Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

YR6 Rotations > Surgery - Urology > Flashcards

Surgery - Urology Flashcards

1
Q

What is the best form of imaging for kidney stones?

A

CT KUB

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Recall the 4 main types of kidney stone in order of highest to lowest radiointensity

A

Calcium phosphate
Calcium oxalate
Triple (struvite) stones
Uric acid (radiolucent)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Which type of kidney stone is associated with urease bacteria?

A

Triple (struvate) stones

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Which type of kidney stone is associated with hypercalciuria?

A

Calcium oxalate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

How should kidney stone pain be managed?

A

PR/ IM diclofenac

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Recall one contra-indication to diclofenacin renal colic. What should be used instead?

A

CVS disease
IV Paracetamol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What initial investigations should be performed for renal colic?

A

Urine dipstick + culture
Serum creatinine + electrolytes: ?renal function
FBC/ CRP: ?associated infection
Calcium/ Urate: ?underlying causes
Clotting if percutaneous intervention planned
Blood cultures if pyrexial/ signs of sepsis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What imaging should be performed for suspected renal stones?

A

non-contrast CT KUB

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

How should kidney stones be managed depending on size?

A

<0.5cm: expectant Tx +/- tamsulosin

<2cm: ESWL

<2cm + pregnant: uteroscopy

> 2cm (inc. staghorn calculi): percutaneous nephrolithotomy

If hydronephrosis/ infection: nephrostomy tube/ ureteric stent + abx

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Give 4 causes of unilateral hydronephrosis

A

PACT
Pelvic-ureteric obstruction: congenital/ acquired
Aberrant renal vessels
Calculi
Tumours of renal pelvis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Give 5 causes of bilateral hydronephrosis

A

SUPER
Stenosis of the urethra
Urethral valve
Prostatic enlargement
Extensive bladder tumour
Retro-peritoneal fibrosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

How is hydronephrosis investigated?

A

USS: identifies presence of hydronephrosis + assess kidneys
IV Urography: assess position of obstruction
Antegrade or retrograde pyelography: allows Tx

If suspect renal colic: CT scan

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Describe management of hydronephrosis

A

Remove obstruction + drain of urine

Acute upper urinary tract obstruction: nephrostomy tube

Chronic upper urinary tract obstruction: ureteric stent or a pyeloplasty

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

2 RFs for BPH

A

Age
Black > White > Asian

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What does BPH present with?

A

LUTS-
Obstructive Sx: Hesitancy, Incomplete emptying, Poor flow, Straining
Irritative Sx: Frequency, Urgency, Nocturne, Incontinence
Terminal dribbling

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Investigations for BPH

A

Urine dipstick
U+Es: esp. if chronic retention suspected
PSA: if obstructive Sx or if patient is worried about prostate cancer
Urinary frequency-volume chart for at least 3 days
IPSS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Name 2 alpha-1 antagonists

A

Tamsulosin
Alfuzosin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Recall 2 options for medically managing BPH

A

Alpha-1 antagonist: 1st line for mod-sev voiding Sx (IPSS >,8)

5 Alpha reductase inhibitors: indicated if significantly enlarged prostate + high risk of progression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Describe the MOA of alpha-1 antagonists in BPH

A

Decrease smooth muscle tone of prostate + bladder
Improves urine flow + reduces Sx

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

List 4 side effects of alpha-1 antagonists used in BPH

A

Dizziness
Postural hypotension (systemic vasodilation)
Dry mouth
Depression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Describe the MOA of 5 Alpha-reductase inhibitors in BPH

A

Block conversion of testosterone to dihydrotestosterone (DHT) which is known to induce BPH
Reduce prostate volume, may slow progression
May decrease PSA conc.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Describe 1 drawback of 5 Alpha-reductase inhibitors

A

Reducing prostate volume takes time, Sx may not improve for 6 months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Give 4 side effects of 5 Alpha-reductase innhibitors

A

ED
Reduced libido
Gynaecomastia
Ejaculation problems

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What is the main way in which BPH can be surgically managed?

A

TURP (transurethral resection of the prostate)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What is the main complication of TURP to be aware of?

A

TURP syndrome: irrigation fluid enters systemic circulation
* Hyponatraemia: dilutional
* Fluid overload
* Glycine toxicity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

List 4 complications of transurethral resection

A

TURP
Turp syndrome
Urethral stricture/ UTI
Retrograde ejaculation
Perforation of the prostate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

When can PSA levels not be done?

A

Within:
- 6w of a prostate biopsy
- 1w of DRE
- 4w following a proven UTI/ prostatitis
- 48h of vigorous exercise +/or ejaculation
- Urinary retention
- Instrumentation of urinary tract

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

When would a multi-parametric MRI be used to investigate possible prostate cancer?

A

If PSA is inappropriate or if high chance of Ca

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What is the gold-standard investigation for prostate cancer?

A

Multiparametric MRI (this has replaced TRUS-guided biopsy)
Results compared to 5-point Likert scale

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What scoring system is used for prostate cancer?

A

Grade group (new)
Gleason score (old)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

How is the Gleason score determined?

A

Most common grade (1-5)
Highest grade (1-5)
Most common grade + highest grade = Gleason score

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What does each Gleason score/ Grade Group indicate?

A

GS6, GG1: similar to normal cells, slow growing, low risk
GS7 (3+4), GG2: mostly similar to normal, slow growing, intermediate risk
GS7 (4+3), GG3: less like normal cells, moderate rate of growth, high risk
GS8, GG4: some abnormal cells, moderate-fast growing, high risk
GS9-10, GG5: very abnormal cells, fast growing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Recall 3 options for managing localised prostate cancer (T1/T2)

A
  • Conservative with active monitoring
  • Radical prostatectomy
  • Radiotherapy (external beam + brachytherapy)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Name a complication of radiotherapy in prostate cancer

A

Proctitis
Inflammation of lining of rectum- rectal pain + bleeding

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Recall 3 options for managing localised advaced prostate Ca

A
  • Hormonal therapy
  • Radical prostatectomy
  • Radiotherapy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

How should metastatic prostate cancer disease be managed?

A

Hormonal therapy only

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

What are the options for hormone therapy in prostate cancer?

A

Synthetic GnRH agonist + 3w cover of anti-androgen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Recall 2 types of benign epithelial renal tumour

A

Papillary adenoma

Renal oncocytoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

What sort of tumour is an angiomyolipoma?

A

Benign mesenchymal renal tumour composed of thick-walled blood vessels, smooth muscle + fat

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

What is the maximum size for a papillary adenoma?

A

15mm

If more than this = malignant papillary renal cell carcinoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

What type of renal tumour can be seen in Birt-Hogg-Dube syndrome?

A

Renal oncocytoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

What type of renal tumour can be seen in tuberous sclerosis?

A

Angiomyolipoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

Renal cell cancer accounts for … of primary renal neoplasms

A

85%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

In which patients is renal cell carcinoma more common?

A

Middle-aged Men

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

List 5 RFs for renal cell carcinoma

A

Smoking
HTN
Obesity
Diabetes
FH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

Name 2 genetic syndromes that predispose to renal cell carcinoma

A

Von Hippel Lindau
Tuberous sclerosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

What are the 3 main subtypes of renal cell carcinoma, and which is most common

A

Clear cell (75-85%)
Papillary (2nd)
Chromophobe (3rd)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

Which tumours are people with Von-Hippel-Lindau predisposed to?

A

Phaeochromocytoma
Neuroendocrine pancreatic
Clear cell renal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

Which type of renal cell tumour is associated with loss of 3p?

A

Clear cell renal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

Which type of renal tumour is associated with long-term dialysis?

A

Papillary renal cell carcinoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

Classic triad of S/S in renal cell carcinoma

A

Haematuria
Loin pain
Abdominal mass

Rare to present with these (<10%)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

How do renal cell carcinoma patients usually present?

A

Often asymptomatic until late stages
>50% detected incidentally on imaging

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

What percentage of symptomatic renal cell carcinomas present with neoplastic syndromes? What are these?

A

30%
EPO: Polycythaemia
Renin: HTN
Parathyroid like hormone: Hypercalcaemia
ACTH: Cushing’s

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

What features on examination may suggest renal cell carcinoma?

A

Varicocele (tumour compressing veins)
Bilateral lower limb oedema (venous involvement)
Pyrexia of unknown origin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

What is Stauffer syndrome?

A

Paraneoplastic disorder a/w RCC
Presents as cholestasis/ hepatosplenomegaly
Due to increased levels IL-6

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

Give 2 indications for 2ww referral in potential RCC

A

Unexplained macroscopic haematuria w/o UTI
Persistent macroscopic haematuria despite successful UTI Tx

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

Investigations for RCC

A

CT CAP
MRI for small lesions/ vascular involvement

CT + MRI with contrast

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

Surgical management for local RCC

A

Partial nephrectomy (<7cm, confined to kidney)
Radical nephrectomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

Medical management for metastatic RCC

A

Alpha-interferon + IL2
VEGF receptor TK inhibitors: Sorafenib, Sunitinib

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

What is Wilm’s tumour?

A

Nephroblastoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

How should high-grade transitional cell carcinomas be managed?

A

1st: intravesical immunotherapy
2nd: radical cystectomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

How should traumatic urethral injuries be investigated and managed?

A

Ix: ascending urethrogram
Mx: suprapubic catheter

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

How should traumatic bladder injuries be investigated and managed?

A

Ix: Intravenous urogram or cystogram
Mx: laparotomy if intraperitoneal, conservative if extraperitoneal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

What is the most common malignancy in men aged 20-30?

A

Testicular cancer

65
Q

What proportion of testicular tumours are germ cell tumours?

A

95%

66
Q

Name 2 non-germ cell testicular tumours

A

Leydig cell tumours
Sarcomas

67
Q

List 5 risk factors for testicular cancer

A

Infertility
Cryptorchidism
FH
Klinefelter’s syndrome
Mumps orchitis

68
Q

What are the subtypes of germ cell testicular tumours?

A

Seminomas (50%)
Non-seminoma (embryonal, yolk sac, teratoma, choriocarcinoma)

69
Q

What are the signs and symptoms of testicular cancer?

A

Painless lump (most common)
Hydrocele
Gynaecomastia

Pain in minority

70
Q

What causes gynaecomastia in testicular cancer?

A

Increased oestrogen:androgen ratio

Germ cell tumours: hCG causes leydig cell dysfunction, increases both oestradiol + testosterone production (oestradiol more)

Leydig cell tumours: directly secrete more oestradiol + convert additional androgen precursors to oestrogens

71
Q

How should suspected testicular cancer be investigated?

A

1st = USS
2nd = AFP, hCG, LDH
3rd = CT CAP
NO biopsy

Biopsy can promote seeding. Histology performed after orchidectomy

72
Q

Which tumour markers are associated with the different types of germ cell testicular cancer?

A

LDH elevated in 40% germ cell tumours
Seminomas: hCG in 20%
Non-seminomas: AFT +/- b-hCG in 80%

73
Q

What are the stages of testicular cancer?

A

Stage 1: confined to testis
Stage 2: regional LN involvement
Stage 3: distant mets

74
Q

How can testicular cancer be managed?

A

Orchidectomy via inguinal approach
+/- chemotherapy
+/- radiotherapy

Inguinal approach reduces risk of seeding

75
Q

What is the prognosis for testicular cancer?

A

95% 5y survival

76
Q

Describe testicular torsion

A

Twist of spermatic cord resulting in testicular ischaemia + necrosis

77
Q

What are the 2 aetiological types of testicular torsion?

A

Intravaginal: due to ‘Bell Clapper Deformity’. Abnormal fixation of tunica vaginalis to testicle which allows testicle to rotate freely within tunica vaginalis

Extravaginal: mostly in neonates before gubernaculum has fixated testes to bottom of scrotum (Rare)

78
Q

Give 4 risk factors for testicular torsion

A

FH
Undescended testicle
Testicular tumour
Testicles with horizontal lie

79
Q

List 3 symptoms of testicular torsion

A

Acute onset severe unilateral testicular pain
N+V
Pain initially intermittent, becomes constant

80
Q

Give 5 signs on examination of testicular torsion

A

Swelling + erythema
Testis sits higher than contralateral one (Deming’s sign)
Testis may have horizontal lie (Angel’s sign)
Pain not relieved by elevation (Prehn’s sign)
Absent cremasteric reflex

81
Q

Describe investigations for testicular torsion

A

Urgent surgical exploration
Should NOT perform imaging as may delay Tx
Urine dip

Dx cant be excluded OE + imaging

82
Q

Describe management of testicular torsion

A

Analgesia
If testis viable: fix both to tunica vaginalis
If non-viable: orchidectomy

83
Q

Is the cremasteric reflex pos or neg in testicular torsion?

A

Neg

84
Q

What is the cremasteric reflex?

A

Stroking of the skin of the inner thigh causes the cremaster muscle to contract + pull up the ipsilateral testicle toward the inguinal canal

85
Q

What is Prehn’s test?

A

Elevating scrotum + assessing for difference of pain - positive if pain is relieved

86
Q

Is Prehn’s test pos or neg in testicular torsion?

A

Neg

87
Q

What condition is Prehn’s test positive in?

A

Epididymitis

88
Q

How should testicular torsion be managed?

A

Surgical exploration + BL orchidopexy

89
Q

What is an orchidopexy

A

Surgical procedure that moves undescended testicle into the scrotum

90
Q

What are the main RFs for ED?

A

EtOH
Drugs (beta-blockers, SSRI)
CVD RFs (metabolic syndrome, hyperlipidaemia etc)

91
Q

How should ED be investigated?

A 
QRisk score 
Free testosterone (9-11am) --> if low, FSH, LH, prolactin --> if abnormal, refer to endo
92
Q

How can ED be managed?

A

1st: PDE4 inhibitors (sildenafil)

2nd line: vacuum devices

93
Q

How should pregnant women with asymptomatic bacteriuria? UTI be managed?

A

MC&S –> Abx
7 days nitrofurantoin 100mg BD (AVOID AT TERM )
OR
Amoxicillin/cephalexin

94
Q

How should UTIs in men be managed?

A

7 days trimethoprim/nitrufurantoin

95
Q

When should men be referred to urology for UTI?

A

If 2 or more uncomplicated UTIs

96
Q

How should catheterised patients with asymptomatic bacteriuria be managed?

A

No treatment needed

97
Q

How should catheterised patients with symptomatic UTI be managed?

A

7 days trimethoprim/nitrofurantoin

98
Q

What are the most common cause of scrotal swelling seen in primary care?

A

Epididymal cysts

99
Q

Give 3 features of epididymal cysts on examination

A

Tender
Separate from body of testicle
Posterior to testicle

100
Q

List 3 conditions associated with epididymal cysts

A

Polycystic kidney disease
Cystic Fibrosis
von Hippel-Lindau syndrome

101
Q

What are the most common causes of Epididymo-orchitis?

A

Chlamydia (1st) + Gonorrhoeae (2nd): Young sexually active men

E.coli: Older adults (>35) with low-risk sexual hx

Local spread of infection from genital tract or bladder

102
Q

What is the causative organism in 95% of cases of prostatitis?

A

E coli

103
Q

What are the signs and symptoms of prostatitis?

A

Referred pain
Obstructive voiding symptoms
Fever and rigors may be present

104
Q

How should prostatitis be investigated?

A

DRE –> tender, boggy prostate gland

105
Q

How should prostatitis be managed?

A

Quinolone 14/7

STI screening

106
Q

How should urinary incontinence be investigated?

A

1st: speculum - exclude prolapse
2nd: Urine dip + MC&S (r/o DM + UTI)
3rd: Bladder diaries (minimum 3 days) - if inconclusive –>
4th: Urodynamic testing (if mixed incontinence)

107
Q

What is measured by urodynamic testing?

A

3 pressures measured from inside rectum + urethra:

  • bladder
  • detrusor
  • IAP
108
Q

How should stress incontinence be managed?

A

1st line: lifestyle advice, WL if BMI>30, pelvic floor exercises
2nd line: duloxetine or surgical treatment

109
Q

How should pelvic floor exercises be done for stress incontinence?

A

8 contractions, TDS, 3 months

110
Q

Recall some options for sugical management of stress incontinence

A
  • Burch colposuspension
  • Autologous rectus fascial sling
  • Bulking agents
111
Q

Recall some RFs for stress vs urge incontinence

A

Stress: age, children, traumatic delivery, pelvic surgery, obesity

Urge: age, obesity, smoking, FHx, DM

112
Q

What is the normal post-void volume for <65 vs >65ys?

A 
<65 = <50mLs
>65 = <100mLs
113
Q

How should urge incontinence be managed?

A

1st line: lifestyle advice, bladder training, avoid fizzy drinks, DM control
2nd line: oxybutynin/tolterodine or desmopressin
3rd line: mirabegron (beta-3 agonist)
4th line: surgical

114
Q

Recall an important side effect of oxybutynin and an alternative option if there is concern

A

Falls

Can give mirabegron instead

115
Q

How can urge incontinence be managed surgically?

A

Botox injection, sacral nerve stimulation, urinary diversion

116
Q

How should overflow incontinence be managed?

A

Refer to specialist urogynaecologist

1st line = timed voiding

117
Q

What is a hydrocele?

A

Accumulation of fluid within tunica vaginalis
Communicating or non-communicating

118
Q

What causes communicating hydroceles? In which patients are these mostly seen?

A

Patency of processus vaginalis allowing peritoneal fluid to drain down into scrotum
Newborn males
Usually resolve within months

119
Q

How should an infantile communicating hydrocele be managed?

A

Reassurance
Surgical repair if not resolved by 1-2y to avoid complications e.g. incarcerated hernia

120
Q

What causes non-communicating hydroceles?

A

Excessive fluid production within tunica vaginalis

121
Q

Hydroceles may develop secondary to what 3 conditions?

A

Epididymo-orchitis
Testicular torsion
Testicular tumours

122
Q

List 5 features of hydroceles

A

Soft, non-tender swelling of hemi-scrotum
Usually anterior to + below testicle
Confined to scrotum, can ‘get above’ mass OE
Transilluminates
Testis may be difficult to palpate if hydrocele large

123
Q

Investigation for hydrocele

A

Clinical dx
USS if doubt in dx or underlying testis can’t be palpated

10% testicular malignancies present as hydrocele

124
Q

How should hydrocele be managed in adults?

A
  • Watch + wait
  • Aspiration if surgery CI (often reaccumulates)
  • Surgical: Lloyd’s Plication/ Jaboulay’s repair
125
Q

Why does varicocele affect the LHS more than the RHS?

A

Left testicular vein:

  • drains into renal vein at 90 degree angle
  • is longer than right
  • often lacks a terminal valve to prevent backflow
  • can be compressed by renal and bowel pathology

>80% occur on left

126
Q

What is the best investigation for varicocele?

A

Doppler USS

127
Q

If varicocele has a sudden onset, what must be considered?

A

Renal cell carcinoma

128
Q

How should varicocele be managed?

A 
Conservative (scrotal support) 
or surgical (radiological embolisation or operation to expose and ligate vein)
129
Q

In a patient with hypercalciuria and recurrent calcium renal stones, what drug can be used as prevention?

A

Thiazide like diuretics (they decrease urinary calcium)

130
Q

What can treatment of prostate cancer with GnRH agonists initially cause?

A

‘Tumour flare’
Paradoxical increase in Sx.

131
Q

Describe the pathophysiology of tumour flare

A

GnRH temporarily causes pituitary to increase LH secretion before inhibiting LH release
Leads to increased stimulation of Leydig cells + production of more testosterone which stimulates survival + growth + Sx of prostate cancer

132
Q

What are the symptoms of ‘tumour flare’?

A

Bone pain
Bladder obstruction

133
Q

What should be done before treatment with goserelin (GnRH agonist) for prostate cancer?

A

Pre-Tx with anti-androgen to avoid initial “tumour flare effect”
e.g. Flutamide, Bicalutamide, Cyproterone acetate

134
Q

What can occur as a complication of the scarring that occurs in balanitis xerotica oblilterans?

A

Phimosis

135
Q

Give 4 medical indications for circumcision

A

Phimosis
Paraphimosis
Recurrent balanitis
Balanitis xerotica obliterans

136
Q

What must be excluded prior to circumcision?

A

Hypospadias as foreskin may be used in surgical repair

137
Q

What anaesthetic cover is circumcision performed under?

A

LA or GA

138
Q

Describe the prevelance of bladder cancer

A

2nd most common urological cancer
M > F
50-80y

139
Q

Give 4 risk factors for bladder cancer

A

Smoking (past or current)
Occupational exposure to aromatic amines + hydrocarbons
Pelvic radiotherapy
SCC RF: long term catheters + chronic inflammatino from schistosomiasis

140
Q

What are the subtypes of bladder cancer?

A

> 90% Urothelial (transitional cell carcinoma)
5% SCC (higher in areas affected by schistosomiasis)
2% Adenocarcinoma

141
Q

Give 3 ways in which bladder cancer may present

A

Painless macroscopic haematuria (most common)

Microscopic haematuria + LUTS (urgency, dysuria)

Pelvic pain + Sx of urinary tract obstruction (advanced)

142
Q

What are the indications to make a 2ww referral for suspected bladder cancer?

A

> 45 with UE macroscopic haematuria or macroscopic haematuria that persits after UTI Tx
60 with UE microscopic haematuria + dysuria/ raised WCC

UE = unexplained

143
Q

What investigations should be performed in suspected bladder cancer?

A

Urine dip + culture: r/o infection
1. Flexible cystoscopy OP
+/- urine cytology
2. Transurethral resection of bladder tumour (TURBT
3. CT CAP + CT urography for staging

144
Q

Describe management of bladder cancer

A

Superficial lesions: TURBT

Recurrences/ high grade/ risk: Intravesical chemotherapy

> > ,T2: radical cystectomy + ileal conduit + neoadjuvant chemo

145
Q

What does each tumour staging in bladder cancer indicate?

A

T1: superficial, confined to urothelium/ connective tissue
T2: muscle invasion
T3: through muscle to fat
T4: spread to other pelvic organs/ abdomen

146
Q

Define acute urinary retention

A

Abrupt development of inability to pass urine (hours)

147
Q

Give 7 causes of acute urinary retention

A

BPH (most common)
Urethral strictures
Prostate cancer
Calculi
Cystocele
Constipation
Neurological (less common)

148
Q

List 5 drugs that can cause acute chronic urinary retention

A

Anticholinergics
TCAs
Antihistamines
Opioids
Benzodiazepines

149
Q

In patients with predisposing causes, what can cause urinary retention?

A

UTI

150
Q

Give 2 scenarios acute urinary retention is common in

A

Postoperatively
Postpartum

151
Q

Give 4 S/S of acute urinary retention

A

Inability to pass urine
Lower abdo discomfort
Pain + distress
Acute confusional state (esp elderly)

152
Q

How may acute urinary retention present on examination?

A

Palpable distended urinary bladder on abdo/ rectal exam
Lower abdo tenderness

153
Q

What examinations should be performed in acute urinary retention?

A

Rectal + Neuro exam

Pelvic exam in females

154
Q

Investigations for acute urinary retention

A
  • Post-catheterisation urinalysis + culture
  • Post-void bladder scan for residual vol
  • Serum U+Es + creatinine
  • FBC + CRP
155
Q

Which investigation can confirm acute urinary retention?

A

Bladder USS Vol >300cc

156
Q

Management for acute urinary retention

A

Catheterisation (decompress bladder)
Volume drained in 15 mins measured: >400cc, leave catheter in place

157
Q

Give 1 complication of Tx of acute urinary retention

A

Post-obstructive diuresis

158
Q

What is post-obstructive diuresis?

A

Kidneys increase diuresis due to loss of medullary conc. gradient. Can take time re-equilibrate

Can lead to volume depletion + worsening of any AKI

Some may require IV fluids to correct this temporary over-diuresis

159
Q

Define chronic urinary retention

A

Gradual (months-years) development of inability to empty the bladder completely
Characterised by a residual volume >1L or a/w a distended/ palpable bladder

YR6 Rotations (22 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions