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Urology / Renal Flashcards

1
Q

What does a scrotal swelling that you cant get above indicate?

A

Inguinal hernia

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2
Q

What may be present with an inguinal hernia causing a scrotal swelling?

A

Cough impulse

May be reducible

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3
Q

Presentation of testicular tumour

A

Often discrete testicular nodule (may have associated hydrocele)
Symptoms of mets may be present

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4
Q

Investigations of testicular tumour

A

USS scrotum
Serum AFP
BHCG

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5
Q

Presentation of acute epididymo-orchitis

A

Dysuria
Urethral discharge
Swelling - tender and may be eased by elevating testis

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6
Q

What are most cases of acute epididymo-orchitis due to?

A

Chlamydia

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7
Q

Presentation of Epididymal cysts

A

Scrotal swelling
May contain clear or opalescent fluid (Spermatoceles)
Painless
Lie above or behind testis
Single or multiple cysts
Usually possible to get ‘above the lump’ on examination

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8
Q

What age usually gets epididymal cysts?

A

> 40 y/o

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9
Q

Presentation of hydrocele

A

Non painful, soft, fluctuant swelling
Often possible to “get above it” on examination
Usually contain clear fluid
Will often transilluminate

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10
Q

What may the presence of hydrocele be an early indicator of in young men?

A

Testicular cancer

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11
Q

Presentation of testicular torsion

A

Severe sudden onset testicular pain

Tender tesits - not eased by elevation

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12
Q

Who does testicular torsion usually effect?

A

Adolescents and young males

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13
Q

Risk factor for testicular torsion

A

Abnormal testicular lie

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14
Q

What is a varicocele?

A

Varicosities of the pampiniform plexus

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15
Q

Where do varicoceles typically occur and why?

A

On the left

Because the testicular vein drains into the renal vein

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16
Q

What may a varicocele be a presenting feature of?

A

Renal cell carcinoma

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17
Q

What may the affected testis in varicocele look like?

A

Smaller

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18
Q

What may bilateral varicoceles do?

A

Affect fertility

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19
Q

Commonest subtype of testicular tumours

A

Seminoma

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20
Q

Average age of diagnosis of seminoma

A

40

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21
Q

Tumour markers in seminoma

A

AFP normal
HCG elevated in 10%
Lactate dehydrogenase elevated in 10 - 20%

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22
Q

What are the other non seminomatous germ cell tumours?

A

Teratoma
Yolk sac tumour
Choriocarcinoma
Mixed germ cell tumours (10%)

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23
Q

Age of presentation of non seminomatous germ cell tumours

A

20 - 30 y/o

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24
Q

Which of a seminoma or non seminomatous germ cell tumours carry a worse prognosis?

A

Non Seminomatous germ cell tumours worse

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25
Tumour markers in non seminomatous germ cell tumours
AFP elevated 70% | HCG elevated in 40%
26
Risk factors for testicular cancer
``` Cryptorchidism Infertility FH Kleinfelters syndrome Mump orchitis ```
27
Presentation of testicular cancer
Painless lump most common presenting symptom Pain in a minority Hydrocele Gynaecomastia
28
Diagnosis of testicular cancer
USS 1st line CT Tumour markers
29
Management of testicular cancer
Orchidectomy (inguinal approach) Chemo and radio depending on stage Abdo lesions > 1cm following chemo may require retroperitoneal lymph node dissection
30
Prognosis for testicular cancer
Excellent
31
Definition of priapism
Persistent penile erection, typically defined as lasting over 4 hours and is not associated with sexual stimulation
32
Types of priapism
Ischaemic | Non ischaemic
33
Pathology of ischaemic priapism
Due to impaired vasorelaxation and therefore reduced vascular outflow resulting in congestion and trapping of de-oxygenated blood within the corpus cavernosa
34
Pathology of non ischaemic priapism
Due to high arterial inflow, typically due to fistula formation often as a result of congenital or traumatic mechanisms
35
Causes of priapism
``` Idiopathic Sickle cell disease or other haemoglobinopathies Erectile dysfunction medications Drugs - anti HTNs - Anticoagulants - antidepressants - cocaine, cannabis and ectasy ```
36
Presentation of priapism
Persistent erection > 4 hours Pain localised to the penis More rarely a non painful erection or an erection that is not fully rigid (suggestive of non ischaemic) History of trauma to perineal or genital region (suggestive of non ischaemic)
37
Investigations of priapism
Cavernosal blood gas (to distinguish between non and ischaemic - in ischaemic p02 and pH would be reduced with increased CO2) Doppler or duplex ultrasound FBC and toxicology screen Largely clinical diagnosis
38
Is priapism a medical emergency?
Yes if ischaemic
39
Treatment of ischaemic priapism
> 4 hours - aspiration of blood from the cavernous cavernosa - with injection of saline flush to help clear the viscous blood that has been pooled If that fails - Intracavernosal injection of vasoconstrictive agent such as phenylephrine is used and repeated at 5 min intervals Surgical can then be considered if medical fails
40
Treatment of non ischaemic priapism
Observation
41
1st line investigation of a testicular mass
Testicular USS
42
What is an indication for circumcision?
Recurrent balantitis
43
What does periureteric fat on CT KUB with no ureteric calculus indicate?
Recent stone passage
44
Treatment of renal calculus with a stone burden of less than 2cm in aggregate
Lithotripsy
45
Treatment of renal calculus with a stone burden of less than 2cm in pregnant females
Ureteroscopy
46
Treatment of renal calculus if complex renal calculi and staghorn calculi
Percutaneous nephrolithotomy
47
Treatment of renal calculus if ureteric calculi is < 5mm
Manage expectantly
48
Renal stones of what size will likely pass spontaneously and in how long?
< 5mm in maximum diameter | Within 4 weeks of symptom onset
49
Describe shockwave lithotripsy
A shock wave is generated external to the patient Internally cavitation bubbles and mechanical stress lead to stone fragmentation Analgesia will be required before and afterwards as it is unpleasant
50
Complications of shockwave lithiotripsy
Passage of shock waves may lead to solid organ injury | Fragmentation of larger stones may result in development of ureteric obstruction
51
Describe uteroscopy
A ureteroscope is passed retrograde through the ureter into the renal pelvis Indicated in complex cases (e.g. pregnant women) where lithiotripsy is contraindicated and in complex stone disease In most cases a stent is left in for 4 weeks post procedure
52
Describe percutaneous nephrolithotomy
Access is gained to the renal collecting system | One access is achieved, intra corpeal lithiotripsy or stone fragmentation is performed and stone fragments removed
53
Urinary incontinence in a man with a PMH of gonorrohoea may be due to what?
Urinary stricture
54
Most common cause of epididymis in > 35 y/o men
E coli
55
Causes of unilateral hydronephrosis
Pelvic ureteric obstruction (congenital or acquired) Aberrant renal vessels Calculi Tumours of the renal pelvis
56
Causes of bilateral hydronephrosis
``` Stenosis of the urethra Urethral valve Prostatic enlargement Extensive bladder tumour Retroperitoneal fibrosis ```
57
Treatment of acute upper urinary tract obstruction
Nephrostomy tube
58
Treatment of chronic upper urinary tract obstruction
Ureteric stent or pyeloplasty
59
Complication of TURP
TURP syndrome Urethral stricture / UTI Retrograde ejaculation Perforation of the prostate
60
Pathology of TURP syndrome
Occurs when irrigation fluid enters the systemic circulation
61
Triad of features of TURP syndrome
1. Dilutional hyponatraemia 2. Fluid overload 3. Glycine toxicity
62
1st line investigation for renal stones
Non contrast CT
63
Most common form of prostate cancer
Adenocarcinoma
64
Investigation for hydronephrosis
USS
65
1st line for BPH
Alpha-1-antagonist
66
Investigation for acute prostatitis symptoms
STI testing
67
Most common organism causing acute prostatitis
E coli
68
Risk factors for acute bacterial prostatitis
Recent UTI Urogenital instrumentation Intermittent bladder catheterisation Recent prostate biopsy
69
Presentation of acute bacterial prostatitis
``` Pain - can be referred to a variety of areas - perineum - penis - rectum - back Obstructive voiding symptoms Fever / rigors on DRE; tender, boggy prostate ```
70
Treatment for acute bacterial prostatitis
Screen for STIs | 2 week course of quinolone
71
What may ureteric stones occur in the background of?
Dehydration
72
What cancers are patients at risk of following radiotherapy for prostate cancer?
Bladder cancer Colon cancer Rectal cancer

Surgery (9 decks)

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