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Urology Flashcards

1
Q

What level are the kidneys found at

A

T12-L3

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2
Q

Where do the ureters cross

A

Pelvic brim at SI joint

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3
Q

Ureter location in relation to the uterine artery and vas deferens?

A

Ureters are posterior to these

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4
Q

What cell type is the bladder made from?

A

Transitional cell epithelium

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5
Q

Parasympathetic control contracts the detrusor muscle. T/F

A

T
Para - contracts
Symp - relaxes

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6
Q

What nerve controls the external urethral sphincter?

A

Pudendal

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7
Q

Renal Stones Ix (Gold standard)

A

(non contrast) CT KUB

It is more sensitive than an X-ray and US

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8
Q

What is the most common type of renal stone?

A

Calcium oxalate

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9
Q

Where are they most commonly found?

A

VUJ, PUJ, SI joints

VUJ - vesicouterer –> where the ureters meet the bladder
PUJ - pelvic utero –> where the ureters meet the pelvic of the kidney

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10
Q

Mx of stones?

A

Analgesia - Diclofenac
Usually conservative for small stones
Medical –> Tamsulosin, nifidepine, most pass within 48 hrs
Surgical:
- Less invasive = extracorporeal shockwave therapy
- More invasive = Ureteroscopy
Generally the rule is - if it is smaller than 1cm, use ESWL, if it is bigger than 1cm, use URS
Same rule applies for renal pelvis but the cut off is 2cm

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11
Q

Where does BPH occur in the prostate?

A

Transition zone

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12
Q

Symtpoms of BPH

A

Similar symptoms of overflow incontinence - poor stream, hesitancy, incomplete emptying, dribbling

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13
Q

Ix for BPH

A

PR exam, Urine dip, IPPS

TRUS is also used - US of the prostate

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14
Q

What is IPPS?

A 
Prostate size score:
40-49 - 2.7
50-59 - 3.9
60-69 - 5 
70-79 - 7.2

Anything outwith these ranges gives a worse prognosis

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15
Q

Medical Mx of BPH

A

Tamsulosin

Finasteride

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16
Q

What type of drug is finasteride. How does it work?

A

5-alpha reductase inhibitor
Reduces peripheral conversion of testosterone
Takes up to 6 months to work

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17
Q

Surgical Mx of BPH

A

TURP - Trans uretheral resection of the prostate

Can also do laser ablation or a prostatectomy

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18
Q

Causes of incontinence?

A 
DIAPERS 
D = Delirium 
I = Infection 
A = Atropic vaginitis 
P = Pharmaceuticals - diuretics, anticholinergics
E = Endocrine - DM, DI, Hypercalceamia 
R = Restricted mobility 
S = Stool impaction
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19
Q

Pathophysiology behind stress incontinence

A

Weak pelvic floor muscles - common in women who have had children

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20
Q

Pathophysiology behind urge

A

Detrusor overactivity

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21
Q

medical Mx for stress or urge?

A

Oxybutynin (<75) or mirabegron (<75)

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22
Q

Scortal swelling:

Involves the testis and is not transilluminable

A

Testiculuar tumour

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23
Q

Scortal swelling:

You can’t get above the swelling

A

Inguinoscrotal hernia

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24
Q

Scroatal swelling:

Swelling is seperate from the testis and is a smooth swelling

A

Epididymal cyst

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25
Varicoceles Mx
Radiological embolization or surgical ligation
26
Types of renal cancers
Renal cell carcinoma - most common Occurs in the tubules within the epithelium (outside) Transitional cell carcinoma Occurs in the calyces within the uroepithelium Wilms - cancer in kids
27
X-ray signs of renal cancer
cannonball mets in the lungs
28
First line Ix
US
29
Mx of renal cancer
Surgery - partial or total nephrectomy | 7cm is cutoff
30
What stage of renal cancer is: | Tumour is in major veins or adrenal gland, tumour within Gerota's fascia or 1 regional lymph node involved
Stage 3
31
Mx in stage 2+ RCC
Nephrectomy + immunotherapy - INF alpha or IL2 or tyrosine kinase inhibitors
32
BLadder cancer - what is schistosomiasis?
Squamous cell cancer of the bladder - least common type
33
main symptom of bladder cancer
painless haematuria
34
Ix bladder cancer
1st line - urine cytology Diagnostic - cystoscopy w biopsy Staging - CT urogram
35
Mx for superficial non-invasive bladder cancer
TURBT | +/- chemo = mitomycin C
36
Mx for T2, T3 bladder cancer
Radical cystectomy w ileal conduit | Neoadjuvant chemo
37
Mx of inoperable locally advanced bladder cancer (T4)
Palliative chemo | Long term catheterization
38
Follow up from bladder cancer as recurrence rates are HIGH
Regular cystopscopies every 3 months for 2 years
39
Where is prostate cancer most common?
Adenocarcinoma of the peripheral zone
40
Diagnostic for prostate cancer
Transrectal/transperineal biopsy + PSA
41
What score is used for prostate cancer
Gleason score
42
If prostate cancer is low risk, what is the Mx?
Active surveillance PSA + DRE every few months Biopsy at 12 months if concerned
43
If prostate cancer is medium-high risk
Radical prostacteomy + seminal vesicles + pelvic LNs | External beam RT
44
If prostate cancer is advanced, what is Mx?
Pelvic EBRT + androgen deprivation
45
If prostate cancer is metastatic, what is Mx?
Bilateral orchidectomy | Androgen deprovation therapy (goserelin, zoladex) - note S/E flare phenomenon
46
What is flare phenomenon?
Goserelin = increase of symptoms of prostatic cancer due to increase in LH prior to down regulation Symtpoms = bone pain, cord compression, acute bladder obstruction, AKI
47
How to avoid flare phenomenon?
Use anti-androgens such as cryptorone-acetate should be prescribed 3 days before starting gosrelin
48
Testicular cancer sub types
Germ cell: 1) Seminomas 2) Non-seminoma germ cell tumours (NSGCT) NSGCT: a) mixed b) yolk sac c) choriocarcinoma d) embryonal carcinoma e) Teratoma
49
Symptoms of testicular cancer
Painless lump Hydrocele Loss of testicular sensation
50
Blood results for testicular cancer
increase bHCG for seminomas and NSGCTs increase ALP just seminoma Increase AFP just NSGCTs
51
Ix testicular cancer
US | Note - NO BIOPSY, diagnosis must be made from total excision and histology
52
Mx seminomas
Stage 1-2 = inguinal radical orchidectomy + para-aortic LN removal + radiotherapy Stage 3-4 = all of the above + chemo chemo drugs = bleomycin, etoposide, cisplatin
53
Mx NSGCTs
Stage 1 - inguinal orchidectomy 2 - " " + chemo + para-aortic LN dissection 3 - IO + chemo 4 - IO with spermatic cord clamping + chemo
54
Follow up testicular cancer
18-24 months = CT + tumour markers (bHCG, ALP, AFP, LDH)
55
In testicular torsion, is the cremasteric reflex +ve or -ve
-ve (only if the whole spermatic cord is affected)
56
Mx of testicular torsion
Inform a senior NBM, analgesia, pre-op bloods Surgical mx --> Bilateral surgical orchidopexy (suture testis to scrotum) Consent for orchidectomy
57
What investigations do you want to do when someone presents with acute urinary retention?
US renal tract - hydroneprhosis CT abdo/pelvis - mass? MRI/CT head - neurological cause
58
Mx of acute urinary retention
Immediate catheterization | Give Tamsulosin to prepare for TWOC (after 24-72hrs)
59
Causes of AUR?
DRUGS --> Anticholinergics, CCBs, Opioids, INFECTIONS --> balanitis, prostatitis, vulvovaginitis, HSV OBSTRUCTION --> BPH most common, phimosis, prolapse, pelvic mass (uterine fibroid) and many more!
60
What is fournier's gangrene?
Necrotising fasciitis of the perineum
61
What organisms are likely cause of fournier's ?
It is polymicrobial: | E. coli, staphs, anerobes
62
Who is most at risk of fourneir's?
T2DM, Immunocompromised, alcohol excess
63
Mx for founier's
ABCDE + SEPSIS 6 - broad spec abs - gent + taz - prep for theatre for debridement

Finals Revision (7 decks)

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