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Year 6 - Surgery > Intro Wk: Uro > Flashcards

Intro Wk: Uro Flashcards

1
Q

Epi of stones

A

Caucasian

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2
Q

Most common stone composition

A

CaOx

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3
Q

Which rare inherited condition can predispose to stones?

A

Cystinuria

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4
Q

What may be underlying recurrent stones?

A

Metabolic problems - hyperPTH, gout, cystinuria

Anatomical problems - PUJ obstrc, horseshoe kidney, ureteric stricture

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5
Q

Renal colic ddx

A

AAA, biliary colic, constipation, bowel obstrc, ectopic pregnancy

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6
Q

When would you admit a pt w renal colic?

A

Single kidney, renal impairment, pyrexia, continuing pain, large stone, severe obstrc on CT, pregnant

NB: otherwise can be discharged w stone clinic OPA

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7
Q

What is the gold standard imaging for stones?

A

Non-contrast CT KUB

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8
Q

Tx of stones

A 
Conservative
Tamsulosin
ESWL
Ureteroscopy
PCNL
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9
Q

What is the conservative advice?

A

Ensure high fluid intake 2.5-3L/day, red salt and animal proteins esp red meat, don’t cut back on dairy just ca sups

NB: attend A&E if pyrexia or pain not controlled by analgesia

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10
Q

Haematuria ddx

A

Underlying malignancy UNTIL proven otherwise along the length of the urinary tract, infection, trauma, drugs, urological hx e.g. 2° haemorrhage

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11
Q

When would you admit a pt w haematuria?

A 
Clots/retention
Anaemic/renal impairment
Tachycardic/hypotensive
Prolonged bleeding
Elderly/frail

NB: otherwise encourage fluids, ix cause, next available haematuria clinic app

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12
Q

What are the two important ix to do for haematuria?

A

CT Urogram and Cystoscopy

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13
Q

Describe the three way catheter used for haematuria

A

Attachments: inflates balloon, urine bag, wash inflow for bladder irrigation

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14
Q

Most common bladder ca

A

Transitional cell carcinoma

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15
Q

Which type of bladder ca does schistosomiasis cause?

A

Squamous cell carcinoma

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16
Q

Bladder ca classification

A

Carcinoma in situ

Ta - affects the epithelium

T1 - invades subepithelial connective tissue

T2a - invades superficial muscle

T2b - invades deep muscle

T3a - invades perivesical tissue microscopically

T3b - invades perivesical tissue macroscopically

T4 - invades contiguous organs

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17
Q

Bladder ca RFs

A

Smoking, aniline dyes, rubber, textiles, printing

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18
Q

Mx of bladder ca

A

TURBT
Flexible cystoscopy surveillance
Intravesical chemo (mitomycin C) or immuno (BCG)
Radical cystectomy or radio

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19
Q

What does TURBT stand for?

A

Transurethral Resection of Bladder Tumour

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20
Q

What are the three components of the hald diagram?

A

LUTS, BPE, Bladder Outflow Obstrc

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21
Q

LUTS FUNDD HIPSS

A

Storage Sx:
Freq
Urgency
Nocturia

Post-Micturition Sx:
Dribbling
Dysuria

Voiding Sx:
Hesitancy
Intermittency
Poor Flow
Straining
Sensation of Incomplete Emptying
22
Q

BPE vs BPH

A

Benign Prostate Enlargement (clinical dx) vs Hyperplasia (histo dx)

23
Q

Epi of BPH

A

Afro-Caribbean

24
Q

BPH RFs

A

Age, hormonal, obesity, diabetes, dyslipidaemia, genetic

25
Q

Medical mx of BPH

A

Tamsulosin - alpha blocker

Finasteride - 5 alpha reductase inhibitor

Solifinacen - anticholinergic

Mirabegron - beta 3 agonist

Sildenafil - PDE5 inhibitor

26
Q

Surgical mx of BPH

A

TURP
HoLEP
Urolift
Rezum

27
Q

How do you assess urinary retention?

A

Palpate suprapubic swelling, dull to percuss, bladder scan, consider CISC if post pelvic surgery, urethral catheterisation

28
Q

What do you do if urethral catheterisation fails?

A

Use a catheter introducer, flexi guided, go suprapubic

29
Q

Mx of acute retention

A

Painful and <1-1.5L

Catheter and alpha blockers, record residual urinalysis u&e, consider TWOC

30
Q

What does TWOC stand for?

A

Trial WithOut Catheter

31
Q

Mx of chronic retention

A

Painless and >1-1.5L

Leave the catheter in, ultrasound, monitor residuals, F/U, consider surgery if enlarged prostate

32
Q

List the different types of Foleys

A

Short Term:
Simplastic
PTFE Coated

Long Term:
Hydrogel Coated & Silicone

33
Q

What are the most common px of urinary sepsis?

A

UTI, pyelonephritis, pyonephrosis, shock, multi organ failure, ARDS

34
Q

Who should you involve if the pt has urinary sepsis?

A

Urologist, microbiology, HDU/ITU

35
Q

What is a medical emerg in urology?

A

Pyonephrosis - obstrc w infection - requires nephrostomy (local anaes) or stent (general anaes)

36
Q

What can cause a raised PSA?

A 
BPH
UTI
Urinary Retention
Catheterisation
Prostate Cancer
37
Q

What is the most sensitive test for testicular ca?

A

Urgent same day ultrasound showing hypoechoic area

38
Q

What is Fournier’s gangrene?

A

Fulminant infective nec fas of perineum +/- suprapubic and thighs, rapidly spreads, offensive odour, crepitus under the skin, severe pain

39
Q

Which pts are most at risk of Fournier’s gangrene?

A

Diabetics + Immunosuppressed

40
Q

Tx of Fournier’s gangrene

A

Urgent broad spec abx + radical debridement -> referral to plastics for graft

41
Q

What must you always do after placing a catheter?

A

Pull the foreskin forward to prevent paraphimosis and document that you have

42
Q

What should you be considering in a pt w haematuria?

A

The anatomical area (ultrasound lower vs cystoscopy upper) and cause (infection, calculi, malignancy)

43
Q

What do you want to perform for suspected malignancy?

A

Tissue biopsy to confirm dx (ureteroscopy + biopsy) and consider both local and regional staging (CT urogram + CT chest)

44
Q

What should be noted if you suspect a staghorn calculus on plain AXR?

A

Establish if the pt has had contrast in the last few hrs as it may not have been excreted due to a distal obstruction

45
Q

Ddx for Acute Scrotal Pain

A

Torsion
Trauma
Infection
Malignancy

46
Q

When is Prehn’s sign pos?

A

Scrotal elevation relieves pain in epididymitis but not torsion

47
Q

When do you refer pts for suspected bladder/renal cancer?

A

Aged 45 and over with: unexplained visible haematuria w/o urinary tract infection or visible haematuria that persists or recurs after successful tx of UTI

Aged 60 and over with: unexplained non-visible haematuria and either dysuria or a raised WCC

48
Q

What is nutcracker syndrome?

A

Left varicocele due to compression of the testicular vein by RCC as it joins left renal vein

49
Q

RFs for RCC

A 
Smoking
Industry
Dialysis
HTN
Obesity
PCKD
50
Q

Where do most prostate adenocarcinomas arise?

A

Posterior Peripheral Zone

Year 6 - Surgery (27 decks)

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