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Year 2 Revision > Urology Investigations and Management > Flashcards

Urology Investigations and Management Flashcards

1
Q

When would you do cystoscopy with LUTS?

A 
If previous urological surgery
Haematuria
Profound symptoms
Pain
Recurrent UTIs
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2
Q

What 2 classes of drugs are used in BPH?

A

Alpha blockers first line e.g. tamsulosin

5-alpha reductase inhibitors e.g. finasteride

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3
Q

What is the main surgical option for BPH?

A

TURP

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4
Q

Investigations for bladder tumour?

A

Cystoscopy with biopsy
CT urogram (diagnostic and staging)
Can do urine microscopy or cytology
MRI can show nodal involvement

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5
Q

Management of bladder cancer not invading the muscle.

A

Diathermy/transurethral resection of bladder tumour (TURBT)

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6
Q

Management of bladder cancer invading muscle.

A

Radical cystectomy.

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7
Q

Management of stones <5mm in lower ureter.

A

90-95% pass spontaneously, give fluids.

Alpha blocker

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8
Q

Management of stones >5mm/pain not resolving.

A
  1. Extracorporeal shock wave lithotripsy (ESWL)
  2. Endoscopic retrograde laser evaporation of the stone
    Both first line
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9
Q

What are the imaging modalities for staging prostate cancer?

A

Bone scan
MRI
CT

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10
Q

List potential managements of organ-confined disease

A

Watchful waiting
Active monitoring
Radical prostatectomy
Radical radiotherapy

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11
Q

List managements of locally advanced prostate cancer

A

Radiotherapy with neo-adjuvant hormonal therapy (curative)
Watchful waiting
Hormonal therapy (palliative)

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12
Q

List managements of metastatic prostate cancer

A
  1. Androgen deprivation therapy (hormone therapy, bilateral subcapusular orchidectomy, maximal androgen blockade)
  2. Diethylstilbesterol/steroids
  3. Cytotoxic chemotherapy
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13
Q

What must be done for all patients >40 with frank haematuria?

A

Cytoscopy

CT urogram

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14
Q

Management of acute urinary obstruction

A

Catheterisation

Maybe trial without catheter afterwards (give alpha blocker before this)

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15
Q

Investigation and management of post-obstructive diuresis

A

Monitor fluid balance. Beware if output >200ml/hour

Usually resolves in 24-48 hours but may need IV fluid and sodium replacement

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16
Q

Ureteric colic management

A

NSAID and maybe opiate

Alpha blocker for small stones expected to pass

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17
Q

Indications to treat ureteric stone urgently

A

Pain unrelieved
Pyrexia
Persistent nausea/vomiting
High-grade obstruction

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18
Q

Management of acute ureteric stone

A

Ureteric stent or stone fragmentation/removal

Percutaneous nephrostomy if infected

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19
Q

Clot retention management

A

3 way catheter

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20
Q

Testicular torsion investigation

A

Doppler US sometimes helpful

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21
Q

Management of testicular torsion

A 
Prompt exploration (irreversible ischaemic injury may begin as soon as 4 hours)
2-3 point fixation with fine non-absorbable sutures (also contralateral side)
If testis necrotic then remove
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22
Q

Management of torsion of appendix testis

A

Nothing, will resolve spontaneously

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23
Q

Investigation for epididymitis

A 
Doppler US (swollen epididymis, increased bloodflow)
Urine culture and chlamydia PCR
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24
Q

Epididymitis management

A

Analgesia and scrotal support, bed rest

Ofloxacin 400mg/day for 14 days

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25
Q

Management of paraphimosis

A

Iced glove, granulated sugar for 1-2 hours, multiple punctures in oedematous skin
Manual compression of glans with distal traction of oedematous foreskin
Dorsal slit

26
Q

Priapism investigation

A

Aspirate blood from corpus cavernosum (dark, low O2, high CO2 in low flow, normal in high flow)
Colour duplex USS (minimal or absent in low flow, normal to high flow in non-ischaemic)

27
Q

Ischaemic priapism management

A

Aspiration and irrigation with saline
Injection of alpha agonist e.g. phenylephrine
Surgical shunt
Unlikely to respond to intracavernosul treatment >48-72 hours
Very delayed may think immediate replacement of penile prosthesis

28
Q

Non-ischaemic priapism management

A

Observe, may resolve spontaneously

Selective arterial embolisation with non-permanent materials

29
Q

Fournier’s gangrene investigation

A

Plain x-ray or USS may confirm gas in tissues

30
Q

Fournier’s gangrene management

A

Antibiotics and surgical debridement

31
Q

Emphysematous pyelonephritis investigations

A

KUB x-ray (gas)

CT

32
Q

Emphysematous pyelonephritis management

A

Often requires nephrectomy

33
Q

Perinephric abscess investigation

A

CT

34
Q

Perinephric abscess management

A

Antibiotics

Percutaneous or surgical drainage

35
Q

Renal trauma imaging indications

A

Frank haematuria in adults
Frank or occult haematuria in child
Occult haematuria and shock
Penetrating injury with any degree of haematuria

36
Q

Renal trauma investigation

A

CT with contrast

37
Q

Renal trauma management

A

98% of blunt managed non-operatively
Angiograph/embolisation
Surgery (persistent renal bleeding, expanding perirenal haematoma, pulsatile perirenal haematoma, urinary extravasation, non-viable tissue, incomplete staging)

38
Q

Bladder injury imaging

A

CT cystography (if extraperitoneal will have flame shaped collection of contrast in pelvis)

39
Q

Bladder injury management

A

Large-bore catheter
Antibiotics
Repeat cystogram in 14 days
If intraperitoneal will need laparotomy

40
Q

Urethral injury investigation

A

Retrograde urethrogram

41
Q

Urethral injury management

A

Suprapubic catheter

Delayed reconstruction after at least 3 months

42
Q

Penile fracture management

A

Prompt exploration and repair

Circumcision incision with degloving of penis to expose all 3 compartments

43
Q

Testicular injury investigation

A

USS to assess integrity/vascularity

44
Q

Testicular injury management

A

Early exploration/repair

45
Q

Renal tumour imaging

A

FBC (renal and liver functions)
USS
CT chest, abdomen and pelvis for staging
Biopsy

46
Q

Oncocytoma CT appearance

A

Spoke wheel pattern

47
Q

Angiomyolipoma USS and CT appearance

A

USS: bright echo pattern
CT: fatty tumour of low density

48
Q

Management of angiomyolipoma

A

Treat after 4cm
Elective: embolisation/partial nephrectomy
Emergency: embolisation/emergency nephrectomy

49
Q

Renal cell carcinoma management

A

<3cm: surveillance in elderly unfit patients, ablation techniques in fit elderly patients and selected younger patients

> 3cm: partial nephrectomy (robotic) or radial nephrectomy

Large tumours: radical nephrectomy (laparoscopic approach gold standard)

50
Q

Follow up from RCC

A

FBC/renal and liver functions
CT/USS and CXR
Duration 5-10 years

51
Q

Testicular cancer investigations

A 
USS testicle
CT chest and abdomen for staging
Serum tumour markers (aFP, b-HCG, LDH)
FBC
LFTs
Kidney function
52
Q

Testicular cancer management

A

Radical inguinal orchidectomy (offer sperm preservation, testicular prosthesis)
Re-check tumour markers 1 week post-operative (chase CT scan if still raised)
Further follow up by oncologist (chemo as adjuvant even in non-metastatic cases)

53
Q

Penile cancer investigation

A

MRI (assess tumour depth)

CT abdomen, pelvis, chest in advanced disease

54
Q

Penile cancer management

A 
Circumcision
Glans resurfacing
Glansectomy
Total penile amputation with formation of perineal urethrostomy 
Inguinal lymphadenectomy
55
Q

Basic incontinence investigations

A 
Urinalysis (and culture)
Bladder diary (frequency/volume chart)
Urodynamics: uroflowmetry and cystometry (more invasive)

Urodynamics only if surgery being considered, uncertain of diagnosis, check for voiding dysfunction or if drug treatment for urge has failed

56
Q

Stress incontinence conservative management

A

Lifestyle modification
Pelvic floor exercises
Biofeedback

57
Q

Stress incontinence medication

A

Duloxetine (SSRI)

58
Q

Stress incontinence surgical management

A

Injection of bulking agents
Tension free vaginal tape (or pubovaginal slings)
Burch culposuspension (retropubic suspension, not used as much)
Artificial urinary sphincter

59
Q

Urge incontinence conservative management

A

Lifestyle advice
Bladder retraining
Medication (anticholinergics, B-agonists)

60
Q

Urge incontinence invasive management

A

Intravesical botulinum toxin A
Neuromodulation
Augmentation “clam” ileocytoplasty
Ileal conduit urinary diversion

Year 2 Revision (45 decks)

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