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Urology Flashcards

1
Q

Acute bacterial prostatitis causes

A

gram - bacteria entering prostate gland via urethra

E coli - most commonly isolated pathogen

RFs: recent UTI, urogenital instrumentation, intermittent bladder catheterisation and recent prostate biopsy.

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2
Q

Mx of acute bacterial prostatitis

A

14 day course of quinolone
consider STI screening

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3
Q

Causes of ATN

A

ischaemia
- shock
- sepsis

nephrotoxins
- aminoglycosides
- myoglobin secondary to rhabdomyolysis
- radiocontrast agents
- lead

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4
Q

Medication that can cause acute urinary retention

A

anticholinergics, tricyclic antidepressants, antihistamines, opioids and benzodiazepines

(affect nerve signals to bladder)

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5
Q

Ix & Mx acute urinary retention

A
  • bladder USS - vol > 300 cc confirms dx, but can be lower if symptoms
  • urine catheterisation & sample for urinalysis
  • find & tx cause

Look out for complication: post-obstruction diuresis (mx: IV fluids to prevent AKI)

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6
Q

Balanitis tx

A
  • conservative: gentle saline washes, ensuring to wash properly under the foreskin
  • more severe irritation and discomfort :1% hydrocortisone

treat cause if infective

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7
Q

tool for classifying the severity of lower urinary tract symptoms in BPH?

A

International Prostate Symptom Score (IPSS)

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8
Q

Mx of BPH

A

Watchful waiting

1st line: Alpha 1 antagonists - tamsulosin, alfuzosin

5 alpha-reductase inhibitors - finasteride
- if the patient has a significantly enlarged prostate and is considered to be at high risk of progression
- takes 6mo to work

combination of both works well - if moderate-severe voiding symptoms & prostatic enlargement

antimuscarinic ( tolterodine or darifenacin ) - storage & voiding symptoms not responsive to a-blockers

transurethral resection of prostate (TURP)

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9
Q

RFs for bladder ca

A

urothelial (transitional cell) carcinoma of the bladder
- smoking
- aniline dyes (2-naphthylamine and benzidine) in printing & textile industry
- rubber manufacture
- cyclophosphamide

SCC
- Schistosomiasis
- smoking

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10
Q

Medical indications for circumcision

A

phimosis
recurrent balanitis
balanitis xerotica obliterans
paraphimosis

( exclude hypospadias prior to circumcision as foreskin used for repair )

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11
Q

Epididymal cysts associated conditions

A

polycystic kidney disease
cystic fibrosis
von Hippel-Lindau syndrome

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12
Q

Epididymo-orchitis Ix & mx

A

Ix (depends on age)
younger - assess for STI
Older w low risk STI - send mid-stream urine (MSU) for microscopy and culture

Mx
- STI -> refer to sexual health clinic. If organism unknown: : ceftriaxone 500mg IM single dose, plus doxycycline 100mg by mouth BD for 10-14 days
- If enteric organisms -> empirically w oral quinolone for 2 weeks whilst awaiting MSU

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13
Q

RFs for erectile dysfunction

A

increasing age
CVS disease
Alcohol use
SSRIs, Beta blockers

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14
Q

Ix for erectile dysfunction

A

10 yr CVS risk calculated - measuring lipid & fasting glucose

Free testosterone between 9-11am - if low/borderline, repeat w FSH, LH & prolactin - if low, refer to endo

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15
Q

Mx for erectile dysfunction

A

PDE-5 inhibitors (sildenafil ‘viagra’)

If Ci to above - vacuum erection devices

young man who has always had difficulty achieving an erection -> referral to urology

Stop cycling >3hrs a week if ED

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16
Q

communicating vs non communicating hydroceles

A

accumulation of fluid w/in the tunica vaginalis

communicating: latency of processus vaginalis. so peritoneal fluid drains into scrutum. Common in newborn males & resolve in few mos

non-communicating: excessing fluid production w/in tunica vaginalis

can occur secondary to: epididymis-orchitis, testicular torsion, testicular tumours

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17
Q

Hydrocele ix & mx

A

ix - clinical but USS used if any doubt about dx if underlying testis cannot be palpated

Mx
- infantile hydroceles repaired if no spontaneous resolution by age 1-2yrs
- adults - conservative approach depending on severity. Uss to rule out underlying cause- e.g. tumour

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18
Q

Ix of hydronephrosis

A

1st line: USS - presence of hydronephrosis & can assess kidneys

intravenous urogram (IVU) - position of obstruction

Antegrade or retrograde pyelography- allows treatment

if potential real colic - CT scan

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19
Q

Mx of hydronephrosis

A

remove obstruction & drain urine

acute upper urinary tract obstruction: nephrostomy tube

Chronic: ureteric stent or pyeloplasty

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20
Q

types of urethral injury and features

A

Bulbar rupture
- most common
- straddle type injury (bicycles)
- triad: urinary retention, perineal haematoma, blood at meatus

Membranous rupture
- can be extra or intraperitoneal
- mostly due to pelvic fracture
- penile or perineal/ heamatoma
- PR prostate displaced upwards

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21
Q

urethral injury ix & mx

A

ascending urethrogram

suprapubic catheter (surgically placed, not percutaneously)

22
Q

Bladder injury px, ix, mx

A

px
- haematuria or suprapubic pain
- pelvic fracture & inability to void!!
- inability to retrieve all fluid after irrigation through Foley

Ix
- IVU or cyst-gram

Mx
- laparotomy if intraperitoneal, conservative if extraperitoneal

23
Q

Voiding vs store vs post micturition LUTS

A

Voiding
- hesitancy, poor stream, straining, incomplete emptying, terminal dribbling

Storage (FUNI)
- Frequency, Urgency, Nocturne, Incontinence

Post-micturition
- post-micturition dribbling
- sensation of incomplete emptying

24
Q

Lower urinary tract symptoms ix

A

Ix
- urinalysis
- DRE
- PSA test
- urinary frequency-volume chart
- International Prostate Symptom Score (IPSS): classifies severity

25
predominantly Voiding LUTS symptoms
pelvic floor muscle training, bladder training, prudent fluid intake and containment products tx as BPH
26
Predominately overactive bladder
conservative - moderating fluid intake bladder retraining antimuscarinic drugs : oxybutynin (immediate release), tolterodine (immediate release), or darifenacin (once daily preparation) mirabegron - if first-line drugs fail
27
Nocturne mx
moderating fluid intake at night furosemide 40mg in late afternoon desmopressin
28
Post prostatectomy syndrome/ complications
haemorrhage, urosepsis, retrograde ejaculation and electrolyte disturbances from the irrigation fluids used during surgery.
29
Causes of priapism
ischemic - impaired vasorelaxation -> reduced vascular outflow -> congestion and trapping of de-oxygenated blood within the corpus cavernosa Non-ischaemic priapism -> high arterial inflow (due to fistula formation <- congenital or traumatic mechanisms) (more likely to be non-painful & not fully rigid) idiopathic, sickle cell disease, haemoglobinopathies, medication (esp Erectile dysfunction meds), recreational ( cocaine, cannabis and ecstasy), trauma
30
Ischaemic priapism ix & mx
ix - Cavernosal blood gas analysis (Po2 & pH reduced, increased pCO2) - Doppler or duplex ultrasonography - FBC & toxicology - Dx: mostly clinical, Ix helps classify into 2 types Mx Ischemic: - a medical emergency! otherwise, long term ED - >4hrs- aspirate blood from cavernous & Inject saline flush. - if failed -> intracavernosal injection of a vasoconstrictive agent (phenylephrine), repeated at 5 min intervals - -> surgical options non-ischemia priapism- not emergency & suitable for observation
31
prostate ca ix
DIgital recital examination -> asymmetrical, hard, nodular enlargement with loss of median sulcus prostate specific antigen measurement (age dependent but >3 in 50-69, or >5 if older) Multiparametric MRI - 1st line ix for ppl w people with suspected clinically localised prostate cancer (due to biopsy complications) Trans rectal USS (+/- biopsy) MRI/ CT & bone scan for staging Graded using Gleason grading system - based on histology (95% adenocarcinoma)
32
First lympathics that prostatic ca spreads to? & first place of distant spread?
Lymphatic spread - obturator nodes local extra prostatic speed to seminal vesicles
33
Prostatic ca tx
Watch & wait - elderly, lots of co-morbities, low Gleason score <- NICE recommend active surveillance for low risk men! (T1/2) - need at least 10 biopsy & one re-biopsy. If evidence of disease progression (T3/4) -> medical treatment !! Radiotherapy - either External or Internal (brachytherapy) (SE: proctitis, bladder/colon/rectal ca) Surgery - radical prostatectomy & obturator node removal (usually robotic) Hormonal therapy - 95% of ca is testosterone dependent. so injections/ bilateral orchidectomy- rapid reduction/ GNRH agonists (goserelin) & anti androgens to cover initial T rise/ bicalutamide (non-steroidal anti-androgen. Blocks androgen receptor) Chemotherapy - docetaxel
34
Prostate ca RFs
increasing age obesity Afro-Caribbean ethnicity family history
35
PSA levels rise due to
prostate ca (poor specificity & sensitivity) BPH prostatitis & UTI (postpone till 1mo after tx) ejaculation (last 48hrs) vigorous exercise (last 48hrs) urinary retention instrumentation of urinary tract
36
Renal cell carcinoma pathology
a.k.a hypernephroma 85% of renal neoplasms arises from proximal renal tubular epithelium most common histological subtype-> clear cell carcinoma (75-85%) haematogenous metastasis
37
renal cell carcinoma associations
middle-aged men smoking von Hippel-Lindau syndrome Tuberous sclerosis ADPKD (only slight increase)
38
Px of renal cell carcinoma
triad: haematuria, loin pain, abdo mass pyrexia of unknown origin endocrine effects (epo-> polycythemia, parathyroid related protein-> hypercalcaemia, renin, ACTH, hypertension) Stauffer sundrome - paraneoplastic hepatic dysfunction syndrome - cholestasis & hepatosplenomegaly left sided varicocele (compression of the renal vein between AA & SMA - nutcracker angle)
39
Tumour staging for RCC
T1 - =<7cm & confined to kidney T2 - >7cm & only kidney T3 - extending into major veins/ perinephric tissue. But not T4 T4 - beyond Gerota's fascia, ipsilateral adrenal gland
40
RCC mx
confined disease - partial or total nephrectomy T1 (<7cm) - offered partial nephrectomy alpha-interferon, interleukin-2, receptor tyrosine kinase inhibitors (e.g. sorafenib, sunitinib) -> reduce tumour size
41
Nephroblastom vs Neuroblastoma
nephro- most common genitourinary malignancies in under 15 Neuro - neural crest origin- 50% in adrenal gland. mostly under 4yrs. most common extra cranial tumour of childhood.
42
Transitional cell carcinoma mx
Radical nephroureterectomy
43
Angiomyolipoma?
benign kidney tumour hamartoma type lesion - composed of blood vessels, smooth muscle and fat 80% sporadically, 20% w tuberous sclerosis
44
types of renal stones?
calcium oxalate - most common, radio-opaque Cystine- inherited recessive disorder of transmembrane cystine transport, radio-opaque uric acid - radiolucent, low urinary pH (acid), diseases w increased tissue breakdown- malignancy, children with inborn errors of metabolism Calcium phosphate - renal tubular acidosis 1 & 3, normal/high urinary pH, radio-opaque struvite - magnesium, ammonium and phosphate, urease producing bacteria, chronic infections, high urine pH (alk), Slightly radio-opaque
45
Renal & ureteric stone mx
Pain mx - NSAID: IM diclofenac (careful of increased risk of CV events) --> IV paracetamol Renal stone - <5mm & asymptomatic - watchful waiting. will pass in 4 weeks. - 5-10mm - shockwave lithotripsy - 10-20mm shockwave lithotripsy OR ureteroscopy - > 20mm percutaneous nephrolithotomy Ureteric stones - < 10mm - shockwave lithotripsy +/- alpha blockers - 10-20 mm ureteroscopy obstructive urinary calculi & signs of infection -> urgent renal decompression (nephrology time/ureteric catheter/ ureteric stent) & IV antibiotics if pregnant -> lithotripsy is contraindicated, rather ureteroscope
46
Prevention of renal stones
Calcium stones (likely due to hypercalciuria) - high fluid intake - add lemon juice to drinking water - avoid carbonated drinks - potassium citrate - thiazide diuretics (increase distal tubular calcium resorption) Oxalate stones - cholestyramine reduces urinary oxalate secretion - pyridoxine reduces urinary oxalate secretion Uric acid stones - allopurinol for gout - urinary alkalinization e.g. oral bicarbonate
47
types of testicular ca
95% are germ-cell tumours which are divided into: seminomas non-seminomas: including embryonal, yolk sac, teratoma and choriocarcinoma Non-germ cell tumours include Leydig cell tumours and sarcomas.
48
Testicular tumor markers
seminomas: beta-HCG elevated in 20%, AFP normal non-seminomas: AFP and/or beta-hCG are elevated in 80-85% (non seminoma = embryonal, yolk sac, teratoma and choriocarcinoma)
49
testicular ca ix & mx
Dx - USS is first line - tumor markers Mx - depends on if tumor is seminoma or non-seminoma - orchidectomy - chemotherapy and radiotherapy
50
Risk factors for testicular cancer
Cryptorchidism Infertility Family history Klinefelter's syndrome Mumps orchitis
51

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