Urology I Flashcards
Scrotal swelling you can’t get above: []
Scrotal swelling you can’t get above: inguinal hernia
Describe the GI side effects of bisphosphonates like alendronic acid [3]
How do you instruct patients to take this medication to reduced the risks? [1]
Alendronic acid, a bisphosphonate used in the treatment of osteoporosis, can cause gastrointestinal side effects, including dyspepsia, oesophagitis and gastric ulcers.
It is important for patients to take alendronic acid correctly (with a full glass of water, without lying down for 30 minutes afterwards) to reduce these risks.
What is the differnce between Balanoposthitis and Balanitis [1]?
Balanitis is an inflammation of the glans penis, often caused by infection. It presents with redness, swelling, and pain at the glans but does not involve the foreskin.
Balanoposthitis is the inflammation of both the glans penis (balanitis) and the foreskin (posthitis).
What’s the difference between posthitis and phimosis?
Posthitis: is an inflammation of the foreskin, often caused by infection or irritation.
Phimosis is the inability to retract the foreskin over the glans penis
A patient presents with a non-seminoma. What biomarker would raised to suggest this? [1]
AFP
A 67 year old man is being consented for a transurethral resection of the prostate (TURP) for benign prostatic hyperplasia. He is concerned about the possible complications of the operation. Which is the most common complication?
Priapism
1
Hypernatraemia
2
Increased risk of prostate cancer
3
Loss of sensation over the skin of the scrotum
4
Retrograde ejaculation
A 67 year old man is being consented for a transurethral resection of the prostate (TURP) for benign prostatic hyperplasia. He is concerned about the possible complications of the operation. Which is the most common complication?
Retrograde ejaculation
What are the treatment algorithms for stress and urge incontinence?
Stress:
- Pelvic floor muscle retraining
- Surgery
- Duloxetine
Urge:
- 6 weeks retraining
- Oxybutnin
Urge inconteince
Which patient population is oxybutnin often CI in? [1]
What do you give instead [1]
Old frail people
- Give mirabegron
A patient has BPH and concurrent DMT2 peripheral neuropathy. Which treatment for the peripheral neuropathy is CI because of his BPH? [1]
Amitriptyline due to the risk of urinary retention.
amyDRIPtyline - don’t prescribe to BPH patients with terminal dribbling
Patients with obstructive urinary calculi and signs of infection require what treatment? [2]
Patients with obstructive urinary calculi and signs of infection require urgent renal decompression and IV antibiotics due to the risk of sepsis
How do you treat unilateral and bilateral undescended testes in newborns? [2]
unilateral undescended testis:
- Arrange a review at 6-8 weeks
bilateral undescended testes:
- Refer to a senior paediatrician for endocrine or genetic investigation
- the presence of bilateral undescended testes should prompt the clinician to consider the possibility of an underlying pathology (commonly congenital adrenal hyperplasia (CAH).
How do you decide when to use mirabegron or oxybutynin? [2]
Oxybutynin
- is an immediate-release antimuscarinic drug, often used for urge incontinence.
- However it can lead worsening of dementia and postural hypotension in older patients
Mirabegron
- beta-3 receptor agonist
- it is used in frail elderly patients as it has fewer anticholinergic side-effects so will not worsen dementia.
how do you treat variocele [2]
- Mild varcicoeles do not need intervention and can be managed conservatively
- occasionally surgery is required if the patient is troubled by pain. There is ongoing debate regarding the effectiveness of surgery to treat infertility
What is the treatment choice for a women with a UTI who is breast feeding their newborn child? [1]
Trimethoprim 200mg twice daily for 3 days
- While nitrofurantoin can be used to treat UTI, it should be avoided in breastfeeding women, as its presence in milk can cause haemolysis in G6PD-deficient infants.
How do you determine if you give nitrofurantoin or trimethoprim in UTI tx? [2]
Nitrofurantoin (100mg BD for three days):
- eGFR must be greater than or equal to 45ml/minute.
Trimethoprim (200mg BD for three days) is the drug of choice if eGFR < 45ml/minute
State the male LUTS from BPH that can be split into voiding [5], storage [4] and post micturition symptoms [1].
Voiding:
SHITE
- Straining
- Hesitancy
- Intermittant stream
- Terminal dribbling
- (incomplete) emptying
Storage:
- Urgency
- Frequency
- Incontinence
- Nocturia
Post mic:
- Dribbling (more delayed than terminal dribbling)
What is the max flow rate score that is suggestive of bladder outflow obstruction due to BPH? [1]
Max flow rate < 10ml per second is suggestive of bladder outflow obstruction due to BPH
LUTS + what size prostate [1] or PSA score [1] would you move to second line treatment for BPH? [1]
- Prostate larger than 30g
- PSA > 1.4
BPH Treatment:
The general idea is that [] are used to treat immediate symptoms, and [] are used to treat enlargement of the prostate.
They may be used together where patients have significant symptoms and enlargement of the prostate.
The general idea is that alpha-blockers are used to treat immediate symptoms, and 5-alpha reductase inhibitors are used to treat enlargement of the prostate.
They may be used together where patients have significant symptoms and enlargement of the prostate.
Describe the MoA of finasteride [4]
5-alpha-reductase inhibitor:
* Blocks conversion of testosterone to DHT;
* DHT is considered to be the primary androgen playing a role in the development and enlargement of the prostate gland. It serves as the hormonal mediator for the hyperplasia upon accumulation within the prostate gland
What is the most common congenital male reproductive disorder?
Testicular torsion
Cryptorchidism
Hydrocoele
Peyronie disease
What is the most common congenital male reproductive disorder?
Testicular torsion
Cryptorchidism
Hydrocoele
Peyronie disease
TOM TIP:
The notable side effect of tamsulosin is [].
The most common side effect of finasteride is [] (due to reduced []).
TOM TIP: The notable side effect of alpha-blockers like tamsulosin is postural hypotension. If an older man presents with lightheadedness on standing or falls, check whether they are on tamsulosin and check their lying and standing blood pressure.
The most common side effect of finasteride is sexual dysfunction (due to reduced testosterone).
Describe the pathophysiology of TURP syndrome? [3]
How serious is it? [1]
It is caused by irrigation with large volumes of glycine, which is hypo-osmolar and is systemically absorbed when prostatic venous sinuses are opened up during prostate resection
This results in hyponatremia, and when glycine is broken down by the liver into ammonia, hyper-ammonia and visual disturbances.
TURP syndrome is a rare and life-threatening complication
Signs and symptoms of:
Early stage prostate cancer? [6]
Late stage prostate cancer? [3]
Early stage:
* Often asymptomatic
* Urinary frequency
* Poor flow
* Nocturia
* Dribbling
* Renal obstruction
* Haematuria / Haematospermia
* Nodular hard craggy prostate on DRE
If metastised:
* Weight loss
* Bone pain
* Anaemia
Name this form of taking prostate biopsies [1]
Why is it better than trans rectal biopsy? [1]
Template / transperineal biopsy (BP)
Less infections; more biopsies can be taken
What is an aide for memorising upper age limit of PSA levels? [1]
(Age-20) / 10
