Urology Flashcards
(188 cards)
1
Q
What is the definition of haematuria ?
A
The presence of blood in the urine either visible or non-visible.
2
Q
What is the classification of haematuria ?
A
Visible - blood is visible in urine colouring it pink, red or dark brown
Non-visible - blood is present in the urine on urinalysis but not visible. This can be separated further for symptomatic and non-symptomatic.
3
Q
What are some causes of haematuria ?
A
UTI
Renal cancer
Bladder cancer
Renal calculi
Prostate cancer
BPH
Glomerulonephritis
Goodpasture’s disease
4
Q
What key questions should be asked to assess haematuria ?
A
Quantity ( pink vs dark red )
Presence of clots
Any fever, suprapubic pain, flank pain, weight loss or recent trauma
Drug history and smoking status
Recent foreign travel
5
Q
What simple investigations should be performed for haematuria ?
A
Urinalysis - the presence of leucocytes and nitrates may suggest UTI
Baseline bloods - FBC, U&E’s and clotting, PSA in men,
Referral to a urologist may be needed
6
Q
What is the criteria for a urological referral for haematuria ?
A
Aged over 45 with either :
- unexplained visible haematuria with no UTI
- visible haematuria that persists or recurs after successful treatment of a UTI
Aged over 60 with unexplained non-visible haematuria and either dysuria or a raised WCC
7
Q
What are some specialist investigations that are performed for haematuria ?
A
Flexible cytoscopy is gold standard
USS of renal tract
CT urogram
8
Q
What is the pathophysiology of RCC ?
A
It is an adenocarcinoma of the renal cortex arising from the proximal convoluted tubule most often appearing in the upper pole of the kidney.
It spreads through direct invasion ( perinephric tissues, adrenal gland or renal vein )and lymphatic system ( nodes ) or haematogenous ( bones, liver, brain and lungs ).
9
Q
What are some risk factors for RCC ?
A
Smoking
Industrial exposure to carcinogens ( cadmium, lead )
Dialysis
HTN
Diabetes
PCKS
10
Q
What are some clinical features of RCC ?
A
Haematuria ( visible or non-visible )
Flank pain
Flank mass
Lethargy
Weight loss
11
Q
What is the classic triad of RCC ?
A
Haematuria
A mass
Flank pain
12
Q
What may be seen on examination in someone with RCC ?
A
Mass palpated in the flank or hypochondrial region
Left sided masses may also be present with a left varicocoele due to compression of the left testicular vein as it joins the renal vein.
13
Q
What are some investigations for RCC ?
A
Routine bloods - FBC, U&E’S, LFTs, CRP
Urinalysis
Urine cytology
USS renal tract, kidneys
CT imaging - abdomen pelvis ( pre and post contrast ) is gold standard
Biopsy
14
Q
What is the management for a localised RCC ?
A
Smaller tumours - partial nephrectomy
Larger tumours - radical nephrectomy ( removal of the kidney, perinephric fat and local lymph nodes )
Not suitable for surgery - percutaneous radio frequency nephrectomy
15
Q
What is the management of metastatic RCC ?
A
Nephrectomy combined with immunotherapy
Biological agents can be used in combination
Metastasectomy is recommended if resectable
( Chemotherapy is ineffective )
16
Q
What are some uncommon presentations caused by paraneoplastic syndrome of the RCC ?
A
Polycythaemia duct to erythropoietin
Hypercalcaemia due to increase in PTH
HTN due to increase in renin
Pyrexia
17
Q
What does a transurethral resection of bladder tumour consist of ?
A
Resection of bladder tissue by diathermy during rigid cytoscopy.
Usually performed under general or regional anaesthesia.
The biopsy samples can aid is assessing the stage of disease.
18
Q
What are the subtypes of bladder cancer ?
A
Transitional cell carcinoma
Squamous cell carcinoma
Adenocarcinoma ( rare )
Sarcoma ( rare )
19
Q
What are the 4 layers of the bladder wall ?
A
Inner lining - transitional epithelium or urothelium
Connective tissue layer - lamina propria
Muscular layer - muscularis propria
Fatty connective tissue
20
Q
What are some risk factors for bladder cancer ?
A
Smoking
Age
Exposure to aromatic hydrocarbons ( industrial dyes or rubbers )
Schistomiasis infection
Previous radiation to the pelvis
21
Q
What are some clinical features of bladder cancer ?
A
Painless haematuria ( visible or non-visible )
Recurrent UTI’s
Lower urinary tract symptoms ( frequency, urgency or feeling of incomplete voiding ).
Pelvic pain
Weight loss
Lethargy
22
Q
In TNM what is the T staging ?
A
Tis - in situ ( contained within the basement membrane )
T1 - through lamina propria into sub-epithelial connective tissue
T2 - into muscularis propria layer
T3 - invasion into the perivesical tissues
T4 - direct invasion into adjacent local structures
23
Q
In TNM what is the N staging ?
A
N0 - no nodal involvement
N1 - single node involvement less than 2cm
N2 - single node involvement 2-5cm or multiple nodes less than 5cm
N3 - one or more nodes greater than 5cm
24
Q
In TNM what is the M staging ?
A
M0 - no metastases
M1 - metastases present
25
What are the investigations for bladder cancer ?
Urgent cystoscopy - flexible cytoscopy under local ( rigid cytoscopy may be performed for more definitive assessment ).
Biopsy and TURBT
CT staging
Urine cytology
26
What is the management for bladder cancer in situ or T1 ?
Respected via TURBT
High risk disease may require adjuvant intravesical therapy
Radical cystectomy can also be offered for high risk
27
What is the management for muscle invasive bladder cancer ?
Radical cystectomy if fit - complete removal of the bladder
Neoadjuvant chemotherapy
28
What are some urinary diversions that can be used following a radical cystectomy ?
Ileal conduit formation
Bladder reconstruction
29
What is the management for locally advanced or metastatic bladder cancer ?
Chemotherapy
Palliative care should be discussed
30
What are the causes of LUTS ?
BPH
UTI
Bladder cancer
Prostate cancer
Chronic prostatitis
31
How can you classify LUTS ?
Voiding and storage symptoms.
32
What are some voiding LUTS ?
Hesitancy or straining in micturition
Poor flow
Terminal dribble
Feeling of incomplete emptying
33
What are some storage LUTS ?
Increased urinary frequency
Nocturia
Increased sense of urgency to urinate
Urge incontinence
34
What are some simple investigations for someone presenting with LUTS ?
Urinalysis
Bladder diary
Flow rate and post void scanning
Routine bloods ( U&E’s, FBC )
PSA test
35
What are some specialist investigations which can be performed in a patient with LUTS ?
Urodynamic studies
Cystoscopy
USS urinary tract
36
What is the conservative management for someone presenting with LUTS ?
Treat underlying pathology
Regulate fluid intake
Double voiding
In men urethral milking
Pelvic floor exercises
Bladder training
37
What are some pharmacological management options for people presenting with LUTS ?
Alpha blockers - tamsulosin ( BPH )
5 alpha reductase inhibitors - finasteride ( BPH )
Anti-cholinergics - oxybutynin ( OAB )
Mirabegron ( beta 3 agonist ) - OAB
38
What are some complications of people presenting with LUTS ?
Retention - infection and formation of calculi
Overflow incontinence
Bilateral hydronephrosis
39
What is the pathophysiology of prostate cancer ?
Influenced by androgens
Majority are adenocarcinoma as
Arise from the peripheral zone
40
What are some risk factors of prostate cancer ?
Non- modifiable :
. Age
. Ethnicity
. Family history
BRCA1 or BRCA2 gene are at greater risk
Modifiable :
. Obesity
. DM
. Smoking
. Exercise
41
What are some early symptoms of a localised prostate cancer ?
Weak stream
Increased urinary frequency
Urgency
42
What are some later symptoms of advanced localised prostate cancer ?
Haematuria
Dysuria
Incontinence
Suprapubic pain
Loin pain
43
What are some symptoms indicating a prostate cancer has metastasised ?
Bone pain
Lethargy
Anorexia
Fixed irregular mass
44
what should a DRE be checking for ?
Evidence of asymmetry
Nodularity
Fixed irregular mass
45
What investigations should be performed for someone with prostate cancer ?
PSA
MRI scan
Biopsy
46
Other than prostate cancer what conditions can cause PSA to be raised ?
BPH
Prostatitis
UTI
Recent urological surgery
47
What grading system is used for prostate cancer ?
Gleason grading system
48
What is the management of low risk prostate cancer ?
Active surveillance - 3 monthly PSA tests, 6 monthly to yearly DRE’s, re-biopsy at 1-3 yearly intervals
Radical treatments for evidence of disease progression
49
What is the management for high risk prostate cancer ?
Radical prostatectomy - removal of the prostate gland and resection of the seminal vesicles along with the surrounding tissue
Performed laparoscopically
50
What are some side effects of radical prostatectomy ?
Erectile dysfunction
Stress incontinence
Bladder neck stenosis
51
What is the management of metastatic prostate cancer ?
Chemotherapy and anti-androgen therapy
52
What is the Gleason grading score ?
A scoring system by which prostate cancers are graded based upon their histological appearance.
53
What does each stage of the Gleason grading system indicate ?
1 - small uniform glands
2 - more stroma between glands
3 - distinctively infiltrative margins
4 - irregular masses of neoplastic glands
5 - only occasional gland formation
54
What is a transrectal ultrasound guided ( TRUS ) biopsy ?
Taking a sample of the prostate transrectally using USS as guidance
55
What are the possible risks of a TRUS biopsy ?
Haematuria
Infection
Pain
Repetition of biopsy due to insufficient amount
56
What do the majority of upper tract TCC present with ?
Visible haematuria
57
What investigations are used for upper tract TCC ?
CT urogram
Ureteroscopy
58
What is the management of low grade upper tract TCC ?
Laser ablation
59
What is the management of the majority of non-metastatic upper TCC ?
Laparoscopic nephro-ureterectomy
60
What are some issues with urinary continent diversions ?
Hyperchloraemic metabolic acidosis
Incontinence
Stones
Mucus
Perforation
61
What are some problems with screening prostate cancer ?
Significant over diagnosis and over treatment
Approx 12 treated to prevent 1 death
62
what are some pros of prostate screening ?
Reduced mortality
63
What are some germ cell tumours ?
Non-seminomatous germ cell tumours
Seminomas
64
How can testicular cancers present ?
A lump - solid
65
What are some testis tumour markers ?
Alpha-fetoprotein - specific to non-seminomatous germ cell tumours
Beta-HCG
LDH
66
What is the treatment of testicular cancer ?
Inguinal orchidectomy
Chemotherapy - metastatic
Radiotherapy can be used for seminomas
67
What are some risk factors for testicular cancer ?
Cryptorchidism - undescended testes
Previous testicular malignancy
Family history
Caucasian ethnicity
Kleinfelter’s syndrome
68
What are some clinical features of testiclaur cancer ?
Unilateral painless testicular lump
Irregular firm and fixed
Weight loss
Back pain
69
What are the differentials for a scrotal lump ?
Epididymal cyst
Haematoma
Epididymitis
Hydrocoele
Testicular cancer
70
What are some investigations for testicular cancer ?
Bloods - tumour markers
Scrotal USS
CT imaging with contrast - staging
71
What are some complications of testicular cancer ?
Those undertaking chemotherapy and radiotherapy have an increased risk of secondary malignancies
72
What does penile cancer have a strong association to ?
HPV
73
What is the most common type of penile cancer ?
Squamous cell carcinoma
74
What are some risk factors for penile cancer ?
HPV infection
Phimosis
Smoking
Untreated HIV
75
What are some clinical features of penile cancer ?
Palpable or ulcerating lesion on the penis - located on the glans
Lesions are often painless - may be discharge or prone to bleeding
76
What are some differentials for ulcerating lesions of the penis ?
Herpes
Syphilis
Psoriasis
Balanitis
Penile cancer
77
What are some investigations for penile cancer ?
Penile biopsy
PET-CT - assess inguinal lymphadenopathy
CT imaging of chest-abdomen-pelvis for complete staging
78
What staging system is used for penile cancer ?
TNM
79
What is the management of penile cancer ?
Often a combination of surgery, radiotherapy and chemotherapy.
Topical chemotherapy agents - 5 fluorouracil
Local excision or glansectomy
Invasive penile cancer - partial amputation or total penectomy
80
What are renal stones made of ?
Calcium oxalate
Calcium phosphate
Mixed
81
Which type of renal stone is radiolucent ?
Urate stones
82
What are the most common sites for ureteric stones ?
Pelviureteric junction - renal pelvis becomes the ureter
Crossing the pelvic brim where the iliac vessels travel across the ureter in the pelvis
Vesicoureteric junction where the ureter enters the bladder
83
What are the clinical features of renal stones ?
Pain - ureteric colic
Sudden onset, severe radiating from flank to pelvis
Nausea and Vomiting
Haematuria
May have signs of dehydration
84
What are some differentials for flank pain ?
Pyelonephritis
Renal stones
Ruptured AAA
Biliary pathology
MSK pain
85
What are some investigations for renal stones ?
Urine dip
FBC and CRP
Urate and calcium levels
Non-contrast CT scan of the renal tract
AXR
USS may assess for hydronephrosis
86
What is the initial management of renal stones ?
Adequate fluid resuscitation as often dehydrated
Majority will pass spontaneously
Analgesia
Any evidence of infection - IV antibiotics
87
What are definitive management options for renal stones ?
Extracorporeal shock wave lithotripsy - sonic waves break up the stone into smaller pieces
Percutaneous nephrolithotomy - larger stones, access to kidney with a nephroscope then the stone is fragmented
88
What are some complications of renal stones ?
Infection
Post renal AKI
Recurrent renal stones can cause scarring and loss of kidney function
89
What is a nephrostomy ?
A tube is placed directly into the renal pelvis and collecting system relieving the obstruction proximally
90
What is prostatitis ?
Inflammation of the prostate gland.
91
What is the pathology of prostatitis ?
Most cases of acute bacterial prostatitis are caused by ascending urethral infection although occasionally direct or lymphatic spread from the rectum or haematogenous spread via bacterial sepsis.
92
What are some causative organisms for prostatitis ?
E. Coli
Enterobacter
Pseudomonas
Chlamydia
Gonorrhoea
93
what is chronic bacterial prostatitis ?
Chronic bacterial infection of the prostate with or without prostatitis symptoms and is thought to be the sequelae of inadequately treated prostatitis.
94
What are the risk factors of acute bacterial prostatitis ?
Indwelling catheter
Phimosis or urethral stricture
Recent surgery
Immunocompromised
95
What are some clinical features of prostatitis ?
LUTS
Pyrexia
Perineal or suprapubic pain
Urethral discharge
96
What are some investigations for prostatitis ?
Urine culture
STI screen
FBC, CRP, U&E’s
PSA
97
What is the management of prostatitis ?
Prolonged antibiotics treatment - quinolone
Analgesia
Second line - alpha blocker or 5alpha reductase inhibitor
98
How is chronic prostatitis managed ?
Analgesia
4-6 week trial of alpha blocker
6 week course of antibiotics
Consider referral to chronic pain specialist
99
What is definition of bacteruria ?
On an MSU more than 105 colony forming units/ml
100
Asymptomatic bacteruria isn’t treated except in these 2 circumstances ?
Pregnant women
Prior to urological surgery
101
Why is treating asymptomatic bacteruria actively harmful ?
It replaces low virulence organisms with something worse
102
What is the acute investigations and management of an UTI ?
Typical symptoms + nitrates / leucocytes on urine dip is enough to start treatment
MSU in case empirical treatment fails
3 days of oral antibiotics for uncomplicated UTI in women
103
When can’t trimethoprim be given ?
1st trimester of pregnancy
104
When can’t nitrofurantoin be given ?
Not effective in renal failure
Cant be given in final trimester of pregnancy
105
How to manage recurrent UTI’s ?
Exclude structural cause with USS +/- cystoscopy
Advise fluid intake
Post-coital single dose of antibiotic
Low dose finite 3-6 month prophylactic abx course
106
What is the definition of pyelonephritis ?
Inflammation of the kidney parenchyma and renal pelvis typically due to bacterial infection.
107
What is the most common causative organism of pyelonephritis ?
E.coli
108
What is the classical triad for pyelonephritis ?
Fever
Unilateral loin pain
Nausea and vomiting
109
What are some differentials for pyelonephritis ?
Renal calculi
Ectopic pregnancy
Pelvic inflammatory disease
Diverticulitis
110
What are some investigations for pyelonephritis ?
Urinalysis - nitrates and leucocytes
Urinary beta-hCG
Urine culture
Routine bloods - FBC, CRP
Renal US scan for evidence of obstruction
Non contrast CT imaging if obstruction is suspected
111
What is the management of pyelonephritis ?
Start empirical antibiotics and IV fluids
Consider admission if complicated
112
what are the complications of pyelonephritis ?
Severe sepsis
Multi-organ failure
Renal scarring leading to CKD
Pyonephrosis
Chronic pyelonephritis
113
What is the epididymitis ?
Inflammation of the epididymis
114
What is the epididymo-orchitis ?
Local extension of infection from the lower urinary tract either via enteric ( classic UTI ) or non-enteric ( STI ) organisms
115
What is the most common cause of Epididymo-orchitis in men under 35 ?
STI - gonorrhoea and chlamydia
116
What is the most common cause of Epididymo-orchitis in men over 35 ?
Enteric organism from a urinary tract infection - E. coli
117
What are some risk factors for Epididymo-orchitis ?
Non-enteric - males who have sex with males, multiple sexual partners
Enteric - recent catheterisation, bladder outlet obstruction or immunocompromised
118
How does epididymitis present ?
Unilateral scrotal pain
Swelling
Fever
Rigors
Dysuria
LUTS
Urethral discharge
119
What are some investigations for epididymitis ?
Urine dipstick
Urine culture ( MC & S )
First void urine - NAAT
STI screen
FBC, CRP
Blood cultures
USS - Doppler
120
What is the management of epididymitis ?
Antibiotic therapy -
- Enteric : ofloxacin 200mg
- STI : ceftriaxone 500mg
Sufficient analgesia
Abstain from sexual activity until abx course is finished
121
What are the complications of epididymitis ?
Hydrocoele formation
Abscess formation
Testicular infarction
122
What is testicular torsion ?
Occurs when the spermatic cord and its contents twist within the tunica vaginalis compromising the blood supply to the testicle.
It is a surgical emergency
123
What is the pathophysiology of testicular torsion ?
Occurs when mobile testes rotate on the spermatic cord. This leads to reduced arterial blood flow, impaired venous return, venous congestion, resultant oedema and infarction to the testis.
Bell clapper deformity
124
What are the risk factors for testicular torsion ?
Age
Previous testicular torsion
Family history
Undescended testes
125
Sudden onset severe unilateral testicular pain
Nausea and vomiting - secondary to the pain
Swollen testes
Cremasteric reflex is absent
126
What are some investigations for testicular torsion ?
Clinical
Doppler USS
Urine dipstick
127
What is the management of testicular torsion ?
Surgical emergency with 4-6 hours window
Analgesia
Urgent surgical exploration
Bilateral orchidoplexy
Where the testis are non-viable an orchidectomy may be warranted
128
What are the complications of testicular torsion ?
Testicular infarction
Infertility
129
What is a scrotal lump ?
An abnormal mass or swelling within the scrotum. They can originate from either testicular or extra-testicular sources.
130
What are the clinical features to ask about when someone presents with a scrotal lump ?
Time of onset
Associated symptoms
Previous episodes
131
On inspection of a scrotal lump what should be looked for ?
Site
Size
Shape
Symmetry
Skin changes
Scars
132
On palpating a scrotal lump what should be assessed ?
Tenderness
Temp
Transillumination
Consistency
Mobility
Pulsation
Irreducibility
133
What are the investigations for scrotal lumps ?
USS
Bloods
134
What are some differentials for scrotal lumps ?
Hydrocoele
Varicocoele
Epididymal cyst
Epididymitis
Inguinal hernia
Testicular tumour
Testicular torsion
Orchitis
135
What is a hydrocoele ?
An abnormal collection of peritoneal fluid between the parietal and visceral layers of the tunica vaginalis enveloping the testis.
136
How do hydrocoeles usually present ?
Painless fluctuations swelling that will transilluminate either unilateral or bilateral.
They can grow very large and cause discomfort when sitting or walking.
137
If a male between 20-40 presents with a hydrocoele what should be performed urgently ?
USS
138
What is transillumination ?
It involves using a pen torch to shine light from behind a scrotal lump to observe whether the light travels through and illuminates the lesion.
The technique is used to assess whether a mass is fluid filled.
139
What scrotal lumps tend to transilluminate ?
Hydrocoeles and large epididymal cysts
140
What is a varicocoele ?
An abnormal dilation of the pampiniform venous plexus within the spermatic cord.
141
how do varicocoeles present ?
It often presents as a lump and is described as a bag do worms.
Disappears on lying flat
142
What can varicocoeles cause ?
Infertility
Testicular atrophy
143
What are some red flags for varicocoeles ?
Acute onset
Right sided
Remain when lying flat
144
What is the surgical management of varicocoeles ?
Embolisation by interventional radiologist and surgical approaches either open or laparoscopic approach for ligation of the spermatic veins.
145
What is an epididymal cyst ?
A benign fluid filled sac arising from the epididymis. They present as a smooth fluctuations nodule.
146
How do inguinal hernias cause scrotal lumps ?
They pass into the scrotum via the external inguinal ring entering the inguinal canal initially at the internal ring ( indirect )or through hesselbach’s triangle ( direct ). They pass into the scrotum and run alongside the spermatic cord.
147
How is an inguinal hernia causing a scrotal lump assessed on examination ?
You can’t get above the hernia - can’t palpate the superior surface
A cough may exacerbate the swelling and it may disappear when lying flat.
148
What is the most common malignancy in men aged 20-40 ?
Testicular cancer
149
What are some examples of benign testicular lesions ?
Leydig cell tumours
Sertoli cell tumours
Lipomas
Fibromas
150
What is Peyronie’s disease ?
A condition characterised by an acquired curvature of the penis due to fibrosis of the tunica albuginea
151
What are the groups of Peyronie’s disease ?
Asymptomatic - doesn’t limit sexual function
Moderate to severe curvature causing pain or impeding sexual function
Erectile dysfunction
152
What is the pathophysiology of peyronie’s disease ?
Acute phase - pro-inflammatory cytokines lead to acute inflammation of the tissue. A fibrotic healing process occurs disrupting the normal tissue of the penis.
Fibrotic plaques develop at the dorsum of the penis and cause painful shortening and curvature. This limits sexual intercourse. The scarring can reduce blood flow and lead to erectile dysfunction.
153
What are some risk factors for Peyronie’s disease ?
Age
DM
HTN
Certain medications - beta blockers
154
What are some clinical features of Peyronie’s disease ?
Significant curvature
Shortening
Erectile dysfunction
Painful erection
155
What is the management of Peyronie’s disease ?
Phosphodiesterase 5 inhibitors such as sildenafil
Intracaervnosal injections
Surgical
156
What is fournier’s gangrene ?
A form of necrotising fasciitis that affects the perineum. It is a urological emergency.
Rapidly spreading necrosis of the subcutaneous tissue and fascia
157
What are the most common causative organisms for fournier’s gangrene ?
Group A streptococcus
C. Perfringes
E. Coli
158
What are risk factors of fournier’s gangrene ?
DM
Excess alcohol intake
Poor nutritional status
Excess steroid use
Haematologial malignancies
Recent trauma
159
What are some clinical features of fournier’s gangrene ?
Severe pain
Pyrexia
Crepitus
Skin necrosis
Haemorrhagic bullae
Rapidly deteriorate
160
What are some investigations for fournier’s gangrene ?
Largely clinical
FBC, CRP, U&E’s, LFT’s
Blood cultures
HbA1c
CT imaging to assess fascial swelling and soft tissue gas
161
What is the management of fournier’s gangrene ?
Urgent surgical debridement - often extensive
Broad spectrum abx
May require skin grafts
162
What is paraphimosis ?
The inability to pull forward the retracted foreskin over the glans of the penis.
163
What is the pathophysiology of paraphimosis ?
There is a presence of a tight restriction band preventing retraction. This causes the glans to become increasingly oedematous due to reduced venous return causing engorgement. If untreated it can cause penile ischaemia and infection.
164
What are some risk factors for paraphimosis ?
Phimosis
Indwelling urethral catheter
Poor hygiene
Prior paraphimosis
165
What is the typical presentation of paraphimosis ?
Progressive pain and swelling
Unable to retract their foreskin
166
What is the management of paraphimosis ?
Reduction
Analgesia
167
what are some risk factors of erectile dysfunction ?
Vascular - ischaemic heart disease
Neurological - DM, spinal injury
Hormonal - low testosterone
Medications - anti-depressants
Pyschogenic
168
What are some investigations for erectile dysfunction ?
Address vascular risk - BP, lipids, glucose and smoking status
Early morning testosterone levels
Prolactin, LH , FSH levels
169
What is the management of erectile dysfunction ?
Pyschosexual counselling
PDE5 inhibitors
Treat low testosterone
Intracavernosal prostaglandin injections
Penile prosthesis
170
What is phimosis ?
Tight foreskin
There is scarring of the foreskin opening leading to non-retractibility
171
What are the management options for phimosis ?
Topical steroids
Circumcision
172
What is nocturnal polyuria ?
1/3 of urine output is produced at night
173
What contributes and worsens nocturia ?
Chronic deep venous insufficiency
Congestive HF
COPD
Sleep apnoea
DM
CKD
174
What are the pressures like in urodynamics ?
Slow gentle rise in pressure during the filling phase
High pressure in the voiding phase
175
What is the treatment for BPH ?
Lifestyle advice - fluid intake and caffeine
Medical - alpha blockers ( tamsulosin ) , 5 alpha reductase inhibitor ( finasteride ) or anticholinergics
Surgical - TURP
176
How do alpha blockers work in the treatment of BPH ?
Relax the prostatic / bladder neck smooth muscle
Uro-selective
Improves symptoms only
177
What are some side effects of alpha blockers ?
Retrograde ejaculation
Postural hypotension
178
How do 5 alpha reductase inhibitors work ?
Reduce conversion of testosterone to DHT
Reduce prostatic volume
179
What are some side effects of 5 alpha reductase inhibitors ?
Erectile dysfunction
Decreased libido
Rash
180
What is TURP syndrome ?
Irrigation for standard TURP is glycine not saline which absorption of during a long resection can lead to dilutional hyponatraemia
181
What are some features of TURP syndrome ?
Confusion
Fits
Visual symptoms
Coma
182
What is overactive bladder syndrome ?
Urgency with or without incontinence often accompanied by frequency and nocturia
183
What is the treatment of OAB ?
Weight loss, stop smoking, pelvic floor training
Anti-cholinergics
Beta 3 agonist - mirabegron
Botulinum toxin injections
Sacral nerve stimulation
Ileocystoplasty
184
What are some treatment options for stress incontinence ?
Weight loss
Pelvic floor exercises
Autologous fascial sling
Artificial urinary sphincter
185
What are the 2 types of urinary retention ?
Acute - painful inability to void
Chronic - painless and may still void
186
What are some causes of urinary retention in men ?
BPH
Prostate cancer
UTI
Constipation
Recent surgery
Drugs
Urethral stricture
187
What are some causes of urinary retention in women ?
UTI
Constipation
Recent surgery
Drugs
Urethral stricture or stenosis
Pelvic mass
188
What are some examinations and investigations for acute urinary retention ?
Catheterise and record residual volume
Abdo exam, DRE and external genitalia
Urine dip
U&E’s
