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Urology Flashcards

1
Q

What is testicular torsion?

A

surgical emergency and describes the twisting of the spermatic cord and its contents

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2
Q

What is the most common age group for testicular torsion?

A

between the ages of 10-30 (peak in 13-15)

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3
Q

How would someone with testicular torsion present?

A
  • severe sudden onset pain in scrotum
  • referred to lower abdo
  • N&V
  • unable to walk or sit, fidgeting
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4
Q

How would testicular torsion appear on examination?

A
  • swollen, tender testis retracted upwards
  • long axis orientated transversely due to shortening of spermatic cord
  • erythema
  • loss of cremasteric reflex
  • Prehn’s sign - elevation of testis does not ease pain
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5
Q

What is the management for testicular torsion?

A

urgent surgical exploration - within 6 hours

  • incision made in midline of testes, untwist cord and see if colour returns (will appear blue/black)
  • soak in warm saline and hyper-oxygenate the patient for 5-10 mins
  • 3 point fixation of testicle - albuginea to dartos
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6
Q

list some ddx for testicular torsion

A
  • epididymo-orchitis
  • tumour
  • trauma
  • acute hydrocele
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7
Q

what is epidiymitis and in what populations does it present?

A

inflammation of the epididymis

young (<35) due to STIs - chlamydia and gonorrhoea

older (>35) due to gram -ve bacteria (e.coli and pseudomonas) - associated with UTIs and BPH

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8
Q

How does epidiymitis present?

A

acute onset scrotal pain - tenderness and swelling of posterior testicle
fever
chills
myalgia or muscle pain

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9
Q

What is epidiymo-orchitis and how does it present?

A

epidiymitis that has spread to the testicle

acute onset scrotal pain
fever
N&V

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10
Q

what are the specific exam findings for epidiymo-orchitis?

A

testicular swelling and tenderness

positive phrehn sign - pain relived when elevating testicle

intact cremasteric reflex

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11
Q

what is cryptorchidism?

A

congenital undescended testis is one that has failed to reach the bottom of the scrotum (can affect one or both)

usually occurs in premature babies

testis usually gets stuck in the inguinal canal

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12
Q

what is the treatment for cryptorchidism?

A

if not descended by 2 years - orchidopexy

usually not required as testes will complete descent by 6 months

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13
Q

what is variocele?

A

abnormal enlargement of the testicular veins

dilatation of the pampinifrom plexus due to increased venous pressure

they are usually asymptomatic but may be important as they are associated with infertility

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14
Q

which side of the testes does varicocele more commonly effect?

A

left testis

left testicular vein drains into left renal vein forming perpendicular angle before draining into IVC = increases resistance to blood flow

unlikely to occur on right as the right testicular vein drains directly into the IVC therefore shorter route and less resistance

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15
Q

if a patient presents with right sided varicocele what should we suspect?

A

retroperitoneal tumour - renal cell carcinoma

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16
Q

how does varicocele present?

A 
soft scrotal mass
feeling of pressure or dull achy scrotal pain 
feels like a bag of worms 
mass distends/gets bigger when cough 
does not transilluminate
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17
Q

what is the treatment for varicocele?

A

conservative

surgical ligation or embolisation of dilated pampiniform plexus

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18
Q

what is hydrocele and what are the 2 types?

A

accumulation of fluid within the tunica vaginalis - between the visceral and parietal layer

congenital = communicating

  • failure of processus vaginalis to close up, allows peritoneal fluid to drain into scrotum
  • usually resolves within 1st few months of life

acquired = non-communicating

  • due to underlying condition - excessive fluid production within tunica vaginalis
  • trauma
  • infections - roundworm
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19
Q

how does a hydrocele present on examination?

A

soft, non-tender swelling of the hemi-scrotum. Usually anterior to and below the testicle
the swelling is confined to the scrotum, you can get ‘above’ the mass on examination
transilluminates with a pen torch
the testis may be difficult to palpate if the hydrocele is large

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20
Q

how to confirm the diagnosis of hydrocele?

A

US

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21
Q

management of hydrocele?

A

infantile hydroceles are generally repaired if they do not resolve spontaneously by the age of 1-2 years

in adults conservative - resolve on their own

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22
Q

what are neohrolithiasis and why do they form?

A

renal stones

form due to solute in the urine precipitating out and crystallising

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23
Q

what are the 6 different types of renal stones and which is the most common?

A
  • calcium oxalate (most common)
  • calcium phosphate
  • uric acid
  • struvite (Mg, ammonia, P)
  • cysteine
  • xanthine
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24
Q

what are the 3 most common places for renal stones to get stuck?

A
  • uretero-pelvic junction
  • vesico-ureteric junction
  • location where ureters cross sacroiliac joint
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25
Q

what are the risk factors for renal stones?

A
  • age - middle aged
  • M>F
  • Caucasian
  • Diet - excess animal protein
  • Chronic dehydration, low urine output
  • Obesity
  • FHx
  • PMHx - anatomical abnormalities, diabetes, gout, hyperparathyroidism, PKD
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26
Q

how would renal stones present in a patient?

A
  • renal colic (loin to groin)
  • N&V
  • haematuria
  • dysuria and straining
  • restless, unable to lie still
  • fever and sweating (if co-current UTI)
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27
Q

describe the feature of renal colic in renal stones

A 
sudden onset 
unilateral abdo pain 
lasts mins-hours 
spasms
loin to groin
28
Q

a patient presents with renal stones, what investigations would you organise?

A

urine dip - blood present
urine culture - MC&S
bloods - U&Es (check urine function), FBC and CRP (infection), clotting (if intervention planned)
blood culture - if pyrexial or signs of sepsis

imaging - non contrast CT KUB within 14 hours

29
Q

what colour do renal stones show up on non contrast CT KUB and why?

A

white - due to containing calcium

30
Q

what pain relief is given to a patient with renal stones?

A

NSAID - paraenteral analgesia (IM diclofenac for rapid pain relief)

31
Q

what is the management for a stone <5mm?

A

conservative
generally pass spontaneously
if causing obstruction or infection - requires urgent surgery

32
Q

what is the management for a stone >5mm with pain?

A

pain relief

estracorporeal shockwave lithotripsy (ESWL)

33
Q

what is the management for a large, multiple or complex renal stone?

A

percutaenous nephrolithotomy - access gained directly through the skin

34
Q

what is the management for a renal stone presenting with infection and obstruction?

A

percutaneous nephrostomy or ureteric stent (rigid cystoscopy)

35
Q

what is BPH?

A

condition where a biopsy of the prostate shows histological signs of hyperplastic changes (abnormalities at the cellular level)

36
Q

what LUTS is most common in men with BPH?

A

voiding sx

37
Q

how are LUTS classified?

A
  • Voiding sx (obstructive)
    • weak/intermittent flow, straining, hesitancy, terminal dribbling
  • Storage sx (irritative)
    • urgency, frequency, urge incontinence, nocturia
  • Post-micturition
    • dribbling
  • Complications
    • UTI, retention, obstructive uropathy
38
Q

what are risk factors for BPH?

A
  • Age - 50% of 50 year old men will have BPH (30% experience sx), 80% of 80 year old men will have BPH
  • Ethnicity (black and white - less in Asian)
  • FHx of BPH
  • Cigarette smoking
  • Male pattern baldness
  • Metabolic syndrome
39
Q

how would someone with BPH present?

A
  • Presence of risk factors
  • Storage sx - frequency, urgency, nocturia
  • Voiding sx - weak stream, hesitancy, post-void dribbling, incomplete emptying
40
Q

what are the investigations for a man presenting with LUTS?

A

urine dip
U&Es (if chronic retention suspected)
PSA (if sx obstructive and patient worried about PCa)
urinary freq volume chart
internation prostate symptom score (IPSS) 0-35

41
Q

what is the management for a patient with suspected BPH?

A

watchful waiting, medication, surgery

42
Q

what drugs are given to those with moderate-severe voiding sx from BPH?

what are the SE?

A

tamsulosin, alfuzosin (alpha 1 antagonists)

SE: dizziness, postural hypotension, dry mouth, depression

43
Q

what drugs are given to those with a significantly enlarged prostate and high risk of progression?

what are the SE?

A

finasteride (5 alpha reductase inhibitors)

blocks conversion of T-> DHT therefore reduces prostate volume

SE: erectile dysfunction, ejaculation problems, gynaecomastia

44
Q

what drug is given to a patient with moderate/severe voiding AND prostatic enlargement?

A

combination therapy - (alpha-1 antagonist + 5-alpha reductase inhibitor)

45
Q

you have given a patient with BPH an alpha-blocker but their storage and voiding sx still persist, what will you prescribe?

A

anti-muscarinic (tolterodine, darifenacin)

46
Q

what type of surgery is offered to men with BPH?

A

transurethral resection of the prostate (TURP)

47
Q

which zone of the prostate does BPH occur in?

A

transitional zone

48
Q

what happens to the bladder detrusor muscle in response to BPH?

A

needs to generate more pressure to eject urine

therefore it undergoes compensatory hypertrophy

can see trabeculations on the detrusor muscle

49
Q

what are the complications of BPH?

A

bilateral hydronephrosis
bilateral hydroureter
increased infection
loss of renal function

50
Q

what is a primary care test used to assess the prostate gland?

A

PSA

51
Q

what is a TRUS?

A

trans rectal ultrasound guided biopsy of prostate

12 biopsies taken from prostate

52
Q

what type of cancers are prostate cancers usually?

A

adenocarcinomas

53
Q

what scoring system is used to grade prostate cancer

A

Gleason score

54
Q

what is prostatic intraepithelial neoplasia?

A

precancer of prostatic adenocarcinoma

asymptomatic and has the ability to progress to cancer but not inevitable

55
Q

which zone of the prostate gland does prostate cancer usually arise in?

A

peripheral zone

56
Q

where does prostate cancer usually metastasise to?

A

bones (spine)

they appear to be osteoscleorotic (calcifications and bony lesions)

can impinge nerves

57
Q

what other cancers metastasise to the bone?

A

breast
kidney
thyroid
lung

osteolytic mets (destroys bone)

58
Q

what type of tumour is most common in testicular cancers

A

seminomas (germ cell tumours)

arise from seminiferous tubules

59
Q

what is the classification for testicular cancer

A

seminoma and non-seminomatous germ cell tumour

60
Q

which testicular cancer behaves most aggressively

A

NSGCTs

61
Q

risk factors for testicular cancers

A
    • age - 30-40
    • infertility
    • cryptorchidism
    • fhx
    • klinefelter syndrome
    • mumps orchitis
62
Q

clinical features of seminoma

A
  • painless lump
  • hydrocele
  • gynaecomastia
63
Q

where do seminomas spread

A

via lymphatics to para-aortic nodes

64
Q

testicular cancer investigations

A
  • US of testes
  • serum tumour markers - raised hCG
  • staging with CT TAP (TNM)
65
Q

management of testicular cancer

A
  • radical orchidectomy

- radiotherapy to retroperitoneal nodes

Revision (20 decks)

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