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Phase 2a > Urogenital Diseases > Flashcards

Urogenital Diseases Flashcards

1
Q

What is the epidemiology of urethritis?

A

Most common condition in men at GUM clinics
Non-gonococcal urethritis is more common than gonococcal urethritis
Chlamydia is the most common STI in young people

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2
Q

What are the main causes of urethritis?

A

Gonococcal: Neisseria gonorrhoea
Non-gonococcal: chlamydia trachmatis, mycoplasma genitalium, ureaplasma urealyticum, trichomonas vaginalis
Non-infective: Trauma, urethral stricture, irritation, urinary caliculi

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3
Q

What are the risk factors for urethritis?

A

Sexually active
Unprotective sex
Male to male sex
Male

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4
Q

What is the clinical presentation of urethritis?

A
  • May be asymtpomatic
  • Dysuria +/- discharge
  • Urethral pain
  • Penile discomfort
  • Skin lesions
  • Systemic symptoms
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5
Q

How is urethritis diagnosed?

A

Nucleic acid amplification test (female= self collected vaginal test, male= first void urine)
Microscopy of gram stained smears of genital secretions
Blood cultures
Urine dipstick to exclude UTI

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6
Q

How is chlamydia urethritis treated?

A

Oral ozithromycin stat, or 1 week oral doxycycline

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7
Q

How is gonorrhoea urethritis treated?

A

IM ceftriaxone with oral azithromycin

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8
Q

How is urethritis treated?

A

Treat infection with antibiotics
Test for other STIs
Partner notification

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9
Q

What is urethritis?

A

Urethral inflammation caused by infectious or non-infectious causes. Normally due to an STD

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10
Q

What is the epidemiology of cystitis?

A

Much more common in women
Can occur in children
Most common cause is E coli

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11
Q

What are the risk factors for cystitis?

A

Urinary obstruction resulting in statis
Previous damage to bladder epithelium
Bladder stones
Poor bladder emptying

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12
Q

What is the clinical presentation of cystitis?

A 
Dysuria
Frequency
Urgency
Suprapubic pain
Smelly and cloudy urine
Haematuria 
Abdominal pain
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13
Q

How is cystitis diagnosed?

A

Microscopy and sensitivity of sterile mid-stream urine= positive if there are leucocytes, blood and nitrates

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14
Q

How is cystitis treated?

A

3-5 days of nitrofurantoin or trimethoprim

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15
Q

What is the epidemiology of prostatitis?

A

Common in men of all ages
Most common UTI in men under 50
Usually presents over 35
Associated with LUTs

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16
Q

What is the aetiology of acute prostatitis?

A

Strep. faecalis, E coli, Chlamydia

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17
Q

What is the aetiology of chronic prostatitis?

A

Bacterial ( same as acute) or non-bacterial such as increased prostatic pressure or pelvic floor myalgia

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18
Q

What are the risk factors of prostatitis?

A

STI, UTI, Indwelling catheter, post-biopsy, increasing age

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19
Q

What is the clinical features of acute prostatitis?

A

Systemically unwell, fever, rigors, malaise, pain on ejaculating, dysuria, straining etc.

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20
Q

What are the clinical features of chronic prostatitis?

A

The acute symptoms for more than 3 months, pelvic pain, recurrent UTIs

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21
Q

How is prostatitis diagnosed?

A

DRE: Prostate is tender or hot to touch. Hard from calcification
Urine dipstick: Positive for leucocytes and nitrates
Mid stream urine microscopy and sensitivity
Blood cultures
STI screen
Trans urethral ultrasound scan

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22
Q

How is acute prostatitis treated?

A

IV gentamycin and IV amoxiclav or IV tazocin
2-4 weeks on a quinolone e.g. ciprofloxacin
Second line= Trimethoprim
Truss guided abcess draining

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23
Q

How is chronic prostatitis treated?

A

4-6 week course of quinolone e.g. ciprofolaxacin
+/- alpha blocker= tamsulosin
NSAIDs

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24
Q

What is the epidemiology of benign prostatic hyperplasia?

A
  • More common in over 60s (40%)
  • Unusual before 45
  • Affects Afro-Caribbean population more due to increased testosterone
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25
Q

What are the risk factors for benign prostatic hyperplasia?

A
  • Higher age

- Non-castration

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26
Q

Briefly explain the pathology of benign prostatic hyperplasia

A

Benign nodular or diffuse proliferation of musculofibrous and glandular layers of prostate. Inner (transitional) zone enlarges. As the prostate gets bigger, it may squeeze or partly block the urethra.

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27
Q

What is the differential diagnosis of benign prostatic hyperplasia?

A

Bladder tumour, bladder stones, trauma, prostate cancer, chronic prostatitis, UTI

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28
Q

What is the clinical presentation of benign prostatic hyperplasia?

A
  • Lower urinary tract symptoms= nocturia, frequency, urgency, post-micturition dribbling, poor stream, hesitancy, overflow, incontinance, bladder stones, haematuria
  • Enlarged bladder
  • Acute urinary retention
  • Anuria in a small number of cases
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29
Q

How is benign prostatic hyperplasia diagnosed?

A
  • DRE: Enlarged but smooth prostate
  • Transrectal ultrasound: Enlarged prostate
  • Biopsy and endoscopy
  • Mid-stream urine sample to check for infection
  • Serum PSA may be raised
  • Low urine flow rate
  • Serum electrolytes and renal ultrasound to exclude renal damage due to obstruction
  • Frequency vol chart: measure vol voided over a minimum of 3 days
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30
Q

How is benign prostatic hyperplasia treated?

A
  • If minimal symptoms, watchful waiting
  • Lifestyle: Avoid caffeine and alcohol, relax when voiding
  • Drugs= alpha 1 antagonists and 5 alpha reductase inhibitors
  • Surgery: Transurethral resection of prostate and transurethral incision of prostate
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31
Q

What are some possible complications of benign prostatic hyperplasia ?

A

Bladder caliculi, haematuria, acute retention, UTI

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32
Q

What is the epidemiology of testicular torsion?

A

Common urological emergency, typically neonates or post-pubertal boys, left side is more common

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33
Q

What is the aetiology of testicular torsion?

A

Underlying congenital malformation- belt clapper deformity, where testis is not completely fixed to scrotum= Free movement

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34
Q

What are the risk factors for testicular torsion?

A

Genetic factors

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35
Q

What is the clinical presentation of testicular torsion?

A
  • Sudden onset of pain in one teste should be checked
  • Pain often comes on during sport or physical activity
  • Pain in abdomen, nausea and vomitting common
  • Inflammation of the testes= Tender, hot and swollen
  • Testes may lie high and transversely
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36
Q

What is the differential diagnosis of testicular torsion?

A
  • Epididymo-orchitis
  • Tumour, trauma and an acute hydrocele
  • Torsion of testicicular and epididymal appendage
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37
Q

How is testicular torsion diagnosed?

A

Doppler ultrasound may demonstrate lack of blood flow to testes
Urinalysis to exclude infection
Surgical exploration

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38
Q

How is testicular torsion treated?

A

Surgery- expose and untwist

Orchidectomy (removal of testes) and bilateral fixation

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39
Q

What are some complications of testicular torsion?

A

Infarction of the testicle and atrophy

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40
Q

What is the epidemiology of chlamydia?

A

Most common STI
More common in women
Most common in 15-25 yr olds

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41
Q

What causes chlamydia?

A

Chlamydia trachomatis (gram -ve bacterium)

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42
Q

What are the sites of occurrence of chlamydia/gonorrhoea in adults?

A

Urethra, endocervical canal, rectum, pharynx, conjunctiva

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43
Q

What are the sites of occurrence of chlamydia/gonorrhoea in neonates?

A

Conjunctiva

Atypical pneumonia also in neonatal chlamydia

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44
Q

What is the transmission rate of chlamydia?

A 
FTM= 70%
MTF= 70%
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45
Q

What are the clinical features of chlamydia in females?

A
  • Asymptomatic in over 70%

- Non specific symptoms of dysuria, menstrual irregularity and discharge

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46
Q

What are the female complications of chlamydia/gonorrhoea infection?

A
  • Pelvic inflammatory disease
  • Neonatal transmission
  • Fitz-Hugh-Curtis syndrome
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47
Q

What are the male complications of chlamydia infection?

A

Epidiymo-orchitis and reactive arthritis

48
Q

How is chlamydia treated?

A
  • Partner management
  • Test for other STIS
  • Oral Azithromycin stat (convinient 1 dose) or oral doxycycline for 7 days
  • Pregnant= erythromycin for 14 days or azithromycin stat
49
Q

How is chlamydia diagnosed?

A
  • Nucleic acid amplification tests= High specificity and sensitivity. but -ve test doesn’t mean not infected
  • Females= Self collected vaginal swab, endocervical swab, first void urine
  • Males= First void urine
50
Q

What is the epidemiology of gonorrhoea?

A

More common in men

51
Q

What causes gonorrhoea?

A

Neisseria gonorrhoea= Gram -ve diplococcus

52
Q

What are the clinical features of gonorrhoea in males?

A
  • Dysuria and urethral discharge
  • Incubation of 2-5 days
  • Can be asymptomatic
53
Q

What are the clinical features of chlamydia in males?

A
  • Rarely dysuria and discharge
  • Incubation= 7-21 days
  • Asymptomatic in 50%
54
Q

What are the rates of transmission of gonorrhoea infection?

A
  • Transmission FTM= 60-80%

- Transmission MTF= 50-90%

55
Q

What are the clinical features of gonorrhoea in females?

A
  • Non specific symptoms of dysuria, menstrual irregularity, discharge
  • Asymptomatic in 50%
  • Incubation is up to 10 days
56
Q

How is gonorrhoea diagnosed?

A
  • Near patient test= Microscopy of gram stained smears of genital secretions (gram -ve diplococci)
  • Male= Sample from urethra
  • Female= Sample from endocervix, NAAT
57
Q

How is gonorrhoea treated?

A
  • Partner notification
  • Test for other STIs
  • Continuous surveillance of antibiotic sensitivity
  • Single dose treatment of IM ceftriaxone with azithromycin
58
Q

What is the epidemiology of testicular cancer?

A
  • Most common cancer in males aged 15-44
  • 10% occur in undescended testes
  • More than 90% arise from germ cells: seminomas (25-40yrs or 60yrs), or teratomas (infancy)
  • 4% arise from non germ cells (leydig cells, sertoli cells etc)
59
Q

What are the risk factors for testicular cancer ?

A
  • Undescended testis
  • Infant hernia
  • Infertility
  • Family history
60
Q

What are the differentials for testicular cancer ?

A
  • Testicular torsion
  • Hydrocele
  • Lymphoma
61
Q

What are the clinical features of testicular cancer ?

A
  • Painless lump in testicle
  • Testicular pain and/or abdominal pain
  • Hydrocele
  • Cough and dyspnoea= lung metastases
  • Back pain= Para-aortic lymph node metastases
  • Abdominal mass
62
Q

How is testicular cancer diagnosed?

A
  • Ultrasound of testicle
  • Biopsy and histology
  • Serum tumor markers= AFP or B-hCG
  • CXR and CT to assess for tumour staging
63
Q

How is testicular cancer treated?

A
  • Radical orchidectomy via inguinal approach
  • Seminomas with metastases below diaphragm= treated with radiotherapy
  • More widespread tumours are treated with chemo
  • Teratomas are treated with chemo
  • Sperm storage offered
64
Q

What is the epidemiology of bladder cancer?

A
  • Bladder tumours form 50% of all transitional cell carcinomas
  • More common in males
  • Incidence peaks in 80s
65
Q

What are the risk factors for bladder cancer?

A
  • Smoking
  • Occupational exposure to carcinogens= azo dyes, benzidine, occupations including petroleum, cable, rubber and chemical industries
  • Exposure to drugs e.g. cyclophosphamide, phenacetin
  • Chronic inflammation of urinary tract
  • > 40yrs
  • Male
  • Family history
66
Q

What are the clinical features of bladder cancer?

A
  • Painless haematuria- but may have pain due to clot retention
  • Any patient over 40 with haematuria should be assumed to have a urothelial tumour until proven otherwise
  • Recurrent UTIs
  • Voiding irritability
67
Q

What are the differentials of bladder cancer?

A

Haemorrhagic cystitis, renal cancer, UTI

68
Q

How is bladder cancer diagnosed?

A
  • Cystoscopy with biopsy= Diagnostic
  • Urine microscopy/ cytology- cancers may cause sterile pyuria
  • CT urogram= Provides staging
  • Urinary tumour markers
  • MRI/ Lymphangiography may show involved pelvic nodes
  • CT/MRI of pelvis
69
Q

How is bladder cancer treated?

A
  • Non muscle invasive carcinoma= Surgical resection +/- chemotherapy- CMV Cisplatin, Methotrexate and vinblastine
  • Localised muscle invasive disease= Radical cystectomy and post op chemo
  • Radical radiotherapy if not fit for surgery
  • Metastatic bladder cancer= Palliative chemo and radiotherapy
70
Q

What are the risk factors for prostate cancer?

A
  • Family history
  • Genetic= HOXB13, BRCA2
  • Increasing age
  • Black men= higher testosterone
71
Q

What is the epidemiology of prostate cancer?

A
  • Most common male malignancy
  • More common in black men
  • Incidence increases with age
72
Q

What are the differentials for prostate cancer?

A
  • Benign prostatic hyperplasia
  • Prostatitis
  • Bladder cancer
73
Q

What are the clinical features of prostate cancer?

A
  • LUTs if local disease= nocturia, poor stream, hesitancy, terminal dribbling, obstruction
  • Metastases= Anaemia, weight loss, bone pain
74
Q

How is prostate cancer diagnosed?

A
  • Digital rectal exam= Hard and irregular
  • Raised PSA
  • Trans-rectal ultrasound and biopsy= diagnostic- histological diagnosis is essential before treatment
  • Urine biomarkers e.g. PCA3, or gene fusion protein
  • Endorectal coil MRI for staging
75
Q

Briefly explain the pathophysiology of prostate cancer

A
  • Most are adenocarcinomas arising in peripheral prostate

- Androgen receptors are responsible for growth

76
Q

How is prostate cancer treated?

A
  • Disease confined to prostate= Radical prostatectomy if <70yrs, hormone therapy, radiotherapy, brachytherapy, active surveillance if >70yrs and low risk
  • Metastatic disease= Androgen deprivation (orchidectomy, Anti-androgens, androgen receptor blockers)
77
Q

What is the aetiology of epididymo-orchitis?

A
  • Under 35= Chlamydia trachomatis, N gonorrhoea
  • Over 35= UTI (Klebsiella spp, e coli, enterococci, pseudomonas, staphylococcus)
  • Mumps
  • Trauma
  • Elderly= Catheter related
78
Q

What are the risk factors for Epididymo-orchitis?

A
  • Previous infection
  • Indwelling catheter
  • Structural/ functional urinary tract abnormality
  • Anal intercourse
79
Q

What are the differentials of Epididymo-orchitis?

A

Testicular torsion- must be ruled out

80
Q

What are the clinical features of Epididymo-orchitis?

A
  • Subacute onset of scrotal pain/ swelling
  • In STD Epididymo-orchitis= Urethritis, urethral discharge
  • Mumps= Headache, fever, unilateral, or bilateral parotid swelling
  • Sweats/ fever
  • On examination= Tenderness and palpable swelling of epididymis and testicles
81
Q

How is Epididymo-orchitis diagnosed?

A
  • STD screening
  • Nucleic acid amplification test
  • Mid stream urine dipstick for UTI
  • Ultrasound to rule out abscesses
  • Urethral smear and swab
82
Q

How is Epididymo-orchitis treated?

A
  • Chlamydia= Oral doxycycline for 7 days or stat azithromycin
  • Gonorrhoea= IM ceftriaxone and stat azithromycin
  • UTI= Oral ciprofloxacin or oral ofloxacin
  • Analgesia= NSAIDs
  • Scrotal support
  • Abstain from sex
  • Partner notification
83
Q

What is varicocele?

A

Abnormal dilation of the testicular veins in the pampiniform venomous plexus, caused by venous reflux

84
Q

What is the epidemiology of varicocele?

A
  • Left side more common
  • Unusual in boys under 10
  • Incidence increases post puberty
  • Associated with sub fertility
85
Q

What is the aetiology of varicocele?

A
  • More common on left
  • The angle at which the left testicular vein enters the left renal vein causes increased reflux from compression of the left renal vein
86
Q

What are the clinical features of varicocele?

A
  • Scrotum hangs lower on side of varicocele
  • Patient may complain of a dull ache or scrotal heaviness
  • Often visible as distended scrotal blood vessels that feel like a “bag of worms”
87
Q

How is varicocele diagnosed?

A
  • Venography

- Colour doppler ultrasound to see blood flow

88
Q

How is varicocele treated?

A

Surgery if there’s pain, infertility or testicular atrophy

89
Q

What is hydrocele?

A

Abnormal collection of fluid within tunica vaginalis

90
Q

What is the epidemiology of hydrocele?

A
  • Clinically apparent scrotal hydrocele are evident in 6% of newborns
  • Most paediatric hydroceles are congenital
91
Q

What is the aetiology of hydrocele?

A
  • Primary= associated with patent processus vaginalis

- Secondary= associated with testis tumour, trauma, infection, TB, testicular torsion, oedema

92
Q

What are the 2 types of hydrocele?

A
  • Overproduction of fluid in the tunica vaginalis (simple)
  • Processus vaginalis fails to close, allowing peritoneal fluid to communicate freely with scrotal portion (communicating)
93
Q

What are the clinical features of hydrocele?

A
  • Scrotal enlargement with non-tender, smooth, cystic swelling
  • Pain is not a feature unless hydrocele is infected
  • Testes are usually palpable but may be difficult in large hydrocele
  • Lies anterior to and below the tesits
94
Q

How is hydrocele diagnosed?

A
  • Ultrasound

- Serum alpha-fetoprotein and hCG to help exclude malignant teratomas or other germ cell tumours

95
Q

How is hydrocele treated?

A
  • Spontaneously resolves
  • Many of infancy resolve in 2 years
  • Therapeutic aspiration or surgical removal
96
Q

What is the epidemiology of epididymal cysts?

A
  • Usually develop around age 40
  • Not uncommon
  • Rare in children
97
Q

What are the clinical features of epididymal cysts?

A
  • Normally present with a lump
  • Often are multiple and may be bilateral
  • Small cysts may remain undetected and asymptomatic
  • Once they get large, they may be painful
  • Well defined and will transluminate since fluid-filled
  • Testis is palpable quite separately from the cyst
98
Q

What are the differentials of epididymal cysts?

A
  • Spermatocele
  • Hydrocele
  • Varicocele
99
Q

How are epididymal cysts diagnosed?

A

Scrotal ultrasound

100
Q

How are epididymal cysts treated?

A
  • Usually not necessary

- If painful and symptomatic, surgical excision

101
Q

What are the classic bladder storage symptoms?

A
  • Urgency
  • Nocturia
  • Frequency
  • Overflow incontinence
102
Q

In what diseases are serum phosphate specific antigen raised?

A
  • BPH
  • Prostate cancer
  • Perianal trauma and mechanical manipulation of the prostate
  • BMI <25
  • Taller men
  • Recent ejaculation
  • Black African
  • Prostatitis
  • UTIs
103
Q

What does a maximum flow rate of <10ml per second suggest?

A

Bladder outflow obstruction due to BPH

104
Q

What are the 5 classic pathogens that cause nearly all UTIs?

A

KEEPS

  • Klebsiella spp.
  • E coli
  • Enterococci
  • Proteus spp
  • Staph spp
105
Q

List the lower urinary tract infections

A
  • Cystitis
  • Prostatitis
  • Epididymo-orchitis
  • Urethritis
106
Q

List an upper urinary tract infection?

A

Pyelonephritis

107
Q

What causes UTIs to be complicated?

A
  • Abnormal urinary tract structure
  • Sickle cell
  • Diabetes
  • Virulent organisms
  • Male
  • Pregnant
108
Q

What are the risk factors for UTI?

A
  • Female
  • Sex
  • Pregnancy
  • Menopause
  • Decrease in host defence
  • Obstruction
  • Catheter
109
Q

What is the epidemiology of UTI?

A

More common in women, affects a third of women in their lifetime

110
Q

What are the risk factors for ectopic pregnancy?

A
  • Previous ectopic pregnancy
  • Prior surgery to fallopian tube or pelvis
  • Certain STDs and PID
  • Endometriosis
111
Q

How common are ectopic pregnancies?

A

1 in 90 pregnancies in the UK

112
Q

Where are ectopic pregnancys most commonly found?

A

The fallopian tube

113
Q

What are the clinical features of ectopic pregnancy?

A
  • Signs of pregnancy including missed period
  • Abdominal flank/groin pain on one side
  • Vaginal bleeding or a brown discharge
  • Pain in the tip of the shoulder
  • Discomfort when voiding and straining
114
Q

What are the clinical features of a fallopian tube rupture?

A

A sharp sudden and intense abdominal pain, syncope and dizziness, nausea and vomitting, pallor

115
Q

How are ectopic pregnancies diagnosed?

A
  • +ve Pregnancy test
  • Transvaginal ultrasound
  • Blood tests for hCG
  • Laproscopy
116
Q

How are ectopic pregnancies treated?

A
  • Regular blood tests
  • Medication- IM methotrexate
  • Keyhole surgery (laparoscopy) to remove the fertilised egg

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