urology + vascular Flashcards
what is imp to exclude before doing a circumcsiion
hypospadias
-as the foreskin may be used in the surgical repair
medical indications for circumcision
- phimosis
- recurrent balanitis
- balanitis xerotica obliterans
- paraphimosis
what is the most imp RF for TCC of bladder
smoking - 3x more likely than non smokers
-account for 50% cases
AAA screening outcomes
<3cm - normal - no more Ix
3-4.4cm - small aneurysm. rescan every 12m
4.5-5.4cm - medium aneurysm - rescan every 3m
>5.5cm - large aneurysm - refer within 2w to vascular surgery for probably intervention
how to differentiate T.Torsion vs epididymitis by Prehn’s sign
PREHN’S SIGN = elevation of testis
- does NOT ease pain= TESTICULAR TORSION
- does ease pain = EPIDYDIMITIS
CONSERVATIVE peripheral arterial disease Mx
CONSERVATIVE:
- stop SMOKING
- treat CO-MORBIDITES: HTN, DM, Obesity
- take ATORVASTATIN 80mg + CLOPI
- EXERCISE training (supervised)
SEVERE Peripheral arterial disease or CLI Mx
ENDOVASCULAR REVASCULARISATION:
- percutaenous transluminal ANGIOPLASTY +/- stent placement
- ENDOVASC techniques are typically used for short segment stenosis (e.g. < 10 cm), aortic iliac disease and high-risk patients
SURGICAL REVASCULARISATION
- surgical BYPASS with an autologous vein or prosthetic material
- ENDARTERECTOMY
- open surgical techniques are typically used for long segment lesions (> 10 cm), multifocal lesions, lesions of the common femoral artery and purely infrapopliteal disease
Drugs licensed for use in PAD
naftidrofuryl oxalate - VASODILATOR - used for pts with poor QoL
how to prevent calcium renal stones due to hypercalciuria , found in up to 5-10% of population
- high fluid intake
- low animal protein, low salt diet (low caclium diet not superior to normocalcaemic diet)
- THIAZIDE DIURETICS (incr dital tubular caclium resorption)
how to prevent oxalate renal stones
- cholestyramine reduces urinary oxalate secretion
- pyridoxine reduces urinary oxalate secretion
how to prevent uric acid stones
allopurinol
urinary alkalinsation eg oral bicarb
prostatitis mx
quinolone eg ciprofloxacin for 14 days
what happens to creamasteric reflex in test torsion of spermatic cord
usu absent
- it is preserved if torsion affects appendage only
prostate cancer 1st line Ix
multiparametric MRI
replaced TRUS biopsy
erectile dysfunction define
persistent inability to attain + maintain an erection sufficient to permit satisfactory sexual performance
-sx not a disease + causes split into organic, psychogenic + mixed
erectile dysfunction psychogenic causes
- -Sudden onset.
- Early collapse of erection.
- Self-stimulated or waking erections.
- Premature ejaculation or inability to ejaculate.
- Problems or changes in a relationship.
- Major life events.
- Psychological problems.
erectile dysfunction organic causes
- Gradual onset.
- Normal ejaculation.
- Normal libido (except hypogonadal men).
- Risk factors in medical history (cardiovascular, endocrine or neurological).
- Operations, radiotherapy, or trauma to the pelvis or scrotum.
- A current drug recognised as associated with ED.
- Smoking, high alcohol consumption, use of recreational or bodybuilding drugs.
complications of TURP
TURP syndrome
Urethral stricture/UTI
Retrograde ejaculation
Perforation of the prostate
TURP syndrome triad + causes
- HYPONATRAEMIA (DILUTIONAL)
- FLUID OVERLOAD
- GLYCINE TOXICITY
- broken down in liver to ammonia –> hyperammonia + visual disturbances
Cause: occurs when irrigation fluid (glycine = hyperosmolar) enters the systemic circulation
Mx = fluid restrict + tx complications assoc with hyponatraemia
what can varicocele + weight loss + anaemia indicate
RENAL CELL CARCINOMA
- varicocele can be sign of malignancy due to COMPRESSION OF RENAL VEIN between ABDOM AORTA + SMV = nutcracker angle
what systems for classification of PAD
Fontaine + Rutherford
what do Fontaine III + IV pertain to
CLI
III - rest pain
IV - ulceration or gangrene
what does non symptomatic mx of ICLaud focus on
RF modification = CONSERVATIVE -QUIT smoking -W Loss -Exercise Training programme -Foot care MEDICAL -statins 80mg atorva -antiplatelets 75mg clopi -NOT ASPIRIN
What are some indications for an amputation
DEAD - ALI, Thrombangiitis obliterans
DANGEROUS - NF, malignancy, sepsis
DAMAGED - trauma, burns, frostbite
DAMNED NUISANCE - pain, neurological damage
