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Conditions Flashcards

(59 cards)

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1
Q

Voiding (obstructive) symptoms

A

Hesitancy
Weak stream
Postmicturition dribble
Incomplete emptying
Straining

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2
Q

Storage (irritative) sx

A

Urgency
Urge incontinence
Frequency
Nocturia
Suprapubic pain

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3
Q

History taking for BPH

A

IPSS to evaluate severity and effect on qol
Voiding sx
Storage sx
Bladder diary
Fluid intake
FHx BPH

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4
Q

Physical exam of BPH

A

PR; size, symmetry, nodules, tenderness, constipation
Penis; phimosis, meatal stenosis, balanitis
Neuro; anal tone, sensation, lower limb neuro

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5
Q

BPH Ix

A

Urinalysis; exclude haematuria, proteinuria, infection
Renal function
USS; if mod-severe sx, abnormal renal function, retention

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6
Q

Causes of elevated PSA

A

Cancer
BPH
Exercise
Sex
Prostatitis
PR exam
Recent IDC

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7
Q

PSA screening

A

Not routine
Consider 2 yearly from 50-69yo if family hx
if doubles in 12mo - suspicious for cancer

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8
Q

Mx BPH

A

Cease caffeine/alcohol
Cease acidic/spicy foods
Tx constipation
Reduce nocte fluid intake
Bladder training + pelvic floor exercises
Moderate-severe BPH
- Alpha blockers, 5 alpha reductase inhibitors
Monitor; annual urinalysis + renal function

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9
Q

Alpha antagonists for BPH

A

1st line monotherapy
Prazosin (0.5mg BD) / tamsulosin
ADR; hypotension, retrograde ejaculation, erectile dysfunction

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10
Q

5-alpha-reductase inhibitors

A

Dutasteride / finasteride
Good if prostate vol >4ml / 30cc
ADR; gyno, ED, reduced sperm count, infertility

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11
Q

Indications for urology referral for BPH

A

Urinary retention
Hydronephrosis
Refractory to medical mx
Recurrent UTI
Gross haematuria
Renal insufficiency

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12
Q

Risk factors prostate cancer

A

FHx
African-American
BRCA
Fhx breast-ovarian Ca syndrome
Lynch syndrome

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13
Q

Acute bacterial prostatitis mx

A

Trimethoprim 300mg 2/52
OR keflex 500mg QID 2/52

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14
Q

Chronic bacterial prostatitis mx

A

Ciprofloxacin 500mg BD 4/52

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15
Q

Hydrocoele mx

A

Neonate; monitor until 12/12 - if not resolve by then OR very large at any stage - refer surg
Child; resolve by 2 years - outpatient referral is ongoing after 2 years

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16
Q

Risk factors of Peyronie’s disease

A

DM
Obesity
HTN
HLIPID
Smoking
Pelvic surgery
Dupuytren’s disease

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17
Q

Cause of priapism

A

Idiopathic
Sickle cell
Spinal shock
Penile trauma
Viagra, antiHTN, antidepressants
Gouts
DM

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18
Q

Priapism mx

A

Cold shower
Pseudoephedrine 120mg
Gentle job
Urgent urology input
- Corporal aspiration
- Intracavernous injection phenylephrine

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19
Q

Causes of LUTs

A

UTI
BPH/Prostate Ca/Prostatitis
Urethral stricture
Phimosis
OAB
Parkinson’s disease/MS/CVA
OSA (nocturnal polyuria)

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20
Q

Hx for LUTs

A

Storage sx
Voiding sx
Post-micturition sx
Haematuria
Polyuria/polydipsia
Weight loss
Smoking (risk bladder Ca)
Fhx prostate Ca
caffeine/ETOH
Volume fluid intake

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21
Q

Causes of haematuria

A

Postinfectious GN
IgA nephropathy
PCKD
Stones
Malignancy
Rigorous exercise
Coagulopathy
Sickle cell

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22
Q

Microscopic Haematuria work up

A

Dipstick - 1+ is significant (trace isn’t)
do UMCS to rule out infection
If proteinuria / reduced eGFr -> consider glomerulonephritis - do USS and refer nephrologist
If nil proteinuria/reduced GFR and have malignancy risk factors -> urine cytology x3, USS, refer to urologist for cystoscopy

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23
Q

Risk factors of urological malignancy

A

Male
>40yo
Hx macroscopic haematuria
Smoking
Pelvic irritation
Exposure to occupational chemical dyes or cyclophosphamide

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24
Q

Overactive bladder sx

Study These Flashcards
A

Urgency
Frequency
Nocturia
Urge incontinence

25
Causes OAB
Neuro; stroke, MS, diabetic neuropathy Urothelial carcinoma Recurrent UTI BPH Urethral stricture Overflow incontinence OSA CHF Diabetes Diuretics
26
Work up of OAB
Urinalysis; exclude infection, blood, glucose USS and post-residual vol Bladder diary 3 days Consider; cytology, urodynamics, cystoscopy etc
27
Mx OAB
Reduce fluid intake 6-8 glasses per day Constipation Incontinence pads Topical oestrogen in females 1st line; Bladder retraining/pelvic floor 2nd line; oxybutynin 5mg TDS, mirabegron 25mg daily (beta-3 agonist) 3rd; intravesical botox 4th; bladder augmentation, urinary diversion
28
Nocturia mx
Reduce fluid intake Low Na diet Lasix 6hr prior to bed Desmopressin
29
Complications of catheter
CAUTI Catheter obstruction; clots, crystals, biofilms Catheter bypass (urine bypassing catheter) - due to small IDC size, underflated balloon, constipation, bladder spasms
30
Workup of suspected renal colic
Urine dipstick + MCS bHCG FBC/CRP/U+E/calcium/uric acid 24hr urine collection volume, calcium, oxalate, uric acid Stone analysis CT KUB - gold standard (do with XR KUB) - if single kidney or renal failure - urgent imaging
31
Renal colic indications for admission
Diabetes eGFR <30 Intractable pain/nausea Single kidney Bilateral ureteric obstruction UTI/sepsis Anuric renal failure
32
Renal colic
Conservative if <=7mm stone - Panadol - NSAID 1st line; celecoxib 200mg single dose - Other; Indomethacin 50mg TDS PRN Medical expulsive therapy (MET) - Tamsulosin 400mcg daily
33
Prevention of renal stones
Increase fluid intake to ensure 2L UO / day Increase K+; nuts, beans Reduce salt/protein intake Normal calcium intake Thiazides can reduce Ca excretion
34
Patient instructions for renal colic
Safety net red flag; fever, intolerable pain Strain urine and catch stone - bring in for analysis Repeat scan 4/52 if not passed stone -> refer urologist if present
35
Causes of testicular lump
Cancer Torsion Orchitis Hydrocoele Varicocoele Spermatocoele Epididymal cyst Epididymitis
36
Varicocele mx
Conservative <=21yo; if assoc atrophy and decreased sperm quality then do surgical ligation If normal sperm - monitor semen analysis every 2 years
37
Orchitis/epididymitis Ix
MSU MCS Urethral swab or FPU chlam/gonorrhoea if sexually active in last 6/12 Consider USS if suspect tumour, torsion etc
38
Orchitis / epididymitis mx
Sexually active tx for chlam + gon (ceftriaxone + doxy) Not sexually active tx for acute cystitis/acute prostatitis (trimethoprim 300mg 2/52) No sex 7/7 after tx No sex w/ partners from last 6/12 Bed rest Scrotal support Analgesia F/u 5/7; tx response, Abx sens, sexual education
39
Risk factors testicular cancer
Fhx Cryptorchidism Previous tumour Down syndrome
40
Testicular ca work up
USS BHCG, AFP, LDH
41
Mx testicular ca
Discuss sperm banking Discuss prosthesis Secondary prevention - weight, diet exercise - continued self examination
42
Undescended testes mx
Unilateral - Routine paed surg referral - Elective repair at 6/12 age - if impalpable - lap exam + staged procedure Bilateral - Palpable; if normal genitalia - routine surg referral. If abnormal genitalia - urgent paed surg referral - Impalpable; urgent referral
43
Retractile testis mx
Annual review to make sure still can be manipulated If >6yo and retractile or cannot be longer manipulated - urgent referral to surg
44
Risk factors ED
Atherosclerosis; CVD, DM, lipid, HTN, smoking Neuro; stroke, dementia, parkinsons, DM Pelvic surgery Endocrine; thyroid, hypogonadism, HPRL Obesity Peyronie's disease Stress/relationship issues/depression Medication; diuretics, beta-blockers, SSRI Alcohol, cocaine OSA
45
ED evaluation
CVD risk; if high risk stop all sexual activity and refer cardiologist - High risk; ACS in last 2/52, high risk arrhythmias, severe AS, NYHA IV BMI BP Testes Size Penile exam Ix - Lipid, HbA1c - Serum testosterone - Sleep study
46
ED mx
Smoking/ETOH cessation Exercise Weight loss Healthy diet Sildenafil 25-100mg Urologist - Intracaversonal injection - Vacuum erection device Psychosexual therapy; masturbation retraining, glans stimulation with vibrator, condom with hole in tip
47
Phosphodiesterase type 5 inhibitor for ED
Contra; nitrates, MI/CVA in last 6/12, HTN >170/100, unstable angina ADR; headache, flushing, priapism Instruction - empty stomach - wait 45min prior to sex - Engage in stimulation prior to sex - Allow 6-7 attempts with medication for full effect - Trial on self with masturbation
48
Mx premature ejaculation
IELT <1min (primary) or <3min (acquired) Sexology referral for techniques to control ejaculation, reduce anxiety Reduce sensitivity; thick condoms, topical EMLA 20min prior to interoucrse Behaviour - stop-start, squeeze technique, extended foreplay, cognitive distractions, Psychosexual - meditation, relaxation SSRI - Dapoxetine - can combined with viagra
49
Causes of haematospermia
Infection; STD Iatrogenic; prostate biopsy/tx, vasectomy Cancer; prostate/testis/bladder/urethral Prolonged intercourse Prolonged abstinence HTN Leukaemia/lymphoma Coagulopathy Idiopathic
50
Initial workup of haematospermia
UMCS urine cytology FBC Coagulation +/- STI screen PSA if >40yo, abnormal DRE or prostate Ca risk factors Urine and semen AFB/parasites
51
Causes of male infertility
HPRL Hypogonadotrophic hypogonadism Varicocoele Radiation Klinefelter syndrome Anti-sperm Ab Retrograde ejaculation
52
Male infertility Ix
Serum FSH + morning testosterone - Low test -> repeat with free test, SHBG, albumin, LH, PRL Semen analysis; 2-3 abstinence, analysed within 1hr, always repeat abnormal result after 1/12 anti-sperm Abs Karyotype if severe oligospermia Scrotal USS; if risk factor for cancer Post-ejaculatory urine analysis - exclude retrograde
53
General measures for male infertility
Cease smoking/alcohol Weight loss Reduce scrotal temperature Avoid drugs Avoid exposure to vibration/pesticides Optimal intercourse timing
54
Clinical features Klinefelter
Small testis <4ml and firm palpation Osteoporosis Gyno Tall Reduce facial/body hair
55
Klinefelter long term complications
CVD COPD osteoporosis Parkinson-like syndrome Breast Ca x50 risk Non-Hodgkin lymphoma Hashimoto's T1DM
56
Klinefelter dx
2x morning fasting test low Raised LH/FSH Consider - BMD - Semen analysis
57
Klinefelter tx
Lifelong TRT from mid-puberty Education risk of osteoporosis/IHD/breast Ca Discuss fertility +/- IVF
58
Functional hypogonadism
Cause; age, overweight, chronic disease Sx; fatigue, hot flushes, low libido, ED Serum test - modest reduction 6-10nmol/L Tx - 10% weight loss - Tx depression/OSA - Remove opioids/steroids
59
Vasectomy patient counselling
Ask if tried other contraception Make sure they know its permanent Determine whether relationship stable Ask about future family intent Not 100% reliable in preventing pregnancy - 1/2000 risk Need for condoms for STI prevention Risk; haematoma, infection, pain Avoid sex for 1 week post-op Need 3/12 interim contraception and 20 ejaculations with semen analysis prior to being declared sterile

Urology / Men's Health (1 decks)

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