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Surgery > Urology P2 > Flashcards

Urology P2 Flashcards

1
Q

What is the most common cause of scrotal swelling in primary care?

A

epididymal cysts

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2
Q

Features of epididymal cysts:

A
  • separate from body of testicle

- posterior to testicle

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3
Q

What are epididymal cysts associated with?

A
  • polycystic kidney disease
  • cystic fibrosis
  • Von Hippel Lindau syndrome
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4
Q

Diagnosis and management of epididymal cysts?

A
  • ultrasound
  • supportive management
  • symptomatic: surgery or sclerotherapy
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5
Q

What is testicular torsion?

A
  • twist of spermatic cord resulting in ischaemia and necrosis
  • males 10-30yo
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6
Q

Features of testicular torsion:

A
  • severe and sudden pain
  • pain referred to lower abdomen
  • nausea and vomiting
  • swollen, tender testis retracted upwards
  • cremasteric reflex lost
  • elevation of testis does not ease pain (Prehn’s sign)
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7
Q

Management of testicular torsion:

A
  • urgent surgical exploration

- both tests as condition of bell clapper testis often bilateral

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8
Q

Diagnosis of prostate cancer:

A
  • few symptoms early on
  • metastatic - bone pain
  • locally advanced: pelvic pain or urinary
  • PSA measurement
  • digital rectal
  • trans rectal USS (biops) - TRUS
  • MRI/CT and bone scan for staging
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9
Q

What to do if irregular prostate felt:

A

refer urology 2 weeks

-multiparametric MRI

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10
Q

TRUS complications:

A
  • sepsis
  • pain
  • fever
  • haematuria and rectal bleeding
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11
Q

PSA test results:

A
  • upper limit 4ng/ml
  • poor specificity and sensitivity
  • 50-59yo: 3
  • 60-69yo: 4
  • > 70yo: 5
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12
Q

Causes of false positive PSA test:

A
  • prostatitis
  • UTI
  • BPH
  • vigorous DRE
  • vigorous exercise
  • urinary retention
  • ejaculation
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13
Q

Risk factors prostate cancer:

A
  • increasing age
  • obesity
  • afro-caribbean
  • family history
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14
Q

Features prostate cancer:

A
  • bladder outlet obstruction: hesitance, urinary retention
  • haematuria, haematospermia
  • pain: back, perineal or testicular
  • DRE: asymmetrical, hard, nodular enlargement with loss of median sulcus
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15
Q

Pathology of prostate cancer:

A
  • 95% adenocarcinoma
  • often multifocal
  • graded using Gleason grading system
  • lymphatic spread occurs first to obturator nodes and local extra prostatic spread to seminal vesicles associated with distant disease
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16
Q

Treatment options prostate cancer:

A

-watch and wait
-radiotherapy (external): late radiation proctitis and rectal malignancy
-internal: brachytherapy
-surgery: radical prostatectomy with obturator nodes
ADR erectile dysfunction
-hormonal therapy: 95% testosterone from testis so bilateral orhidectomy, or LHRH analogues (goserelin) and anti-androgens (flutamide)
-active surveillance: have at least 10 biopsy cores, one re-biopsy

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17
Q

What is acute bacterial prostatitis?

A
  • caused by gram negative bacteria entering prostate via urethra
  • e.coli mostly
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18
Q

Risk factors acute bacterial prostatitis:

A
  • recent UTI
  • urogenital instrumentation
  • intermittent bladder catheterisation and recent prostate biopsy
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19
Q

Features of acute bacterial prostatitis:

A
  • pain of prostatitis - perineum, penis, rectum, back
  • obstructive voiding
  • fevers and rigors
  • DRE: tender, boggy
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20
Q

Management of acute bacterial prostatitis:

A
  • 14 days quinolone

- screen STI

21
Q

Acute urinary retention:

A
  • sudden inability to pass urine
  • men - BPH
  • urethral obstruction: calculi, strictures, cystocele, constipation, masses
  • medications: anticholinergics, TCA, antihistamines, opioids and benzodiazepines
  • neurological - UTI
  • postoperative and postpartum
22
Q

Features of acute urinary retention:

A
  • inability to pass urine
  • lower abdo discomfort
  • considerable pain or distress
  • confusion in elderly
  • if already chronic, overflow incontinence
  • palpable distended urinary bladder on abdominal or rectal exam
  • lower abdominal tenderness
23
Q

Management of acute urinary retention:

A
  • bladder US
  • decompress with catheter
  • underlying cause investigate
24
Q

Complications of acute urinary retention:

A

post operative diuresis:

  • kidneys may diverse due to loss of medullary conc gradient
  • volume depletion and worsening AKI
  • may need IV fluids
25
Q

What is balanitis?

A
  • inflammation of glass and sometimes underside of foreskin - balanoposthitis
  • most commonly infective
26
Q

Candidiasis causing balanitis:

A
  • acute
  • usually after intercourse and associated with itching and white non-urethral discharge
  • children and adults
  • topical clotrimazole 2 weeks
27
Q

Dermatitis causing balanitis (contact or allergic):

A
  • acute
  • itchy
  • sometimes painful
  • occasionally clear non-urethral discharge
  • no other body area affected
  • both children and adults
  • mild potency topical corticosteroids
28
Q

Dermatitis causing balanitis (eczema or psoriasis):

A
  • both acute and chronic
  • very itchy but not associated with any discharge
  • history of inflammatory skin condition
  • both adults and children
  • mild potency topical corticosteroids
29
Q

Bacterial infection causing balanitis:

A
  • acute
  • painful
  • can be itchy with yellow non-urethral discharge
  • both adults and children
  • mostly staph spp or group B strep spp
  • treated with flucloxacillin or clarithromycin
30
Q

Anaerobic bacterial infection causing balanitis:

A
  • acute
  • itchy but most associated with very offensive yellow non-urethral discharge
  • both children and adults
  • topical/oral metronidazole
31
Q

Lichen planus causing balanitis:

A
  • both chronic and acute
  • itchy, presence of Wickham’s striae
  • violaceous papules
  • more commonly adults
32
Q

Lichen sclerosis (balanitis xerotica obliterans):

A
  • chronic
  • itchy
  • associated with white plaques
  • significant scarring
  • both adults and children
  • high potency topical steroids e.g. clobetasol
  • circumcision if recurrent balanitis
33
Q

Plasma cell balanitis of Zoon:

A
  • chronic
  • itchy with clearly circumscribed areas of inflammation
  • both adults and children
  • high potency topical steroids e.g. clobetasol
34
Q

Circinate balanitis:

A
  • both chronic and acute
  • not itchy
  • no discharge
  • painless erosions
  • can be associated with Reiter’s
  • adults
  • mild potency topical corticosteroids
35
Q

Investigations balanitis:

A
  • suspected infective - swab fro microscopy and culture which may show bacteria or candida albicans
  • biopsy if extensive skin changes
36
Q

Treatment balanitis general:

A
  • gentle saline washes

- severe irritation and discomfort - 1% hydrocortisone

37
Q

High pressure chronic urinary retention:

A
  • impaired renal function and bilateral hydronephrosis

- typically due to bladder outflow obstruction

38
Q

Lowe pressure chronic urinary retention:

A

-normal renal function and no hydronephrosis

39
Q

What is depcomression haematuria?

A
  • after catheterisation for chronic retention
  • rapid decrease in pressure
  • no further treatment
40
Q

Benefits of circumcision:

A
  • reduced risk of penile cancer
  • reduce risk UTI
  • reduced risk of acquiring STI including HIV
41
Q

Medical indications circumcision:

A
  • phimosis
  • recurrent balanitis
  • balanitis xerotica obliterans
  • paraphimosis
42
Q

What must you exclude before circumcisions:

A

exclude hypospadias

43
Q

What is epididymo-orchitis?

A

-infection of epididymis with or without testes
-pain and swelling
-spread from genital tract
e.g. chlamydia trachomatis and neisseria gonorrhoea or bladder
if low STI risk - e.coli

44
Q

Features and management of epididymo-orchitis:

A

-unilateral testicular pain and swelling
-urethral discharge may be present, urethritis often asymptomatic
unknown organism - ceftriaxone 500mg IM single dose
doxycycline 100mg by mouth x2 daily for 10-14 days

45
Q

Factors favouring an organic cause of erectile dysfunction:

A
  • gradual onset of symptoms
  • lack of tumescence
  • normal libido
46
Q

Factors favouring a psychogenic causes:

A
  • sudden onset symptoms
  • decreased libido
  • good quality spontaneous or self-stimulated erections
  • major life events
  • problems or changes in relationship
  • previous psychological
  • history premature ejaculation
47
Q

Risk factors erectile dysfunction:

A
  • increasing age
  • CVD
  • alcohol
  • drugs: SSRIs, beta blockers
48
Q

Investigations and management erectile dysfunction:

A
  • free testosterone morning 9-11am
  • if low/borderline, repeat with FSH, LH and prolactin
  • abnormal - endocrinology
  • PDE-5 inhibitors (sildenafil - viagra)
  • vacuum erection devices 1st line if not

Surgery (10 decks)

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