2A revision > Urogenital > Flashcards

Urogenital Flashcards

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1
Q

diagnosing scrotal masses

A
  1. can you get above it?
  2. is it separate from the testis?
  3. cystic or solid?
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2
Q

what is it if you can’t get above a scrotal mass

A

inguinoscrotal hernia

hydrocele extending proximally

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3
Q

what is a separate and cystic scrotal mass

A

epididymal cyst

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4
Q

what is a separate and solid scrotal mass

A

epididymitis / varicocele

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5
Q

what is a testicular and cystic scrotal mass

A

hydrocele

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6
Q

what is a testicular and solid scrotal mass

A

tumour, haematocele, granuloma, orchitis

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7
Q

what is an epididymal cyst and what is it caused by

A
  • benign cyst lesion of the epididymis

- possibly from obstruction of the epididymis

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8
Q

clinical manifestations of epididymal cyst

A
  • small paratesticular swelling
  • tender
  • thin-walled, translucent cystic lesion
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9
Q

what is the management of epididymal cyst

A
  • remove if symptomatic
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10
Q

what is a hydrocele

A
  • an abnormal accumulation of fluid in the space between the two layers of the tunica vaginalis
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11
Q

causes of hydrocele

A

primary cause = trauma

secondary cause = reaction to underlying pathology (epididymitis, orchitis, tumour)

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12
Q

clinical manifestations of a hydrocele

A
  • scrotal swelling
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13
Q

management of a hydrocele

A
  • can resolve spontaneously
  • aspiration
  • surgery = placating the tunica vaginalis/ inverting the sac
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14
Q

what is a varicocele

A

a persistent abnormal dilation of the pampiniform venous plexus in the spermatic cord

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15
Q

clinical manifestations of a varicocele

A
  • nodularity on the lateral side of the scrotum
  • dull ache (worse after prolonged standing)
  • male subfertility (increased blood flow raises temp and impairs spermatogenesis)
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16
Q

management of varicocele

A

surgery to remove

if untreated can lead to infertility

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17
Q

what is an adenomatoid tumour

A
  • most common benign paratesticular neoplasm

- small, solid, grey/white tumours <3cm

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18
Q

where do adenomatoid tumours occur

A

epididymis, spermatic cord, tunica albuginea

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19
Q

causes of urinary tract obstruction

A 
urinary stones
urothelial tumours
extrinsic compression
prostatic hyperplasia 
urinary tract malformations
strictures
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20
Q

clinical manifestations of acute upper tract obstruction

A

ureteric colic (pain radiates to groin)
superimposes infection
enlarged kidney

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21
Q

clinical manifestations of chronic upper tract obstruction

A

flank pain, renal failure, superimposed infection,

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22
Q

clinical manifestations of acute lower tract obstruction

A

acute urinary retention, severe suprapubic pain, acute confusion

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23
Q

clinical manifestations of chronic lower tract obstruction

A

urinary frequency, hesitancy, poor stream, terminal dribbling, overflow incontinence

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24
Q

investigations for urinary tract obstruction

A
  • bloods (U&E, FBC, creatinine, PSA)
  • urine dipstick and MC&S
  • US = hydronephritis (swelling of kidney) or hydroureter
  • CT = level of obstruction
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25
treatment of urinary tract obstruction
- upper = nephrostomy or ureteric stent | - lower = urethral or suprapubic catheter
26
complications of urinary tract obstruction
-risk of infection, stone formation, renal damage
27
what can cause haematuria
- malignancy - calculi - IgA nephropathy - polycystic kidney disease
28
management of haematuria
- urological assessment, imaging, cystoscopy to exclude malignancy and calculi - renal referral
29
clinical manifestation of testicular torsion
- sudden onset pain in one testis and abdomen - nausea and vomiting common - tender, hot, swollen testicle - testis may lie high and transversely
30
differential diagnosis for testicular torsion
- epididymo-orchitis = symptoms of urinary infection and more gradual onset of pain
31
investigations for testicular torsion
- doppler US = lack of blood flow to a testicle | - do not delay surgical exploration
32
management of testicular torsion
- possible orchidectomy + bilateral fixation | - surgery to expose and untwist the testis
33
what is benign prostatic hyperplasia
- enlargement of the prostate gland due to an increase in cell number
34
pathology of BPH
- increased levels of dihydrotestosterone in prostate (androgen) - increased oestrogen levels in blood induce androgen receptors in prostate tissue and stimulate hyperplasia
35
clinical manifestations of BPH
- LUTS = frequency, urgency, nocturia, hesitancy, poor flow, terminal dribbling
36
differential diagnoses of BPH
- overactive bladder, prostatitis, prostate cancer, UTI
37
investigations for BPH
- U&E - US - PSA test - biopsy
38
management for BPH
- lifestyle = avoid caffeine and alcohol. void twice in a row - drugs = tamsulosin (alpha-blockers) - surgery = transurethral resection or incision of prostate, retropubic prostatectomy
39
complications of BPH
- urinary retention - recurrent UTI - bladder stones - obstructive nephropathy
40
what is a renal carcinoma
malignant epithelial neoplasm arising in the kidney
41
clinical manifestations of renal carcinoma
- half present with painless haematuria - picked up incidentally on imaging - small proportion present with metastatic disease - loin pain, abdo mass, anorexia, weight loss, malaise.
42
investigations for renal carcinoma
- hypertension from renin secretion - FBC = polycythaemia from erythropoietin secretion - ESR, U&E, ALP - urine = RBCs - US, CT/MRI, CXR
43
management of renal carcinoma
- radical nephrectomy | - cryotherapy and radiofrequency ablation if not fit for surgery
44
what is a nephroblastoma - Wilm's tumour
- malignant childhood renal neoplasm - abdominal mass and haematuria - most low stage with good prognosis
45
what is a urothelial carcinoma (bladder transitional cell carcinoma)
- a group of urothelial neoplasms arising in the urothelial tract
46
clinical manifestations of urothelial carcinoma
- painless haematuria - LUTS - recurrent UTI - voiding irritability
47
investigations for urothelial carcinoma (bladder cancer)
- urine cytology - IVU - cystoscopy and biopsy - CT/ MRI
48
management of urothelial carcinoma (bladder cancer)
- Tis/Ta/T1 (80% of patients) = transurethral cystoscopy/resection of bladder tumour - T2-3 = radical cystectomy (radiotherapy if need to preserve the bladder) - T4 = palliative chemo/radiotherapy, chronic catheterisation and urinary diversions
49
what is prostate carcinoma
malignant epithelial tumour arising in the prostate
50
pathology of prostate cancer
- arise from precursor lesion (prostatic intraepithelial neoplasia) with neoplastic transformation of the epithelium lining of the prostatic ducts and acini. - mutations in a number of genes
51
clinical manifestations of prostate cancer
- asymptomatic - LUTS - symptoms of metastatic disease
52
investigations for prostate cancer
- often diagnosed through needle biopsy to investigate raised serum PSA - DRE = hard, irregular prostate - increased PSA levels - biopsy
53
management of prostate cancer
- prostatectomy - radiotherapy - analgesia - treat hypercalcaemia
54
what are the two testicular tumours
- seminoma = germ cell tumour of the testicle | - teratoma = non-germ cell tumour of the testicle
55
clinical manifestations of testicular tumour
- painless testis lump after trauma/infection - secondary hydrocele - pain - dyspnoea - abdo mass
56
differential diagnosis of testicular tumour
- hydrocele - abdominal hernias - orchitis
57
investigations for testicular tumours
- CXR - CT - excision biopsy - alpha-FP and beta-hcg useful tumour markers to monitor treatment
58
tumour staging of testicular tumours (1-4)
1. no evidence of metastasis 2. infradiaphragmatic node involvement 3. supradiaphragmatic node involvement 4. lung involvement (haematogenous spread)
59
management of testicular tumours
- radical orchidectomy - seminomas are very radiosensitive - chemo = teratoma - radiotherapy = seminoma
60
what is urolithiasis - urinary tract calculi (nephrolithiasis)
- formation of stony concretions in the bladder or urinary tract
61
pathology of urolithiasis
- calculi form leading to blockage and abrasing structures. | - renal stones = crystal aggregates, form in collecting ducts and deposit anywhere from renal pelvis to urethra
62
where are renal stones classically deposited (3)
1. pelviureteric junction 2. pelvic brim 3. vesicoureteric junction
63
risk factors for renal stones/ urolithiasis
- high protein/ salt intake - male, white - obesity - dehydration - meds = antacids, carbonic anhydrase inhibitor - crystal urea - increase in urinary solutes (calcium, uric acid, oxalate, sodium) and a decrease in stone inhibitors (citrate, magnesium)
64
what can renal stones be formed from
- calcium oxalate/ calcium phosphate (hyperparathyroidism, excess dietary calcium, primary renal disease) - magnesium ammonium phosphate - uric acid (hyperuricaemia, dehydration) - struvite (chronic UTI) - cystine stones
65
what are urinary calculi
- renal stones | - crystal aggregates which form in the renal collecting ducts and become deposited in the urinary tract
66
what are triple stones
- result of infections (eg proteus) that produce the enzyme urease which splits urea to ammonia
67
presentation of renal stones
- fever, vomiting, flank pain - most asymptomatic - stones causing obstruction lead to hydronephritis (obstruction + dilation of renal pelvis causing lasting damage) - larger stones tend to remain confined to the kidney - smaller stones tend to pass into ureter and and become impacted causing ureteric colic - infection, haematuria, proteinuria, sterile pyuria
68
where is pain felt for obstruction of the kidney, mid-ureter, lower ureter and bladder/urethra?
- kidney = felt in loin - mid-ureter = mimic appendicitis - lower ureter = bladder irritability and pain in scrotum, penile tip or labia majora
69
investigations for renal stones
CT = gold standard - Xray to detect kidney stones - urine dipstick = blood - 24h urine sample for stone biochemistry - US = hydronephrosis
70
acute management of renal stones/urolithiasis
- NSAIDs for pain - antiemetics for vomiting and nausea - allow stones <5mm to pass spontaneously - IV fluids
71
surgical management of renal stones/ urolithiasis
- percutaneous nephrostomy (drain urine straight from kidney = symptom relief) - ureteric stent - percutaneous nephrolithotomy = remove stone from the kidney by small puncture of skin - endoscopic/open surgery to break down stone - extracorporeal shock wave lithotripsy = uses shock waves to break down stones so fragments can be passed
72
prevention of renal stones
- overhydration - low salt diet - normal dairy intake - healthy protein intake - reduce BMI - active lifestyle
73
lower urinary tract infections
- cystitis - prostatitis - epididymitis/ orchitis - urethritis
74
upper urinary tract infections
pyelonephritis
75
classification of urinary tract infections
- asymptomatic bacteriuria - uncomplicated (normal renal structure and function) - complicated (structural/ functional abnormality)
76
what is the main pathogen that causes UTI
Escherichia coli
77
why are omen more susceptible to UTI
shorter urethra so closer proximity to anus
78
presentation of cystitis (bladder infection)
- frequency, urgency, dysuria, haematuria, suprapubic pain
79
what is the presentation of ascending spread to the kidneys (acute pyelonephritis)
- more severe | - fever, rigors, vomiting, loin pain
80
diagnosis of UTI
- urinalysis = leucocytes or nitrates = quick screening test - look for protein, blood, pH, ketones, glucose, leucocytes an nitrates - microscopy = WBCs, RBCs, casts and bacteria - microbiological culture (midstream specimen)
81
management of uncomplicated UTI
- Abx for 3 days | - if fails then culture urine and treat according to Abx sensitivity
82
management of UTI in men
- lower UTI with 7 day Abx course | - if prostatitis then give a course of ciprofloxacin (able to penetrate prostatic fluid)
83
management of complicated UTI
7day Abx
84
management of UTI in pregnant women
- asymptomatic bacteriuria should be confirmed on a second sample - Abx
85
what is prostatitis
- inflammation/swelling of the prostate gland | - ascending infection from the urinary tract or haematogenous spread
86
clinical presentation of prostatitis
pain = perineum, rectum, scrotum, penis, bladder, lower back - fever - malaise - nausea - urinary symptoms
87
treatment of acute prostatitis
- Abx treatment for 28days immediately | - treat pain
88
treatment of chronic prostatitis
- pain relief - stool softener - Abx 4-6 weeks
89
what is cystitis
- inflammation of the bladder caused by bladder infection (UTI, E.coli)
90
symptoms of cystitis
- frequency, dysuria, urgency, suprapubic pain, polyuria, haematuria
91
what is pyelonephritis
infection of the renal parenchyma and soft tissues of the renal pelvis/ upper ureter
92
symptoms of pyelonephritis
- loin pain, fever, pyuria (puss in urine) - vomiting - cystitis symptoms - septic shock
93
investigations for pyelonephritis
- abdo examination = tender loin - bloods and cultures - US scan to rule out upper tract obstruction
94
treatment of pyelonephritis
- fluid replacement - broad spec IV Abx (c-amoxiclav) - drain obstructed kidney - analgesia
95
what is urethritis
inflammation of the urethra
96
pathology of urethritis
- mostly sexually transmitted - gonorrhoea - chlamydia trachomatis - needs sexual health referral
97
treatment of urethritis
- depends on cause - gonorrhoea = ceftriaxone - bacteria = oflaxacin - chlamydia = doxycycline
98
presentation of urethritis
- painful/difficult urination
99
what is epididymo-orchitis
inflammation of the epididymis +/- testes
100
causes of epididymo-orchitis
- chlamydia - e.coli - mumps - n.gonorrhoea
101
pathology of epididymo-orchitis
- sexually transmitted infection ascending from the urethra or non-sexually transmitted uropathogens spreading from urinary tract
102
features of epididymo-orchitis
- sudden onset tender swelling, dysuria, fever, urethral discharge - possible infertility - symptoms way worsen before improving
103
treatment of epididymo-orchitis
- doxycycline - sexual abstinence and contact tracing - analgesia and drainage of any abscess
104
genital ulcers
- HSV - flu-like prodrome, vesicles/papules around genitals, anus, throat = burst forming shallow ulcers - urethral discharge, dysuria, urinary retention, proctitis - diagnosis via PCR
105
treatment of genital ulcers
- analgesia = topical lidocaine
106
syphilis
- any genital ulcer is syphilis until proven otherwise - primary= genital skin, nipples, mouth - secondary = onset after infection, skin rash - incubation 9-90 days (usually 21-35 days)
107
diagnosis of syphilis
- PCR - early moist lesions - serology
108
treatment of syphilis
- penicillin injection | - follow up and partner notification essential
109
chlamydia diagnosis
- nucleic acid amplification test (NAAT) - male = first void urine - female = vaginal swab, first void urine, endocervical swab
110
chlamydia treatment
- partner management - doxycycline or azithromycin for 7 days - community screening
111
gonorrhoea diagnosis
- microscopy of gram stained smears of genital secretions look for gram negative diplococci within cytoplasm (male urethra, female endocervix, rectum) - culture on selective medium - sensitivity testing - NAAT
112
gonorrhoea treatment
- surveillance of Abx sensitivities | - ceftriaxone with azithromycin
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