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Year 2 > Genitourinary: Part 5 > Flashcards

Genitourinary: Part 5 Flashcards

1
Q

6 Indications for LUTS

A
  1. Retention
  2. UTIs
  3. Stones
  4. Haematuria
  5. Elevated creatinine du eto bladder outflow obstruction
  6. Symptoms deteriorating
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2
Q

What defines benign prostatic hyperplasia

A

Increase in size of prostate without present of malignancy

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3
Q

What proportion of volume of seminal fluid is contributed to by the prostate

A

70%

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4
Q

What age does BPH effect

A

Over 60

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5
Q

What ethnicity does BPH effect

A

Afro-caribbeans more than men (higher levels of testosterone)

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6
Q

Risk factors for BPH

A

Age

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7
Q

What is a protective measure for preventing BPH

A

CASTRATION (removal of testicales)

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8
Q

Does Testosterone cause BPH

A

No, it is a requirement for BPH but doesn’t cause it

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9
Q

When should castration occur for BPH to not manifest

A

Castration prior to puberty or genetic disease inhibiting androgen production

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10
Q

What layers over-proliferate in the prostate in BPH

A

Musculofibrous and glandular layers

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11
Q

BPH vs prostate CARCINOMA histologically

A

Transitional (inner) zone enlarges in contrast to peripheral layer expansion seen in prostate carcinoma

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12
Q

Pathophysiology of BPH

A

Enlarged prostate can block the urethra

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13
Q

Clinical presentation of LUTS

A
  1. Nocturne
  2. Frequency
  3. Urgency
  4. Post-micturition dribbling
  5. Poor stream/flow
  6. Hesitancy
  7. Overflow incontinence
  8. Haematuria
  9. Bladder stones
  10. Delay in initiation of micturition
  11. Incomplete emptying
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14
Q

Diagnosis of LUTS

A
  1. AXR
  2. Digital rectal exam
  3. FBC
  4. ULTRASOUND
  5. BIOPSY and ENDOSCOPY
  6. MID-stream urine sample
  7. Flow rate and residual volume
  8. Frequency volume chart
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15
Q

What would AXR show in LUTS

A

Enlarged BLADDER

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16
Q

What would digital rectla exam accomplish in LUTS

A

Feel prostate is enlarged but SMOOTH

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17
Q

Why is ultrasound done in LUTS

A
  1. Exclude renal damage by obstruction

2. Transrectal ultrasound - size of prostate

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18
Q

What would FBC show in LUTS

A

Serum electrolytes - excludes renal damage

PSA raised

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19
Q

What max flow rate indicates bladder outflow obstruction due to BPH

A

Less than 10ml per second is suggestive

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20
Q

What is the frequency volume chart

A

Measures volume voided and time over MINIMUM 3 days

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21
Q

Why is frequency volume chart important

A

Can indicate if nocturne is present

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22
Q

If symptoms are minimal for BPH what do we do

A

Watchful waiting

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23
Q

Lifestyle changes in BPH

A
  1. Avoid caffeine and alcohol to reduce urgency and nocturne
  2. Relax when voiding
  3. Void twice in a row to aid emptying
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24
Q

First line drug treatment of BPH

A

ORAL TAMSULOSIN

ORAL FINASTERIDE (alternatief(

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25
How does TAMSULOSIN work
1. Relaxes smooth muscle in bladder neck and prostate thereby producing increase in urinary flow rate and improvement in obstructive symptoms
26
Side-effects of Tamsulosin
DDDEE ``` D - Drowsy D - Dizzy D - Depression E - Ejactulatory failure E - Extra-pyramidal signs ``` also: Weight gain and nasal congestion
27
When do we avoid tamsulosin
Postural hypotension
28
Role of ORAL FINESTERIDE
Bolocks conversion of testosterone to dihydrotestosterone - androgen responsible for prostate enlargement
29
Side-Effects of ORAL FINESTERIDE
1. Decreased Libido | 2. Impotence
30
Surgical intervention for BPH
1. TURP - Transurethral resection of prostate (MAIN) | 2. TUIP - Transurethral incision of prostate
31
When is surgery done for BPH
When prostate is too large and isn't being improved
32
Indications for BPH
1. Recurrent haematuria 2. Acute urinary retention 3. Failed voiding trials 4. Renal insufficiency 5. Failure of medical treatment
33
Complications of BPH if left untreated
1. Bladder calculi 2. UTI 3. HAEMATURIA 4. ACUTE retention
34
What part of the kidney is effected by RENAL CELL CARCINOMA
PCT epithelium
35
In what gender is renal cell carcinoma caused in
Males over females
36
Average age of renal cell carcinoma presentation
55
37
Risk factors for renal cell carcinoma
1. Smoking 2. Obesity 3. Hypertension 4. Renal failure + haemodialysis 5. Polycystic kidneys 6. Von Hippel Lindau syndrome
38
Genetic pattern of Von Hippel Lindau syndrome
Autosomal dominant
39
What gene causes VHL syndrome
Mutation of chromosome 3 on p arm Causes loss of both copies of tumour suppressor genes
40
Characteristic of RCC caused by VHL syndrome
Bilateral and multifocal
41
Where do malignancies spread to in RCC caused by VHL syndrome
Renal, pancreatic and cerebellar
42
How does RCC spread
1. Renal vein | 2. Lymph or haematogenous (bone, liver and lung)
43
Clinical presentation of RCC
1. Asymptomatic and discovered incidentally 2. Haematuria, loin/flank pain and abdo mass 3. Anorexia, malaise and weight loss 4. Invasion of left renal vein - testicaulr vein compression causing varicocele in left testicular vein 5. Polycythaemia 6. Hypertension due to renin secretion 7. Anaemia due to depression of erythropoietin 8. Fever
44
Differential diagnosis of RCC
1. Transitional cell carcinoma 2. WILM's tumour 3. Renal oncocytoma 4. Leiomyosarcoma
45
Diagnostics of RCC
1. ULTRASOUND 2. CT and abdo contrast 3. MRI 4. BP 5. FBC 6. RENAL BIOPSY 7. Bone scan
46
Role of ultrasound in RCC
Distinguish simple cyst to complex cyst or tumour
47
Role of CT chest and abdo with contrast in RCC
1. Detects renal mass, involvement of renal vein of inferior vena cava 2. Kidney function seen by contrast (should be taken up and excreted by wet functioning kidney)
48
Role of MRI in RCC
Tumour staging
49
FBC results in RCC
1. Polycythaemia and anaemia as EPO decreased 2. ESR raised 3. Liver biochemistry may be abnormal
50
Role of Renal biopsy in RCC
1. Get histology to identify tumour
51
When is bone scan done for RCC
Only if there are signs of raised serum ca
52
Treatment of RCC
1. Nephrectomy unless TUMOURS ARE BILATERAL (partial nephrectomy if bilateral) 2. Ablative techniques 3. IL-2 and INF-alpha for remission - --- 2nd line---- 4. Sunitinib, BEVACIZUMAB and SORAFENIIB 5. TEMSIROLIMUS - mTOR inhibitor (more effective than INF-alpha)
53
What is WILMS' tumour
Childhood tumour of primitive renal tubules and mesenchymal cells
54
When is WILM's tumour seen
First 3 years of life
55
Clinical presentation of WILMS' tumour
ABdo mass and haematuria
56
Diagnostics of WILMS' tumour
ULTRASOUND, CT and MRI
57
How is WILMS' tumour treated
Nephrectomy, radiotherapy and chemotherapy
58
What carcinoma is bladder ancer
Transitional cell carcinoma
59
What structures are lined by transitional epithelium
``` Calyces Renal pelvis Ureter Bladder Urethra ```
60
What gender is TTC more common in
Men than female
61
Risk factors for TTC
1. Smoking 2. Exposure to carcinogens 3. Exposure to drugs 4. Chronic inflammation of urinary tract 5. Greater than 40 6. Male 7. Family history
62
What causes chronic inflammation of the urinary tract
Schistomiasis - squamous carcinoma Indwelling catheter
63
What carcinogens can increase risk of bladder cancer
1. Beta-napthylamine, benzidine, azo dyes | 2. Workers in PETROLEUM, chemical, cable and rubber industries
64
What drugs can cause bladder cancer
CYCLOPHOSPHAMIDE | PHENACETIN
65
Where does bladder cancer spread locally
Pelvic structure
66
Lymphatic spread of bladder cancer
Iliac, para-aortic nodes
67
Haematogenous spread of bladder cancer
Liver and lungs
68
Clinical presentation of bladder cancer
1. PAINLESS HAEMATURIA - pain in clot retention 2. Any patient over 40 with haematuria presumed tumour 3. Recurrent UTIs 4. Voiding irritability
69
Differential diagnosis of TTC
1. Haemorrhagic cystitis 2. Renal cancer 3. UTI 4. Urethral trauma
70
How is TTC diagnosed
1. Cystoscopy (bladder endoscopy) and biopsy - DIAGNOSTIC 2. Urine microscopy - STERILE PYURIA (pus in urine) caused in cancer 3. CT urogram - staging and DIAGNOSTIC 4. Urinary tumour markers 5. MRI/Lymphangiogrpahy for pelvic lymph nodes 6. CT/MRI of pelvis
71
Treatment of TTC
- -------(non-muscle invasive bladder cancer)---------- 1. SURGICAL RESECTION 2. CHEMOTHERAPY (with surgery) - -------- (localised muscle invasive disease)------------- 3. RADICAL CYSTECOMY (GOLD STANDARD) 4. RADICAL RADIOTHERAPY (if not fit for surgery) 5. CHEMOTHERAPY
72
Non-muscle invasive bladder cancer chemotherapy
MITOMYCIN DOXORUBICIN CISPLATIN - reduces recurrence
73
Post-op chemotherapy after radical cystectomy in Localised muscle invasive disease
1. METHOTREXATE 2. VINBLASTINE 3. ADRIAMYCIN + CISPLATIN
74
Chemotherapy in localised muscle invasive disease
1. METHOTREXATE 2. VINBLASTINE 3. CISPLATIN
75
Treatment of metastatic bladder cancer
Palliative chemotherapy and radiotherapy
76
IN what layer of the prostate is prostatic carcinoma found in
Peripheral zone
77
Common metastasis in prostatic carcinoma
Bone and lymph
78
What gender is prostatic cancer common
Men
79
Why is prostatic cancer more common in black people
More testosterone
80
Family history of prostatic cancer
1. 3 or more affected relatives | 2. 2 relatives who have developed early onset
81
What gene predisposes you to prostatic cancers
1. HOXb13 | 2. BRCA2 confers a 5-7 times higher risk
82
Local spread of prostatic cancer
Seminal vesicles, bladder and rectum
83
Haematological spread of prostatic cancer
Bone (sclerotic bony lesions), brain, liver and lung
84
Clinical presentation of prostatic cancer
Signs for LUTS: 1. Nocturne 2. Haematuria 3. Poor stream 4. Terminal dribbling 5. Obstruction - bladder outflow problems similar to BPH
85
Presentation of metastatic prostatic cancer
1. Weight loss 2. Bone pain 3. Anaemia
86
Differential diagnosis of prostatic cancer
1. BPH 2. Prostatitis 3. Bladder tumours
87
Diagnostics of prostatic cancer
1. Digital rectal exam 2. Trans-rectal ultrasound + biopsy - DIAGNOSTICS 3. Urine biomarkers 4. Endorectal coli MRI
88
Urine biomarkers for prostatic cancer
PCA3 or gene fusion protein
89
Why is an endorectal coli MRI done for prostatic cancer
Locally stage tumour
90
Results of DRE in prostatic cancer
1. Hard, irregular prostate | 2. Raised PSA (over 16 ng/ml)
91
Treatment of prostatic cancer if disease is confined to prostate
1. Radical prostatectomy (over 70) 2. Radiotherapy + hormone therapy 3. Brachytherapy 4. Hormone therapy temporarily delays tumour progression 5. Active surveillance (over 70 and low risk)
92
What is brachytherapy
Implantation of radioactive material targeted at tumour
93
Metatstic prostatic carcinoma treatment
NOTE: BINDING AT THE ANDROGEN RECEPTOR STIMULATES TUMOUR GROWTH 1. Orchidectomy (remove testes) 2. LH receptor hormon agnost: 3. Androgen receptor blocker
94
Name two LH receptor hormone agonist
1. GOSERELIN | 2. SC LEUPRORELIN
95
How do LH hormone receptor hormone
1. Stimulate then inhibit testosterone release from pituitary
96
How is initial surge of pituitary testosterone medicated
1. ORAL CYPROTERONE ACETATE
97
Name an androgen receptor blockers
BICALUTAMIDE
98
Side effects of BICALUTAMIDE
1. Weakness 2. Nausea 3. Hot flushes 4. Weight change
99
How are symptoms of Prostatic cancer treated
1. ANALGESIA 2. HYPERCALCAEMIA RADIOTHERAPY - bone metastases/spinal cord compression
100
Why should Tamsulosin not be given in postural hypotension
It is an alpha-1 antagonist: alpha-1 receptors cause contraction of smooth vascular muscles so if we give during hypotension then BP would get even worse

Year 2 (155 decks)

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