Urology Flashcards

(78 cards)

1
Q

What is epididymo-orchitis

A

Clinical syndrome consisting of pain, swelling and inflammation of epididymis, with or without inflammation of the testes

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2
Q

What is orchitis

A

Infection limited to the testis

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3
Q

Most common cause of epididymo-orchitis in men under 35 yrs old

A

Sexually transmitted pathogen such as chalmydia trachomatis and neisseria gonorrhoeae

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4
Q

Most common cause of epididymo-orchitis in men over 35 years old

A

Non-sexually transmitted gram neg enteric organism such as escherichia coli, pseudomonas spp etc

Risk factors include recent instrumentation or catheterisation

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5
Q

Aetiology of acute orchitis

A

Viral: Mumps, coxsackie A, varicella

Bactieral: E. coli

Granulomatous: Syphilis, TB

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6
Q

Presentation of epididymo-orchitis

A

Unilateral scrotal pain and swelling(acute)

Symptoms of urethritis or urethral discharge

Symptoms of underlying cause(mumps, TB)

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7
Q

IX for epididymo-orchitis

A

Gram-stained urethral smear

MSU

HIV testing

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8
Q

General advice for epididymo-orchitis

A

Rest, analgesia and scrotal support

NSAIDs

Avoidance of sexual partner until completion of treatment

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9
Q

Medical management of epididymo-orchitis

A

If epididymo-orchitis is thought to be due any sexually transmitted organism, including gonorrhoea:
Treat without waiting for test results with ceftriaxone 1g intramuscular (IM) injection plus doxycycline

If epididymo-orchitis is thought to be due to chlamydia or other non-gonococcal organism:
Treat orally with doxycycline or ofloxacin

If epididymitis is thought to be due to sexually transmitted chlamydia and gonorrhoea and/or enteric organisms:
Consider treating with 1g ceftriaxone IM plus ofloxacin 200 mg orally twice daily for 10 days.

If epididymo-orchitis is thought to be due to an enteric organism (for example, Escherichia coli):
Treat without waiting for test results with ofloxacin levofloxacin

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10
Q

Complications of epididymo-orchitis

A

Reactive hydrocele

Abscess formation and infarction of the testicle

Infertility

Testicular atrophy in mumps

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11
Q

Causes of AUR in men

A

BPH
Meatal stenosis
Paraphimosis and phimosis
Prostate cancer
Infections such as balanitis and prostatic abscess

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12
Q

Causes of AUR in women

A

Prolapse(cystocele, rectocele)
Pelvic mass(malignancy, fibroid, ovarian cyst)
Acute vulvovaginitis

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13
Q

Drug-related causes of AUR

A

Anticholinergics(antipsychotics, antidepressants)
Opioids
Alpha agonists
Benzodiazepines
NSAIDs

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14
Q

Which precipitants should be considered in AUR

A

Alcohol consumption
Recent surgery
UTI
Constipation
Large fluid intake
Cold exposure or prolonged travel
PMH
Meds

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15
Q

Appropriate imaging ix for AUR

A

Ultrasound - can provide a measure of post-void residual urine
CT scan

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16
Q

Initial management of AUR

A

Immediate and complete bladder decompression(immediate catheterisation for men)

Alpha-blocker should be offered before removal of catheter

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17
Q

Pharmacological treatment for post-op retention

A

Cholinergics
Intravesicle prostaglandin

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18
Q

Secondary management of AUR

A

Prostatic surgery
Trial without catheter(TWOC) for men with BPH and AUR
Alpha-blocker is prescribed before commencing TWOC

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19
Q

Complications of AUR

A

UTIs
AKI
Post-obstructive diuresis
Post-retention haematuria

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20
Q

Prevention of AUR in men with BPH

A

Long-term medical treatment(5-reductase inhibitors alone or in combination with alpha-blockers)

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21
Q

What does chronic urinary retention refer to

A

Painless inability to pass urine
Significant bladder distension due to long standing retention resulting in bladder desensitisation

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22
Q

Most common cause of chronic urinary retention in men

A

Benign prostate hyperplasia (BPH)

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23
Q

Most common cause of chronic urinary retention in women

A

Pelvic prolapse or pelvic masses

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24
Q

Clinical features of chronic urinary retention

A

Painless urinary retention
Associated voiding LUTS(weak stream and hesitancy)
Reduced functional capacity(ability of bladder to store urine)
Overflow incontinence may also be present
Nocturnal enuresis

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25
IX for chronic urinary retention
Post-void bedside bladder scan
26
What is high-pressure urinary retention
Refers to urinary retention causing such high intra-vesicular pressures that the anti-reflux mechanism of the bladder and ureters is overcome and backs up into upper renal tract
27
what does high-pressure urinary retention lead to
Hydroureter and hydronephrosis
28
What is low pressure urinary retention
Occurs in patients with retention with the upper renal tract unaffected due to competent urethral valves or reduced detrusor muscle contractility/complete detrusor failure
29
What is post-obstructive diuresis
Following resolution of the retention through catheterisation, the kidneys can often over-diurese due to the loss of their medullary concentration gradient, which can take time to re-equilibrate Over-diuresis can lead to worsening AKI
30
Mx of chronic urinary retention
Patients with high post-void volumes or high pressure should be catheterised long-term Should not undergo a TWOC due to concerns of repeat renal injury
31
What is an option for chronic urinary retention if patients do not wish for a long term cath
Intermittent self catheterisation
32
Complications of chronic urinary retention
UTIs Bladder calculi Chronic kidney disease
33
What is vesicoureteral reflux(VUR)
Refers to urine refluxing from the bladder back into the ureters
34
Presentation of upper urinary tract obstruction
Loin to groin or flank pain on the affected side (due to stretching and irritation of ureter and kidney) Reduced or no urine output Non-specific systemic symptoms, such as vomiting Impaired renal function on blood tests (i.e. raised creatinine)
35
Presentation of lower urinary tract obstruction
Difficulty or inability to pass urine (e.g., poor flow, difficulty initiating urination or terminal dribbling) Urinary retention, with an increasingly full bladder Impaired renal function on blood tests (i.e. raised creatinine)
36
Common causes of upper urinary tract obstruction
Kidney stones Tumours pressing on the ureters Ureter strictures Retroperitoneal fibrosis Bladder cancer Ureterocele (ballooning of the most distal portion of the ureter – this is usually congenital)
37
Common causes of lower urinary tract obstruction
Benign prostatic hyperplasia (benign enlarged prostate) Prostate cancer Bladder cancer (blocking the neck of the bladder) Urethral strictures (due to scar tissue) Neurogenic bladder
38
what does neurogenic bladder refer to
Refers to abnormal function of the nerves innervating the bladder and urethra. It can result in overactivity or underactivity in the detrusor muscle of the bladder and the sphincter muscles of the urethra.
39
Key causes of neurogenic bladder
Multiple sclerosis Diabetes Stroke Parkinson’s disease Brain or spinal cord injury Spina bifida
40
Consequences of neurogenic bladder
Urge incontinence Increased bladder pressure Obstructive uropathy
41
Management of obstructive uropathy
Nephrostomy Urethral or Suprapubic catheter
42
What is a nephrostomy
A nephrostomy may be used to bypass an obstruction in the upper urinary tract (e.g., a ureteral stone). A nephrostomy involves surgically inserting a thin tube through the skin at the back, through the kidney and into the ureter. This tube allows urine to drain out of the body, into a bag.
43
Complications of obstructive uropathy
Pain AKI(post-renal) CKD Infection Hydronephrosis Urinary retention Overflow incontinence of urine
44
What is idiopathic hydronephrosis as a result of
Result of a narrowing at the pelviureteric junction (PUJ) – the site where the renal pelvis becomes the ureter. This narrowing may be congenital or develop later.
45
Mx of idiopathic hydronephrosis
It can be treated with an operation to correct the narrowing and restructure the renal pelvis (pyeloplasty).
46
Typical features of hydronephrosis
Vague renal angle pain and a mass in the kidney area
47
Imaging ix for hydronephrosis
Ultrasound CT KUB or iV urogram
48
Treatment of hydronephrosis
Treat underlying cause Percutaneous nephrostomy Antegrade ureteric stent
49
Where do cancers in the bladder arise from
Cancer in the bladder arises from the endothelial lining (urothelium). The majority are superficial (not invading the muscle) at presentation.
50
Risk factors for bladder cancer
Smoking Age Aromatic amines(dye and rubber industries) Schistosomiasis(SCC of bladder)
51
What type of bladder cancer do factory workers in industries such as dye and rubber tend to get
Transitional cell carcinoma of the bladder
52
Types of bladder cancer
Transitional cell carcinoma (90%) Squamous cell carcinoma (5% – higher in areas of schistosomiasis) Rarer causes are adenocarcinoma (2%), sarcoma and small-cell carcinoma
53
Presentation of bladder cancer
Painless macroscopic haematuria
54
When do NICE recommend two week wait referral for suspected bladder cancer
Aged over 45 with unexplained visible haematuria, either without a UTI or persisting after treatment for a UTI Aged over 60 with microscopic haematuria (not visible but positive on a urine dipstick) PLUS: Dysuria or; Raised white blood cells on a full blood count
55
Diagnosis of bladder cancer
Cystoscopy (a camera through the urethra into the bladder) can be used to visualise bladder cancers. The cystoscope can be rigid or flexible. Cystoscopy can be performed under local or general anaesthetic.
56
Staging of bladder cancer
TNM There is a clear distinction between: Non-muscle-invasive bladder cancer (not invading the muscle layer of the bladder) Muscle-invasive bladder cancer (invading the muscle and beyond)
57
Mx of bladder cancer
Transurethral resection of bladder tumour(TURBT) Intravesical chemotherapy Intravesical BCG vaccine Radical cystectomy Radiotherapy may also be used
58
What is TURBT
Transurethral resection of bladder tumour (TURBT) may be used for non-muscle-invasive bladder cancer. The involves removing the bladder tumour during a cystoscopy procedure.
59
When is intravesical chemotherapy used
Intravesical chemotherapy (chemotherapy given into the bladder through a catheter) is often used after a TURBT procedure to reduce the risk of recurrence.
60
Use of BCG in bladder cancer treatment
Intravesical Bacillus Calmette-Guérin (BCG) may be used as a form of immunotherapy. Giving the BCG vaccine (the same one as for tuberculosis) into the bladder is thought to stimulate the immune system, which in turn attacks the bladder tumours.
61
Options for drainage of urine following a radical cystectomy
Urostomy with an ileal conduit (most common) Continent urinary diversion Neobladder reconstruction Ureterosigmoidostomy
62
What type of cancers are most prostate cancers
Adenocarcinomas that grow in the peripheral zone of the prostate
63
Key risk factors for prostate cancer
Increasing age Family history Black African or Caribbean origin Tall stature Anabolic steroids
64
Presentation of prostate cancer
Asymptomatic LUTS(similar to BPH) Hesitancy, frequency, weak flow, terminal dribbling and nocturia Haematuria Erectile dysfunction Symptoms of advanced disease or metastasis (e.g., weight loss, bone pain or cauda equina syndrome)
65
Above what age can men request PSA
Men over 50
66
Common causes of raised PSA
Prostate cancer Benign prostatic hyperplasia Prostatitis Urinary tract infections Vigorous exercise (notably cycling) Recent ejaculation or prostate stimulation
67
How might a cancerous prostate feel on palpation
A cancerous prostate may feel firm or hard, asymmetrical, craggy or irregular, with loss of the central sulcus. There may be a hard nodule. Any of these features can indicate prostate cancer and warrant further investigation. In primary care, these findings require a two week wait urgent cancer referral to urology.
68
1st line ix for prostate cancer
Multiparametric MRI of prostate
69
2nd line ix for prostate cancer
Prostate biopsy - Transrectal ultrasound-guided biopsy(TRUS), transperineal biopsy
70
Main risks of prostate biopsy
Pain (particularly lower abdominal, rectal or perineal pain) Bleeding (blood in the stools, urine or semen) Infection Urinary retention due to short term swelling of the prostate Erectile dysfunction (rare)
71
Grading prostate cancer
Gleason grading system based on histology from prostate biopsies
72
Mx of prostate cancer
Depending on the grade and stage of prostate cancer, treatment can involve: Surveillance or watchful waiting in early prostate cancer External beam radiotherapy directed at the prostate Brachytherapy Hormone therapy Surgery
73
what is a key complication of external beam radiotherapy
A key complication of external beam radiotherapy is proctitis (inflammation in the rectum) caused by radiation affecting the rectum. Proctitis can cause pain, altered bowel habit, rectal bleeding and discharge. Prednisolone suppositories can help reduce inflammation.
74
What is brachytherapy
Involves implanting radioactive metal “seeds” into the prostate. This delivers continuous, targeted radiotherapy to the prostate. The radiation can cause inflammation in nearby organs, such as the bladder (cystitis) or rectum (proctitis). Other side effects include erectile dysfunction, incontinence and increased risk of bladder or rectal cancer.
75
Purpose of hormone therapy in prostate cancer mx
Aims to reduce the level of androgens (e.g., testosterone) that stimulate the cancer to grow. They are usually either used in combination with radiotherapy, or alone in advanced disease where cure is not possible. The options are: Androgen-receptor blockers such as bicalutamide GnRH agonists such as goserelin (Zoladex) or leuprorelin (Prostap) Bilateral orchidectomy to remove the testicles (rarely used)
76
Side effects of hormone therapy in prostate cancer mx
Hot flushes Sexual dysfunction Gynaecomastia Fatigue Osteoporosis
77
Key complications of radical prostatectomy
erectile dysfunction urinary incontinence
78
Which type of rta causes nephrolithiasis
Type 1 RTA