
mx balanitis xerotica obliterans
topical steroids
circumcision
mx phimosis
normal in childhood
circumcision
what is urethral stricture disease
subepithelial fibross within the corpus spongiosum causeing a narrowing of the urethra
cause urethral stricture disease
trauma
inflammation-urethritis
features urethral stricture disease
voiding luts
urinary retention
utis
difficult to pass a catherter
mx urethral stricture disease
surgery-dilatation or urethrotomy
RF incontinence
age
gender
oestrogen deficiency
anatomical disorders - fistulae
childbirth and pregnancy
abdominal, pelvic, perineal and prostate surgery
DM
smoking
obesity
uti
poor mobility
neuro: MS, parkinsons, spinal cord injury
what is stress urinary incontinence
involuntary leakage of urine on effort, exertion, sneezing or coughing
cause of stress urinary incontinence
hypermobility of bladder base, pelvic floor and urethral sphincter deficiency
tx stress urinary incontinenc
conservative: wt loss, exercise
pelvic floor training
surgical: tape, slings
artificial urinary sphincter implamentation-men post prostatectomy
what is urge urinary incontience
involuntary leakage of urine accompanied by or immediatelt proceeded by urgency
cause of urge urinary incontience
over active detrusor muscle
what is overactive bladder syndrome
urgency with or witjout urge incontinence, often with frequency and nocturia
mx urge urinary incontience
conservative: reduce caffeien, alcohol
anti-muscarinics: oxybutynin
b3 adrenoreceptor agonist: mirabegron
neuromodulation
botox
clam cytoplasty or urinary diversion
what is mixed urinary incontience
the involuntary leakage of urine associated with effort, exertion, coughing or sneezing accompanied by or immediately proceeded by irgency
cause mixed urinary incontience
hypermobility of bladder base, pelvic floor and urethral sphincter deficiency and over active detrusor muscle
what is overflow incontinence
involuntarty leakage of urine when the bladder is abnormally distened with large volumes of urine
cause overflow urinary invontinence
often due to bladder outflow obstruction and a degree of detrusor failure
mx overflow urinary incontience
tx bladder outflow obstruction
long term catheter
intermittent self catheterisation
uncomplicated UTI
in an otherwise normal urinary tract
complicated uti
in an abnoral (structure or cancer/stones) or male urinary tract
symptoms uti
suprapubic pain or discomfort
freq
urgency
strangury
dysuria
haematuria
malodorous urine
delirium
fever
loin pain or rigors in pyelonephritis
signs of utis
suprapubic tenderness
renal angle tenderness in pyelonephritis
positive urinary dipstick testing for leucocytes
haematuria
delirium
sepsis
common causes uti
e.coli
proteus mirabilis - can be associated with stones
klebsiella
mx uti
uncomplicated: 3d abx
complicated : 7d abx, mayneed iv
RF uti
female
prev utis
post-menopausal
age
DM
pregancy
anatomcal abnormalities urinary tract
catheters
definition recurrent utis
2 infections in 6m or 3 in 1 y
ix recurrent uti
for cause e.g, stones or malignancy
CT/USS and cystoscopy
mx recurrent utis
conservative: increase fluid, vaginal oestrogen in post menopausal, avoid constipation, good hygiee, void before and after sex
self start abx
post coital prophylactic abx if trigger
long term low dose prophylacttic abx
common reasons for failing to catheterise m
enlarged prostate
urethral stricture
when to provide prophylactic abx if catheterised
prev infections from catheter
high risk infection
difficult insertion
at risk endocarditis
common reasons for failing to catheterise a f
meatal stenosis
cystocele
position urethral meatus
acute risks catheterisation
pain
bleeding
false passage
failure
urethral damage
paraphimosis
infection
chronic rissk catheterisation
stricture formation
failed TWOC
stones
cancer
symptoms gonorrhoea
penile/vaginal discharge
dysuria
conjunctivitis
pelvic pain/deep dyspareunia/pot coital and intermenstrual bleeding
cause gonorrhoea
neisseria gonorrhoea
complications gonorrhoea
PID
epididymo-orrchitits
tubo-ovarian abscess
ectopic pregnancy
infertility
systemic - disseminated gonococcal infection (rash, septic arthritis)
mx gonorrhoea
IM ceftriaxone
cause of chllamydia
chlamydia trachomatis
sx chlamydia
penile/vaginal discharge
dysuria
conjunctivitis
pelvic pain/deep dyspareunia/pot coital and intermenstrual bleeding
complications chlamydia
PID
epididymo-orrchitits
tubo-ovarian abscess
ectopic pregnancy
infertility
systemic - disseminated gonococcal infection (rash, septic arthritis)
systemic: sexually acquired reactive arthritis, peri hepatitis
mx chlamydia
doxycycline 1wk
cause of lymphogranulom a venerum
chlamydia trachomatis serova l1-3
sx lymphogranulom a venerum
proctitis- bleeding, tenesmus, change in bowel habit, inguinal ymphadenopathy
complications lymphogranulom a venerum
fistula
mx lymphogranulom a venerum
doxycycline 3w
cause of syphilis
treponema pallidum
mx syphilis
penicllin
sx trichomonas vaginalis
vaginal discahrge, vulval itch
mx trichomonas vaginalis
metronidazole
cause of genital herpes
herpes simplex type 1 and 2
sx herpes
uclers, dysuria, occassionalyy dischagre
complications herpes
disseminated encephalitis
mx herpes
aciclovir
cause genital warts
hpv 6 and 11
mx genital wart
imiquimod/podophyllotoxin, cryotherapy
ix for stis - heterosexual
CT/GC DNA NAAT and 2w after LSI
men=urine, women = vulvovaginal swab
serology baseline plus
syphilis 4-6w post lsi, hiv 4-6w using 4th gen test but need to finalise at 12w, hep b at 12w
ulcers/dishcarge/pain: refer
when to consider PEP HIV
all who present u to 72h
type of activity, where, sexual orientation
what is PEP
truvada (tenofovir/emtracitabine) plus raltegravir
presentation HIV
2-6w after exposure
glandular fever/flu like sx: fever, sore throat, rash, lymphadenopathy, muscle and joint pain, mouth ulcers/candida
pneumonia
viral meningitis
presentation primary syphilis
single painless genital ulcer 9-90d after exposure
presentation secondary syphilis
6-12w after exposure
generalised rash: palms and soles of feet, warts on genitals, snail track ulcers of mouth
hair loss
flu, lymoh nodes enlarged
bone pain, joint pain
liver and kidney problems
viral meningitis, iritis
tropical stis
chancroid
donovanosis
presntation tropical stis
pustule
painful or painless ulcers
lymphadenopathy
asx sti screening female
vulvovaginal swab for gonorrhoea/chlamydia naat
bloods for sts and hiv
x st screening heterosexual male
First void urine for Chlamydia/Gonorrhoea
NAAT
Bld test for STS + HIV
asx screening men who have sex with men
First void urine for Chlamydia/Gonorrhoea
NAAT
Pharyngeal swab for Chlamydia/Gonorrhoea
NAAT (may be self taken)
Rectal swab for Chlamydia/Gonorrhoea NAAT
(may be self taken)
Bld for STS, HIV, Hep B (& Hep C if indicated)
sx screening stis female
Vulvo-vaginal swab for Gonorrhoea + chlamydia NAAT
High vaginal swab (wet & dry slides) for Bacterial Vaginosis (BV), Trichomonas Vaginalis (TV), Candida
Cervical swab for slide + Gonorrhoea culture
Dipstick urinalysis (If has dysuria)
Bld for STS + HIV
symtpomatic screening heterosexual male
Urethral swab for slide + Gonorrhoea culture
First void urine for Gonorrhoea + Chlamydia NAAT
Dipstick urinalysis (If has dysuria)
Bld for STS + HIV
symptomatic screening men who have sex with men
First void urine for Chlamydia/Gonorrhoea
NAAT
Pharyngeal swab for Chlamydia/Gonorrhoea
NAAT (may be self taken)
Rectal swab for Chlamydia/Gonorrhoea NAAT
(may be self taken)
Bld for STS, HIV, Hep B (& Hep C if indicated)
urethral and rectal slides
urethral, rectal, pharyngeal culture plates
who to screen for hep b
Men who have Sex with Men (MSM)
Commercial Sex Workers (CSW) and their sexual
partners
IVDUs (current or past), and their sexual partners
People from high risk areas and their sexual
partners: Africa, Asia, Eastern Europe
primary prevention strategeis to reduce stis
awareness compaigns
discussion
vaccination - hep b, hpv
pre and post exposure prophylaxis
secondary prevention stis
easy access to tests and treatments
partner notification
targeted screening
markers to monitor HIV infection
CD4+ t cell count
HIV viral load
AIDS defining conditions
infections: candidiasis, extra-pulmonary crptococcosis, CMV, mycobacterium TB, toxoplasmosis, HSV, pneumocystis jiroveci pneumonia
neoplasms: kaposis sarcoma, primary cns lymphoma, non hodgkins lymphoma
direct hiv effect: dementia/encephalopathy, wasting
features clinically latent phase HIV
no findings other than persistent generalised lymphadenopathy
features early symptomatic HIV
oral/vaginal candida
oral hairy leukolakia
VZV
cervical dysplasia
peripheral neuropathy
bacillary angiomatosis
immune mediated ITP
PID
listeriosis
Types androgen deprivation therapy for prostate ca
LHRH agonists - buserelin
LHRH antagonist - degarellix
Anti androgenic- flutamide, bicalutamide
Bilateral orchidectomy
LHRH agonists for prostate ca
E.g. buserelin, goserelin
Take a while to work
Reduce LH so less testosterone
When LHRH agonists are first given, testosterone levels go up briefly before falling to very low levels. This effect, called tumor flare, give antiandrogenz to counteract
LHRH antagonist for prostate ca
Degarelix
Works quickly
Increases LH so testosterone reduces due to negative feedback
GnRH blocker
When LHRH agonists are first given, testosterone levels go up briefly before falling to very low levels
