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Y3 Surgery > Urology > Flashcards

Urology Flashcards

1
Q

PC

A

VH
Lumps
LUTS
Incontinence
Constitutional- fatigue, weight loss, SOB

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1
Q

Occupation

A

QOL- how is it affecting their day to day life

Bladder cancers:
Dyes
Rubber
Textiles
Paints
Leather
Chemicals

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2
Q

PMHx

A

Previous pelvic surgery (ovarian surgery- injury to the ureter).
DVT
Neurological (MS, spinal cord inj, obGYN (how many children have they had), menopausal symptoms, urethral catheters (always a risk factor for stricture, splitting of the urine stream), previous STIs, stones
Co-morb-
DM- poorly controlled, recurrent infections
HF- patient on diuretics
CKD, stroke

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3
Q

Lifestyle

A

Coffee
Tea
Beverages- how much are they drinking, squash, fizzy drinks
Smoking
Alcohol

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4
Q

Ethnicity with prostate

A

More aggressive forms in afro-carribean, more common in caucasian

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5
Q

Why do you have to be careful when asking about gender?

A

Are they transgender?- could be a man who transitioned to a lady- still has a prostate.

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6
Q

LUTS

A
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7
Q

FHx

A

Urological malignancies

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8
Q

DHx

A

Anticoagulant
Anti-platelets, anti-cholingergics, diuretics, HRT
Allergies- malignant hyperthermia (succinamide)

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9
Q

How long should anti-platelets be stopped for before surgery?

A

5-7 days

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10
Q

How long should anti-coagulants be stopped for before surgery?

A

24-72 hours

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11
Q

Mnemonic for BPH

A

FUN WISE
Frequency
Urgency
Nocturia
Weak stream
Intermittent
Straining
Emptying incontinence

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12
Q

What scoring system can you use for BPH symptoms

A

IPSS
International prostate scoring system

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13
Q

What catheter should you use for patients with enlarged prostates?

A

Tie manns
Coude tip

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14
Q

Normal diameter of the detrusor muscle (wall of the bladder)

A

3mm

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15
Q

What can happen to the bladder with BPH?

A

Bladder wall thickens (increased intra-abdominal pressure)
Trabeculations
Diverticular in the bladder (may have up to 20ml of urine)
No detrusor muscle around the diverticular- still feel there is urine there but they can’t empty their bladder
Once you have diverticular- nothing you can do about it
Pointless to put a catheter in for these patients- it will never empty the bladder

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16
Q

Average amount of time to go to the toilet

A

6 times in a day (10 seconds)
Only opens for one minute a day

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17
Q

What lobe of the prostate does finasteride not shrink?

A

The median lobe- need surgery for that

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18
Q

How do divide causes of hematuria

A

Urological
Nephrological
Glomerular
Non glomerular

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19
Q

Are patients at a higher malignancy risk with frank or non-visible haematuria?

A

Frank

Most common cause of haematuria= UTI

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20
Q

Criteria for referring people on the bladder cancer pathway

A

Refer people using a suspected cancer pathway referral (for an appointment within 2 weeks) for bladder cancer if they are:

aged 45 and over and have:
unexplained visible haematuria without urinary tract infection or

visible haematuria that persists or recurs after successful treatment of urinary tract infection, or

aged 60 and over and have unexplained non‑visible haematuria and either dysuria or a raised white cell count on a blood test.

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21
Q

When should you consider a non-urgent referral for bladder cancer?

A

Consider non-urgent referral for bladder cancer in people aged 60 and over with recurrent or persistent unexplained urinary tract infection.

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22
Q

Risk factors for bladder cancer

A

Male >35
Smoking
Occupation- chemicals, benzenes
Long term catheter
History of pelvic irradiation

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23
Q

How can haematuria be classified?

A

Haematuria can be classified as visible (VH), symptomatic non-visible (s-NVH) or asymptomatic non-visible (a-NVH)

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24
Q

What is the gold standard for investigating the lower urinary tract?

A

Flexible cystoscopy

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25
Q

How much urine can the bladder hold?

A

400-600ml of urine

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26
Q

Complication of chronic urinary retention

A

Hydroureters- hydronephrosis

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27
Q

Inx for Haematuria

A

Urine MCS, cytology
Group and save
Urine MCS
FBC, Us&Es, LFT and clotting screen
USS KUB
CT KUB/CT KUB with contrast
Flexible cystoscopy
PSA

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28
Q

Why do you need flexible cystoscopy?

A

CT and USS will miss a tumor

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29
Q

If a patient has risk factors and USS and FC are normal, what would you request?

A

CT KUB with contrast

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30
Q

Management of urinary retention secondary to clots

A

Patients with significant haematuria, especially those in clot retention (acute urinary retention secondary to clots obstructing the bladder outflow), will need inpatient admission under Urology. These patients will require the insertion of a three-way catheter for ongoing washout and irrigation +/- evacuation of clots.

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31
Q

MSU vs Cytology

A

MSU- bugs, e.coli, klebsiella, pseudonomas (stones)
Cytology- cancer cells

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32
Q

Diffs for renal colic

A
  • Leaking AAA
  • Bowel perf
  • MI
  • Ectopic
  • Ovarian
  • Testicular torsion
  • Malaria (black water fever)
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33
Q

Difference between peritonitic pain and renal colic pain

A

Renal colic- pain is there constantly, doesn’t matter about position

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34
Q

Most common situations for kidney stones

A

Vesico-ureteric junction
Pelvic-ureteric junction

35
Q

Cut off diameter for stones to pass

A

> 5mm
Even tho ureter diam is 3mm, can stretch to pass the stone

36
Q

Criteria for inpatient admission for kidney stones

A

The majority of renal stones can be treated in the outpatient setting. However, criteria that often warrant the need for hospital admission include:

Post-obstructive acute kidney injury
Uncontrollable pain from simple analgesics
Evidence of an infected stone(s)
Large stones (>5mm)

37
Q

Gold standard imaging for renal colic

A

CT KUB- can’t admit a patient until there is evidence of a stone

38
Q

3 things you have to rule out first with suspected kidney stones

A
  • Pregnancy test
  • Ultrasound for AAA
  • Urine MCS
39
Q

What imaging do you choose for a pregnant patient with kidney stones?

A

MRI or ultrasound

40
Q

Firs line pain management for kidney stones

A

Diclofenac 100mg PR

41
Q

What management can you give for a 5mm stone at the junction between the bladder and ureter

A

Medical expulsive therapy- tamsulosin, nifedipine, relax the vesicular-ureteric junction

42
Q

Causes for urgent decompression (stent vs nephrostomy)

A
  • Sepsis
  • Unremitting pain
  • Single kidney
  • AKI
  • Stone size 6mm
  • Social reason (airline pilot)
43
Q

Screening for risk factors of kidney stones

A

Bone profile, uric acid, crohn’s disease, parathyroid hormone, gout, steroids

44
Q

What type of kidney stones can a CT miss?

A

Uric acid, ammonium urate, drug-stones (HIV), Xanthine

45
Q

What are some complications of kidney stones?

A

The main complications that can occur from ureteric stones is infection and post-renal acute kidney injury, however both can be treated if managed early.

Recurrent renal stones can lead to renal scarring and loss of kidney function

46
Q

CTAP ?
CT abdo and pelvis

A

Will need contrast for renal cacner

47
Q

CTU ?

A

For patients with haematuria- when you suspect bladder cancer

48
Q

Causes of urge incontinence

A
  • Minor condition, infection, neurological disorder or diabetes
  • Go back to LUTS
  • Think of irritating causes
  • Overactive bladder
49
Q

Overflow incontinence

A

Frequent or constant dribbling of urine, due to a bladder that doesn’t empty properly
Catheter solves the problem

50
Q

Causes of functional incontinence

A

Arthritis or unable to unbutton your trousers quickly enough

51
Q

PV exam

A

Prolapse
Atrophic vaginitis
Pelvic floor muscles
Speculum- any rectocele/cystocele

52
Q

Rectocele

A

A rectocele is a condition where weakened tissues in your pelvis cause your rectum to sag onto your vaginal wall.

53
Q

Inx for incontinence

A
  • Bladder diary
  • Flow study, PVR
  • Urine dip, MCS
  • USS
  • Flexible cystoscopy
  • UDS (urodynamic studies)
54
Q

What should you do before invasive procedure for incontinence?

A

UDS- confirmation of the diagnosis of detrusor activity

55
Q

Common side effects of anti-cholinergics

A
  • Dry mouth
  • Dyspepsia
  • Constipation
  • Blurred vision
  • Drowsiness
56
Q

Exhausting drugs for incontinence?

A

Botox of the bladder
Repeat every 6-9 months
Not permanent

57
Q

Where does the cremasteric layer lie?

A

Between the external and internal spermatic fascia

58
Q

How long do you have to operate with testicular torsion?

A

Within 6 hours

59
Q

Definition of testicular torsion?

A

Testicular torsion occurs when the spermatic cord and its contents twists within the tunica vaginalis, compromising the blood supply to the testicle.

Testicular torsion is a surgical emergency, as without treatment the affected testicle will infarct within hours. Whilst theoretically it can occur at any age, peak incidence is in neonates and adolescents between the ages of 12-25yrs.

60
Q

History for testicular torsion

A
  • Previous episodes
  • Any previous surgery (has it been fixed before)
  • Undescended testicles
  • Trauma
  • Recent cold/sore throat (mumps orchitis)
  • Family history (
61
Q

Paraphimosis vs phimosis

A

Phimosis (uncircumscised)
Paraphimosis- you can see the glans. Common when you don’t replace the foreskin after insertion of a catheter

62
Q

Examination of testicular torsion

A
  • Visible skin changes
  • Blue dot (testicular appendage, cyst of morgagni)
  • Obvious testicular swelling
63
Q

Palpation with testicular torsion

A

Tenderness
Temperature
Lie-angell’s sign (bell clapper deformity, testes is lying horizontally)
Relative testicular position
Palpable torsion
Cremasteric reflex, phren sign, deming’s sign (high riding)
Transillumination test

64
Q

What is phren’s sign?

A

Pain continues despite elevation of the testicle, termed a negative Prehn’s sign (whilst in epididymo-orchitis, Prehn’s test is often positive). The veins are dilated, improves venous drainage when you lift up the testes.

Negative in testicular torsion

65
Q

What is an important question to ask in the history of testicular torsion?

A

It is often worth clarifying with the patient the normal position of their testes in their scrotum (i.e. which testis normally sits higher)

66
Q

What is deming’s sign?

A

High riding testes

67
Q

How to differentiate between a hernia and a scrotal swelling?

A

With a scrotal swelling, you will be able to hold all of the scrotum.

68
Q
A

Testicular torsion
Epididymo-orchitis
Torsion of testicular appendix
Hydrocele
Testicular lump
Inguino scrotal hernia

69
Q

What can you do if you have an orchidectomy?

A

Implant of a testes

70
Q

What do you call the testicular appendix?

A

Cyst of morgagni

71
Q

Do you fix a twisted testicular appendix?

A

No- risk of needle trauma

72
Q

Do you investigate testicular torsion?

A

No!- Call the urology registrar on call urgently

73
Q

Management of testicular torsion

A

Urine dip, MCS, bloods, USS, tumor markers (alpha-fetoprotein, beta-HCG, LDH but no specific), keep them NBM

74
Q

Why do you do a CT scan with testicular torsion

A
75
Q

What is the vascular supply to the testes?

A

The main arterial supply to the testes and epididymis is via the paired testicular arteries, which arise directly from the abdominal aorta. They descend down the abdomen, and pass into the scrotum via the inguinal canal, contained within the spermatic cord.

However, the testes are also supplied by branches of the cremasteric artery (from the inferior epigastric artery) and the artery of the vas deferens (from the inferior vesical artery). These branches give anastomoses to the main testicular artery.

76
Q

What lymph nodes will be enlarged with testicular cancer?

A

Para-aortic lymph nodes

77
Q

Examination of a hydrocele

A

You will not be able to tell the testes apart

78
Q

Causes of urine blockage at the tip of the penis

A
  • Balanitis xerotica obliterans
  • Phimosis
  • Paraphimosis
  • Prostatitis
  • Meatal stenosis
  • Stricture (previous catheters)
79
Q

What is the antibiotic treatment for epididymo-orchitis?

A

14 days of ofloxacin (fluoroquinolone)

80
Q

What medication do you give to prevent occurrence of calcium oxalate stones?

A

Thiazides

81
Q

What medication do you give to prevent occurrence of uric acid stones?

A

Allopurinol or potassium citrate

82
Q

Treatment of epididymo-orchitis caused by chlamydia

A

Oral Doxycycline

83
Q

Treatment of epididymo-orchitis caused by gonorrhoea

A

IM Ceftriaxone

84
Q

First line analgesia for renal colic

A

PR Diclofenac

85
Q

What is trans-urethral resection of the prostate?

A

Reduces the intraluminal size of the prostate and decreases urinary resistance on micturition. It is a surgical treatment for BPH and not prostate cancer.

86
Q

What type of bladder cancer do long term catheters increase the risk of?

A

Squamous cell carcinomas

Y3 Surgery (7 decks)

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