Flashcards in Genitourinary Deck (50):
Name 3 types of stones. Which is the most common?
1. Calcium oxalate (70%)
2. Uric acid
3. Magnesium ammonium phosphate
What are some risk factors for ureteric stone development?
Diet high in animal protein &salt
What are the initial investigations for a suspected stone?
-Serum calcium & uric acid
-CT-KUB and plain KUB
What are some indications for intervention for a ureteric stone?
-Inability to control symptoms
-Unlikely to pass spontaneously
What organism usually causes obstructive pylonephrosis?
What is the management of obstructive pylonephrosis?
-IV Abs (gentamicin?)
-Supportive care (fluids, monitoring)
What are some medical treatments for ureteric stones?
-a-blockers, eg. Tamsulosin 0.4mg OD for 2 weeks
-calcium channel blockers & steroids not as effective
What are the surgical options for a ureteric stone?
-JJ stent & delayed management
-Ureteroscopy & lithotrospsy
-Shock wave lithotripsy
What is the likely make-up of a radiolucent stone?
-Uric acid (or cystine)
-Form in acidic urine
What are some strategies to prevent stone recurrence?
-Adequate fluid intake
-Medical therapy - allopurinol, thiazide diuretics
What are 5 causes of urological haematuria?
-Carcinoma of the prostate
Which common drugs can make the urine beetroot red?
What is the acute work-up for haematuria?
-Bloods: Hb, clotting, creatinine
-MSU -> M/C/S
-Upper tract imaging: CT-IVP, U/S
-Others: urine cytology, PSA, urinalysis
What are the obstructive urinary symptoms?
Poor flow, hesitancy, intermittency, terminal dribbling
What are the irritative urinary symptoms?
Frequency, urgency, nocturia, incontinence
What are the 3 most common causes of obstructive urinary symptoms?
What are 5 causes of irritative urinary symptoms?
-Secondary to obstruction
What is your work-up for lower urinary tract symptoms?
-Voiding flow rate
-US - residual urine, hydronephrosis
Which drugs can be used in lower urinary tract symptoms?
-5-alpha reductase inhibitors
What are the surgical options for treatment of lower urinary tract symptoms?
-BNI (bladder neck incision)
What is acute urinary retention?
Sudden and PAINFUL inability to pass urine
What are some painless causes of urinary retention?
-Longterm voiding detrusor dysfunction
What can precipitate acute urinary retention?
-Diuresis (esp. ALCOHOL)
What are common causes of acute urinary retention in females?
-Extrinsic compression - prolapsed uterus or pelvic mass
What are the appropriate size catheters for: men, women & haematuria?
What is the management of obstructive nephropathy?
-Monitor urine hourly
-Replace urine volume with 1/2 volume 0.9% NaCl
-Monitor UECs regularly
-Replace magnesium & phosphate as required
What are the treatment options for AUR?
-Alpha-blocker & TOV
-Surgery: TURP, laser, open
Differential diagnosis of a painless scrotal lump?
Hydrocoele, epididymal cyst, varicoele, benign tumour, idiopathic scrotal oedema, testicular cancer, lymphoma, inguinal hernia, ascites
What 3 serum markers might be elevated in testicular cancer?
Which lymph nodes do the testicles drain to first?
Retroperitoneal lymph nodes (require CT abdomen & pelvis for staging)
What are the treatment options for testicular cancer?
-Retroperitoneal lymph node dissection
What are the main investigations for suspected testicular cancer?
-Serum tumour markers
-Urgent scrotal U/S
What 2 places does testicular cancer commonly metastasize to first?
-Retroperitoneal lymph nodes
What are the differentials for an acute scrotum?
-Testicular appendage torsion
-Acute indirect inguinal hernia
What conditions can predispose to testicular torsion?
-Bell clapper deformity
What are the physical findings in testicular torsion?
-Tender, firm, high-riding testicle with a horizontal lie
-Absent cremasteric reflex
-Epididymis not posterior to testis
What are the common causative bacteria in epididymo-orchitis?
Men 35: E. coli & other GNBs
What are the risk factors for epididymo-orchitis?
What are the physical examination findings in epididymo-orchitis?
-Swollen, tender testis
What investigations should be ordered in suspected epididymo-orchitis?
-U/S - to rule out torsion
-Urinalysis & MSU
-Urine/urethral swab for PCR
Which antibiotics should be used in epididymo-orchitis?
GNB coverage: trimethoprim, cephalexin, augmentin or norfloxacin for 2 weeks
-give ampicillin & gentamicin via IV until afebrile
STI coverage: ceftriaxone & azithromycin & doxycycline
What are the macroscopic & microscopic features of papillary bladder cancer in situ?
-Cytologically malignant cells
-Lack of cohesiveness
-Mucosal reddening, granularity or thickening
What conditions predispose to carcinoma of the bladder?
-Industrial exposure to arylamines
-Long-term use of analgesics
-Long-term exposure to cyclophosphamide
What are the histological features of a testicular seminoma?
Large cells with distinct borders, pale nuclei, prominent nucleoli & sparse lymphocytic infiltrate
What are the 3 broad classifications of testicular neoplasms?
-germ cell tumours
-sex cord stromal tumours
What are common germ cell tumours of the testicles?
-Yolk sac tumour
In which region of the prostate does hyperplasia typically arise?
In which region of the prostate does carcinoma typically arise?
What does a Gleason score confer?
Degree of differentiation of cells (GRADE)