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Surgery > Urology P3 > Flashcards

Urology P3 Flashcards

1
Q

What is a hydrocele?

A

accumulation of fluid in tunica vaginalis

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2
Q

What is a communicating hydrocele?

A
  • patency of processus vaginalis allows peritoneal fluid to drain down into scrotum
  • common in newborns and resolve in first few months
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3
Q

What is a non-communicating hydrocele?

A

excessive fluid production within tunica vaginalis

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4
Q

What can hydroceles be secondary to?

A
  • epididymo-orchitis
  • testicular torsion
  • testicular tumour
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5
Q

Features of hydrocele:

A
  • soft, non tender swelling of hemi-scrotum (usually anterior and below)
  • swelling confined to scrotum, can get ‘above mass’
  • transilluminates
  • testis may be difficult to palpate if hydrocele large
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6
Q

Investigation and management of hydrocele:

A
  • US if unclear diagnosis

- infantile hydroceles generally repaired if no spontaneous resolve

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7
Q

Most common cause of lower genitourinary tract trauma:

A
  • 85% pelvic fractures

- 10% males pelvic associated with urethras or bladder injuries

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8
Q

Types of urethral injury:

A
  • bulbar rupture

- membranous rupture

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9
Q

Bulbar rupture:

A
  • most common
  • straddle type injury e.g. bicycles
  • triad: urinary retention, perineal haematoma, blood at meatus
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10
Q

Membranous rupture:

A
  • extra or intraperitoneal
  • penile or perineal oedema/haematoma
  • PR: prostate displaced upwards
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11
Q

Investigating urethral injury and management:

A
  • ascending urethrogram

- suprapubic catheter (surgical placement)

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12
Q

Features of bladder injury:

A
  • rupture intra or extraperitoneal
  • haematuria or suprapubic pain
  • inability to retrieve all fluid used to irrigate the bladder through Foley catheter indicates injury
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13
Q

Investigation and management of bladder injury:

A
  • IVU or cystogram
  • manage with laparotomy if intraperitoneal
  • conservative is extraperitoneal
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14
Q

Examinations for lower urinary tract symptoms in men (voiding, storage, post micturition etc.)

A
  • urinalysis: infection, haematuria
  • DRE
  • PSA
  • urinary frequency-volume chart
  • IPSS
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15
Q

Management of voiding symptoms:

A
  • conservative: pelvic floor muscle training, bladder training
  • alpha blocker
  • 9 alpha reductase inhibitor
  • mixed symptoms with alpha blocker unresponsive - antimuscarinic
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16
Q

Management of overactive bladder:

A
  • bladder retraining
  • anti-muscarincs: oxybutynin, tollerodine, darifenacin
  • mirabegron
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17
Q

Management nocutria:

A
  • furosemide 40mg late afternoon

- desmopressin

18
Q

Priapism:

A
  • persistent erection >4 hours
  • ischaemic: impaired vasorelaxation so reduced vascular outflow - congestion and trapping of deoxygenated blood in corpus cavernosa
  • non-ischaemic: high arterial inflow, typically fistula or congenital/traumatic
19
Q

Causes of priapism:

A
  • idiopathic
  • sickle cell disease or other haemalobinopathies
  • erectile dysfunction medications (sildenafil, PDE-5 inhibitors)
  • drugs: anti-hypertensives, anticoagulants, antidepressants, cocaine, cannabis, ecstacy
  • trauma
20
Q

Investigations priapism:

A
  • cavernosal blood gas analysis: ischaemic - pO2 and pH reduced, pCO2 raised
  • doppler or duplex ultrasonography
21
Q

Management priapism:

A
  • ischaemic = medical emergency: aspiration of blood and saline flush to clear viscous blood, intracavernosal injection of vasoconstrictor e.g. phenylephrine and repeat 5 min intervals
  • non-ischaemic: observation
22
Q

Examination of inguinal hernia:

A
  • cannot get above it
  • cough impulse present
  • reducible
23
Q

Examination of testicular tumours:

A
  • discrete testicular nodule (may have associated hydrocele)
  • symptoms of metastatic disease
  • USS scrotum and serum ADP and bHCG
24
Q

Examination of acute epidiymo-orchitis:

A
  • dysuria and urethral discharge
  • swelling tender and eased by elevating testis
  • Chlamydia
25
Q

Examination of epididymal cysts:

A
  • single or multiple cysts
  • clear or opalescent fluid
  • over 40yo
  • painless
  • above and behind testis
  • able to get above lump
26
Q

Examination of hydrocele:

A
  • non painful, soft, fluctuant
  • clear fluid
  • tranilluminates
  • may be presenting feature of cancer in young men
27
Q

Examination of testicular torsion:

A
  • severe, sudden onset testicular pain
  • RF: abnormal testicular lie
  • adolescents and young males
  • tender and pain not eased by elevation
  • urgent surgery indicated, contralateral testis also fixed
28
Q

Examination of varicocele:

A
  • varicosities of pam-uniform plexus
  • typically left (testicular vein drains into renal vein)
  • presenting feature of RCC
  • affected testis may be smaller and bilateral varicoceles may affect fertility
29
Q

Management of testicular malignancy:

A

orchidectomy via inguinal approach: high ligation of testicular vessels and avoids exposure of another lymphatic field to tumour

30
Q

Management hydrocele:

A
  • children: inguinal approach (processus ligated)

- adults: scrotal approach (sac excised or plicated)

31
Q

Testicular cancer tumour types:

A
  • 95% germ cell tumours: seminomas and non-seminomas

- non germ cell: Leydig cell tumours, sarcomas

32
Q

Risk factors testicular cancer:

A
  • infertility
  • cryptorchidism
  • family history
  • Klinefelter’s
  • mumps orchitis
33
Q

Features of testicular cancer:

A
  • painless lump most common
  • pain in minority
  • hydrocele, gynaecomastia
  • raised AFP 60% germ cell
  • raised LDH 40% germ cell
  • seminomas: hCG raised 20%
34
Q

Diagnosis of testicular cancer:

A

ultrasound

35
Q

Features of seminomas, tumour markers and pathology:

A
  • most common subtype
  • AFP normal
  • hCG elevated 10%
  • LDH elevated 10-20%
  • sheet like lobular patterns of cells with substantial fibrous component
  • fibrous septa contain lymphocytic inclusions and granulomas
36
Q

Features of non-seminomas, tumour markers and pathology:

A
  • teratoma, yolk sac tumour, choriocarcinoma, mixed germ cell tumours
  • younger age peresntation
  • advanced disease worse prognosis
  • retroperitoneal lymph node dissection needed after chemotherapy
  • AFP raised 70%
  • hCG elevated 40%
  • heterogenous texture with occasional ectopic tissue e.g. hair
37
Q

What is TURP syndrome?

A
  • rare, life threatening complication
  • irrigation with large volumes of glycine (hypoosmolar) - systemically absorbed when prostatic venous sinuses opened during resection
  • hyponatraemia, hyperammonia, visual disturbances
  • CNS, resp and systemic symptoms
38
Q

Risk factors TURP syndrome:

A
  • surgical time >1 hour
  • height of bag >70cm
  • resected >60g
  • large blood loss
  • perforation
  • large amount of fluid used
  • poorly controlled CHF
39
Q

Causes of urethral strictures:

A
  • iatrogenic
  • STI
  • hypospadias
  • lichen sclerosus
40
Q

What is a varicocele?

A
  • abnormal enlargement testicular veins
  • asymptomatic
  • infertility
  • more common left
  • bag of worms
41
Q

Diagnosis and management of varicoceles:

A
  • ultrasound with doppler

- usually conservative, occasionally surgery if pain

42
Q

Vascectomy:

A
  • more effective than female sterilisation
  • under LA, home within hours
  • doesnt work immediately
  • semen analysis twice after before sex (16 and 20 weeks)
  • bruising, haematoma, infection, sperm granuloma, chronic testicular pain
  • success rate reversal 55% if within 10 years

Surgery (10 decks)

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