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3b > Urology > Flashcards

Urology Flashcards

1
Q

Stress incontinence aetiology

A

Detrusor pressure > Closing pressure of urethra

Obesity
Menopause - Lack of oestrogen
Pelvic radiation
Childbirth / pregnancy

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2
Q

Stress incontinence presentation and investigations

A

Involuntary passage of urine with increase in intra-abdominal pressure

  • Coughing
  • Sneezing
  • Laughing

Urine dip / MC&S - Infection?
F/V chart - Normal
Urodynamics - Pre-surgery

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3
Q

Stress incontinence management

A

Conservative

  • Lose weight
  • Stop smoking
  • Pelvic floor exercises - 3 months
  • Decrease caffeine
  • Reduce fluid intake

SSRI - Duloxetine
Surgery - TVT

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4
Q

Urge incontinence aetiology

A

Overactive bladder
Overactive detrusor muscle

Obesity

Neuro disease

  • MS
  • Stroke
  • Parkinson’s
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5
Q

Urge incontinence presentation and investigations

A

Key in door syndrome!

  • Urgency
  • Frequency
  • Nocturia

Investigations

  • Urine dip / MC&S - Infection?
  • F/V chart - Increased frequency
  • Urodynamics - Pre-surgery
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6
Q

Urge incontinence management

A

Conservative - Bladder retraining!

  • Lose weight
  • Stop smoking
  • Pelvic floor exercises - 3 months
  • Decrease caffeine intake
  • Reduce fluid intake

Ach antagonist - Oxybutynin - Falls risk!
M3 agonist - Mirabegron

Botox injections

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7
Q

BPH aetiology

A

5a reductase converts testosterone into dihydrotestosterone
Hypertrophy of cells in transitional zone
Narrowing of urethra
Increase in smooth muscle contractility

50% of men aged 50 - 30% symptomatic
80% of men aged 80

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8
Q

BPH presentation

A

Voiding symptoms - Obstructive

  • Weak / intermittent flow
  • Straining
  • Hesitancy
  • Terminal dribbling
  • Incomplete emptying

Storage symptoms - Irritative

  • Urgency
  • Frequency
  • Urgency incontinence
  • Nocturia
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9
Q

BPH investigations

A
  1. PSA - Prostate cancer?
  2. DRE
  3. TRUS

Scoring system - International Prostate Scoring System

Urine dip / MC&S
USS-KUB
F/V chart

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10
Q

BPH management

A

Behavioural - E.g. fluid restriction at night

A-blocker - Tamsulosin / Doxasozin

  • Postural hypotension
  • Sexual dysfunction

5a reductase inhibitor

  • Finasteride
  • Gynaecomastia

Surgery - TURP

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11
Q

BPH complications

A

Urinary retention
Hydronephrosis
Stones
Infection

TURP syndrome!

  • Aetiology - Long surgery / Large blood loss
  • Clinical features - Fluid overload, hyponatraemia, headache
  • Management - Supporting, correct hyponatraemia
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12
Q

Prostate cancer aetiology

A

Peripheral zone
Adenocarcinoma

Family history 
Black ethnicity
Dietary fat
BRCA
HPC-1
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13
Q

Prostate cancer presentation

A

Bladder outlet obstruction

  • Nocturia
  • Frequency
  • Hesitancy

Haematuria

Pain

  • Perineal
  • Testicular
  • Back - Secondary to metastases

Weight loss

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14
Q

Prostate cancer investigations

A
  1. PSA
  2. TRUS + Biopsy
  3. DRE - Asymmetrical, hard, nodular, loss of median sulcus

+ MRI

+ CT/PET staging

Urine dip / MC&S

+ Markers

  • Serum - PSMA
  • Urinary - PCA3
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15
Q

Prostate cancer metastases and staging

A

Bone
Lung
Liver

Staging

  1. Non-palpable / non-visible
  2. Palpable / visible
  3. Beyond capsule
  4. Beyond seminal vesicles
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16
Q

Prostate cancer management

A

T1/2

  • Active monitoring
  • Brachytherapy
  • Prostatectomy

T3/4

  • Hormonal
  • Brachytherapy
  • Prostatectomy

Metastatic

  • Synthetic GnRH
  • Anti-androgen
  • Orchidectomy
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17
Q

Prostate cancer treatment complications

A

Incontinence
Sexual dysfunction
Gynaecomastia

Radiation - Cancer risk

  • Bladder
  • Colon
  • Rectal
18
Q

PSA

A

Increased…

  • Prostate cancer
  • BPH
  • Vigorous exercise
  • Ejaculation
  • Infection
  • Urinary retention

Age

  • 50-59 (< 3.0)
  • 60-69 (< 4.0)
  • > 70 (< 5.0)
19
Q

Bladder cancer pathophysiology

Blood supply + Lymph

A

Transitional cell carcinoma
Squamous cell carcinoma - Schistosomiasis

Bladder blood supply

  • Superior vesical artery
    • Umbilical artery
  • – Internal iliac artery

Lymph node spread

  • Obturator
  • Internal/external iliac
20
Q

Bladder cancer risk factors and presentation

A 
Smoking
Printing /textile industry - Aniline dyes - 2-naphthylamine
Pelvic radiation
Schistomiasis - SCC
HNPCC
Family history
Chronic bladder inflammation

Presentation - Painless haematuria!
+ Weight loss

21
Q

Bladder cancer investigations / staging / management

A

Urinalysis - Haematuria
Flexible cystoscopy + Biopsy - 2ww referral
CT/PET staging

Stage (s/r)

  1. Lamina propria (90%)
  2. Beyond muscle (60%)
  3. Beyond fat (35%)
  4. Metastases (25%

Management

  • TURBT ± Intravesical chemotherapy
  • Cystectomy ± Chemo
22
Q

Testicular torsion

A

Twisting of spermatic cord - Ischaemia + Necrosis

Risk factors - Peak incidence 13-15 years

  • Bell-clapper deformity
  • Trauma

Presentation

  • Sudden severe groin/abdo pain ± N/V
  • Absent cremasteric reflex
  • Red swollen testis
  • Elevating the testis does not relieve pain

Investigations - USS - Whirlpool sign

Management - Surgical repair - Bilateral

23
Q

Hydrocoele aetiology

A

Accumulation of fluid in tunica vaginalis
Communicating - Peritoneal fluid drains into scrotum
Non-communicating - Excessive fluid production in TV

Secondary to…

  • Epididymo-orchitis
  • Torsion/cancer
  • Failure of processus vaginalis closure
24
Q

Hydrocoele presentation / investigations / management

A

Swelling - Anterior/inferior

  • Increases with activity
  • Diurnal variation
  • Confined to scrotum - Can get above mass
  • Testis difficult to palpate

Investigations

  • Pen torch - Transilluminates
  • USS

Management - Conservative

  • Surgery if processus vaginalis defect
  • Aspiration
25
Q

Varicocoele aetiology and clinical features

A

Enlargement of pampiniform plexus

Aetiology - Idiopathic

  • Compression of venous drainage - E.g. tumour
  • More common on the LEFT - LTV drains into LRV

Clinical features - “Bag of worms”

  • Dull ache / heaviness
  • Visible veins - More prominent on valsalva
26
Q

Varicocoele investigations / management / complications

A

Investigations

  • Pen torch - Transilluminates
  • USS - Colour doppler
  • Investigate cause - CT

Management - Conservative

Complications

  • Increased blood flow to prostate - BPH
  • Increased temperature of testis - Subfertility
27
Q

Testicular cancer aetiology

A

Most common malignancy in young adult men - 20-34

Germ cell

  • Seminoma - LDH
  • Non-seminoma - Teritoma, Yolk-sac - AFP + hCG

Non germ cell

  • Leydig
  • Sarcoma

Risk factors

  • Family history
  • Infertility
  • Cryptorchidism
  • Klinefelters
  • Mumps
28
Q

Testicular cancer presentation / investigations / management / prognosis

A 
Painless scrotal swelling
Haematospermia
Hydrocoele
Varicocoele
Gynaecomastia

Investigations

  • USS
  • CT/PET staging
  • bHCG - Teritoma / Yolk sac
  • AFP - Teritoma / Yolk sac
  • LDH - Seminoma

Management

  • Orchidectomy
  • Chemo/Radio

Prognosis - 85-95% survival

Lymph node spread

  • Retroperitoneal
  • Para-aortic
29
Q

Urolithiasis aetiology

A

Renal stones

  • Calcium oxalate - 85%
  • Calcium phosphate
  • Struvite - Magnesium, ammonia, sulphate
  • Urate - Gout, ileostomy
  • Crystine

Risk factors

  • Dehydration
  • HYPER - Hypercalciuria, hyperPTH, hypercalcaemia
  • PKD
  • Obstruction - BPH

Drugs causing stones

  • Loop diuretics
  • Steroids
  • Acetazolamide
  • Theophylline
30
Q

Urolithiasis clinical features / investigations

A 
Loin to groin pain - Severe ± N/V
Urinary frequency / urgency
Haematuria
Testicular pain
Fever

Investigations

  • Urine dip / MC&S - Haematuria
  • CTKUB - Within 14 hours
  • Serum calcium / urate
  • CRP - Infection?
  • U&E
31
Q

Urolithiasis management and complications

A

< 5mm - Pass spontaneously

  • Analgesia - Diclofenac / Morphine
  • IV fluids
  • Anti-emetic

< 10mm - Tamsulosin PO

Shockwave lithotripsy - CI in pregnancy
Ureteroscopy
Percutaneous nephrolithotomy

Complications

  • Hydronephrosis - Nephrostomy
  • Obstruction / retention
  • Rupture - Sepsis
32
Q

Urolithiasis prophylaxis

A

Hypercalciuria

  • High fluid intake
  • Low animal protein
  • Low salt diet
  • Thiazides - Increased distal tubular calcium resportion

Oxalate - Reduce urinary oxalate secretion

  • Cholestyramine
  • Pyridoxine

Uric acid

  • Allopurinol
  • Urinary alkalinisation - Bicarbonate
33
Q

Haematuria aetiology

A 
Cancer - Prostate / Renal
BPH
UTI
Stones
Renal disease - Glomerular disease - Nephritic syndrome
Bleeding disorder
Catheter
34
Q

Haematuria investigations

A 
Urine dip / MC&S
FBC
Clotting
U&E
LFT
Flexible cystoscopy
CT
35
Q

Urinary retention aetiology and management

A

Neurological - Stroke / MS

Infection - UTI

Obstruction

  • Malignancy
  • BPH
  • Stones
  • Strictures
  • Structural abnormalities
  • Constipation

Drugs

  • Anti-cholinergics
  • Tricyclics
  • Antihistamines
  • Opioids
  • Benzos

Management - Catheter
If > 400ml urine output - Retention confirmed

36
Q

UTI aetiology

A 
E.Coli
Enterobacter
Klebsiella - Stones
Proteus - Stones
Pseudomonas

Risk factors

  • Catheter
  • Female - Sexually active
  • Structural abnormality
  • Immunocompromise
  • Pregnancy
37
Q

UTI presentation and investigations

A 
Dysuria
Urgency / frequency
Cloudy offensive smelling urine
Suprapubic pain
Fever
Haematuria

Investigations - Septic screen?

  • Urine dip / MC&S
  • ESR / CRP
  • Blood cultures
  • KUB-USS - Check for underlying cause
  • MCUG - Check for underlying cause
  • DMSA - Check for scarring
38
Q

UTI management and complications

A

Non-pregnant women - Trimethoprim / Nitro
Pregnant women - Amoxicillin
Men - Trimethoprim / Nitro

Complications

  • Urinary retention
  • Stones - Klebsiella/Proteus
  • Sepsis
  • Abscess formation
  • Pyelonephritis - Give IV/PO Cef
39
Q

Prostatitis

A

Aetiology - E.Coli

  • UTI
  • Post urological instrumentation
  • BPH

Presentation

  • Painful perineum
  • Painful ejaculation
  • Obstructive urinary symptoms
  • Fever / Rigors

Investigations

  • DRE - Boggy prostate
  • Urine MC&S - UTI screen
  • STI screen
  • PSA

Management - Cipro

40
Q

Epididymo-orchitis

A

Aetiology

  • STI - Chlamydia / Gonorrhoea
  • UTI

Presentation

  • UTI symptoms
  • STI symptoms - Discharge
  • Unilateral pain and swelling
  • Cremasteric reflex present

Investigations - Rule out testicular torsion!

  • STI screen
  • UTI screen - Urine MC&S
  • USS doppler

Management

  • IM Cef
  • PO Doxy - 2 weeks

3b (23 decks)

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