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Dan Surgery > Urology > Flashcards

Urology Flashcards

1
Q

Define Urolithiasis

A 
Formation of crystalline solutes anywhere along the urinary tracts
Renal Stones (in Kidney) or Ureteric
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2
Q

Name 2 stone inhibitors

A

Magnesium

Citric Acid

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3
Q

State four different types of Renal Stones

A

Calcium (80%)
Uric Acid (High levels of Purines)
Struvite/Infective
Cystine

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4
Q

Name two causes of high purine levels

A

High red meat intake

Myeloproliferative Disorders

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5
Q

What is the one type of radiolucent stone

A

Urate

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6
Q

Name the infective organism that most commonly causes Struvite Stones

A

Proteus

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7
Q

Name the three most common locations for stones to form

A

PUJ
VUJ
As ureter passes pelvic brim

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8
Q

Give 5 risk factors for stone formation

A 
Age
Family History
Anatomical Abnormalities (Horseshoe Kidney, Medullary Sponge)
Dehydration
Crohns
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9
Q

Describe three clinical features of RTC

A

Ureteric Colic (Loin to Groin)
Nausea and Vomiting
Haematuria

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10
Q

What is the main differential for flank pain

A

AAA

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11
Q

What is the Gold Standard Investigation for RTCs (except in pregnant or young)?

A

CTKUB WITHOUT contrast

Contrast has a similar density to stone

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12
Q

What might be present on a CT of an RTC that would indicate infection?

A

Fat Stranding (ie haziness)

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13
Q

What are Matrix Stones?

A

Rare stones related to HIV/Hepatitis treatment

Invisible on CT

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14
Q

How is the patient positioned for a CT KUB?

A

Prone Position

Otherwise hard to differentiate position of stone

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15
Q

Describe the conservative management of RTC

A

Fluids
Analgesia (Rectal Diclofenac/Paracetamol)
Anti-Emetic
Medical Expulsion Therapy (eg Tamsulosin)

If under 5mm, 68% of stones will pass spontaneously

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16
Q

Name four indications for surgical management of RTCs

A

Severe Pain > 48hrs
Renal Dysfunction
Previous Renal Disease Bilateral Stones

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17
Q

Describe three surgical options for RTC

A

Extracorporeal Shock Wave Lithotripsy
Uteroscopy and Stone Removal (with laser)
Percutaneous Nephrolithotomy (if in kidney)

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18
Q

Name two contraindications to ESWL in RTCs

A

AAA

Blood Thinners

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19
Q

How would an RTC present if it was close to/in the bladder?

A

Frequency

Urgency

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20
Q

What happens if an RTC becomes infected?

A

an infected obstructed system is a urological emergency and patients can die

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21
Q

Describe a 3 step management plan for an Infected Obstructed System

A

Sepsis 6

Stent under GA or Percutaneous Nephorstomy under LA

HDU/ITU

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22
Q

Define Pyelonephritis

A

Inflammation of Kidney Parenchyma and Renal Pelvis, typically due to bacterial infection

Bacteria can reach by ascending urinary tract, haematogenous spread, or lymphatic spread (from retroperitoneal abscess)

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23
Q

Give 3 risk factors of Pyelonephritis

A 
Halted flow of urine (BPH/Spinal Cord)
Retrograde Ascent (Female, Indwelling Catheter)
Factors Predisposing (DM, Steroids)
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24
Q

Describe the clinical features of Pyelonephritis

A

Fever
Loin Pain
Nausea and Vomiting
May have corresponding LUTS

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25
Q

Describe three investigations for Pyelonephritis

A

Urinalysis
Urine Culture
Renal Ultrasound Scan

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26
Q

How would you manage Pyelonephritis?

A

Antibiotics

Fluids

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27
Q

Give two complications of Pyelonephritis

A 
Chronic Pyelonephritis and Scarring
Emphysematous Pyeonephritis (from gas forming bacteria, gas around kidney, usually in diabetic patients)
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28
Q

Give 3 features of a ‘complex’ Renal Cyst

A

Thick walls
Calcifications
Risk of Malignancy

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29
Q

Give 4 risk factors for Renal Cysts

A

Age
Hypertension
Smoking
Gender (PCKD, Von Hippel Lindau)

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30
Q

Give 3 clinical features of Renal Cysts

A

May be asymptomatic
Flank Pain
Haematuria

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31
Q

What is Bosniak Scoring?

A

Classifies Renal Cysts from I-V with increasing risk of malignancy

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32
Q

How would you manage Renal Cysts?

A

Asymptomatic Cysts don’t need further follow up or treatment

Symptomatic - Analgesia and deroofing

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33
Q

Bladder Cancer can be invasive or non-invasive, state three histological subtypes

A

Transitional Cell Carcinoma
Squamous Ce;; Carcinoma
Adenocarcinoma

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34
Q

Describe the four layers of the bladder wall

A

Inner Lining - Urothelium (Transitional Epithelium)
Second Layer - Lamina Propria
Third Layer - Muscular Layer
Fourth Layer - Outer CT

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35
Q

Give 3 risk factors for Bladder Cancer

A

Smoking
2 - Napthylamine
Schistosomiasis

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36
Q

Give 3 clinical presentations of Bladder Cancer

A

Painless Haematuria
Recurrent UTIs
LUTS

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37
Q

Name 3 investigations for Bladder Cancer

A

Urgent Cytoscopy
Biopsy via TURBT (Transurethral Resection Bladder Tumour)
CT Staging

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38
Q

Describe the management of non muscle invasive Bladder Cancer

A

TURBT (Diathermy using cytoscope)
Intravesicle Chemo (Mitomycin C)
Radical Cystectomy

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39
Q

Describe the management of muscle invasive Bladder Cancer

A

Radical Cystectomy

Neoadjuvant Chemotherapy

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40
Q

How is a Urinary Diversion created surgically?

A

Ileal Conduit and Urostomy

IE Bladder reconstruction using small bowel

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41
Q

What is the scoring system for BPH called?

A

International Prostate System Score

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42
Q

What volume of Prostate is considered enlarged?

A

Over 30ml

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43
Q

Describe two types of medical management for BPH

A

Alpha Blockers (eg Tamsulosin) - relax prostatic smooth muscle

5a Reductase Inhibitors (eg Finasteride) - prevents conversion of testosterone to DHT

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44
Q

Describe two types of surgical management for BPH

A

TURP (using diathermy loop)

Holmum Laser Enucleation of the Prostate (uses heat to dissect)

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45
Q

What is TURP Syndrome?

A

The use of hypo-osmolar irrigation during the procedure can result in hypervolaemia and hyponatraemia

Presenting with confusion, nausea and agitation

46
Q

Name the two histological subtypes of Prostate Cancer

A

Acinar
Ductal

(Adenocarcinomas)

47
Q

Give 3 risk factors for Prostate Cancer

A

Age
Ethnicity (Black African and Caribbean)
BRCA1/2

48
Q

Describe the normal PSA levels

A

40-49 <2.5
50-59 <3.5
60-69 <4.5
>70 <6.5

49
Q

Describe the two methods of biopsy for suspected Prostate Cancer

A

Transperineal

Transrectal

50
Q

How is Prostate Cancer Graded?

A

Gleason Grading

51
Q

How is Prostate Cancer managed?

A

Asymptomatic and Low Risk- Active Surveillance
High Risk - Radical Treatment (Prostatectomy, Surrounding Tissue and Lymph Nodes) or Radiotherapy
Metastatic - Chemo and Anti Hormonal treatment

52
Q

Name two Anti-Androgens

A

LHRH agonists - Goserelin

GnRH Antagonists - Degarelix

53
Q

Define Prostatitis

A

Inflammation of the prostate (most common urological disease in men under 50)

Can be acute, chronic or non bacterial

54
Q

Describe the pathophysiology of Acute Bacterial Prostatitis

A

Ascending urethral infection
Direct/Lymphatic spread from rectum
Haematogenous spread from sepsis

55
Q

Describe the pathophysiology of Chronic Bacterial Prostatitis

A

Inadequately treated Acute Prostatitis

56
Q

Give 3 risk factors for Prostatitis

A

Phimosis
Indwelling Catheter
Dysfunctional Bladder

57
Q

How would a patient with Prostatitis present?

A

LUTS
Perineal/Suprapubic pain
Urethral Discharge

58
Q

How would an inflammed postate feel on DRE?

A

Tender and Boggy

59
Q

Give 3 investigations for suspected Prostatitis

A

Urine Culture
STI Check
Transrectal Prostatic Ultrasound

60
Q

Describe the management of Prostatitis

A

Prolonged Antibiotics (Quinolones generally have good prostatic penetrance)
Analgesia
Chronic - Tamsulosin/Finasteride

61
Q

Define Epididymitis

A

Inflammation of the Epididymis

Generally thought to occur concurrently with Orchitis (inflammation of testes)

62
Q

There is a bimodal age distribution of Epididymitis, explain the respective pathophysiology of both

A

Under 35 - STI (Gonorrhoea, Chlamydia

Over 35 - Infection secondary to UTI

63
Q

Give 5 clinical features of Epididymitis

A 
Unilateral Scrotal Pain and Swelling
Fevers/Rigors
Dysuria
Urethral Discharge
Positive Prehn's Sign (elevating the testes relieves pain)
64
Q

What is Mumps Orchitis?

A

Can be uni or bilateral around 4-8d after Parotiditis

Can causes testicular atrophy/infertility

65
Q

State 3 investigations for Epididymitis

A

First Void NAAT
Routine Bloods
US Doppler

66
Q

Describe the management of Epididymitis

A

Antibiotics (Ciprofloxacin for enteric organisms, Ceftriaxone/Doxycylcine for STI)
Abstinence until antibiotics are completed/symptoms resolved

67
Q

Define Testicular Torsion

A

Spermatic cord and its contents twist inside the Tunica Vaginalis, compromising blood supply

68
Q

Describe the bimodal age distribution of Testicular Torsion

A

Neonates

Adolescents aged 12-25

69
Q

Describe the pathophysiology of Testicular Torsion

A

Mobile Testes rotate, reducing arterial blood flow, impairing venous return, causing venous congestion and oedema

More prone if bell clapper deformity

In neonates the attachment between the scrotum and tunica vaginalis is not fully formed therefore it can all twist - extra vaginal torsion

70
Q

Describe the clinical presentation of Testicular Torsion

A 
Sudden onset severe, unilateral testicular pain
Referred Abdominal Pain
Nausea and Vomiting
Absent Cremasteric Reflex
Negative Prehns Sign
71
Q

How would you investigate a suspected Testicular Torsion?

A

Urgent Surgical exploration

Ultrasound doppler

72
Q

How would you manage Testicular Torsion?

A

Within 4-6 hours

Cord and Testes are untwisted, both testes are fixed to scrotum (Bilateral Orchidopexy)

73
Q

One of the main differentials for Testicular Torsion is Hyatid of Morgagni Torsion, describe it

A

Remnant of Mullerian ducts that become torted

Blue dot on upper half of hemiscrotum

74
Q

Describe the two types of Primary Testicular Tumour

A

Germ Cell - Seminomas (slow growing and good prognosis) or Non Seminomas (Yolk Sac, Choriocarcinomas, Teratoma)

Non Germ Cell - Leydig or Sertoli

75
Q

Give 3 risk factors for Testicular Cancer

A

Cryptorchidism
Klinefelters
Family History

76
Q

Give 3 Clinical Features for Testicular Cancer

A

Unilateral Painful Testicular Lump
Weight Loss
If metastasises - Back Pain, Dyspnoea

77
Q

Give 3 investigations for Testicular Cancer

A

Tumour Markers (B-HCG, AFP)
Scrotal USS
CT for Staging

78
Q

Describe the staging of Testicular Cancer

A

I - Confined to testes
II - Infradiaphragmatic Lymph Node Involvement
III - Supra and Infradiaphragmatic Lymph Node Involvement
IV - Extralymphatic Metastatic Spread

79
Q

Describe the management of Testicular Cancer

A

Mainstay of treatment is Inguinal Radical Orchidectomy (testes and spermatic cord)

If metastatic then chemoradiotherapy (this may render them infertile so consider cryopreservation)

80
Q

Define Urethritis

A

Inflammation of the urethra

Can be Gonococcal or Non Gonococcal

81
Q

Give 3 clinical features of Urethritis

A

Dysuria
Penile Irritation
Discharge

82
Q

Name three investigations for Urethritis

A

Urethral Swab & Gram Stain
First catch urine and NAAT
STI Screening

83
Q

Describe the management for Urethritis

A

1) Gonococcal - IM Ceftriaxone and Azithromycin
Non Gonococcal - Doxycycline

Abstain from sexual activity and contact trace

84
Q

What is Fournier’s Gangrene?

A

Necrotising Fasciitis affecting the perineurium

Can be monomicrobial or polymicrobial

85
Q

Give 3 risk factors for Fourneir’s Gangrene

A

Alcohol
Diabetes Mellitus
Steroid Use

86
Q

Give 3 clinical features of Fournier’s Gangrene

A

Severe Pain (out of proportion to clinical signs)
Crepitus/Necrosis
Sepsis

87
Q

How would you investigate Fournier’s Gangrene?

A

Surgical Exploration

88
Q

How would you manage Fournier’s Gangrene?

A

Extensive Surgical Debridement (Potentially requiring skin grafts)
Antibiotics
HDU/ITU

89
Q

What is Paraphimosis?

A

Inability to pull a retracted foreskin over the glans
Causes the glans to become increasingly oedematous due to reduced venous return leading to vascular engorgement
Can cause penile ischaemia if left untreated

90
Q

Give 3 risk factors for Paraphimosis

A

Phimosis
Indwelling Catheter (and non diplaced foreskin)
Poor Hygiene

91
Q

Give 3 features of management for Paraphimosis

A

Analgesia
Consider Circumcision
Reduction

92
Q

Describe four reduction techniques for Paraphimosis

A
  • Manual pressure and lubricant jelly
  • Dextrose soaked gauze
  • Dundee Technqiue (puncturing glans)
  • Dorsal Slit
93
Q

Define Priapism

A

Unwanted painful erection (not associated with sexual desire) lasting longer than four hours

94
Q

Describe the pathophysiology of Priapism

A

Blood stays within Corpus Cavernosa

Venous Stasis occurs, which if prolonged can cause fibrosis and impotence

95
Q

Describe the three subtypes of Priapism

A

High Flow - Non Ischaemic, blood flows faster than it can be drained, associated with initial sexual stimulation

Low Flow - Blockage to venous drainage

Stuttering/Intermittent - Repetitive and painful episodes, associated with Sickle Cell

96
Q

Describe the clinical features of Priapism

A

Ischaemic - Painful and rigid erection

Non Ischaemic - Painless and not fully rigid erection

97
Q

Describe two investigations for Priapism

A

Corporeal Blood Gas - to differentiate between ischaemic and non ischaemic
Bloods - to look for underlying cause

98
Q

How would you manage Priapism

A

Coproreal Aspiration OR injection of sympathomimetic agent

Shunt insertion

99
Q

What is a Penile Fracture

A

Traumatic rupture of Corpus Cavernosa and Tunica Albuginea in an erect penis via blunt trauma
Deviated from axis

100
Q

How would Penile Fractures present?

A

Popping sensation with immediate pain/swelling/loss of erection
Aubergine Sign

101
Q

How would you investigate a Penile Fracture?

A

Generally a clinial diagnosis
Cavernosonography - locate the rupture site
Retrograde Urethrography if any urethral injury is suspected

102
Q

Describe the surgical management of Penile Fractures

A

The penis is degloved, haematoma evacuated and the tear repaired using absorbable sutures

103
Q

Name two types of Radiotherapy for

Prostate Cancer

A

External Beam

Brachytherapy (radioactive source directly into the prostate)

104
Q

Other than bleeding and infection, give two complications of Prostate Cancer Surgery

A 
Impotence (50%)
Urinary Incontinence (10%)
105
Q

Name three types of Renal Cancer

A

Renal Cell Carcinoma (most common)

Wilm’s Tumour/ Nephroblastoma (paediatric)

Squamous Cell Carcinoma (associated with chronic inflammation - eg Schistosomiasis)

106
Q

Give 4 Risk Factors for Renal Cell Carcinoma

A 
Smoking
Industrial Exposure (eg Lead)
Structural Abnormalities (Horseshoe Kidney, ADPCKD)
Genetic (Von Hippel Lindau)
Obesity
107
Q

Give three possible presenting features of Renal Cell Carcinoma

A

Haematuria
Varicocoele (if on left side)
Paraneoplastic (Polycythaemia, Hypertension, Hypercalcaemia)

108
Q

How would you investigate a suspected Renal Cell Carcinoma?

A

Urinalysis
Bloods
CT with AND without contrast
May require biopsy

109
Q

How would you manage localised RCC?

A

Partial or Radical Nephrectomy (aim to avoid removing adrenal gland - Addisons)

If unfit for surgery - cryotherapy, percutaneous radiofrequency ablation

Surveillance

110
Q

How would you manage Metastatic RCC

A

Chemotherapy is NOT effective

Aim for Nephrectomy and Immunotherapy (biologics such as Sunitinib)

Dan Surgery (9 decks)

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