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Flashcards in Uro Deck (12):
1

International prostate symptom score (IPSS)
IFIUWSN

1. Incomplete voiding 排尿不濟
2. Frequency 尿頻
3. Intermittency 排尿斷續
4. Urgency 尿急
5. Weak stream 尿流無力
6. Straining 排尿費力
7. Nocturia 夜尿次數

2

Urodynamic studies

Study function of LUT

Parameters measured
1. Intravesical and Rectal pressure
2. Detrusor (deduced)
3. Uroflow rate
4. Sphincter function EMG
5. Bladder volume

Cystogram and reflux (video)

Pressure flow study
- “Low uroflow rate with high detrusor pressure” = BOO

BOO = Urodynamic Dx

3

PSA cutoff value
(Prostate-specific-Ag)

- 40-49y = 2.5 (ng/mL)
- 50-59y = 3.5
- 60-69y = 4.5
- 70-79y = 6.5

In general
- <4 is normal
- 4-10 has 20% chance of cancer, consider biopsy
- >10 has 50% cancer, biopsy indicated
- Detection rate of PSA on CA prostate is not as high as in books

4

Absolute indication and Cx of TURP for BPH
Rev

1. Refractory urinary retention
2. Recurrent urinary infection from BPH
3. Recurrent gross hematuria from BPH
4. Bladder stone from BPH
5. Obstructive uropathy

Cx
1. Bleeding
2. Infection/sepsis
3. Incontinence (1%)
4. Retrograde ejaculation (90%!!; can't have kids)
5. Erectile dysfunction (>50%)
6. Late urethral stricture
7. Late bladder neck stenosis
8. (TUR syndrome)

5

Urinary stones
Rev

M>F (2:1)

RF
HT, DM, Menopause, HyperPTH, obesity, gout, Crohn's...

Urgent drainage if sepsis (pyonephrosis)

NCCT for Ix

IVU + KUB for planning intervention and FU

6

3 most common for stones to lodge (narrowest parts)
Rev

1. PUJ (Pelvic-ureteric junction)
2. UVJ (Ureterovesicular junction)
3. When ureter touches pelvic brim

7

Absolute indications for intervention for Urinary stones
Rev

1. Obstructive: Pyelonephritis, may need ABX, if fail, drainge with PCN/JJ +/- ICU for shock

2. Unremitting pain

3. Deterioration of RFT

4. Anuria due to ureteric obs

8

Surgical intervention for urinary stones
Rev

Nephrectomy for non-functioning kidney

PCNL vs ESWL
- ESWL only <2cm; 1-2cm not lower pole ones

9

CA kidney

Triad: Pain, Mass, Hematuria

Most discovered on routine CT/USG (small tumors)

Paraneoplastic
- High ESR
- HT
- Anemia
- LOW
- Abnormal liver function

M:F 2:1

RF
- Smoking
- Dialysis
- Obesity
- Von Hipple-Lindau syndrome
- Exposure to asbestos, cadmium

Tx
Radical for big
Partial for small polar ones,
esp exophytic (<3cm)

Cyto-reductive nephrectomy for big tumors, then targeted therapy (TKI: Sunitinib)

10

CA bladder
Rev

RFs
- Smoking
- Occupation: aromatic amines
- Chemo, e.g. Cyclophosphamide
- Hereditary

M>F 3:1

Tx
- Superficial papillary TCC, i.e. non-muscle invasive --> Endoscopic tx (TURBT) --> +/- intravesical BCG instillation

- Invasive --> aggressive, i.e. Cystectomy and urinary diversion (Total cystectomy with ileal conduit)

RT/Chemo for Adju/Neoadj/unfit for surgery

11

PSA high in

BPH
Prostatitis
AROU
UTI
Within 48h after ejaculation

12

CA prostate

Dx by elevated PSA +/- abnormal DRE

Ix: TRUS + prostate biopsy
Multiparametric MRI
Bone scan

Tx: Radical prostatectomy / RT
Active surveilance
Advanced --> Hormonal therapy (LHRH analog, bil orchidectomy)

Cx for radical prostatectomy
- Stress incontinence
- Erectile dysfunction