Flashcards in General urology Deck (40):
what is the grading score of prostate cancer?
The Gleason score based on histology:
Score 6- low risk
Score 7-8 intermediate risk
Score 8-10 high risk
What is PSA?
PSA (prostate specific antigen)- is a kallikrien protein produced within the prostate.
If you note that the pSA is raised. what are your ddx?
Benign prostatic hyperplasia
infection of the urine
what are the risk factors for prostate cancer?
• Increasing age
• Family hx of prostate and breast cancer (BRCA1 and 2)
Prostate health index ratio?
Free to total ratio
if low ratio= cancer
if high ratio- not cancer
ADT for prostate ca management?
androgen deprivation therapy. Initiated post intervention. Can either use LHRH and anti-androgens
SE of androgen deprivation therapy for P.cancer?
• High risk of IHD
• Increased weight
• Hot flushes
• Cognitive change, low mood
• CVS- hypercholesterolemia
Lethargy, reduction in libido
what is brachytherapy?
Defined as radiotherapy from an sealed internal source. In prostate cancer, it can either be permanent or temporary. For prostate cancer- radioactive seeds are surgically implanted to release high dose radiation to the prostate
what do we mean by 'watchful waiting' for prostate cancer assessment?
Expectant management is defined as watchful waiting until symptoms or signs of disease become clinically evident before instituting definitive treatment (e.g., radiotherapy, surgery, or hormonal manipulation).
what is orchidectomy? how is it used in prostate ca?
removal of the testicles- a form of castration. in the setting of prostate ca- it is used as a palliative method/androgen deprivation therapy
how does LHRH (ADT) therapy work in the management of prostate ca?
LHRH agonists mimic the signal released by the hypothalamus in the presence of lowering levels of testosterone.
The LHRH agonist occupies the receptors of the pituitary gland that receive the normal signal.
For approximately 7 to 10 days, the pituitary gland recognises the LHRH agonist as a signal to produce large amounts of testosterone that may produce a painful flare. After 7 to 10 days, the LHRH agonist continues to occupy the pituitary gland's receptors, the pituitary gland subsequently signals the testicles to stop making testosterone, and the hormone level then drops by 90% to 95% to castration levels.
how is a prostate biopsy performed?
transrectal ultrasound guided biopsy
what are some complications for prostate surgery?
erectile dysfunction and urinary incontinence
what is the differential diagnosis for painless scrotal lump?
cancer (benign or malignant, germ cell vs non germ cell)
What germ cell tumours are there in the testes
Seminoma, non seminoma germ cell tumours
what other tumours are there in the testes?
tumour from the leydig/sertoli cells, tumour from the stroma, tumour from the granulosa cells
is testicular cancer painful or painless?
What virus can cause orchitis?
what is a risk factor for testicular cancer?
how might bacteria cause orchitis?
urinary tract infection/bladder infection or STI
what transilluminates on scrotal mass examinations?
simple fluids- like hydrocele or cyst. not blood
what tumour markers do you screen for if you worry about testicular cancer? which tumours secrete tumour markers?
alpha feto protein, bHCG, LDH- non seminoma tumour
what is the commonest testicular cancer in men over 50 years old?
where does testicular cancer metastasise to?
1. retroperitoneal lymph nodes
2. nodes in the chest
3. lungs (look for cough and haemoptysis)
how do we resect testicular cancer?
via inguinal canal exploration (because we don't want to contaminate the scrotal basin)
ddx for the acute scrotum- new onset scrotal pain, swelling, tenderness, erythema
1. testicular torsion
2. appendix torsion on top of the testes
4. tumour (not that likely)
what is cryptorchidism?
maldescended or absent testes usually congenital
acute management of testicular torsion?
• Urgent referral to urology
• Analgesia- morphine
Surgery- Orchiectomy or orchiplexy
what is TURP syndrome
hyponatremia secondary to too much fluid being washed into the prostatic venous sinuses during TURP surgery
where can you get pain from testicular torsion?
Illiac fossa pain
where do you get stones in the ureter?
and VUJ (vesicouteric junction)
upper limits for the diameters of a renal stone?
five or 6 mms
Management of BPH?
1. Watchful waiting until symptoms progress
2. Alpha blocker tamsulosin
3. PDE inhibitor
5. Five alpha reductase inhibitor
6. Refractive to medical therapy- TURP
7. Restrict alcohol/fluid binge
A 30-year-old presents with a painless swelling of his left testicle and gynaecomastia. Diagnosis?
A 15-year-old boy presents with pain in both testes a week after developing painful facial swellings. what are you thinking?
in a male patient with high suspicion of testicular torsion- what ix would you do?
exploration of the testes
skip U/s. u/s only good for ruling out testicular torsion in the case if you are unsure or have a low index of suspicion for testicular torsion
when do you go for TURP surgery for BPH?
severe urinary obstructive symptoms
or when there is evidence of complications such as hydronephrosis and urinary retention
what type of testicular tumours are there?
1. germ cell tumours consisting of seminomas and non seminomas
2. non germ cell tumours consisting of leydig and stromal tumours
key question for urine retention-
is it painful or not painful??