Urology Flashcards
Most common causative organism in acute bacterial prostatitis?
E.coli
Investigations in acute urinary retention?
Urine sample which should be sent for urinalysis and culture.
Serum U&Es and creatinine should also be checked to assess for any kidney injury.
A FBC and CRP should also be performed to look for infection.
PSA is not appropriate in acute urinary retention as it is typically elevated.
What level does a urinary USS become positive for retention?
> 300
Management of acute urinary retention?
Bladder USS
Catheter
Causes of balanitis?
Candidiasis
Dermatitis (contact or allergic, eczema and psoriasis)
Staph spp (and other bugs)
Lichen planus and sclerosus (rarer)
Management of BPH?
Watchful waiting
Medication:
First line: alpha-1 antagonists (Tamsulosin),
Then: 5 alpha-reductase inhibitors (finasteride).
The use of combination therapy was supported by the Medical Therapy Of Prostatic Symptoms (MTOPS) trial.
Surgery: transurethral resection of prostate (TURP)
Risk factors for bladder cancer?
Smoking
Exposure to aniline dyes in the printing and textile industry: examples are 2-naphthylamine and benzidine
Rubber manufacture
Cyclophosphamide
Causes of hydronephrosis?
SUPER - bilateral
Stenosis of the urethra
Urethral valve
Prostatic enlargement
Extensive bladder tumour
Retro-peritoneal fibrosis
PACT - unilateral
Pelvic-ureteric obstruction (congenital or acquired)
Aberrant renal vessels
Calculi
Tumours of renal pelvis
What are the two types of urethral injury?
Bulbar rupture (most common)
- Straddle type injury (bike)
- Triad signs: urinary retention, perineal haematoma, blood at the meatus
Membranous rupture
- Can be extra or intraperitoneal
- Commonly due to pelvic fracture
- Penile or perineal oedema/ hematoma
- PR: prostate displaced upwards (beware co-existing retroperitoneal haematomas as they may make examination difficult)
How would a traumatic bladder injury present?
Rupture is intra or extraperitoneal
Presents with haematuria or suprapubic pain
History of pelvic fracture and inability to void: always suspect bladder or urethral injury
Inability to retrieve all fluid used to irrigate the bladder through a Foley catheter indicates bladder injury
What are the LUTS?
Divide into three categories
Storage
- Urgency
- Frequency
- Nocturia
- Urinary incontinence
Voiding
- Hesitancy
- Poor or intermittent stream
- Straining
- Incomplete emptying
- Terminal dribbling
Post micturition
- Post-micturition dribbling
- Sensation of incomplete emptying
Most common type of prostate cancer?
Adenocarcinoma
Where does prostate cancer spread to with regards to lymphatic spread?
Lymphatic spread occurs first to the obturator nodes and local extra-prostatic spread to the seminal vesicles is associated with distant disease.
How do you grade prostate cancers?
Gleason grading system
Treatment options for prostate cancer?
Watch and wait
- Elderly
- Low gleason score
Radiotherapy
- Curative and palliative roles
Radical prostatectomy
- Most common
- Robot is being used
- Erectile dysfunction is a common side effect
Antiandrogen and GnRH agonist medical therapy
- Treatment for metastatic disease
- Can be used for localised advanced cancer
- Cyproterone is an anti-androgen
- Goserelin is an anti-GnRH
Features of prostate ca.?
Bladder outlet obstruction: hesitancy, urinary retention
haematuria, haematospermia
Pain: back, perineal or testicular
Digital rectal examination: asymmetrical, hard, nodular enlargement with loss of median sulcus
Age adjusted limits for PSA?
50-59
- 3.0
60-69
- 4.0
> 70 years
- 5.0
What can raise the PSA?
Benign prostatic hyperplasia (BPH)
Prostatitis and urinary tract infection (NICE recommend to postpone the PSA test for at least 1 month after treatment)
Ejaculation (ideally not in the previous 48 hours)
vigorous exercise (ideally not in the previous 48 hours)
Urinary retention
instrumentation of the urinary tract (e.g. catheter!)
Features of renal cell cancer (adenocarcinoma)?
haematuria, loin pain, abdominal mass
Pyrexia of unknown origin
Left varicocele (due to occlusion of left testicular vein)
Endocrine effects: may secrete erythropoietin (polycythaemia), parathyroid hormone (hypercalcaemia), renin, ACTH
Most common type of renal stone?
Calcium oxalate (85%)
Features of renal stones?
Loin pain: typically severe, intermittent ‘colic’ pain. The patient often is restless/moving around
Nausea and vomiting is common
Haematuria
Dysuria
Secondary infection may cause fever
Management of renal colic?
NSAID
- Diclofenac traditionally used, but watch out for cardiovascular complications
Investigation for Renal stones?
BOXES
Bloods
- FBC, CRP - look for associated infection
- Clotting if intervention planned
Orifices
- Urine dip and culture
- Us&Es - check renal function
- Calcium/urate - look for underlying causes
X (imaging)
- Non contrast CT KUB, within 14 hours of admission
E
S
What is the management for urinary stones?
<5mm will pass spontaneously. Lithotripsy and nephrolithotomy for more serious cases.
If <5mm but there are features such as
- Ureteric obstruction
- Horseshoe kidney (or other developmental abnormality)
- Previous renal transplant
Then need more intense treatment
If there is ureteric obstruction then you need to decompress, this can include:
- Nephrostomy tube placement
- Ureteric catheters
- Ureteric stent
If non-emergency
- Shockwave lithotripsy
- Uretoscopy (when shockwave is inappropriate e.g. preggers)
- Percutaneous nephrolithotomy (lithotripsy but from within)
Summary:
Stone burden of less than 2cm in aggregate
- Lithotripsy
Stone burden of less than 2cm in pregnant females
- Ureteroscopy
Complex renal calculi and staghorn calculi
- Percutaneous nephrolithotomy
Ureteric calculi less than 5mm
- Manage expectantly
