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Urology Flashcards

(75 cards)

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1
Q

What are Lower Urinary Tract Symptoms?

A

Storage (irritative):
frequency
urgency
nocturia
incontinence

Voiding (obstructive):
hesitancy
poor stream
straining
terminal dribbling
incomplete emptying

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2
Q

Investigations for LUTS?

A

International Prostate Symptom Scale
Bladder diary
Uroflowmetry

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3
Q

Causes of polyuria?

A

primary polydipsia
cranial diabetes insipidus
nephrogenic diabetes insipidus
T1DM
T2DM

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4
Q

What does uroflowmetry measure?

A

the volume of urine released
the speed at which it is released
how long the release takes
the post-residual volume

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5
Q

What is a normal post-residual volume?

A

<50ml is normal
<100ml usually acceptable in patients >65

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6
Q

What is urinary incontinence?

A

the involuntary leakage of urine

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7
Q

Types of urinary incontinence?

A

stress incontinence
urge incontinence
mixed incontinence
overflow incontinence
functional incontinence
anatomical (fistula, ectopic ureter)

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8
Q

Investigations for urinary incontinence?

A

U&Es
MSSU -> culture & sensitivity
urinalysis
flow studies
bladder diary
US bladder
cystoscopy
urodynamic studies

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9
Q

What is stress incontinence?

A

involuntary leakage of urine in the presence of raised intra-abdominal pressure and in the absence of detrusor activity

caused by intrinsic sphincter deficiency

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10
Q

Mx of stress incontinence?

A

conservative:
weight loss, caffeine reduction, pelvic floor exercises, medication review
medical:
duloxetine, topical oestrogen can help in post-menopausal women
surgical:
urethral bulking agents, no sling/suspension

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11
Q

What is urge incontinence?

A

involuntary loss of urine associated with urgency due to overactivity of the detrusor muscle, aka overactive bladder

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12
Q

Mx of urge incontinence?

A

conservative:
lifestyle, red. caffeine, alcohol, bladder retraining
medical:
anticholinergics, beta-3 adrenergic agonist (mirabegron)
surgical:
intra-vesical Botox, neuromodulation, CLAM ileocystoplasty, diversion procedures

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13
Q

Mx of mixed incontinence?

A

discover which form of incontinence is affecting the patient more and treat this

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14
Q

Mx of overflow incontinence?

A

usually due to urinary retention
catherisation

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15
Q

Causes of temporary incontinence?

A

DIAPPERS
Delirium
Infection
Atrophic Vaginitis
Pharmaceuticals (diuretics, opiates, anticholinergics)
psychological issues
excess fluid
reduced mobility
stool (constipation)

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16
Q

Risk Factors for urinary incontinence?

A

female
Caucasian
childbirth
vaginal birth
multiparity
multiple pregnancy
traumatic or prolonged delivery
pelvic surgery
radiotherapy
neurological diseases
incr. age

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17
Q

Morbidity associated with urinary incontinence?

A

decreased QOL
sexual dysfunction
perineal infections
incr. risk of falls
psychological
incr. caregiver burden

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18
Q

What is benign prostatic hyperplasia?

A

a benign proliferation of the smooth muscles and the epithelial cells within the transition zone of the prostate

cause unknown but testosterone believed to play a role

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19
Q

Epidemiology of BPH?

A

extremely common
50% in 50yrs
80% in 80yrs
25% require treatment

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20
Q

Presentation of BPH?

A

asymptomatic (incidental finding)
voiding symptoms (obstructive LUTS)
decreased urine flow rate
outflow obstruction
acute urinary retention
haematuria
hydronephrosis and renal compromise
UTIs

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21
Q

Investigations for BPH?

A

Hx
DRE
urinalysis + U&Es
PSA
renal US (hydronephrosis)
cystoscopy (bladder disease)
uroflowmetry

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22
Q

Mx of BPH?

A

conservative:
watchful waiting
lifestyle changes (caffeine, evening fluids)
medical:
alpha antagonists (tamsulosin)
5 alpha reductase inhibitors (finasteride)
+ anticholinergics
surgical:
TURP
laser prostatectomy
simple prostatectomy

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23
Q

What is haematuria?

A

the presence of blood in the urine
can be microscopic or macroscopic

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24
Q

Causes of transient haematuria?

A

vigorous exercise
sexual intercourse
menstruation

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25
DDx for haematuria?
kidney: trauma pyelonephritis/renal TB RCC renal calculi infarction glomerulonephritis/ IgA nephropathy HSP ureter: calculus tumour bladder: trauma cystitis calculus tumour schistosomiasis urethra: trauma calculus carcinoma stricture urethritis prostate: ca prostatitis BPH bleeding disorders anticoagulation transient haemolysis rhabdomyolysis
26
Investigations for haematuria?
urinalysis (normal + early morning MSU for renal TB and Schistosoma eggs) bloods (FBC, coag, ESR, blood film) biochemistry (U&Es, serum Ca, LFTs, CPK, PSA) imaging (CXR, CT KUB, renal US, CT scan, cystoscopy, ureteroscopy, renal biopsy)
27
When to refer to urology in cases of haemturia?
all macroscopic all symptomatic microscopic all microscopic in patients > 40, <40 refer to renal all persistent asymptomatic
28
Reasons to admit to hospital in haematuria?
clot retention anaemia shock
29
What is visible haematuria until proven otherwise?
bladder cancer
30
Types of bladder cancer?
transitional cell cancer 90% SCC 4% adenocarcinomas 2%
31
RFs for bladder cancer?
male incr. age Caucasians smoking (TCC) aromatic hydrocarbons (TCC) chronic inflammation (SCC) schistosomiasis EGYPT (SCC) cyclophosphamide exposure to other carcinogens Hx of pelvic radiotherapy
32
Presentation of bladder cancer?
visible painless haematuria (bladder ca until proven otherwise) storage-related LUTS anaemia
33
Staging of bladder cancer?
TNM non-muscle invading (CIS, Ta, T1) muscle-invasive (T2-T4)
34
Mx of bladder cancer?
Non-muscle invasive: TURBT single dose intravesical chemo follow-up TURBT after 6wks long-term cystoscopy follow up intravesical BCG to reduce recurrence risk Muscle-invasive: radical cystectomy urinary diversion metastatic disease -> radical radiotherapy chemotherapy with platinum-based
35
Prognosis of bladder cancer?
low-grade superficial lesions - 90% 5yr SR invasive/high-grade lesions - 50% 5yr SR
36
Risk Factors for prostate cancer?
age African ethnicity more common in Scandinavian diet (animal fat) obesity genetic endocrine (testosterone) nationality (less common in Japan)
37
Staging and grading of prostate cancer?
Staging - TNM grading - Gleason score
38
Presentation of prostate ca?
most asymptomatic (incidental finding) LUTS due to outflow obstruction acute urinary retention more advanced disease -> ureteric obstruction or bony mets
39
Investigations for prostate ca?
Bloods (FBC, coag, U&E, LFTs) PSA DRE (firm irregular prostate) MRI TRUS isotope bone scan for bony mets (sclerotic lesions) CXR and CT TAP for mets
40
Causes of raised PSA?
UTIs ejaculation cycling recent urology procedures including DRE BPH prostate ca
41
Mx of prostate cancer?
local stage T1 and T2: radical prostatectomy radical radiotherapy brachytherapy active surveillance watchful waiting if life expectancy <10yrs locally advance (T3 and T4): radical prostatectomy radical radiotherapy androgen deprivation therapy metastatic disease: androgen deprivation therapy
42
Prognosis of prostate cancer?
localised tumour 80% 5yr SR local spread 40% 5yr SR mets 20% 5yr SR
43
What is RCC?
renal cell carcinoma is a kidney cancer that originates in the lining of the proximal convoluted tubule clear cell most common type most lethal urological cancer
44
RFs for RCC?
smoking obesity radiation cadmium exposure leather industry FHx in von-Hippel-Lindau syndrome
45
Presentation of RCC?
most commonly asymptomatic classic triad: macroscopic haematuria flank pain palpable mass paraneoplastic syndromes (haem, endo, hepatic cell dysfunction) mets (B, B, L, L)
46
Investigations for RCC?
Bloods (FBC, ESR, U&Es, LFTs, coag, LDH, Ca) renal US CT (staging and planning sz)
47
Staging of RCC?
Stage 1 - cancer <7cm stage 2 - cancer >7cm Stage 3 - cancer expanded into veins or adrenal gland Stage 4 - ca cells in more than one LN
48
Mx of RCC?
Sx management primarily, RCC usually resistant to chemorads Sx: radical nephrectomy partial nephrectomy minimally invasive: radiofrequency ablation microwave cryoablation observation may be suitable for small asymptomatic in patients with limited life expectancy mets -> tyrosine kinase inhibitors +/- cytoreductive nephrectomy if good response
49
Prognosis of RCC?
T1 - 70-94% T2 - 50-75% T3 - 22-70% T4 - 5%
50
First-line investigation in suspected prostate ca?
multiparametric MRI had replaced TURS
51
Times to wait before checking PSA?
prostate biopsy - 2 months prostatitis - 1 month ejaculation or vigorous exercise - 48hrs
52
Types of testicular cancer?
90% GCT seminomas: classical anaplastic spermatocytic non-seminomas: teratoma embryonal yolk sac choriocarcinoma
53
Presentation of testicular cancer?
painless lump pain in 5% features of mets (weight loss, lymphadenopathy, abdo pain)
54
DDx for testicular lump?
testicular cancer hydrocele epididymal cyst indirect inguinal hernia
55
Investigations for testicular ca?
scrotal US serum tumour markers (LDH, AFP, bhCG) CT TAP
56
Mx of testicular ca?
Sx is the mainstay -> radical inguinal orchidectomy + Stage 1 -> adjuvant platinum chemo Stage 2 -> adjuvant chemo + retroperitoneal LN dissection
57
Prognosis for testicular ca?
generally v good >90% SR for stage 1 >60% for stage 4
58
Which testicular cancers are particularly sensitive to chemorads?
chemotherapy -> teratomas radiotherapy -> seminomas
59
Tumour markers in testicular cancer?
LDH - raised in both HCG - raised in non-seminomas, sometimes in seminomas AFP - raised in non-seminomas only
60
Types of penile cancer?
SCC 95% Kaposi's sarcoma BCC melanoma
61
RFs for penile cancer?
pre-malignant lesion foreskin smoking HPV
62
Presentation of penile cancer?
painless lump or ulcer on the distal aspect of penis/glans inguinal mass (nodal disease)
63
Investigations for penile cancer?
bloods biopsy CT TAP MRI penis with artificial erection
64
Mx of penile cancer?
topical treatments (imiquimod, 5-FU) for small and superficial sx -> circumcision to partial penectomy to total penile amputation sentinel lymph node biopsy +/- dissection chemorads in advanced disease
65
What is a hydronephrosis?
dilation of the renal pelvis and calyces, can occur with or without an obstruction
66
Presentation of hydronephrosis?
incidental flank pain anuria renal failure sepsis HTN palpable bladder palpable mass
67
Investigations for hydronephrosis?
U&Es Renal US CT urogram excretory renogram
68
Causes of unilateral hydronephrosis?
obstructing stone blood clot pelviurerteric junction obstruction ureteric TCC bladder TCC extrinsic mass (pregnancy, tumour)
69
Causes of bilateral hydronephrosis?
bladder outlet obstruction BPH urethral stricture posterior urethral valve bilateral ureteric obstruction at bladder level cancer (cervical, prostate, rectal, bladder) adjacent IBD retroperitoneal fibrosis hydronephrosis of pregnancy bilateral PUJO
70
What is acute urinary retention?
inability to pass urine when bladder is full commonly accompanied by suprapubic discomfort/pain, tenderness on palpation and dullness to percussion
71
Predisposing factors to urinary retention?
obstruction post-op post-partum meds (opioids, antimuscarinics) insufficient detrusor muscles trauma neurological impairment
72
Symptoms of urinary retention?
inability to pass urine suprapubic discomfort abdo pain distress, delirium, restlessness overflow incontinence
73
Investigations for urinary retention?
bladder US urinary catherisation (diagnostic + therapeutic) urinalysis bloods urodynamics
74
Mx of urinary retention?
decompression of bladder (needle in emergency, catherisation)
75
Treatment of renal stones?
stone <5mm - expectant stone <2cm - lithotripsy stone <2cm + pregnant - ureteroscopy complex stone - nephrolithotomy hydronephrosis - nephrostomy

Surgery (10 decks)

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