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Year 5 > Urology Surgery > Flashcards

Urology Surgery Flashcards

1
Q

Features of benign prostatic hyperplasia (BPH)

A 
Hesitancy 
Urgency 
Increased frequency 
Intermittency 
Straining to void 
Terminal dribbling 
Incomplete emptying
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2
Q

Assessment of patient with BPH symptoms

A

Urine dipstick - to exclude infection
PSA - to exclude malignancy
DRE exam - to feel for prostate enlargement

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3
Q

Medical management of BPH

A 
Alpha blockers (relax smooth muscle) - e.g, tamsulosin 
5-alpha reductase inhibitors (block testosterone and help reduce size of prostate) - e.g, finasteride
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4
Q

What surgical management is available for BPH

A

Transurethral resection of the prostate (TURP)
Involves “shaving” off prostate tissue from inside using diathermy
The aim is to create a wider space for urine to flow through

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5
Q

Complications of TURP procedure

A 
Mnemonic FIRES:
Failure to resolve symptoms 
Incontinence 
Retrograde ejaculation 
Erectile dysfunction 
Strictures
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6
Q

Features that distinguish prostate cancer from BPH

A 
Haematuria 
Erectile dysfunction 
Weight loss 
Fatigue 
Bone pain
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7
Q

Primary investigations when prostate cancer is suspected

A

DRE
PSA
MRI scan - this is done first and Likert score calculated

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8
Q

When would you do a prostate biopsy when investigating for prostate cancer

A

When Likert score is >3 following MRI scan

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9
Q

What are the normal upper limits for PSA depending on age

A 
50-60 = 3
60-70 = 4 
70-80 = 5
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10
Q

Aside from prostate cancer, what else can cause a rise in PSA?

A 
BPH
Infection e.g, prostatitis or UTI 
Ejactulation (within 48 hours)
Vigorous exercise (within 48 hours)
Urinary retention 
Instrumentation of urinary tract
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11
Q

Complications of transrectal USS guided (TURS) biopsy

A

Sepsis
Pain
Fever
Haematuria and rectal bleeding

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12
Q

When is hormonal therapy used in prostate cancer

A

In the presence of metastases

High graded prostate cancer

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13
Q

What drugs are used in hormonal therapy of prostate cancer

A

Goserelin - synthetic GnRH

Cyproterone acetate - given alongside goserelin initially to prevent rise in testosterone

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14
Q

Grading system for prostate cancer

A

Gleason scale

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15
Q

Management of acute prostate is

A

Quinolone antibiotic

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16
Q

Most common type of kidney stone

A

Calcium oxalate (85%)

17
Q

Which type of kidney stone presents as a staghorn calculus

A

Struvite kidney stones

Magnesium ammonium phosphate

18
Q

Imaging of kidney stones

A

Non contrast CT KUB

19
Q

Management of kidney stones

A

Depends on size:
<5mm - manage expectantly (tamsulosin can help)
<2cm - shock lithotripsy
Complex renal calculi - percutaneous nephrolithotomy

20
Q

Pain relief given for kidney stones

A

IM diclofenac

21
Q

Features of kidney stones

A 
Renal colic 
Loin to groin pain 
Haematuria 
Nausea, vomiting 
Oliguria
22
Q

Advice for patients to prevent recurrence of kidney stones

A

Increase fluid intake
Reduce salt intake
Reduce oxalate rich food intake e.g, spinach, nuts rhubarb, tea
Reduce urate rich food intake e.g, kidney, liver, sardines
Limit dietary protein

23
Q

Causes of unilateral hydronephrosis

A 
PACT
Pelvic ureteric obstruction 
Aberrant renal vessels 
Caliculi 
Tumours of renal pelvis
24
Q

Causes of bilateral hydronephrosis

A 
SUPER
Stenosis of urethra
Urethral valve
Prostate enlargement 
Extensive bladder tumour 
Retroperitoneal fibrosis
25
Q

Management of hydronephrosis

A

Remove obstruction and drain urine - catheter

Nephrostomy

26
Q

Most common type of renal cancer

A

Renal cell carcinoma (clear cell)

27
Q

Where does renal cancer commonly metastasise to?

A

Lung - causing cannon ball metastases

28
Q

Risk factors for renal cancer

A

Smoking
Von hippel-lindau syndrome (tumours in multiple organs)
Tuberous sclerosis
ADPKD

29
Q

Paraneoplastic features of renal cancer

A

Polycythaemia (as kidney secretes unregulated EPO)
Hypercalcemia (RCC secretes hormone that mimics PTH)
Stauffer syndrome (abnormal liver function tests demonstrating obstructive jaundice - without any localised liver or biliary metastases)

30
Q

Main causes of epididymo-orchitis

A 
E.Coli 
Chlamydia 
Gonorrhoea 
Mumps 
Drug cause - amiodarone
31
Q

Features of testicular torsion

A

Usually presents in teenage boys
Acutely tender testicle
Absent cremasteric reflex
Abnormal lie e.g, horizontal lie, rotated or elevated

32
Q

Tumour markers for testicular cancer

A

Alpha fetoprotein - may be raised in teratomas

Beta-hCG - may be raised in teratomas and seminomas

33
Q

Features of varicocele

A

Usually left sided - because testicular vein on left drains into the renal vein
Feels like bag of worms on examination
Can be presenting feature of renal cell carcinoma

34
Q

Features of hydrocele

A

Non painful swelling of testicle
Often possible to ‘get above mass’ on examination
Contain clear fluid - transluminate with torch

Year 5 (17 decks)

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