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urology Flashcards

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1
Q

*retracted testes with negative cremasteric reflex

A

Testicular torsion

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2
Q

*adult with a hydrocele

A

Refer urgently for a testicular US - could be a tumour

In babies - resolves within a year usually

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3
Q

First line investigation for testicular mass

A

Ultrasound

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4
Q

*periureteric fat ‘stranding’

A

Can indicate the passage of a recent renal stone

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5
Q

Most common type of renal stone

A

Calcium oxalate

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6
Q

Which renal stones are NOT opaque (radiographically)

A

Urate
Cystine
Xanthine

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7
Q

*stag-horn calculus

A

These renal stones involves the renal pelvis and are composed of struvite

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8
Q

Gold standard for suspected urolithiasis

A

CT KUB (ct of kidneys, ureters and bladder)

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9
Q

Management of acute urinary retention

A

Emergency !
Catheterisation and decompression

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10
Q

What may develop after catheterisation due to acute urinary retention

A

Post-obstructive diuresis

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11
Q

What occupational exposure is a recognised risk of developing transitional cell cancer

A

Aniline dye

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12
Q

*transilluminates, not tender to touch

A

Hydrocele

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13
Q

Gold standard for renal calculus

A

CT non-contrast

US + X-ray brings up accuracy only a bit

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14
Q

What is hydronephrosis

A

When stone comes down the tract and stretches it

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15
Q

Small stone

A

<4mm

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16
Q

Medium sized stone

A

> 4mm - 2cm

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17
Q

Large kidney stone

A

> 2cm

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18
Q

Management of small sized kidney stone

A

Conservative management + observe

On the US a year on check up to see if its gotten any bigger

But should pass by itself

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19
Q

Renal colic included symptoms

A

Flank pain radiating down leg / groin
Nausea
Microcytichaematuria

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20
Q

Management of medium sized stone

A

ESWL
FLexible URS + Laser
PCNL

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21
Q

What is ESWL

A

‘Shockwave lithotripsy’

—> patient put under sedation , ballon attached to skin over flank , high frequency sound waves target the stone - which then fragments and get passed down the ureter

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22
Q

Side effects of ESWL

A

Haematoma to gut
Haematuria

Quite aggressive tool but effective

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23
Q

What is flexible URS + laser

A

‘Urothroscopy’ = camera going through ureter to the stone

Once the stone is found , the laser fragments the stone into smaller pieces which is then passed

Can’t have anaesthetic , infection risk - the stone harbours bacteria as well as external source, hydronephrosis developing into pyelonephritis

But has a higher clearance rate than ESWL (90% success rate)

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24
Q

Management for large stone

A

PCNL = percutaneous nephrolithodotomy

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25
What is PCL
Patient goes under anaes. Needle inserted through skin via wire , a tract is built from outside to kidney and camera goes in and then breaks stone —> which are then extracted externally Benefit = can be more specific in target and can clear completely (highest rate of clearance)
26
Side effects of PCNL
Risk of bleeding Injury to associated structures (diaphragm —> pneumothorax, liver, spleen etc)
27
First line for renal colic
Diclofenac (NSAIDs)
28
How to decide who goes to theatre with a ureteric stone
1. Pain (not controlled) 2. Single kidney (bilateral , one missing) 3. Infection - can spread very rapidly to the rest of the body 4. Stone >7mm cannot be managed conservatively 5. Multiple stones
29
What are the two management options of ureteric stones
1. ESWL 2. Uretothroscopy (main)
30
Renal stone vs ureteric stone symptoms
Ureteric = 12/10 pain , this one is worse due to back flow pressure back into the kidney
31
What is the JJ stent
Stent between kidney and the bladder - to stop scarring / sclerosis from laser and stuff which would cause blockage Patient brought back in a few weeks later to get stent removed
32
Risk factors for pyelonephritis
Female DM On steroids Immunocompromsied Past urological procedures History of stones
33
How does pyelonephritis present
Macroscopic haematuria Flank and back pain Fever
34
*loin percussion tenderness
Pyelonephritis Percussing with a closed fist over the flank - due to the oedema around the kidney the neural supply is even more sensitive - patient has severe pain
35
Mx of stable pyelonephritis (Normal vitals and no significant fever)
= oral abx for up to 7 days
36
Mx of unstable pyelonephritis
Admit to hospital IV abx (but need a culture before staring abx - if culture taken after the abx can mask what’s there)
37
What are the causative organism common in pyelonephritis
E.coli Klebsiella Pseudomonas (All gram neg.) and can be treated with trimethoprim (oral) or co-trimoxazole (oral)
38
Patient admitted with pyelonephritis caused by gram neg - what is the treatment ?
IV gentamicin
39
Treatment of pyelonephritis caused by gram +
Co-amoxiclav. (If don’t know causative organism then can prescribe both co-amoxiclav. and gentamicin)
40
Treatment of pyelonephritis due to anaerobe ?
Metronidazole
41
Pregnancy complications of pyelonephritis
Premature labour IUGR Stillborn
42
Why does every pregnant mother get a urine dipstick in first trimester
Rule out infection just in case - can do foetal damage
43
Safest antibiotic for pregnant woman with pyelonephritis
Trimethoprim Amoxicillin Also cephalosporins
44
Investigation for prostate cancer - initial
MRI prostate (lymph nodes, mets, local cancer)
45
Diagnostic for prostrate cancer
MRI (gold standard)
46
Who qualifies for an MRI of prostate in suspicion
PSA <20 T1/T2 (localised) <80 years
47
*PSA >20 , T3/T4 disease What investigation appropriate ?
Bone scan (for mets —> osteoblastic areas) CT of chest , abdo, pelvis (for lymph nodes)
48
What is normal PSA
<4
49
PET scan after treatment of prostate cancer ?
Check for radiotherapy damage
50
PIRADS grading system ?
Local cancer for prostate cancer (4/5 is typical for cancer)
51
Commonest place on the prostate for cancer to develop ?
Peripheral zone (Can be detected on DRE) For BPH cancer is in the transitional zone (presses on the ureter)
52
Treatment for prostate cancer
A. Localised cancer and patient is healthy (no bone mets/lymphadenopathy) —> robotic prostatectomy (removal of prostate and capsule (tissue around it)), can also give localised radiotherapy (brachytherapy) B. Locally advanced (ie lymph nodes but no mets) —> radiotherapy OR hormonal (usually no surgery) C. Metastatic (PSA = 150, bone mets, back pain etc) —> hormonal therapy with GnRH agonist / antagonist (definitely no surgery)
53
How do GnRH work to help metastatic prostate cancer
GnRH released by hypothalamus —> LH/FSH to be released from ant. Pit. —> testosterone (released from testes and reticularis) —> AGONIST : causing LH/FSH to downregulate ( chronically, acutely this causes an increase in testosterone initially ) —> leading to cessation of testosterone production *need to use and anti-androgen with a GnRH agonist to stop testosterone flair , why antagonist is used by itself - no flair
54
What needs to be co-prescribed with GnRH Agonist
Anti-androgens (ie -amides)
55
Limitation of hormonal therapy in treatment of prostate cancer
Only lasts about 3 years - body changes to keep up with hormonal change —> would then start to use chemo.
56
What is PSA density
For every gram of prostate per PSA >0.15mg/dl tells of cancer (normal should be 0.1) Can use this to distinguish between BPH and cancer
57
Causes of BPH
1. Testosterone 2. Genetic 3. Oestrogen diet (soya + red meat) 4. Idiopathic (mainly)
58
What is IPSS
International prostate stimulation score Measures age, quality of life, obstructive symptoms, bladder related symptoms
59
*nocturnal incontinence
Retention , patient in trouble
60
Investigation for BPH
1. PSA 2. Uroflow (chart on how fast man is peeing) 3. Bladder scan (to check for post-void residual)
61
Management of BPH
1. Conservative - dietary (stop caffeine (causes detrusor muscle dysfunction - incontinence)), timed voiding, nocturia - stopping fluid 2-3 hours before bed and have one set alarm to wake up and go 2. Alpha block - tamsulosin 0.4mg 1d SYMPTOMATIC CONTROL BY RELAXING TRIGONE AND PROSTATIC URETHRA (causing it to widen —> easier passage of urine, no change in prostate size) 3. 5-a-reductase inhibitors - finesteride (reduces size of prostate by 1/3, the epithelium)
62
Side effects of tamsulosin
Postural hypotension Dry ejaculations (could be used as male contraception!) Contraindicated in acute closed angle glaucoma
63
MoA of Finesteride
Stops conversion of testosterone —> DiHydroTestosterone (active) Therefore side effects can include: anxiety, decrease in libido, increase chance of ED, depression
64
Resection of prostate in BPH ?
If prostate is >20-80g and no response to 5-a-reductase etc Then TURP (transurethral resection of prostate) , peeling back layers of prostate
65
What is Steam therapy for BPH
Steam injected into prostate (9 seconds each) and this causes coagulative necrosis Benefits = no loss of sexual function , no bleeding (like in TURP)
66
Treatment of prostate hyperplasia of >80g
HOLFP ‘Homeum Laser enucleation of the prostate’ Laser peels of prostate of the capsule around it, the central and transitional zone peeled away , this is pushed into the bladder where it is then sucked out Benefits - day procedure (no prostate left)
67
Limitation of TURP
Prostate could regrow

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