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MRCS A > UROLOGY - Bladder + Prostate > Flashcards

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
Q

SE alpha blockers (4)

A

Dizzy
Drowsy
HoTN
Depression

26
Q

SE 5a reductase inhibitors (2)

A

Impotence
Decreased libido

27
Q

Surgical Mx BPH (2)

A

TURP - retrograde ejaculation almost universal after
HoLEP - endoscopic

28
Q

What % of >80s have prostate cancer

A

80%

29
Q

What type of cancers are the majority of prostate cancers?

A

Adenocarcinomas

30
Q

Spread - prostate cancer (34)

A

Local
Lymphatic
Haematogenous
Bone to BONE

31
Q

Risk factors prostate cancer (2)

A

FHx
Raised testosterone levels

32
Q

PS Prostate cancer

A

Asymp often
Filling/voiding Sx
W loss/bone pain if mets

33
Q

O/E Prostate cancer

A

hard craggy prostate

34
Q

Ix prostate cancer (4)

A

PR
PSA
Transrectal USS/biopsy
Bone XR/scan

35
Q

What 2 scores can be used in Prostate cancer

A

Gleason grade
D’Amico risk stratification

36
Q

How does Gleason grade work

A

2 areas of tissue are graded/5
Indicative of prognosis

37
Q

Gleason grade 6

A

Low risk/good prognosis

38
Q

Gleason grade 8>

A

High risk/ bad prognosis

39
Q

What is D’Amico risk stratfication

A

Combines Gleason w/ clinical stage + PSA
==> more accurate prognosis

40
Q

Mx prostate cancer - T1/2

A

Active surviellance
Radiotherapy
Radical prostatectomy

41
Q

Mx prostate cancer - T3/4

A

Radiotherapy or surgery

42
Q

Mx prostate cancer - mets

A

GnRH agonists - goserelin/busereline
+ antiandrogen (cyrpoterone acetate)
Prevents early rise testosterone

43
Q

Mx - urethral trauma - partial

A

Prolonged catheter

44
Q

Mx = urethral trauma - complete tear

A

Suprapubic catheter + repair

45
Q

What is a urethral stricture

A

Scar of the urethral epithleium, which commonly extends into the underlying corpus spongiosum

46
Q

What part of the urethra is most commonly damaged in a urethral stricture

A

Bulbar urethra

47
Q

Causes urethral stricture (4)

A

Blunt perineal trauma (#/saddle injury)
Iatrogenic (catheter)
Gonococcal/non-gonococcal urethritis
BXO

48
Q

PS urethral stricture (4)

A

Initial frequency/dysuria
Hesitancy/straining
Urinary retention
Splayed stream

49
Q

O/E urethral stricture

A

Firm areas consistent w/ scarring

50
Q

Ix urethral stricture (3)

A

Uroflowmetry
Retrograde urethrogram
Urethroscopy

51
Q

Mx urethral stricture

A

Optical urethrotomy

52
Q

Mx recurrent urethral stricture

A

Urethroplasty

MRCS A (36 decks)

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