Urology revision

Question 1

Testicular cancer stats and intro, RF

Answer 1

most common in young men- 25-45 year old
mainly-
Teratomas-v young, Seminomas-older young
Yolk sack
Lymphomas- OLD (>60)

RF
Undescended testes- 3-15x risk of cancer -mitigated with orchidopexy
HIV
White>black
Fhx

Question 2

Scrotal lump Hx

Answer 2

fast growing-
how quickly is it growing
how detected
painful-usually infective
Painless- Cancer?

STI?
UTIsx
trauma
Lumps in abdo/neck
SOB- metastatic
smoke
examination self for a while
FHx

Question 3

ddx for scrotal mass-esp for exams

Answer 3

Skin- sebaceous cyst, melanoma

Vaginal area-epidimytis (hard tender mass behind testes-settle on own), Torted
Hydrocele, Epidymial cyst,

testicular-cancer (hard craggy mass IN testes, rapid enlarge), orchitis, Lymphoma
Other-Lipoma of cord

Question 4

Good intial Ix of scrotal masses

Answer 4

USS scrotum/testes–heterogenous lump IN testes

Bloods-BHCG, aFP, LDH are the markers

FBC, UE, CRP
Dipstick/culture for UTI

Question 5

Testicular cancer markers

Answer 5

Not as useful for diagnsosis but crucial for monitor- esp before surgery

AFP-raised 70% in non seminoma
BHCG-raised across board, 10% of seminoma
LDH-more tumour bulk marker

Question 6

Testicular cancer MX

Answer 6

Once diagnosed
biopsies are too slow
CTCAP isnt a bad idea but only if can be done fast for metastases

But you need orchidectomy -Inguinal approach (reduce seeding risk)
FAST-that’s the mx

CTCAP after-lung mets,
Chemotherapy-depends on CT and Path staging of cancer (generally - surveillance if no mets, Chemo upfront if mets)

Question 7

testicular cancer survival

Answer 7

90%> if good (non metastatic)
>60% survival if metastatic

good cancer to have

Question 8

Heamaturia Hx

Answer 8

How long
Previous?
LUTS
Fever/rigors?
Hx of stones, Flank pain
FHX of RCC etc
Dyes, smoker (TCC)

Is it infective or should I be worried

Exam- Look at the urine-real blood
Mass in Abdo

Question 9

Ix of Heamaturia

Answer 9

Bedside dip, MSI

Bloods, UE
MSU

Gold standards—CT urogram and flexible cystoscopy
Non visible- do USS urogram first cause cancer less likely

TURBT (take a sample with scope) and biopsy with muscle for path

Question 10

ddx of heamturia

Answer 10

Bladder cancer
renal cancer
stones
UTI
prostatic

visible heamturia- 20% cancer, most bladder
Invisible heamturia-5% cancer

LUTS, Weight loss etc-

Question 11

Bladder cancer presentation

Answer 11

most common heamturia cancer (esp visible

Question 12

Heamaturia reference guidelines

Answer 12

Urgent
over 45 with visible and no UTI

Over 60 and above with non visible + either WCC up, Dysuria

Question 13

Bladder cancer staging and mx

Answer 13

TURBT (take a sample with scope) and biopsy with muscle for path

TNM stage-has it invaded muscle
bread muscle- radiotherapy, cystesctomy
Superficial- intravesical chemo
Or surveillance if low risk
Metastatic-chemo

Question 14

Cystectomy follow up

Answer 14

get a stoma in Left illiac fossa- small urine catheter with spouted–usually a bit of bowel connecting the ureters to skin

Question 15

Classifying hematuria for PACES

Answer 15

Anatomy approach
Renal (cancer n infection), Ureteric stones, Uretheric cancer, Bladder (cancer and infection), Prostate (cancer and infection), trauma, Urethra

or ddx
Infective, cancer, other
eg- pylonephritis, cystisis
bladder cancer (TCC), prostate, Renal (RCC)