UROLOGY - Bladder + Prostate Flashcards

1
Q

What type of cancer are 90% of bladder cancers?

A

TCC;s

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2
Q

RF bladder cancer/TCC (4)

A

Smoking
Aromatic amines
Chronic cystitis
Pelvic irradiation

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3
Q

PS TCC/bladder cancer (4)

A

Painless haematuria +/- clots
Recurrent UTI/’cystitis’
Voiding Sx
Haematuria –> anaemia

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4
Q

Mx TCC in situ/T1

A

TURBT @ cystoscopy _ intravesical chemotherapy

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5
Q

Mx TCC T2-3

A

Radical cystectomy + pre op chemo

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6
Q

Ix TCC

A

Urine MCS
Cystoscopy + biopsy = GOLD STANDARD
CT/MRI - assess spread

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7
Q

Mx TCC T4

A

Palliative

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8
Q

Mx of intraperitoneal bladder rupture

A

Laparotomy + suturing of bladder

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9
Q

Mx of extraperitoneal bladder rupture

A

Prolonged urethral/suprapubic catheter

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10
Q

Bladder outlet obstruction - luminal causes

A

Bladder tumour

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11
Q

Bladder outlet obstruction - mural causes (3)

A

Urethral stricture
Congenital abnormalities
Neuropathic bladder

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12
Q

Bladder outlet obstruction - extra mural causes (2)

A

BPH/carcinoma
Phimosis/paraphimosis

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13
Q

CF Bladder outlet obstruction

A

Suprapubic pain
Hesitancy + diminished force of stream
Terminal dribbling
Overflow incontinence
Signs infection - stasis urine

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14
Q

Signs - bladder outlet obstruction (3)

A

Palpable full bladder
Loin tenderness
Enlarged prostate PR

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15
Q

Ix Bladder outlet obstruction (4)

A

Bloods - FBC/U+E
Urine dip/MCS
USS
CT/MRI

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16
Q

What is BPH

A

Benign proliferation of glandular layers of the prostate –> enlargement of inner transitional zone

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17
Q

What % of >70s have BPH

A

70%

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18
Q

Sx BPH (8)

A

Freq (1st noticed as nocturia)
Urgency
Hesitancy
Poor/int stream
Post void dribbling
Strangury
Retention w/ overflow incontinence/acute retention
Occasionally - haematuria

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19
Q

Ix BPH (8)

A

PR
IPPS
Freq/vol chart
Bloods incl FBC/U+E/PSA
Urinalysis
Uroflowmetry
Bladder USS
Transrectal USS + biopsy

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20
Q

Norm PSA value

A

<4

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21
Q

Apart from BPH/Prostate cancer, what other conditions cause PSA to rise (5)

A

Inflammation
Infection
Trauma
Ejaculation
Ageing

22
Q

Acute Mx BPH

A

Attempt urethral catheter drainage

23
Q

Lifestyle mods BPH (4)

A

Avoid alcohol
Relax when voiding
void twice in a row
Bladder retraining

24
Q

Medical Tx BPH

A

Alpha blockers 0 tamulosin, doxasosin
5a reductase inhibitors - finasteride

25
SE alpha blockers (4)
Dizzy Drowsy HoTN Depression
26
SE 5a reductase inhibitors (2)
Impotence Decreased libido
27
Surgical Mx BPH (2)
TURP - retrograde ejaculation almost universal after HoLEP - endoscopic
28
What % of >80s have prostate cancer
80%
29
What type of cancers are the majority of prostate cancers?
Adenocarcinomas
30
Spread - prostate cancer (34)
Local Lymphatic Haematogenous Bone to BONE
31
Risk factors prostate cancer (2)
FHx Raised testosterone levels
32
PS Prostate cancer
Asymp often Filling/voiding Sx W loss/bone pain if mets
33
O/E Prostate cancer
hard craggy prostate
34
Ix prostate cancer (4)
PR PSA Transrectal USS/biopsy Bone XR/scan
35
What 2 scores can be used in Prostate cancer
Gleason grade D'Amico risk stratification
36
How does Gleason grade work
2 areas of tissue are graded/5 Indicative of prognosis
37
Gleason grade 6
Low risk/good prognosis
38
Gleason grade 8>
High risk/ bad prognosis
39
What is D'Amico risk stratfication
Combines Gleason w/ clinical stage + PSA ==> more accurate prognosis
40
Mx prostate cancer - T1/2
Active surviellance Radiotherapy Radical prostatectomy
41
Mx prostate cancer - T3/4
Radiotherapy or surgery
42
Mx prostate cancer - mets
GnRH agonists - goserelin/busereline + antiandrogen (cyrpoterone acetate) Prevents early rise testosterone
43
Mx - urethral trauma - partial
Prolonged catheter
44
Mx = urethral trauma - complete tear
Suprapubic catheter + repair
45
What is a urethral stricture
Scar of the urethral epithleium, which commonly extends into the underlying corpus spongiosum
46
What part of the urethra is most commonly damaged in a urethral stricture
Bulbar urethra
47
Causes urethral stricture (4)
Blunt perineal trauma (#/saddle injury) Iatrogenic (catheter) Gonococcal/non-gonococcal urethritis BXO
48
PS urethral stricture (4)
Initial frequency/dysuria Hesitancy/straining Urinary retention Splayed stream
49
O/E urethral stricture
Firm areas consistent w/ scarring
50
Ix urethral stricture (3)
Uroflowmetry Retrograde urethrogram Urethroscopy
51
Mx urethral stricture
Optical urethrotomy
52
Mx recurrent urethral stricture
Urethroplasty