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Renal/Urology > Urology - Passmedicine > Flashcards

Urology - Passmedicine Flashcards

1
Q

What are causes of scrotal swellings?

A 
Inguinal hernia
Testicular tumours
Acute epididymo-orchtis
Epididymal cysts
Hydrocele
Testicular torsion
Variocele
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2
Q

What does an inguinal hernia present like?

A

Inguinoscrotal swelling (can’t get above it)
Cough impulse may be present
May be reducible

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3
Q

How do testicular tumours tend to present?

A

Discrete testicular nodules

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4
Q

What investigations are required in suspected testicular tumour?

A

USS scrotum
Serum AFP
bHCG

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5
Q

How does acute epididymo-orchitis tend to present?

A

Hx dysuria, urethral discharge

Swelling may be tender + eased by elevating testis

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6
Q

What causes most cases of epididymo-orchitis?

A

Chlamydia

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7
Q

At what age are epididymal cysts more common?

A

> 40 years

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8
Q

How do epididymal cysts tend to present?

A

Painless cyst above and behind the testis (may contain clear/opalescent fluid)
Usually possible to get above the lump

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9
Q

How does a hydrocele present?

A

Non-painful, soft, fluctuant swelling
Can get above it
Contains clear fluid + will transilluminate

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10
Q

What may a hydrocele be a presenting feature of?

A

Testicular cancer in young men

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11
Q

How does testicular torsion present?

A 
Severe, sudden onset testicular pain 
Usually in a young male
O/e testis is tender and pain not eased by elevation (Prehn's sign), swollen, tender testis is retracted upward, skin may be reddened
Pain may be referred to lower abdomen
NV
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12
Q

What are risk factors for testicular torsion?

A

Abnormal testicular lie

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13
Q

How is testicular torsion managed?

A

Urgent surgery

Contralateral testis also fixed

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14
Q

What is a variocele?

A

Varicosities of the pampiniform plexus

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15
Q

Where do varioceles typically occur and why?

A

On the left (as the testicular vein drains into the renal vein)

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16
Q

What can a variocele be a presenting feature of?

A

Renal cell carcinoma

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17
Q

Do varioceles affect fertility?

A

They can if they are bilateral

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18
Q

How is testicular malignancy treated?

A

Orchidectomy via inguinal approach - allows high ligation of testicular vessels + avoids exposure of another lymphatic field to the tumour

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19
Q

How can torted testicles be fixed?

A

Sutures or placement of the testis in a Dartos pouch

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20
Q

How are varioceles managed?

A

Usually conservatively

If concerns about testicular function/infertility then surgery/radiological management may be considered

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21
Q

How can epididymal cysts be excised?

A

Via scrotal approach

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22
Q

How are hydroceles managed?

A

In children (pathology is due to patient processus vaginalis + so) inguinal approach to ligate processus is used

In adults a scrotal approach is preferred + the hydrocele sac is excised/plicated (Lords or Jabouley procedure)

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23
Q

95% of testicular cancers are what?

A

Germ cell tumours

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24
Q

How are germ cell tumours divided?

A

Seminoma

Non-seminomatous germ cell tumours

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25
Q

What are the kinds of Non-seminomatous germ cell tumours?

A

Teratoma
Yolk sac tumour
Choriocarcinoma
Mixed germ cell tumour

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26
Q

What is the commonest subtype of testicular tumour?

A

Seminoma

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27
Q

What is the average age of diagnosis with a seminoma?

A

40

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28
Q

How is survival with a seminoma?

A

Good

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29
Q

What do the tumour markers tend to show in a seminoma?

A

HCG and AFP often normal

Lactate dehydrogenase raised in 10-20%

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30
Q

What do you see on the histology of a seminoma?

A

Sheet like lobular patterns of cells with substantial fibrous component
Fibrous septa contains lymphocytic inclusions + granulomas

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31
Q

What is the average age of diagnosis of non-seminoma germ cell tumours?

A

20-30

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32
Q

What is the prognosis of non-seminoma germ cell tumours?

A

Much worse

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33
Q

Apart from excision what additional treatments may be required to manage non-seminoma germ cell tumours?

A

Retroperitoneal LN dissection after chemo

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34
Q

What do you tend to see in the tumour markers of someone with a non-seminoma germ cell tumour?

A

AFP raised 70%

HCG raised 40%

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35
Q

What is the histology of non-seminoma germ cell tumours?

A

Heterogenous texture with occasional ectopic tissue, e.g. hair

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36
Q

What are RFs for testicular cancer?

A 
Cryptorchidism
Infertility
FH
Klinefelter's syndrome
Mumps orchitis
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37
Q

What is the most common presenting symptom for testicular cancer?

A

Painless lump

other features: hydrocele, gynaecomastia

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38
Q

What is the first line imaging for suspected testicular cancer?

A

US

+ tumour markers

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39
Q

What imaging is used to stage testicular cancer?

A

CT chest/abdo/pelvis

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40
Q

How is testicular cancer managed?

A

Orchidectomy (inguinal approach)
Chemo/radio depending on stage
Abdominal lesions >1cm following chemo may req. retroperitoneal lymph node dissection

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41
Q

What is acute epididymitis?

A

Acute inflammation of the epididymis

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42
Q

What drug can cause epididymitis?

A

Amiodarone

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43
Q

How can you differentiate epididymitis from torsion?

A

In epididymitis, the tenderness is usually confined to the epididymis

Torsion usually affects the entire testis

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44
Q

What is testicular torsion?

A

Twist of spermatic cord leading to testicular ischaemia and necrosis

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45
Q

When is it most common to get a testicular torsion?

A

Aged between 10 and 30

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46
Q

What is the pain of testicular torsion like?

A

Usually severe + of sudden onset

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47
Q

What reflex is lost in testicular torsion?

A

Cremasteric

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48
Q

How is testicular torsion treated?

A

Surgical exploration

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49
Q

In younger men, why should hydrocele be investigated with testicular US?

A

To rule out tumour

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50
Q

What diagnosis must you exclude when someone presents with epididymo-orchitis?

A

Testicular torsion!!

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51
Q

What factors may suggest torsion over epididymo-orchitis?

A

Age <20
Severe pain
Sudden onset

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52
Q

How does epididymo-orchitis tend to present?

A

Unilateral testicular pain + swelling

Urethral discharge may be present, but urethritis is often asymptomatic

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53
Q

How should you treat epididymo-orchitis if the organism is unknown?

A

Ceftriaxone 500mg IM single dose + doxycycline 100mg PO BD 10-14d

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54
Q

In sexually active men <35y the commonest cause of epididymo-orchitis is chlamydia. what is the most common cause in men >35y?

A

Usually enteric organisms (e.g. E. coli, E. faecalis) that cause UTIs

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55
Q

What is the analgesic of choice for renal colic?

A

IM diclofenac

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56
Q

Is circumcision for religious/cultural reasons available on the NHS?

A

No

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57
Q

What are the medical benefits of circumcision?

A

Reduces risk of penile cancer, UTIs, STIs (incl. HIV)

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58
Q

What are medical indications for circumcision?

A

Phimosis
Recurrent balanitis
BXO
Paraphimosis

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59
Q

What is it important to check for before circumcising a boy and why?

A

Exclude hypospadias as foreskin may be used in surgical repair

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60
Q

What type of anaesthetic is used to perform a circumcision?

A

LA or GA

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61
Q

What is priapism?

A

A persistent penile erection (typically defined as lasting >4 hours and is not associated with sexual stimulation0

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62
Q

What are the two types of priapism?

A

Ischaemic

Non-ischaemic

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63
Q

What causes ischaemic priapism?

A

Impaired vasorelaxation and therefore reduced vasocular outflow –> congestion and trapping of de-oxygenated blood in the corpus cavernosa

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64
Q

What are causes of non-ischaemic priapism?

A

High arterial inflow, typically due to fistula formation (congenital/traumatic)

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65
Q

At what ages is it most common to get priapism?

A

5-10y or 20-50y

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66
Q

What are causes of priapism?

A 
Idiopathic
Sickle cell dx/haemoglobinopathies
Erectile dysfunction mediation 
Drugs - anti-hypertensives, anticoagulations, antidepressants, cocaine, cannabis, ectasy
Trauma
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67
Q

How does priapism tend to present?

A

Persistent erection
Pain localised to the penis
Hx of haemoglobinopathy/medication
Hx trauma to genital/perineal region

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68
Q

What features in the history would be more suggestive of non-ischaemic priapism compared to ischaemic priapism?

A

A non-pain erection or an erection that is not fully rigid

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69
Q

What is the best investigation to differentiate between non-ischaemic priapism and ischaemic priapism?

A

Cavernosal blood gas analysis

Doppler/duplex can be used as alternative

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70
Q

What other investigations may be done for priapism?

A

FBC, toxicology to assess for cause

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71
Q

How is priapism diagnosed?

A

Clinically

Investigations to help decide if ischaemic or not

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72
Q

Why does ischaemic priapism require urgent treatment?

A

Delayed treatment can lead to permanent tissue damage and long-term erectile dysfunction

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73
Q

How is ischaemic priapism managed?

A

Aspiration of blood from cavernosa (often combined with injection of saline flush to help clear viscous blood that has pooled)

If this fails - intracavernosal injection of vasoconstrictive agent, e.g. phenylephrine used and repeated at 5 min intervals

If this fails - consider surgery

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74
Q

How is non-ischaemic priapism managed?

A

Normally observation first line (not medical emergency)

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75
Q

What post-void volumes are considered physiological in patients <65 years old?

A

<50ml

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76
Q

What post-void volumes are considered physiological in patients >65 years old?

A

<100ml

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77
Q

What is prostate specific antigen?

A

A serine protease enzyme produced by normal and malignant prostate epithelial cells

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78
Q

What are the age adjusted upper limits for PSA?
a. 50-59
b. 60-69
c >70

A

a. 3
b. 4
c. 5

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79
Q

What things may raised PSA levels (not to do with prostate cancer)?

A 
BPH
Prostatitis and UTI 
Ejaculation 
Vigorous exercise
Urinary retention 
Instrumentation of the urinary tract
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80
Q

How long after an episode of prostatitis or UTI should you wait to have your PSA checked?

A

At least 1 month after treatment

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81
Q

How long before getting your PSA checked should you avoid ejaculation?

A

48 hours

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82
Q

How long before getting your PSA checked should you avoid vigorous exercise?

A

48 hours

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83
Q

What % of men with prostate cancer will have a normal PSA?

A

20%

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84
Q

Which drugs are sometimes used to aid the spontaneous passage of a renal stone?

A

CCBs

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85
Q

Define erectile dysfunction

A

Persistent inability to attain and maintain an erection sufficient to permit satisfactory sexual performance

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86
Q

How are the causes of ED split?

A

Organic cause
Psychogenic cause
Mixed

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87
Q

What factors favour an organic cause of ED?

A

Gradual onset of symptoms
Lack of tumescence
Normal libido

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88
Q

What factors favour a pyschogenic cause of ED?

A 
Sudden onset of symptoms
Decreased libido
Good quality spontaneous/self-stimulated erections
Major life events
Problems/changes in relationship
Prev. psychological prolems
Hx of premature ejaculation
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89
Q

What are RFs for ED?

A

CV disease RFs - obesity, DM, dyslipidaemia, metabolic syndrome, HTN, smoking
Alcohol use

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90
Q

What drugs can cause ED?

A

SSRIs, beta blockers

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91
Q

What investigations should be done for someone with ED?

A

10 year CV risk
Free testosterone measured between 9-11am (if low/borderline repeat with FSH and LH and prolactin, if abnormal - refer to endocrine)

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92
Q

What is involved in the treatment of ED?

A

1st line: PDE-5 inhibitors (e.g. sildenafil (Viagra) - given for all aetiologies
2nd line - vaccuum erection devices

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93
Q

If a young man has always had difficulty achieving an erection what additional management should be have?

A

Referral to urology

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94
Q

People with ED doing what activity for >3 hours a week should be advised to stop?

A

Cycling

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95
Q

What is the most common cancer in males in the UK?

A

Prostate cancer

96
Q

What are RFs for prostate cancer?

A

Increasing age
Obesity
Afro-carribbean
FH

97
Q

Why are localised/early prostate cancers usually asymptomatic?

A

Cancers tend to develop in periphery of prostate and don’t cause obstructive symptoms early on

98
Q

What are features of prostate cancer?

A

BOO: hesistancy, urinary retention
Haematuria, haematospermia
Pain: back, perineal, testicular

99
Q

What would you feel on DRE in someone with prostate cancer?

A

Asymmetrical, hard, nodular enlargement with loss of median sulcus

100
Q

Where do Wilm’s tumours tend to metastasise to?

A

Lungs

101
Q

What is the treatment of localised prostate cancer (T1/2)?

A

Conservative - wathcful waiting and active monitoring
Radial prostatectomy
Radiotherapy - external beam and brachy

102
Q

What is the treatment of localised advanced prostate cancer (T3/4)?

A

Hormonal therapy
Radical prostatectomy
Radiotherapy - external beam + brachy

103
Q

What are SEs of radical prostatectomy?

A

ED
Incontinence
Urethral stenosis

104
Q

What are complications of TURP?

A

Retrograde ejaculation
TURP syndrome
Urethral stricture/UTI
Perforation of prostate

105
Q

What are adverse effects of radiotherapy for prostate cancer?

A

Increased risk of bladder, colon and rectal cancer

106
Q

How is metastatic prostate cancer managed?

A

Hormone therapy

Orchidectomy

107
Q

What hormone therapies are used in prostate cancer?

A

Synthetic GnRH agonists (e.g. Goserelin - initially given with antiandrogen to prevent rise in testosterone)
Anti-androgen - cryproterone acetate prevents DHT binding from intracytoplasmic protein complexes

108
Q

How do RCCs tend to present?

A

Haematuria

109
Q

What is the most common renal tumour?

A

RCC

110
Q

What paraneoplastic features are associated with RCC?

A

HTN

Polycythaemia

111
Q

How is RCC treated?

A

Radical/partial nephrectomy

112
Q

How does 90% of nephroblastoma present?

A

Mass in flank

NB 50% hypertensive

113
Q

What is the diagnostic workup of someone with suspected nephroblastoma?

A

USS and CT

114
Q

How is nephroblastoma managed?

A

Surgical resection

Chemo - vincristine, actinomycin D, doxorubicin

115
Q

What is a neuroblastoma?

A

Most common extracranial tumour of childhood
Tumour of neural crest cells (50% occur in adrenal)
Tumour usually calcified

116
Q

What scanning may be used to diagnose a neuroblastoma?

A

MIBG scanning

117
Q

What scanning is used to stage a neuroblastoma?

A

CT

118
Q

How are neuroblastomas managed?

A

Surgical resection
Radio
Chemo

119
Q

Where are transitional cell carcinomas most common?

A

90% of lower urinary tract tumours

ONLY 10% of renal tumours

120
Q

What are RFs for transitional cell carcinomas?

A

Occupaitonal exposure to industrial dies and rubber chemicals
Being male

121
Q

How do most TCCs present?

A

Painless haematuria

122
Q

How is TCC diagnosed and staged?

A

CT IVU

123
Q

How is TCC managed?

A

Radical nephroureterectomy

124
Q

What kind of lesions are angiomyolipomas?

A

Hamartoma type lesions (tumour composed to blood vessels, smooth muscle and fat)

125
Q

What disease are angiomyolipomas associated with?

A

Tuberous slcerosis

126
Q

Massive bleeding occurs in what % of angiomyolipomas?

A

10%

127
Q

How are angiomyolipomas managed?

A

If big enough or symptomatic will require surgical resection

128
Q

Following neobladder construction, what are patients at increased risk of?

A

Adenocarcinoma

129
Q

What is a hydrocele?

A

A collection of serous fluid in the tunica vaginalis

130
Q

What is the first line treatment for BPH?

A

Alpha-1-agonists

131
Q

What is the most common cause of acute bacterial prostatitis?

A

Gram-negative bacteria (E. coli most common) entering the prostate gland via the urethra

132
Q

What are RFs for acute bacterial prostatitis?

A

Recent UTI, urogenital instrumentation, intermittent bladder catheterisation, recent prostate biopsy

133
Q

What clinical features are associated with acute bacterial prostatitis?

A

Pain: perineum, penis, rectum, back
Obstructive voiding symptoms
Fever, rigor

134
Q

What do you feel on DRE with acute bacterial prostatitis?

A

Tender, boggy prostate gland

135
Q

How is acute bacterial prostatitis managed?

A

14 day course quinolones

In younger men screen for STI as a significant minority is caused by chlamydia/gonorrhoea

136
Q

Pain relief on elevating the testis points towards what?

A

Epididymo-orchitis

137
Q

Epididymo-orchitis with a slow STI risk, is likely due to what organism?

A

Enteric organisms, esp. E. coli

138
Q

Give e.g.s of non-germ cell testicular tumours

A

Leydig cell tumours, sarcomas

139
Q

Infertile men are how many times more likely to develop testicular cancer?

A

3X

140
Q

What are the 3 categories of LUTS?

A

Voiding
Storage
Post-micturition

141
Q

What are voiding LUTS?

A 
Hesitancy
Poor/intermittent stream 
Straining
Incomplete emptying
Terminal dribbling
142
Q

What are storage LUTS?

A

Urgency
Frequency
Nocturia
Urinary incontinence

143
Q

What are post-micturition LUTS?

A

Post-micturition dribbling

Sensation of incomplete emptying

144
Q

What investigations should be done in someone presenting with LUTS?

A

Urinalysis - exclude infection, check for haematuria
DRE - size/consistency of prostate
PSA may be indicated

145
Q

What things might you ask someone presenting with LUTS to complete in order to guide management?

A

Urinary frequency-volume chart

International prostate symptom score (symptom severity + impact on life)

146
Q

How are predominantly voiding LUTS managed?

A

PFMT, bladder retraining, prudent fluid intake
Moderate/severe - alpha blocker
If prostate enlarged + considered at high risk of progression - 5alpha reductase inhibitor
If enlarged prostate + moderate/severe symptoms - offer alpha blocker + 5alpha reductase inhibitor
If mixed with storage symptoms and not responding to alpha blocker consider anti-muscarinic

147
Q

How are predominantly storage LUTS managed?

A

Moderate fluid intake
Bladder retaining
Antimuscarinics, e.g. oxybutinin, tolterodine, darifenacin
Mirabegron if 1st line drugs fail

148
Q

How is nocturia managed?

A

Advise re moderating fluid at night
Furosemide 40mg in late afternoon
Desmopressin

149
Q

What are the most common cause of scrotal swelling?

A

Epididymal cysts

150
Q

What conditions are epididymal cysts associated with?

A

PKD
CF
vHL

151
Q

How can you confirm the diagnosis of an epididymal cyst?

A

USS

152
Q

What are the two types of hydroceles?

A

Communicating

Non-communicating

153
Q

What causes communicating hydroceles?

A

Patency of the processus vaginalis allowing peritoneal fluid to drain down into the scrotum

154
Q

Who are communicating hydroceles common in?

A

Newborn males (they usually resolve in the first few months of life)

155
Q

What causes non-communicating hydroceles?

A

Excessive fluid production in the tunica vaginalis

156
Q

What 3 things may hydroceles develop secondary to?

A

Epididymo-orchitis
Testicular torsion
Testicular tumours

157
Q

How are hydroceles diagnosed?

A

May be clinical or if doubt USS can be used

158
Q

How are infantile hydroceles managed?

A

Repair only if they do not resolve themself by age 1-2

159
Q

How are hydroceles in adults managed?

A

Usually conservatively

Further investigation may be done to exclude an underlying cause

160
Q

What may varioceles be associated with?

A

Infertility

161
Q

What are varioceles classically described as feeling like?

A

A bag of worms

162
Q

What may aid the diagnosis of a variocele?

A

USS with doppler studies

163
Q

How are varioceles managed?

A

Usually conservatively

Occasionally surgery if pain is an issue

164
Q

What imaging technique is used to confirm a diagnosis of renal stones?

A

Non-contrast CT

165
Q

What are some key points about vasectomy to remember?

A

Doesn’t work immediately
Day case - under LA or GA
Semen analysis needs to be performed 2x following a vasectomy before a man can have unprotected sex (usually at 16 and 20 weeks)

166
Q

What complications are associated with vasectomy?

A 
Bruising 
Haematoma
Infection 
Sperm granuloma
Chronic testicular pain
167
Q

Why can variocele be a sign of malignancy?

A

Due to compression of the renal vein between the abdominal aorta and superior mesenteric vein

168
Q

How can metastatic prostate cancer present?

A

Bone pain

169
Q

What is involved in the diagnosis of prostate cancer?

A

PSA
DRE
Trans-rectal USS +/- biopsy
MRI/CT for staging

170
Q

What are 95% of prostate cancers?

A

Adenocarcinoma

NB they are often multifocal

171
Q

70% of prostate cancers are found where?

A

Peripheral zone

172
Q

What system is used to grade prostate cancer?

A

Gleason grading system - two grades awarded 1 for the most dominant grade (1-5) and 2 for the second most dominant grade (1-5)
Added together to give Gleason score
2 best prognosis
10 worst

173
Q

Where does lymphatic spread of prostate cancer tend to go to first?

A

Obturator nodes

174
Q

Where does prostate cancer locally spread to first?

A

Seminal vesicles

175
Q

What surgery is performed for prostate cancer?

A

Radial prostatectomy

176
Q

Why might a bilateral orchidectomy be used in the treatment of prostate cancer?

A

Testosterone stimulates prostate tissue (prostate cancers are testosterone dependent)

177
Q

What is the preferred management of prostate cancer for low risk men?

A

Active surveillance

If they are stage T1c, Gleason 3+3, PSA density <0.15ng/ml/ml, who have cancer in <50% of their biopsy cores, with <10mm of any core involved

178
Q

What investigation should be performed in the context of a suspicious DRE regardless of PSA?

A

US guided biopsy of prostate

179
Q

What is TURP syndrome?

A

A rare + life-threatening complication of TURP surgery caused by irrigation with large volumes of glycine which is hypo-osmolar + systemically absorbed when prostatic venous sinuses are opened up during prostatic resection
It leads to hyponatraemia when glycine is broken down in the liver to ammonia, hyperammonia and visual disturbances

180
Q

What are risk factors for developing TURP syndrome?

A 
Surgical time >1h
Height of bag >70cm
Resected >60g
Large blood loss
Perforation 
Large amount of fluid used
Poorly controlled CHF
181
Q

In which gender are urethral injuries mainly seen?

A

Males

182
Q

What do you often see in urethral injuries?

A

Blood at the meatus

183
Q

What are the two types of urethral injuries?

A

Bulbar rupture

Membranous rupture

184
Q

What things tend to cause bulbar rupture?

A

Straddle type injuries, e.g. bicycles

185
Q

What are the triad of signs commonly seen in bulbar rupture?

A

Urinary retention
Perineal haematoma
Blood at meatus

186
Q

What commonly causes membranous rupture?

A

Pelvic fractures

187
Q

What might you see in membranous rupture?

A

Penile/perineal oedema/haematoma

PR: prostate displacement upwards

188
Q

How should you investigate a suspected urethral injury?

A

Ascending urethrogram

189
Q

How should urethral injury be managed?

A

Suprapubic catheter (surgical placement)

190
Q

How does bladder rupture tend to present?

A

Haematuria or suprapubic pain

Inability to retrieve all fluid used to irrigate the bladder through a Foley catheter indicates bladder injury

191
Q

What investigation should be used if bladder rupture is supsected?

A

IVU or cystogram

192
Q

How is bladder rupture managed?

A

Laparotomy if intraperitoneal

Conservative if extraperitoneal

193
Q

History of pelvic fracture and inability to void should ALWAYS raise suspicion of what?

A

Urethral injury!!

194
Q

How is all acute upper urinary tract obstruction managed?

A

Nephrostomy (prevent loss of renal function)

195
Q

What are the causes of unilateral hydronephrosis?

A 
PACT
Pelvic-ureteric obstruction 
Abberant renal vessels
Calculi
Tumours of the renal pelvis
196
Q

What are causes of bilateral hydronephrosis?

A 
SUPER
Stenosis of the urethra
Urethral valve
Prostate enlargement
Extensive bladder tumour
Retroperitoneal fibrosis
197
Q

What investigation is used first line to identify hydronephrosis?

A

USS

198
Q

What other investigations may be used after USS confirms hydronephrosis?

A

IVU - assess position of obstruction
Antegrade/retrograde pyelography - allows treatment
If suspect renal colic - CT scan

199
Q

How are chronic upper urinary tract obstructions managed?

A

Ureteric stent/pyeloplasty

200
Q

How does hydronephrosis present on examination?

A

Ballotable mass

201
Q

What is the first line investigation of a testicular mass?

A

USS

202
Q

What is the difference between active surveillance and watchful waiting?

A

Active surveillance requires more routine follow up and physical examination
Watchful waiting is guided by symptomatology + is preferred for those with low grade disease + significant comorbs

203
Q

What are staghorn calculi composed

A

Struvite (phosphate, magnesium, ammonium)

204
Q

What kind of urine do staghorn calculi form in?

A

Alkaline urine (ammonia producing bacteria, e.g. ureaplasma urealyticum and proteus therefore predispose)

205
Q

Stones under which size can be considered for lithotripsy?

A

2cm

206
Q

What are large proximal renal stones best treated with?

A

Percutaneous nephrolithotomy

207
Q

What testicular pathology is associated with mumps infection?

A

Orchitis

208
Q

What sign may indicate recent stone passage if a ureteric calculus is not present?

A

Periureteric fat stranding

209
Q

PSA should not be measured within ____ of having a prostate biopsy

A

6 weeks

210
Q

PSA should not be measured within ____ of having a DRE

A

1 week

211
Q

What is the most common organic cause of EF?

A

Vascular causes (including CVD, HTN, hyperlipidaemia, DM, smoking)

212
Q

What is balanitis?

A

Inflammation of the glans penis

if affects underside of foreskin too = balanoposthitis

213
Q

What are causes of balanitis?

A

Infective - bacterial/candidal

Autoimmune diseases

214
Q

How is balanitis diagnosed?

A

Through hx and ex

215
Q

Describe the balanitis experienced with a candidal infection

A

Tends to occur after intercourse

Associated with itching and white non-urethral discharge

216
Q

What is balanitis due to dermatitis (allergic/contact) like?

A

Itchy, painful

Occasionally associated with a clear non-urethral discharge

217
Q

What is balanitis due to dermatitis (eczema/psoriasis) like?

A

Very itchy
No discharge
Hx inflammatory skin condition on body elsewhere

218
Q

What is balanitis due to bacterial infection like?

A

Painful, itchy

Yellow non-urethral discharge

219
Q

What is the most common balanitis causing bacterial organism?

A

Staphylococcal spp.

220
Q

What kind of organism causes a very offensive yellow discharge with balanitis?

A

Anaerobic organisms

221
Q

What are features of lichen planus (penile)?

A

Itchy
Wickham’s striae
Violaceous papules

222
Q

How common is lichen sclerosus (BXO)?

A

Rare

223
Q

What are features of BXO?

A

Itchy

Associated with white papules and can cause significant scarring

224
Q

How does plasma cell balanitis of Zoon present?

A

Non-itchy, clearly circumscribed areas of inflammation

225
Q

How does circinate balanitis present?

A

Painless erosions

Can be associated with Reiter’s

226
Q

How is balanitis managed?

A

Gentle saline washes
Ensuring to wash properly under the foreskin
If more severe - 1% hydrocortisone can be used

227
Q

What is the treatment of candidial balanitis?

A

Topical clotrimazole for 1 weeks

228
Q

What is the treatment of bacterial balanitis?

A

Oral fluclox or clarithromycin if penicillin allergic

229
Q

How is anaerobic balanitis managed?

A

Saline washing, topical/oral metronidazole if not settling

230
Q

How are dermatitis and circinate balanitis managed?

A

Hydrocortisone

231
Q

How are lichen sclerosus and plasma cell balanitis of Zoon managed?

A

High potency topical steroids

232
Q

How is BXO managed?

A

Circumcision

233
Q

What can BXO in an uncircumcised mail lead to?

A

Phimiosis

234
Q

What is the first line investigation for suspected prostate cancer?

A

Multiparametric MRI

235
Q

What score on the Linkert scale in a multiparametric MRI would indicate need for a prostate biopsy?

A

> =3

236
Q

What is the investigation of choice for diagnosing bladder cancer?

A

Cystoscopy

237
Q

What are causes of urethral stricutres?

A

Iatrogenic, e.g. traumatic placement of indwelling urinary catheters
STIs
Hypospadias
Lichen sclerosus

Renal/Urology (29 decks)

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