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Urology Flashcards

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1
Q

What are the causes of acute urinary retention?

A
  • benign prostatic hyperplasia
  • urethral strictures/calculi
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2
Q

What is the presentation of acute urinary retention?

A
  • inability to pass urine
  • lower abdominal discomfort
  • pain
  • confusion in elderly patients
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3
Q

What are the signs of acute urinary retention?

A
  • palpable distended bladder
  • lower abdominal tenderness
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4
Q

Investigation for acute urinary retention

A
  • bladder scan >300cc
  • urine dip and culture
  • UEs
  • creatinine
  • FBC
  • CRP
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5
Q

What is the management of acute urinary retention?

A
  • urinary catheterisation (measure the urine drained in 15 minutes >400cc confirms retnetion, <200 excludes)
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6
Q

What is a complication of acute urinary retention?

A

Post obstructive diuresis - worsening of AKI and volume depletion

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7
Q

What is the cause of chronic urinary retention?

A

High pressure retention: impaired renal function and bilateral hydronephrosis, typically due to bladder outflow obstruction

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8
Q

What are the transient causes of haematuria?

A
  • UTI
  • menstruation
  • vigorous exercise
  • sexual intercourse
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9
Q

What are the causes of non visible haematuria?

A
  • cancer
  • stones
  • BPH
  • prostatits
  • urethritis
  • renal causes e.g. IgA nephropathy
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10
Q

What are the causes of visible haematuria?

A
  • prostate/bladder cancer
  • Stones
  • BPH
  • UTI/acute pyelonephritis
  • trauma
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11
Q

Investigations for haematuria

A
  • urinalysis
  • U+Es
  • Albumin: protein (ACR) or protein: creatinine ratio (PCR)
  • blood pressure
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12
Q

Explain referral to urology

A

Urgent referral
- If age >45: unexplained haematuria without UTI, or persists/recurs after treatment for UTI
- If age>60: unexplained non-visible haematuria and dysuria or increased WCC

Non urgent
- Age>60 with recurrent or persistent UTI

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13
Q

What are the types of testicular cancer?

A
  • 95% are germ cell tumours = seminomas and non seminomas
  • Non seminomas = teratotmas, yolk sac, embryological and choriocarcinoma)
  • non germ cell: leydig tumours and sarcomas
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14
Q

What are the risk factors for testicular cancer?

A
  • infertility
  • cryptorchidism
  • family history
  • klinefelter’s
  • mumps orchitis
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15
Q

What is the peak incidence for teratomas?

A

25

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16
Q

What is the peak incidence for seminomas?

A

35

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17
Q

What is the presentation of testicular cancer?

A
  • painless lump
  • pain
  • hydrocele
  • gynaecomastia (in germ cell and leydig)
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18
Q

Investigations testicular cancer

A
  • ultrasound scan
  • tumour markers: alpha fetoprotein (teratoma); beta hCG (teratoma and seminoma); LDH (non specific)
  • staging CT scan
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19
Q

Explain the royal marsden staging system

A
  • stage 1: isolated to the testicle
  • stage 2: retroperitoneal lymph node spread
  • stage 3: spread to lymph nodes above the diaphragm
  • stage 4: metastasised to other organs
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20
Q

What is the most common metastasis from testicular cancer?

A
  • lymphatics
  • lung
  • liver
  • brain
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21
Q

What is the management of testicular cancer?

A
  • radical orchidectomy
  • chemotherapy/radiotherapy
  • sperm banking
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22
Q

What is testicular torsion?

A

Urological emergency caused by twisting of the testicle on the spermatic cord causing constriction of the vascular supply

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23
Q

What is the presentation of testicular torsion?

A
  • sudden onset testicular pain
  • nausea and vomiting
  • negative prehn’s sign
  • absent cremasteric reflex
  • swollen testes, retracted upwards
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24
Q

What is prehn’s sign?

A

No pain relief on elevation of the scrotum

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25
What is the management of testicular torsion?
- emergency scrotal exploration - morphine and ondasetron
26
What are the causes of testicualr torsion?
- trauma - bell clapper testis
27
What are the complications of testicular torsion?
Testicular damage/loss leading to infertility and cosmetic deformity
28
What is the presentation of BPH?
- Storage symptoms: urgency, frequency, urgency incontinence, nocturia - voiding symptoms: weak flow, straining, hesitancy, terminal dribbling, incomplete emptying
29
What are the storage symptoms?
- urgency - frequency - urgency incontinence - nocturia
30
What are the voiding symptoms?
- weak flow - straining - hesitancy - terminal dribbling - incomplete emptying
31
Investigations for BPH
- urinalysis (should be normal if uncomplicated) - prostate specific antigen - IPSS -mild 0-7, moderate 8-19, severe 20-35 - volume charting for at least 3 days
32
What is the management of BPH?
- behavioural management programme - alpha blocker: terazosin - 5-alpha-reductase inhibitor: finasteride (indicated if large prostate and high risk of progression) - anti-cholinergic: tolterodine
33
What are the complications of BPH?
- UTI - renal insufficiency - bladder stones - haematuria - sexual dysfunction
34
What is the presentation of renal stones?
- renal colic: unilateral loin to groin pain - haematuria - nausea and vomiting - decreased urine output
35
Investigations for stones
- Non-contrast helical CT scan/renal USS if CT is contraindicated - urinalysis - FBC: increased WCC may suggest infection - UEs - any hypercalcaemia? or hyperuricaemia?
36
What is the management of renal stones?
- NSAID, anti-emetics (metoclopramide), antibiotics, tamsulosin - watch and wait if <5mm it is likely to pass without intervention - surgery if large stone, infection or renal abnormality
37
What is the urgent management of renal stones?
- decompression - ureteric stent or percutaneous nephrostomy tube
38
Surgery if renal stone <10mm
Shock wave lithotripsy
39
Surgery if renal stone 10-20mm
Shock wave lithotripsy or ureteroscopy
40
Surgery if renal stone >20mm or staghorn
Pecutaneous nephrolithotomy
41
Management of recurrent renal stones
- increase oral intake (2.5-3L a day) - add fresh lemon juice to water - avoid carbonated drinks - reduce dietary salt - maintain normal calcium intake - thiazide (if calcium stones) or potassium citrate (calcium oxalate stones)
42
What are the types of renal stone?
- Calcium oxalate - cysteine - uric acid - calcium phosphate - struvite
43
Which of the renal stones are visible on x ray?
- calcium oxalate - cysteine - calcium phosphate - struvite
44
Which type of renal stone can form a staghorn shape?
Struvite
45
Which drugs increase the risk of calcium renal stones?
- loop diuretics - acetazolamide - theophylline - steroids
46
Which stones are more likely with a high urinary pH?
Calcium phosphate
47
Which stones are more likely with a low urinary pH?
uric acid
48
What is the management of hydronephrosis?
If an upper obstruction: - acute: percutaneous nephrostomy tube - Chronic: ureteric stent If lower obstruction: - urinary or suprapubic catheter
49
What are the risk factors for bladder cancer?
- Smoking - age - aromatic amines - schistosomiasis (squamous cell)
50
What are the types of bladder cancer?
- transition cell - squamous cell - adenocarcinoma
51
What is the presentation of bladder cancer?
Painless haematuria
52
What is the investigation for bladder cancer?
- Cystoscopy: flexible or rigid
53
T staging of bladder cancer
- T0: no evidence of tumour - Ta: non-invasive papillary carcinoma - T1: invades the sub epithelial connective tissue - T2: a: superficial/b: deep invasion of muscularis propria - T3: perivesical fat - T4a: prostatic stroma, seminal vesicle, uterus, vagina - T4b: pelvic sidewall/abdominal sidewall
54
N staging of bladder cancer
- N0: no nodal disease - N1: single regional lymph node - N2: Multiple regional lymph nodes - N3: common iliac lymph nodes
55
M staging of bladder cancer
- M0: no distant mets - M1: distant mets
56
What is the management of bladder cancer?
- Transurethral resection of bladder tumour (TURBT): if non muscle invasive - Intravesicle chemotherapy - Intravesicle BCG - Radical cystectomy
57
What is the presentation of prostate cancer?
- asymptomatic - lower UTI symptoms - Haematuria - erectile dysfunction - symptoms of advanced disease or metastasis (weight loss, bone pain, cauda equina)
58
What are the causes of a mildly raised PSA?
- prostate cancer - BPH - prostatitis - UTI - vigorous exercise - Recent ejaculation or prostate stimulation
59
What should a prostate normally feel like?
- smooth - symmetrical - slightly soft - central sulcus
60
What should an infected prostate feel like?
- enlarged - tender - warm
61
What should a cancerous prostate feel like?
- firm/hard - asymmetrical - craggy/irregular - loss of central sulcus
62
Investigation for prostate cancer
- multiparametric MRI - prostate biopsy (transrectal ultrasound guided biopsy) - isotope bone scan
63
What are the investigations that should be carried out in someone presenting with erectile dysfunction?
- free testosterone (measured between 9 and 11am) - lipid and fasting glucose levels to calculate 10 year cardiovascular risk
64
What are the features of renal cell carcinoma?
Classical triad: - Haematuria - loin pain - abdominal mass Plus: - fever of unknown origin - varicocele (due to tumour compressing veins) -
65
What are the features of epididymo-orchitis?
- unilateral testicular pain and swelling - urethral discharge
66
Investigation for epidiymo-orchitis
- STI (Chlamydia trachomatis and Neisseria gonorrhoeae) - MSU microscopy and culture (E.coli)
67
What are the causes of scrotal swelling?
- inguinal hernia - testicular tumour: discrete testicular nodule - acute epididymo-orchitis: tender swelling, phren's sign may be positive - epididymal cysts: painless, can ge behind cysts - hydrocele: transilluminate - testicular torsion: severe onset testicular pain - varicocele: typically on the left

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