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Surgery > Urology / Renal > Flashcards

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
Q

Tumour markers in non seminomatous germ cell tumours

A

AFP elevated 70%

HCG elevated in 40%

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26
Q

Risk factors for testicular cancer

A 
Cryptorchidism 
Infertility 
FH
Kleinfelters syndrome
Mump orchitis
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27
Q

Presentation of testicular cancer

A

Painless lump most common presenting symptom
Pain in a minority
Hydrocele
Gynaecomastia

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28
Q

Diagnosis of testicular cancer

A

USS 1st line
CT
Tumour markers

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29
Q

Management of testicular cancer

A

Orchidectomy (inguinal approach)
Chemo and radio depending on stage
Abdo lesions > 1cm following chemo may require retroperitoneal lymph node dissection

30
Q

Prognosis for testicular cancer

A

Excellent

31
Q

Definition of priapism

A

Persistent penile erection, typically defined as lasting over 4 hours and is not associated with sexual stimulation

32
Q

Types of priapism

A

Ischaemic

Non ischaemic

33
Q

Pathology of ischaemic priapism

A

Due to impaired vasorelaxation and therefore reduced vascular outflow resulting in congestion and trapping of de-oxygenated blood within the corpus cavernosa

34
Q

Pathology of non ischaemic priapism

A

Due to high arterial inflow, typically due to fistula formation often as a result of congenital or traumatic mechanisms

35
Q

Causes of priapism

A 
Idiopathic
Sickle cell disease or other haemoglobinopathies
Erectile dysfunction medications
Drugs
- anti HTNs
- Anticoagulants
- antidepressants 
- cocaine, cannabis and ectasy
36
Q

Presentation of priapism

A

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
Q

Investigations of priapism

A

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
Q

Is priapism a medical emergency?

A

Yes if ischaemic

39
Q

Treatment of ischaemic priapism

A

> 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
Q

Treatment of non ischaemic priapism

A

Observation

41
Q

1st line investigation of a testicular mass

A

Testicular USS

42
Q

What is an indication for circumcision?

A

Recurrent balantitis

43
Q

What does periureteric fat on CT KUB with no ureteric calculus indicate?

A

Recent stone passage

44
Q

Treatment of renal calculus with a stone burden of less than 2cm in aggregate

A

Lithotripsy

45
Q

Treatment of renal calculus with a stone burden of less than 2cm in pregnant females

A

Ureteroscopy

46
Q

Treatment of renal calculus if complex renal calculi and staghorn calculi

A

Percutaneous nephrolithotomy

47
Q

Treatment of renal calculus if ureteric calculi is < 5mm

A

Manage expectantly

48
Q

Renal stones of what size will likely pass spontaneously and in how long?

A

< 5mm in maximum diameter

Within 4 weeks of symptom onset

49
Q

Describe shockwave lithotripsy

A

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
Q

Complications of shockwave lithiotripsy

A

Passage of shock waves may lead to solid organ injury

Fragmentation of larger stones may result in development of ureteric obstruction

51
Q

Describe uteroscopy

A

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
Q

Describe percutaneous nephrolithotomy

A

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
Q

Urinary incontinence in a man with a PMH of gonorrohoea may be due to what?

A

Urinary stricture

54
Q

Most common cause of epididymis in > 35 y/o men

A

E coli

55
Q

Causes of unilateral hydronephrosis

A

Pelvic ureteric obstruction (congenital or acquired)
Aberrant renal vessels
Calculi
Tumours of the renal pelvis

56
Q

Causes of bilateral hydronephrosis

A 
Stenosis of the urethra
Urethral valve
Prostatic enlargement
Extensive bladder tumour
Retroperitoneal fibrosis
57
Q

Treatment of acute upper urinary tract obstruction

A

Nephrostomy tube

58
Q

Treatment of chronic upper urinary tract obstruction

A

Ureteric stent or pyeloplasty

59
Q

Complication of TURP

A

TURP syndrome
Urethral stricture / UTI
Retrograde ejaculation
Perforation of the prostate

60
Q

Pathology of TURP syndrome

A

Occurs when irrigation fluid enters the systemic circulation

61
Q

Triad of features of TURP syndrome

A
  1. Dilutional hyponatraemia
  2. Fluid overload
  3. Glycine toxicity
62
Q

1st line investigation for renal stones

A

Non contrast CT

63
Q

Most common form of prostate cancer

A

Adenocarcinoma

64
Q

Investigation for hydronephrosis

A

USS

65
Q

1st line for BPH

A

Alpha-1-antagonist

66
Q

Investigation for acute prostatitis symptoms

A

STI testing

67
Q

Most common organism causing acute prostatitis

A

E coli

68
Q

Risk factors for acute bacterial prostatitis

A

Recent UTI
Urogenital instrumentation
Intermittent bladder catheterisation
Recent prostate biopsy

69
Q

Presentation of acute bacterial prostatitis

A 
Pain - can be referred to a variety of areas
- perineum 
- penis
- rectum 
- back 
Obstructive voiding symptoms
Fever / rigors
on DRE; tender, boggy prostate
70
Q

Treatment for acute bacterial prostatitis

A

Screen for STIs

2 week course of quinolone

71
Q

What may ureteric stones occur in the background of?

A

Dehydration

72
Q

What cancers are patients at risk of following radiotherapy for prostate cancer?

A

Bladder cancer
Colon cancer
Rectal cancer

Surgery (9 decks)

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