Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

SURGERY > u r o l o g y > Flashcards

u r o l o g y Flashcards

1
Q

what is haematuria

A

presence of blood in urine

weither visible or non-visible (confirmed by urine dip or urine microscopy)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

what is haematuria classified into

A

visible haematuria

non-visible haematuria = symptomatic vs asymptomatic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

what are the causes pf pseudohaematuria, what is it

A

red or brown urine not sedentary to presence of haemoglobin

caused by meds like rfampcin, methyldopa

hyperbilirubinaemia, myogloburia, certain food - beetroot or rhubarb

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

what are some urological causes of haematuria

A

Infection, including pyelonephritis, cystitis, or prostatitis

Malignancy, including urothelial carcinoma or prostate adenocarcinoma

Renal calculi

Trauma or recent surgery

Radiation cystitis

Parasitic, most commonly schistosomiasis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

in what cases do patients required urgent referral to adult urological service

A

Aged ≥45yrs with either:

Unexplained visible haematuria without urinary tract infection

OR Visible haematuria that persists or recurs after successful treatment of urinary tract infection

Aged 60yrs with have unexplained non‑visible haematuria and either dysuria or a raised white cell count on a blood test.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

what modalities of imaging are used in urology

A

flexible cytoscopy = lower utinarry tract

US KUB = non visible haematuria

CT urogram used in cases of visible haematuria = higher radiation exposure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

what is urinary retention and what is divided into

A

inability to pass urine

acute vs chronic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

what is acute urinary retention

A

Acute urinary retention is defined as a new onset inability to pass urine*,

which subsequently leads to pain and discomfort, with significant residual volumes.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

what is acute on chronic urinary retention

A

patients with chronic retention can also enter acute retention, either as an acute deterioration of the underlying pathology causing their chronic retention

or a new aetiology superimposed on a background of chronic retention.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

how do patients with acute on chronic retention present, what risk do they carry

A

minimal discomfort, despite very large residual volumes.

treated as per acute retention management.

may have much higher residual volumes than other acute retention patients, therefore more at risk to post-obstructive diuresis.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

what are the causes of acute urinary retention

A
  1. BPH is commonest cause
  2. urethral structures
  3. prostate cancer
  4. UTI
  5. constipation
  6. severe pain
  7. medications
  8. neurological causes
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

how does a UTI cause urinary retention

A

urethral sphincter to close, especially in those with already narrowed outflow tracts (e.g. BPH)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

how can constipation cause urinary retention

A

through compression on the urethra

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

which types of medication can cause urinary retention acutely, how do they do this

A

anti-muscarinics or spinal or epidural anaesthesia, can affect innervation to the bladder, resulting in acute retention.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

what are some neuro cause of acute urinary retention

A

peripheral neuropathy, iatrogenic nerve damage during pelvic surgery, upper motor neurone disease (such as Multiple Sclerosis Parkinson’s disease)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

what are the clinical features of acute urinary retention

A

acute suprapubic pain and an inability to micturate

palpable distended bladder with suprapubic tenderness

fever, rigors = infective cause

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

apart from abdominal examination, which other examination should you perform in acute urinary retention, why

A

Ensure to perform a PR examination,

especially in elderly patients, to assess for any prostate enlargement or constipation.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

what Lx are required in acute urinary retention

A

post void bedside bladder scan = volume of retained urine to confirm dx

routine bloods - FBC, CRP, UE

send post catheterisation specimen of urine = assess for presence of infection

pts with features of high-pressure retentionwill require an ultrasound scan of their urinary tract to assess for the presence of associated hydronephrosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

what is chronic urinary retention, what are the two forms of chronic urinary retention

A

Chronic urinary retention is characterised by being painless and insidious.

High pressure retention
impaired renal function and bilateral hydronephrosis
typically due to bladder outflow obstruction

Low pressure retention
normal renal function and no hydronephrosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

what is decompression haeamturia and when is it seen

A

occurs commonly after catheterisation for chronic retention due to the rapid decrease in the pressure in the bladder. It usually does not require further treatment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

in low pressure retention why is the upper renal tract unaffected

A

due competent urethral valves or reduced detrusor muscle contractility / complete detrusor failure.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

in high pressure retention why is upper renal tract affected

A

high intra-vesicular pressures that the anti-reflux mechanism of the bladder and ureters is overcome and ‘backs up’ into the upper renal tract leading to hydroureter and hydronephrosis, impairing the kidneys’ clearance levels.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

what is the treatment of urinary retention

A

immediate urethral catheterisation
ensure to measure volume drained post catheterisation

treat underlying cause = BPH tamsulosin

check CSU for infection and treat w abx

review meds if contributing

pt with large retention volume 1L or more monitor for post catheterisation for evidence of post obstructive diuresis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

what is post obstructive diuresis, what are the complications

A

Following resolution of the retention through catheterisation, the kidneys can often over-diurese

can lead to worsening AKI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

why do kidneys diuresis post urinary retention resolution

A

due to the loss of their medullary concentration gradient, which can take time to re-equilibrate.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

how is post obstructive diuresis managed

A

patients producing >200ml/hr urine output should have around 50% of their urine output replaced with intravenous fluids to avoid any worsening AKI.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

further management of acute urinary retention, high pressure retention, why?

A

high pressure retention = catheter in situ until definitive management due to risk of further episodes of urinary retention leading to AKI and renal scarring and CKD

if no evidence of renal impairment TWOC 24-28hrs after insertion. if TWOC fails after 2 further attempts = long catheter catheter until treat underlying cause

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

what are the complications of acute urinary retention

A

AKI which could lead to CKD if multiple episides of retention leading to renal scarring

increased risk of UTI and renal stones due to urinary stasis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

how is urinary retention diagnosed

A

bladder ultrasound should be performed. A volume of >300 cc confirms the diagnosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

in women what can cause chronic urine retention

A

pelvic prolapse (such as cystocele, rectocele, or uterine prolapse) or pelvic masses (such as large fibroids)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

in women what can cause chronic urine retention

A

pelvic prolapse (such as cystocele, rectocele, or uterine prolapse) or pelvic masses (such as large fibroids)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

what are the clinical features of chronic urinary retention

A

painless urinary retention

associated voiding LUTS = weak stream, hesitance

overflow incontinence =

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

what is overflow incontinence, when is it worse

A

the intra-vesical pressures rise greater than those of the urinary sphincter. T

his is typically worse at night (nocturnal enuresis), when the sphincter tone is reduced

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

what is Intemittent self catheterisation, what are the pt requirements

A

used in patients with chronic retention, however for those who wish to avoid a long-term catheter

Patients are taught how to catheterise themselves at regular intervals (e.g. every 4-6hrs), however requires good manual dexterity and patient compliance, therefore is not suited for all patients.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

what is pyelonephritis

describe the pathophysiology

A

infection of renal parenchyma, ascended from lower urinary tract via blood or via lymphatics

usually bacterial

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

what are the common organisms in pyelonephritis

A

e.coli
staph aureus - catheter
pseudomonas - catheter

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

what are the risk factors associated with pyelonephritis

A
  1. obstruction of urinary tract e.g BPH
  2. colonisation of Bacteria - renal stones
  3. female tract which is shorter
  4. immunocompromised =T2DM
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

how does pyelonephritis present

A

fever
loin pain usually unilateral
nausea and vomiting
over 24-48hrs

may have sx of pre existing UTI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

ddx for pyelonephritis

A

AAA ruptured

renal calculi, acute cholecystitis, ectopic pregnancy, PID

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

what Lx are required in pyelonephritis

A

urine dip and MCS
urine bHcg
FBC, CRP, UE
USS KUB if obstruction suspected CT KUB non contrast

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

how is pyelonephritis managed

A

A-E approach and resus

empirical abx, IV fluids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

what are the complications associated with pyelonephritis

A 
chronic pyelonephritis 
severe sepsis 
multi organ failure 
renal scarring leading to CKD
pyonephritis 
perinephric abscess
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

what is urinary incontinence and what are the different types

A

involuntary leakage of urine

stress
urgency 
overflow
mixed 
continous
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

describe the lx required in urinary incontinence

A

post void bladder scans = esp in suspected overflow UI

midurine dipstick - infection or haematuria

urodynamics to assess intravesicualr and intra abdominal pressures = hyperactivity of bladder muscle may suggest UL

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

describe the management of incontinence

A

general = weight loss, reduce caffeine intake, smoking cessation, avoiding excessive fluid intake each day esp before bed

conservative = pelvic floor muscle training for at least 3 months

for urgent = anti muscranic drugs = oxybutynin or tolterodine which inhibit bladder contraction

surgery = botox A injections for urge and tension free vaginal tape in stress UI

45
Q

what is stress UI

A

urine leakage occurring when the intra-abdominal pressure exceeds the urethral pressure,

such as coughing, straining, laughing, or lifting.

The impaired urethral support is most often due to weakness of the pelvic floor muscle.

46
Q

risk factors of stress UI

A

post partum
constipation due to recurrent straining
obesity
pelvic surgery - TURP leading to external sphincter damage

47
Q

what is urger UI

A

overactive bladder - detrusor hyperactivity which leads to uninhibited bladder contraction,

leading to a rise in intravesical pressure and subsequent leakage of urine.

48
Q

cause of urge UI

A

infection, malignancy

meds = cholinesterase inhibitors

49
Q

what is mixed UI

A

stress UI and urge UI

50
Q

what is overflow UI

A

compilation of chronic urinary retention

progressive stretching of bladder was = damages efferent fibres of the sacral reflx and loss of bladder sensation

most common in BPH

51
Q

what is continuous UI

A

constant leakage of urine
pt always wet

due to anatomical abnormality or bladder fistulae

or due to overflow incontinence

52
Q

in urinary incontience what should you examine for

A

BPH
prolapse
fistula opening

ask pt to keep bladder diaries = help to find precipitating factors

53
Q

what are the causes of ED

A

psychological = anxiety, stress

HTN, hypercholesteremia

hormone deficient = testosterone

side effect of meds

54
Q

management of ED

A

CBT
manage underlying cause = stop causative problems, manage HTN or cholesterol

viagra - sildenafil PDE inhibitor

55
Q

how does sildenafil

A

blocking phosphodiesterase 5 (PDE5),

an enzyme that promotes breakdown of cGMP,

which regulates blood flow in the penis.

It requires sexual arousal, however, to work.

It also results in dilation of the blood vessels in the lungs.

56
Q

what are the potential causes of LUTS

A 
BPH 
UTI
Bladder cancer
prostate cancer 
pelvic floor dysfunction 
urethral stricture
57
Q

what lifestyle factors can exacerbate LUTS

A

drinking fluids late at night
excess alcohol intake
excess caffeine intake

58
Q

how are LUTS classified

A

storage vs voiding sx

59
Q

describe storage sx

A

increase urinary frequency
nocturia
increased sense of urgency to urinate
urge incontinence

60
Q

describe sx for voiding

A

hesitancy or straining in micturition
poor floor
post micturition or terminal dribble
feeling of incomplete emptying

61
Q

features to ask about in history in pt with LUTS

A

associated symptoms, such as visible haematuria, suprapubic discomfort, or colicky pain,

and their medication history, as certain medication, including anticholinergics, antihistamines and bronchodilators, are known to exacerbate LUTS

62
Q

what tool would you use to assess LUTS impact on life in men

A

initially and though out treatment course

IPSS = international prostate symptom score

63
Q

what examinations would be useful in pt with LUTS

A

DRE
examination of external genitalia
abdominal examination

64
Q

what initial investigations would necessary in LUTS

A

post void bladder scan and flow rate = help distinguish causes

bladder diary = highlight behavioural patterns which may be contributing to sx

urinalysis + urine culture

routine bloods = FBC, U+E

PSA may be useful in some conditions

65
Q

what specialist Lx can be used in LUTS

A

urodynamics = assess flow rate, detrusor pressure and storage capacity - neurogenic bladder

also for women with OAB or stress urinary incontincen being conducer for invasive treatment options

cystoscopy = gold stands for assess the LUT

upper urinary tract - CT or USS

66
Q

describe the conservative management of LUTS

A

regulating fluid intake - times and volumes and reduce caffeinated and alcoholic beverages in evenings

voiding sx = urethral milking techniques = manually emptying bulbar urrethra of residual urine or double voiding

pelvic floor exercises = stress and post micturition dribble

bladder training technique in overactive bladder

67
Q

describe the pharmacological management of LUTS

A

anticholinergics = oxybutynin = for overactive bladder - relax bladder muscle by opposing parasympathetic cholinergic control of contraction

alpha blockers - tamsulosin
and 5-reductase inhibitors - finasteride for BPH to reduce prostate size by relaxing prostate muscle

loop diuretics - furosemide, bumetanide - prevent nocturia

68
Q

what are the complications of LUTS

A

increased risk of infection

formation of renal and bladder calculi due to stagnation of urine

renal failure and bilateral hydronephrosis

acute urinary retention

69
Q

ddx for scrotal pain

A

testicular torsion, epididymitis

70
Q

what are the features to ask about in pt presenting with scrotal pain

A

onset, course, and duration of pain, any associated urinary symptoms, relevant sexual history, and history of previous surgery.

71
Q

what is the cremasteric reflex

A

cremasteric reflex is elicited by stroking the proximal and medial aspect of thigh; a normal response is contraction of the cremaster muscle

causing retraction of testes upwards on the ipsilateral side

Absence of the cremasteric reflex is a potential sign for testicular torsion

72
Q

what is Prehn’s sign

A

alleviation of scrotal pain by lifting of the testicle and is suggestive of the diagnosis of acute epididymitis

73
Q

lx required in scrotal pain

A

urrine dipstick/ urinalysis
urine for MCS
urethral swab if STI suspected

bloods - FBC, UE, CRP

doppler USS of scrotum

74
Q

blood tests for testicular cancer

A

AFP
LDH
bets hCG

75
Q

what is a hydrocele

A

abnormal collection of peritoneal fluid between parietal and visceral layers of tunica vaginalis enveloping the testis

76
Q

how do hydrocele present

A

painless fluctuating swelling
transilluminates
uni or bilateral

77
Q

what are the causes of hydroceles

A

primary/ idiopathic
trauma, infection, malignancy

if 20-40yrs with hydrocele whorls under go urgent USS

78
Q

what is a varicocole

A

abnormal dilatation of pampiniform venous plexus within the spermatic cord

79
Q

how does a varicocele present

A

bag of worms with a dragging sensation

may disappear on lying flat

80
Q

which side are varicoceles typically on

A

left side as spermatic veins drain directly into L renal vein compared to IVC on right

81
Q

varicoceles can cause

A

infertility, testicularr atrophy by increasing intra scrotal temperature

82
Q

red flag signs with a varicoceles include

A

acute onset
right sided
remain when lying flat

83
Q

what is the surgical management of varicocole

A

embolisation by international radiologist

surgery = can be open or laparoscopic for ligation of spermatic veins

84
Q

what are epidydmal cysts

A

benign fluid filled scars arising from epididymis

85
Q

how do epidydimal cysts present

A

smooth fluctuant nodule
found above and separate from the testis

transilluminate

often multiple

common in middle ages men
no treatment required unless painful and large = prevent infertility

86
Q

what are the causes of epididymitis and treatment

A

bacterial origin - STI in sexually active younger males or enteric organisms in older males

treat with oral abx and analgesia

87
Q

what is testicular torsion, how does it present

A

twisting of testis on spermatic cord leading to ischaemia

severe unilateral scrotal pain, N+V, loss of cremasteric reflex

88
Q

management of testicular torsion

A

surgical emergency = for scrotal exploration and fixation of both testes

prevent irreversible damage

89
Q

ddx for benign testicular lesions

A

lipomas
fibromas
leydig cell tumours

90
Q

what is orchitis and how is managed

A

inflammation of the testis. It is rare in isolation*, with the main cause being the mumps virus, which often is preceded with a history of parotid swelling.

Treatment is typically rest and analgesia.

91
Q

BPH, PROSTATE Ca, prostatitis, phimosis, paraphimosis

A
92
Q

what is BPH

A

enlargement of the prostate gland which is most often due to benign prostatic hyperplasia (BPH). BPH is a histological diagnosis and is characterised by non-cancerous hyperplasia of the glandular-epithelial and stromal tissue of the prostate leading to an increase in its size.

93
Q

what are the risk factors associated with BPH

A

increasing age, fhx,obesity, african or caribbean ethncity

94
Q

pathophysiology behind BPH

A

the prostate converts testosterone to dihydrotestosterone (DHT) using the enzyme 5α-reductase. DHT is more potent and accounts for 90% of androgen in the tissue

95
Q

cwhat are the clinical features of BPH

A

lower urinary tract symptoms (LUTS), often predominantly voiding symptoms (hesitancy, weak stream, terminal dribbling, or incomplete emptying), accompanied by storage symptoms (urinary frequency, nocturia, nocturnal enuresis, or urge incontinence). Other less common symptoms can include haematuria and haematospermia

96
Q

IN BPH DRE what features are seen

A

A firm, smooth, symmetrical prostate is a reassuring sign (a more rounded prostate of greater than two finger widths may indicate enlargement)

97
Q

what assessment score is used in BPH

A

ipsss

Scores of 0-7 are mild, 8-19 moderate and 20+ severe.

98
Q

ddx for BPH

A

Proaste Ca
UTI
oab
bcc

99
Q

Lx in BPH

A

urinary frequency and volume chart
post void bladder scan
PSA in men 50 or older or 40 in black

USS KUB = hydronephrosis
urodynamics if dx not certain

100
Q

Lx in BPH

A

urinary frequency and volume chart
post void bladder scan
PSA in men 50 or older or 40 in black

USS KUB = hydronephrosis
urodynamics if dx not certain

101
Q

management of BPH

A

sx diary = meds review, suitable lifestyle advice
meds = a- adrenoreceptorr antagonist - tamsulosin, relax prostate smooth muscle via blocking adrenoreceptors = reducing dynamic component

add 5-a reductase inhibitors - finasteride = prevent conversion of testosterone to DHT, reducing prostate volume (can take up to 6 onthd to see sx benefit)

surgery = TURP - remove obstructive prostate tissue and increase urethral lumen size

102
Q

complications of turp

A

TUR syndrome, haemorrhage, sexual dysfunction, retrograde ejaculation, and urethral stricture.

103
Q

BPH complications

A

high pressure retention
UTI
haematuria

104
Q

what is paraphimosis

A

inability to pull forward a retracted foreskin over the glans penis.

105
Q

complication of paraphimosis

A

may lead to penile ischaemia and worsening infection, including Fournier’s gangrene. Consequently, it is a urological emergency

106
Q

rx for paraphimosis

A

Phimosis, indwelling urethral catheter (due to non-replaced foreskin), poor hygiene, and prior paraphimosis.

107
Q

management of paraphimosis

A

reduction - manual pressure
analgesia - penile block without adrenaline
outpatient circumcision

108
Q

scale used for prostate Ca staging

A

Gleason grading

109
Q

DRE findings in prostate Ca

A

evidence of asymmetry, nodularity, or a fixed irregular mass.

110
Q

rx of prostate Ca

A

age, ethnicity - afro caribbean, fhx of disease, genetic BRCA1 or BRCA 2

SURGERY (12 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions