Urology Flashcards
What % of communicating hydroceles are clinically apparent?
Communicating hydroceles are common in newborn males (clinically apparent in 5-10%) and usually resolve within the first few months of life
How are most renal stones managed?
Simplified first-line NICE guidance (please see guidelines for more details) NICE
Renal stones
watchful waiting if < 5mm and asymptomatic
5-10mm shockwave lithotripsy
10-20 mm shockwave lithotripsy OR ureteroscopy
> 20 mm percutaneous nephrolithotomy
Uretic stones
shockwave lithotripsy +/- alpha blockers>< 10mm shockwave lithotripsy +/- alpha blockers
10-20 mm ureteroscopy
How are calcium kidney stones prevented?
Calcium stones may be due to hypercalciuria, which is found in up to 5-10% of the general population.
high fluid intake
add lemon juice to drinking water
avoid carbonated drinks
limit salt intake
potassium citrate may be beneficial NICE
thiazides diuretics (increase distal tubular calcium resorption)
How are oxalate stones managed?
Oxalate stones
cholestyramine reduces urinary oxalate secretion
pyridoxine reduces urinary oxalate secretion
How are urate stones managed?
Uric acid stones
allopurinol
urinary alkalinization e.g. oral bicarbonate
How is renal colic investigated?
Non-contrast CT-KUB is the imaging of choice in suspected renal colic
What are the investigations for epidydmoorchitis?
Investigations for suspected epididymo-orchitis are guided by age:
sexually active younger adults: NAAT for STIs
older adults with a low-risk sexual history: MSSU
When should a PSA be taken?
As PSA levels may be increased, testing should not be done within at least:
6 weeks of a prostate biopsy
4 weeks following a proven urinary infection
1 week of digital rectal examination
48 hours of vigorous exercise
48 hours of ejaculation
What is the criteria for varicocole?
In adult males with subclinical or Grade I (mild) varicocoeles, reassurance and observation is the appropriate measure to take. Therefore in this patient, the alternative option are inappropriate at this stage.
When considering Grade II or III varicocoeles, management depends on whether fertility is a concern and whether the patient is symptomatic.
How are varicoeles treated?
varicocele is an abnormal enlargement of the testicular veins. They are usually asymptomatic but may be important as they are associated with infertility.
Varicoceles are much more common on the left side (> 80%). Features:
classically described as a ‘bag of worms’
subfertility
Diagnosis
ultrasound with Doppler studies
Management
usually conservative
occasionally surgery is required if the patient is troubled by pain. There is ongoing debate regarding the effectiveness of surgery to treat infertility
How are hydrocoeles managed?
Diagnosis may be clinical but ultrasound is required if there is any doubt about the diagnosis or if the underlying testis cannot be palpated.
Management
infantile hydroceles are generally repaired if they do not resolve spontaneously by the age of 1-2 years
in adults a conservative approach may be taken depending on the severity of the presentation. Further investigation (e.g. ultrasound) is usually warranted however to exclude any underlying cause such as a tumour
What is a normal post void urine in someone <65?
Post-void volumes <50 ml are normal in patients aged < 65 years old
What is the most common type of kidney stones?
Calcium oxalate (75%)
Magnesium ammonium phosphate (15%)
What is the imaging for kidney stones?
Offer urgent (within 24 hours of presentation) low-dose non-contrast CT to adults with suspected renal colic. If a woman is pregnant, offer ultrasound instead of CT.
1.1.2Offer urgent (within 24 hours of presentation) ultrasound as first-line imaging for children and young people with suspected renal colic.
When is medical expulsive therapy indicated?
Consider alpha blockers for adults, children and young people with distal ureteric stones less than 10 mm.
How are kidney stones managed?
<10mm decide either for watching waiting if 5mm or <10mm discuss watchful waiting
<10mm then give SWL
> 10mm consider uteroscopy or SWL
> 20mm consider PCNL
How are ureteric stones managed?
<10mm = SWL
>10mm = ureterocopy if distal or if proximal trial PCNL
What can be used for oxalate stone?
Pyroxidine
reduce oxalate rich foods
Suggest the different types of kidney stone.
What are the causes of hydronephrosis?
