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Urology Flashcards

1
Q

what type of muscle is the internal urethral sphincter and what control is it under?

A

smooth muscle under autonomic control

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2
Q

what type of muscle is the external urethral sphincter and what control is it under?

A

skeletal muscle under voluntary control

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3
Q

what type of acute kidney injury would an obstructive uropathy cause?

A

“post-renal” acute kidney injury (AKI)

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4
Q

what are the presenting features of an upper urinary tract obstruction?

A

Loin to groin or flank pain on the affected side
Reduced or no urine output
Non-specific systemic symptoms e.g. vomiting
Impaired renal function on blood tests (i.e. raised creatinine)

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5
Q

what are the presenting features of a lower urinary tract obstruction?

A

Difficulty or inability to pass urine (e.g., poor flow, difficulty initiating urination or terminal dribbling)
Urinary retention, with an increasingly full bladder
Impaired renal function on blood tests

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6
Q

Name 4 causes of an upper urinary tract obstruction

A

Kidney stones
Tumours pressing on the ureters
Ureter strictures
Retroperitoneal fibrosis
Bladder cancer
Ureterocele

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7
Q

Name 3 causes of a lower urinary tract obstruction

A

Benign prostatic hyperplasia
Prostate cancer
Bladder cancer
Urethral strictures
Neurogenic bladder

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8
Q

State 3 causes of a neurogenic bladder

A

Multiple sclerosis
Diabetes
Stroke
Parkinson’s disease
Brain or spinal cord injury
Spina bifida

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9
Q

what are some complications of an obstructive uropathy?

A

Pain
Acute kidney injury (post-renal)
Chronic kidney disease
Infection
Hydronephrosis
Urinary retention and bladder distention
Overflow incontinence of urine

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10
Q

what is hydronephrosis?

A

swelling of the renal pelvis and calyces in the kidney. This occurs due to obstruction of the urinary tract, leading to back-pressure into the kidneys

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11
Q

state 3 indications for inserting a urinary catheter

A

Urinary retention
Neurogenic bladder
Surgery
Output monitoring
Bladder irrigations
delivery of medications

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12
Q
A
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13
Q

Name 3 types of catheters

A

Intermittent
Foley
Three-way
Suprapubic
Coude tip

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14
Q

how should you manage a UTI in a patient with a catheter?

A

without symptoms = no abx
with symptoms = 7d abx, change catheter as soon as possible

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15
Q

State 5 lower urinary tract symptoms

A

Hesitancy
Weak flow
Urgency
Frequency
Intermittency
Straining to pass urine
Terminal dribbling
Incomplete emptying
Nocturia

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16
Q

what scoring system can be used to assess the severity of lower urinary tract symptoms?

A

international prostate symptom score (IPSS)

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17
Q

what is involved in the initial assessment of men presenting with LUTS?

A

Digital rectal examination
Abdominal examination
Urinary frequency volume chart
Urine dipstick
PSA

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18
Q

what are some common causes of a raised PSA?

A

Prostate cancer
Benign prostatic hyperplasia
Prostatitis
Urinary tract infections
Vigorous exercise (notably cycling)
Recent ejaculation or prostate stimulation

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19
Q

what should a benign prostate feel like?

A

smooth, symmetrical and slightly soft, with a maintained central sulcus

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20
Q

what are the 2 medical options of benign prostatic hyperplasia?

A

Alpha-blockers (e.g., tamsulosin)
5-alpha reductase inhibitors (e.g., finasteride)

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21
Q

what is the main surgical option for benign prostatic hyperplasia?

A

Transurethral resection of the prostate (TURP)

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22
Q

what are the features of chronic prostatitis?

A

at least 3 months of:
pelvic pain
LUTS
Sexual dysfunction
Pain with bowel movements
tender and enlarged prostate

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23
Q

what investigations may be done to investigate prostatitis?

A

Urine dipstick testing
Urine microscopy, culture and sensitivities
Chlamydia and gonorrhoea NAAT testing

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24
Q

what is the management of acute bacterial prostatitis?

A

Hospital admission if systemically unwell
Oral antibiotics
Analgesia
Laxatives

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25
what is the management of chronic prostatitis?
Alpha-blockers analgesia psychological antibiotics (if <6m or history of infection) laxatives
26
what are some complications of acute bacterial prostatitis?
Sepsis Prostate abscess Acute urinary retention Chronic prostatitis
27
what type are the majority of prostate cancers?
adenocarcinomas
28
what are risk factors for prostate cancer?
Increasing age Family history Black African or Caribbean origin Tall stature Anabolic steroids
29
what are some symptoms of prostate cancer?
LUTS e.g. hesitancy, frequency haematuria erectile dysfunction
30
what is the 1st line investigations for suspected localised prostate cancer?
Multiparametric MRI
31
what is used to establish a diagnosis of prostate cancer
Prostate biopsy
32
what grading system is used to guide treatment of prostate cancer?
Gleason grading system
33
what are the management options in prostate cancer?
Surveillance or watchful waiting in early prostate cancer External beam radiotherapy directed at the prostate Brachytherapy Hormone therapy Surgery
34
what is the key complications of external beam radiotherapy in the treatment of prostate cancer?
proctitis (inflammation in the rectum)
35
what are some side effects of hormone therapy in the treatment of prostate cancer?
Hot flushes Sexual dysfunction Gynaecomastia Fatigue Osteoporosis
36
what are some causes of Epididymo-orchitis?
Escherichia coli (E. coli) Chlamydia trachomatis Neisseria gonorrhoea Mumps
37
what are the presenting features of Epididymo-orchitis?
Testicular pain Dragging or heavy sensation Swelling of testicle and epididymis Tenderness on palpation, particularly over epididymis Urethral discharge (should make you think of chlamydia or gonorrhoea) Systemic symptoms such as fever and potentially sepsis
38
what investigations may be done in epididymo-orchitis?
urine MC&S Chlamydia and gonorrhoea NAAT testing charcoal swab or purulent urethral discharge Saliva swab (PCR for mumps) Serum antibodies (for mumps) Ultrasound (assess for torsion or tumours)
39
what are complications of Epididymo-orchitis?
Chronic pain Chronic epididymitis Testicular atrophy Sub-fertility or infertility Scrotal abscess
40
how does testicular torsion present?
acute rapid onset of unilateral testicular pain abdominal pain vomiting
41
what are the examination findings in testicular torsion?
Firm swollen testicle Elevated (retracted) testicle Absent cremasteric reflex Abnormal testicular lie (often horizontal) Rotation, so that epididymis is not in normal posterior position
42
what is a Bell-Clapper deformity?
the fixation between the testicle and the tunica vaginalis is absent
43
what is the management of testicular torsion?
Nil by mouth, in preparation for surgery Analgesia as required Urgent senior urology assessment Surgical exploration of the scrotum Orchiopexy (correcting the position of the testicles and fixing them in place) Orchidectomy (removing the testicle) if the surgery is delayed or there is necrosis
44
state 3 differentials for scrotal lumps
Hydrocele Varicocele Epididymal cyst Testicular cancer Epididymo-orchitis Inguinal hernia Testicular torsion
45
what is a hydrocele?
fluid within the tunica vaginalis
46
what are the examination findings in a hydrocele?
The testicle is palpable within the hydrocele Soft, fluctuant and may be large Irreducible and has no bowel sounds (distinguishing it from a hernia) Transilluminated by shining torch through the skin, into the fluid (the testicle floats within the fluid)
47
what can hydroceles be secondary to?
Testicular cancer Testicular torsion Epididymo-orchitis Trauma
48
what is a varicocele?
veins in the pampiniform plexus become swollen
49
what symptoms may varicoceles present with ?
Throbbing/dull pain or discomfort, worse on standing A dragging sensation Sub-fertility or infertility
50
what are examination findings in a varicocele?
A scrotal mass that feels like a “bag of worms” More prominent on standing Disappears when lying down Asymmetry in testicular size if the varicocele has affected the growth of the testicle
51
what investigations may you consider in a varicocele?
Ultrasound with Doppler imaging can be used to confirm the diagnosis Semen analysis if there are concerns about fertility Hormonal tests (e.g., FSH and testosterone) if there are concerns about function
52
what are the examination findings of an epididymal cyst?
Soft, round lump Typically at the top of the testicle Associated with the epididymis Separate from the testicle May be able to transilluminate large cysts (appearing separate from the testicle)
53
state 3 risk factors for testicular cancer
Undescended testes Male infertility Family history Increased height
54
what are the features of a lump suggesting testicular cancer?
Non-tender (or even reduced sensation) Arising from testicle Hard Irregular Not fluctuant No transillumination
55
what is the usual investigation to confirm a diagnosis of testicular cancer?
Scrotal ultrasound
56
what are the tumour markers for testicular cancer?
Alpha-fetoprotein – may be raised in teratomas (not in pure seminomas) Beta-hCG – may be raised in both teratomas and seminomas Lactate dehydrogenase (LDH) is a very non-specific tumour marker
57
what is the staging system for testicular cancer?
Royal Marsden staging system
58
what are common places for testicular cancer to metastasise to?
Lymphatics Lungs Liver Brain
59
what are the symptoms of a lower urinary tract infection?
Dysuria (pain, stinging or burning when passing urine) Suprapubic pain or discomfort Frequency Urgency Incontinence Haematuria Cloudy or foul smelling urine Confusion is commonly the only symptom in older and frail patients
60
what is the duration of antibiotics for a lower urinary tract infection?
3 days of antibiotics for simple lower urinary tract infections in women 5-10 days of antibiotics for immunosuppressed women, abnormal anatomy or impaired kidney function 7 days of antibiotics for men, pregnant women or catheter-related UTIs
61
state 3 risk factors for pyelonephritis
Female sex Structural urological abnormalities Vesico-ureteric reflux (urine refluxing from the bladder to the ureters – usually in children) Diabetes
62
what are the triad of symptoms of pyelonephritis?
Fever Loin or back pain (bilateral or unilateral) Nausea / vomiting
63
what antibiotics are given in pyelonephritis and for how long?
Cefalexin Co-amoxiclav (if culture results are available) Trimethoprim (if culture results are available) Ciprofloxacin (keep tendon damage and lower seizure threshold in mind) 7-10 days
64
what is the typical presentation of interstitial nephritis?
Suprapubic pain, worse with a full bladder and often relieved by emptying the bladder Frequency of urination Urgency of urination Symptoms may be worse during menstruation
65
what cells of the bladder does bladder cancer arise from?
urothelium
66
state 3 risk factors for bladder cancer
smoking increased age aromatic amines (dye and rubber) schistosomiasis (SCC)
67
what are the main 2 types of bladder cancer?
Transitional cell carcinoma (90%) Squamous cell carcinoma
68
what is the presentation of bladder cancer?
painless haematuria
69
what investigation is done to diagnose bladder cancer?
Cystoscopy
70
what are the management options for bladder cancer?
Transurethral resection of bladder tumour (TURBT) Intravesical chemotherapy Intravesical BCG Radical cystectomy
71
what are the 2 key complications of kidney stones?
Obstruction leading to acute kidney injury Infection with obstructive pyelonephritis
72
what are the most common type of kidney stone?
Calcium oxalate (more common) Calcium phosphate
73
what is a Staghorn calculus ?
stone forms in the shape of the renal pelvis
74
what is the initial investigation of choice for diagnosing kidney stones?
Non-contrast computer tomography (CT) of the kidneys, ureters and bladder (CT KUB)
75
what is the management of kidney stones?
NSAIDs e.g. IM diclofenac Antiemetics antibiotics if infection watchful waiting (if <5mm) Tamsulosin surgical -> Extracorporeal shock wave lithotripsy, Ureteroscopy and laser lithotripsy, Percutaneous nephrolithotomy, open surgery
76
what 2 medications may be given to reduce the risk of kidney stones?
Potassium citrate Thiazide diuretics
77
what is the most common type of kidney tumour?
Renal cell carcinoma (RCC)
78
what is the classic triad of symptoms in renal cell carcinoma?
haematuria, flank pain and a palpable mass
79
what are the 3 most common subtypes of renal cell carcinoma?
Clear cell (around 80%) Papillary (around 15%) Chromophobe (around 5%)
80
state 4 risk factors for renal cell carcinoma
Smoking Obesity Hypertension End-stage renal failure Von Hippel-Lindau Disease Tuberous sclerosis
81
what paraneoplastic features are associated with renal cell carcinoma?
Polycythaemia Hypercalcaemia Hypertension Stauffer's syndrome (abnormal LFT's without liver mets
82
how are patient and donor kidneys matched?
Human leukocyte antigen (HLA) type A, B and C on chromosome 6
83
what are patients given 2 doses of after renal transplant surgery to prevent rejection?
Basiliximab
84
what complications can arise following a kidney transplant?
Transplant rejection (hyperacute, acute or chronic) Transplant failure Electrolyte imbalances

Finals (21 decks)

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