Urology Surgery Flashcards
Features of benign prostatic hyperplasia (BPH)
Hesitancy Urgency Increased frequency Intermittency Straining to void Terminal dribbling Incomplete emptying
Assessment of patient with BPH symptoms
Urine dipstick - to exclude infection
PSA - to exclude malignancy
DRE exam - to feel for prostate enlargement
Medical management of BPH
Alpha blockers (relax smooth muscle) - e.g, tamsulosin 5-alpha reductase inhibitors (block testosterone and help reduce size of prostate) - e.g, finasteride
What surgical management is available for BPH
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
Complications of TURP procedure
Mnemonic FIRES: Failure to resolve symptoms Incontinence Retrograde ejaculation Erectile dysfunction Strictures
Features that distinguish prostate cancer from BPH
Haematuria Erectile dysfunction Weight loss Fatigue Bone pain
Primary investigations when prostate cancer is suspected
DRE
PSA
MRI scan - this is done first and Likert score calculated
When would you do a prostate biopsy when investigating for prostate cancer
When Likert score is >3 following MRI scan
What are the normal upper limits for PSA depending on age
50-60 = 3 60-70 = 4 70-80 = 5
Aside from prostate cancer, what else can cause a rise in PSA?
BPH Infection e.g, prostatitis or UTI Ejactulation (within 48 hours) Vigorous exercise (within 48 hours) Urinary retention Instrumentation of urinary tract
Complications of transrectal USS guided (TURS) biopsy
Sepsis
Pain
Fever
Haematuria and rectal bleeding
When is hormonal therapy used in prostate cancer
In the presence of metastases
High graded prostate cancer
What drugs are used in hormonal therapy of prostate cancer
Goserelin - synthetic GnRH
Cyproterone acetate - given alongside goserelin initially to prevent rise in testosterone
Grading system for prostate cancer
Gleason scale
Management of acute prostate is
Quinolone antibiotic
Most common type of kidney stone
Calcium oxalate (85%)
Which type of kidney stone presents as a staghorn calculus
Struvite kidney stones
Magnesium ammonium phosphate
Imaging of kidney stones
Non contrast CT KUB
Management of kidney stones
Depends on size:
<5mm - manage expectantly (tamsulosin can help)
<2cm - shock lithotripsy
Complex renal calculi - percutaneous nephrolithotomy
Pain relief given for kidney stones
IM diclofenac
Features of kidney stones
Renal colic Loin to groin pain Haematuria Nausea, vomiting Oliguria
Advice for patients to prevent recurrence of kidney stones
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
Causes of unilateral hydronephrosis
PACT Pelvic ureteric obstruction Aberrant renal vessels Caliculi Tumours of renal pelvis
Causes of bilateral hydronephrosis
SUPER Stenosis of urethra Urethral valve Prostate enlargement Extensive bladder tumour Retroperitoneal fibrosis
