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Urology Flashcards

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1
Q

What is obstructive uropathy

A

blockage preventing urine flow through the ureters, bladder and urethra

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2
Q

swelling of the kidney

A

hydronephrosis

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3
Q

presentation of upper urinary tract obstruction

A
  • loin to groin/ flank pain on the affected side
  • Reduced or no urine output
  • vomiting
  • Impaired renal function
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4
Q

presentation of lower urinary tract obstruction

A
  • Difficulty or inability to pass urine (e.g., poor flow, difficulty initiating urination or terminal dribbling)
  • Urinary retention
  • Impaired renal function
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5
Q

how to diagnose obstructive uropathy

A

USS KUB

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6
Q

causes of upper urinary obstruction

A
  • Kidney stones
  • Tumours pressing on the ureters
  • Ureter strictures (due to scar tissue narrowing the tube)
  • Retroperitoneal fibrosis (the development of scar tissue in the retroperitoneal space)
  • Bladder cancer
  • Ureterocele (ballooning of the most distal portion of the ureter – this is usually congenital)
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7
Q

Causes of lower urinary tract obstruction

A
  • BPH
  • Prostate cancer
  • Bladder cancer
  • Urethral strictures (due to scar tissue)
  • Neurogenic bladder
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8
Q

what is neurogenic bladder

A

abnormal function of the nerves innervating the bladder and urethra = overactivity or underactivity in the detrusor muscle of the bladder and the sphincter muscles of the urethra

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9
Q

causes of neurogenic bladder

A
  • MS
  • diabetes
  • stroke
  • parkinson’s
  • brain/spinal chord injury
  • spina bifida
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10
Q

issues related to beurogenic bladder

A
  • urge incontinence
  • increased pressure
  • obstructive uropathy
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11
Q

Mx of obstructive uropathy

A

remove or bypass obstruction
- nephrostomy: drain urine out of body (UUTO)
- urethral/suprapubic catheter (LUTO)

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12
Q

complications of obstructive uropathy

A
  • Pain
  • AKI
  • CKD
  • Infection (from bacteria tracking up urinary tract into areas of stagnated urine)
  • Hydronephrosis
  • Urinary retention and bladder distention
  • Overflow incontinence of urine
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13
Q

Mx of hydronephrosis

A

treat cause
- percutaneous nephrostomy
- antegrade ureteric stent

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14
Q

reasons for a catheter

A
  • Urinary retention
  • Neurogenic bladder
  • Surgery
  • Output monitoring in acutely unwell patients (e.g., sepsis or intensive care)
  • Bladder irrigation (e.g., to wash out blood clots in the bladder)
  • Delivery of medications (chemotherapy to treat bladder cancer)
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15
Q

types of catheter and use

A
  • Intermittent catheters: simple catheters used to drain urine, then immediately removed
  • Foley catheter (two-way catheter): “standard” catheter with an inflatable balloon to hold it in place
  • Coudé tip catheter: has a curved tip to help navigate it past an obstruction during insertion
  • Three-way catheter: has three tubes used for inflating the balloon, injecting irrigation and drainage
  • suprapubic catheter: through abdomen into bladder
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16
Q

define BPH

A
  • enlarged prostate due to hyperplasia of stromal and epithelial cells of the prostate
  • very common in older men
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17
Q

presentation of BPH

A
  • hesitancy
  • weak flow
  • urgency
  • nocturia
  • intermittency
  • straining
  • terminal dribbling
  • incomplete emptying
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18
Q

how to assess BPH

A
  • DRE
  • abdo exam
  • urinary frequency volume chart
  • urine dipstick
  • PSA
    Use international prostate symptom scoring system
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19
Q

Causes of a raised PSA

A
  • Prostate cancer
  • BPH
  • Prostatitis
  • UTI
  • Vigorous exercise (notably cycling)
  • Recent ejaculation or prostate stimulation
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20
Q

Mx of BPH

A

MEDICAL
- alpha blocker (tamsulosin) relax smooth muscle
- 5-alpha reductase inhibitors (finasteride): reduce prostate size
can take up to 6 months to reduce prostate size.

SURGICAL
- TURP
- transurethral electrovaporisation of the prostate (TEVAP/TUVP)
- holium laser enucleation of the prostate (HoLEP)
- open prostatectomy

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21
Q

side effect of tamsulosin

A

postural hypotension

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22
Q

side effect of finasteride

A

sexual dysfunction due to reduced testosterone

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23
Q

complication of TURP

A
  • bleeding
  • infection
  • Urinary incontinence
  • Erectile dysfunction
  • Retrograde ejaculation
  • Urethral strictures
  • Failure to resolve symptoms
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24
Q

define prostatitis

A

inflammation of the prostate
- acute bacterial: rapid
- chronic: >3months sx

chronic can be subdivided into chronic or chronic bacterial

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25
presentation of chronic prostatitis
> 3months: - pelvic pain - Lower urinary tract sx - sexual dysfunction - pain with bowel movements - tender/enlarged prostate
26
presentation of acute prostatitis
chronic sx + - fever - myalgia - nausea - fatigue - sepsis
27
Ix for prostatitis
- urine dipstick - Urine MC&S - chlamydia and gonorrhoea NAAT test - DRE
28
Mx of prostatitis
acute - admission if unwell - oral abx (cipro or trimethoprim for 2-4 weeks) - analgesia - laxatives chronic - Alpha-blockers relax smooth muscle - Analgesia - Psychological treatment, where indicated - Abx if < 6 months of sx or hx of infection (e.g., trimethoprim or doxycycline for 4-6 weeks) - Laxatives
29
complications of acute prostatitis
- sepsis - prostate abscess - acute urinary retention - chronic prostatitis
30
most common cancer in men
prostate
31
where does advanced prostate cancer spread to
lymph nodes and bones
32
what is prostate cancer dependent on
androgens (testosterone)
33
most common type of prostate cancer
adenocarcinoma in the peripheral zone
34
RFs for prostate cancer
- Increasing age - Family history - Black African or Caribbean origin - Tall stature - Anabolic steroids
35
presentation of prostate cancer
asymptomatic or lower urinary tract sx - hesitancy - frequency - weak flow - terminal dribbling - nocturia - haematuria - erectile dysfunction - FLAWS for advanced
36
what is the function of PSA
secreted in semen to stop ejaculate from clotting
37
Ix for prostate cancer
- PSA - DRE - multiparametric MRI (1st line) - prostate biopsy (if MRI says could be cancer) TRUS or trasnperineal - isotope bone scan for mets - Gleason Grading based on histology from biopsy
38
what is gleason grading
grade tissues 1-5 add 2 scores: - most prevalent histology pattern and second most 6= low risk 7= intermediate 8= high risk
39
staging for Prostate cancer
TNM
40
Mx of prostate cancer
MDT - Surveillance or watchful waiting in early prostate cancer - External beam radiotherapy directed at the prostate - Brachytherapy - Hormone therapy - Surgery
41
side effect of external beam radiotherapy
proctitis (inflammation of the rectum) bladder, colon, rectal cancer
42
what is epididymo-orchitis
inflammation of the epididymis and testicle usually on one side
43
function of the epididymis
store sperm whilst they mature
44
causes of epididymo-orchitis
- E coli - chlamydia trachomatis - neisseria gonorrhoea - mumps
45
presentation of epididymo-orchitis
gradual onset, over minutes to hours, with unilateral: - 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
46
key differential for epididymo-orchitis
testicular torsion
47
Ix for epididymo-orchitis
- urine MC&S - Chlamydia and gonorrhoea NAAT testing - Charcoal swab of purulent urethral discharge for gonorrhoea culture and sensitivities - Saliva swab for mumps - Serum antibodies for mumps (IgM – acute infection, IgG – previous infection or vaccination) - Ultrasound may be used to assess for torsion or tumours need to distinguish whether E coli or STI cause
48
Mx of epididymo-orchitis
very unwell = IV abx E-coli: - ofloxacin 14 days - Levofloxacin 10 days - Co-amoxiclav 10 days STI - IM ceftriaxone - doxycycline - ofloxacin
49
complications of epidiymo-orchitis
chronic pain chronic epididmitis testicular atrophy sub-fertility/infertility scrotal abscess
50
define testicular torsion
twisting of the spermatic cord with rotation of the testicle EMERGENCY
51
Presentation of testicular torsion
- acute rapid onset of unilateral testicular pain - abdo pain - vomiting - firm swollen testicle - elevated testicle - absent cremasteric reflex - horizontal testicle - rotation of testicle
52
A cause of testicular torsion
Bell Clapper deformity
53
Mx of testicular torsion
NBM analgesia surgical exploration orchioplexy or orchidectomy
54
USS sign in testicular torsion
whirlpool sign
55
causes of scrotal or testicular lumps
- testicular cancer - hydrocele - varicocele - epididymal cyst - Epididymo-orchitis - Inguinal hernia - Testicular torsion
56
what is a hydrocele
collection of fluid within the tunica vaginalis that surrounds the testes
57
presentation of hydrocele
- painless - soft scrotal swelling - TRANSILLUMINATES - testicle palpable - irreducible and no bowel sounds
58
causes of hydrocele
- idiopathic - Testicular cancer - Testicular torsion - Epididymo-orchitis - Trauma
59
Mx of hydrocele
conservative surgery/aspiration in large cases
60
define varicocele
Veins in the pampiniform plexus become swollen. most commonly left side
61
Side effect of varicocele
- infertility - testicular atrophy
62
presentation of varicocele
- Throbbing/dull pain or discomfort, worse on standing - A dragging sensation - Sub-fertility or infertility - "bag of worms" scrotum - prominent on standing, disappears lying down - asymmetry in testicular size
63
concerning signs of varicocele
do not disappear on lying down suggests retroperitoneal tumours urgent referral
64
Mx of varicocele
conservative surgery if painful, testicular atrophy or infertile
65
what is an epididymal cyst
fluid filled sac at the head of the epididymis if it contains sperm = spermatocele
66
presentation of 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
67
Mx of epididymal cyst
harmless- conservative removed if painful
68
what is testicular cancer
arises from the germ cells in the testes (produce sperm) incidence 15-35yrs
69
types of testicular cancer
seminomas non-seminomas (mostly teratomas)
70
what is a teratoma
germ cell tumour that often contains different types of tissue, including cartilage and epithelium can have teeth and hair
71
RFs for testicular cancer
- undescended testes - male infertility - FH - tall
72
presentation of testicular cancer
- painless lump on testicle - hard - irregular - non fluctuant - no transillumination - rarely gynaecomastia (leydig cell tumour)
73
Ix for testicular cancer
Scrotal USS AFP B-hCG LDH Staging CT
74
What staging criteria is used for testicular cancer
Royal Marsden staging system
75
common sites of testicular cancer metastasis
- lungs - lymphatics - liver - brain
76
Mx of testicular cancer
MDT - surgery - chemo - radiotherapy - sperm banking
77
long term side effects of treatment for testicular cancer
- Infertility - Hypogonadism (testosterone replacement may be required) - Peripheral neuropathy - Hearing loss - Lasting kidney, liver or heart damage - Increased risk of cancer in the future
78
prognosis of testicular cancer
- early- 90% cure rate - metastatic often curable - seminomas better prognosis than non-seminomas
79
what is a LUTI
infection in the bladder
80
causes of UTI
E coli klebsiella pneumoniae enterococcus pseudomons aeruginosa staph saprophyticus candida albicans
81
presentation of LUTI
- Dysuria - Suprapubic pain/discomfort - Frequency - Urgency - Incontinence - Haematuria - Cloudy or foul smelling urine - Confusion is common in older and frail patients
82
Mx of LUTI
trimethoprim nitrofurantoin (not in GFR <45) 3 days simple 5-10 days immunosuppressed 7 days- men, pregnant, catheter
83
Mx of LUTI in pregnancy
- nitrofurantoin (avoid in third trimester neonatal haemolysis) - cefalexin - trimethoprim avoidede generally due to risk of neural tube defects in first trimester
84
what is pyelonephritis
inflammation of the kidney resulting from bacterial infection
85
RFs for pyelonephritis
- female - structural urological abnormalities - Vesico-ureteric reflux - Diabetes
86
causes of pyelonephritis
- e coli - Klebsiella pneumoniae - Enterococcus - Pseudomonas aeruginosa - Staphy saprophyticus - Candida albicans
87
presentation of pyelonephritis
LUTI sx + - fever - loin/back pain - N&V - renal angle tenderness
88
Ix for pyelonephritis
- urine dipstick - MSU - Bloods (WCC, CRP) - USS or CT
89
Mx of pyelonephritis
7-10 days of cefalexin
90
what is chronic pyelonephritis
recurrent episodes of infection in the kidneys lead to CKD and ESRF Can do DMSA scan
91
what is interstitial cystitis
chronic condition causing inflammation in the bladder, resulting in lower urinary tract symptoms and suprapubic pain
92
Presentation of interstitial cystitis
similar to LUTI. At least 6 weeks of: - Suprapubic pain, worse with a full bladder and often relieved by emptying the bladder - Frequency - Urgency - Symptoms may be worse during menstruation
93
Ix of cystitis
Need to exclude other causes: - urinalysis - swabs - cystoscopy: see Hunner lesions and granulations - prostate exam
94
Mx of interstitial cystitis
supportive oral: - analgesia, antihistamine, contraceptive intravesical medication: - lidocaine,hyaluronic acid surgery: cauterise hunner lesions, botox
95
what is bladder cancer
cancer in the bladder arises from the endothelial lining majority are superficial at presentation
96
RFs for bladder cancer
- smoking - increased age aromatic amines (dye/rubber industries) (transitional cell) schistosomiasis (SCC)
97
types of bladder cancer
- transitional cell carcinoma (90%) - squamous cell carcinoma (5%) - adenocarcinoma (2%) - sarcoma - small cell carcinoma
98
presentation of bladder cancer
painless haematuria
99
Ix bladder cancer
flexible cystoscopy
100
staging for bladder cancer
TNM - non-muscle invading BC (Tis-T1) - muscle invasive BC (T2-T4)
101
Mx of bladder cancer
- transurethral resection of bladder tumour (early stage) - intravesical chemo - intravesical BCG - radical cystectomy (need a urostomy after) - chemo and radiotherapy
102
what are renal stones
renal calculi, urolithiasis and nephrolithiasis hard stones that form in the renal pelvis, where the urine collects before travelling down the ureters
103
where to stones commonly get stuck
vesico-ureteric junction
104
complications of kidney stones
- obstruction -->AKI - infection with obstructive pyelonephritis
105
types of kidney stones
Calcium - calcium oxalate (MC) - calcium phosphate Other - uric acid - struvite (staghorn) - cystine (inherited)
106
what is a staghorn calculus
stone forms in the shape of the renal pelvis
107
presentation of renal stones
- renal colic: unilateral loin to groin pain, colicky - haematuria - N&V - reduced urine output - sx of sepsis if infection
108
Ix of kidney stones
- urine dipstick - blood tests - Xray - Non contrast CT KUB - USS KUB
109
Mx of kidney stones
- Analgesia (NSAID IM diclofenac) - antiemetic - Abx if infection - watchful waiting <5mm - tamsulosin (muscle relax to help passage) - 5-10mm shockwave lithotripsy - surgery >10mm, or if infection
110
surgical mx for kidney stones
- Extracorporeal shock wave lithotripsy (ESWL): shock externally - Ureteroscopy and laser lithotripsy: camera inserted and then use laser - percutaneous nephrolithotomy (PCNL): camera through pt back and break stones up - open surgery
111
How to prevent future stones
- increase fluids - add lemon juice to water - avoid fizzy drinks - reduce salt - normal calcium intake
112
medications to prevent recurrence of kidney stones
- potassium citrate: calcium oxalate stones - thiazide diuretics: calcium oxalate stones
113
what is renal cell carcinoma
most common type of kidney tumour adenocarcinoma from renal tubules
114
triad presentation of RCC
- haematuria - flank pain - palpable mass (FLAWS)
115
types of RCC
- clear cell (80%) - papillary (15%) - chromophobe (5%) - Wilm's tumour in children <5yrs
116
RFs for RCC
- smoking - obesity - hypertension - ESRF - Von Hippel-Lindau Disease - Tuberous sclerosis
117
where does RCC spread to?
- tissues around the kidney within the Gerota's fascia - cannonball metastasis
118
which paraneoplastic syndromes is RCC associated with?
- polycythaemia - hypercalcaemia - hypertension - Stauffer's syndrome
119
Staging of RCC
CT thorax, abdo, pelvis - Stage 1: < 7cm + confined to the kidney - Stage 2: > 7cm + confined to the kidney - Stage 3: Local spread to nearby tissues or veins, but not beyond Gerota’s fascia - Stage 4: Spread beyond Gerota’s fascia, including metastasis
120
Mx of RCC
Surgery - partial nephrectomy - radical nephrectomy Non-surgical - arterial embolisation - percutaneous cryotherapy - radiofrequency. ablation
121
what is a renal transplant
a kidney is transplanted into a patient with end-stage renal failure adds 10 yrs to life compared to dialysis
122
how is the donor kidney transplanted
- donor kidney blood vessels are connected (anastomosed) with the pelvic vessels, usually the external iliac vessels - ureter of the donor kidney is anastomosed directly with the bladder. - placed anteriorly in the abdomen, “hockey stick” incision
123
immunosuppressants needed after renal transplant
Tacrolimus Mycophenolate Ciclosporin Azathioprine Prednisolone
124
side effects of immunosuppressants
- Immunosuppressants cause seborrhoeic warts and skin cancers (look for scars from skin cancer removal) - Tacrolimus causes a tremor - Cyclosporine causes gum hypertrophy - Steroids cause features of Cushing’s syndrome
125
Complications of renal transplant
- Transplant rejection (hyperacute, acute or chronic) - Transplant failure - Electrolyte imbalances
126
complications related to immunosuppressants
- Ischaemic heart disease - Type 2 diabetes (steroids) - Infections are more likely, more severe and may involve unusual pathogens - Non-Hodgkin lymphoma - Skin cancer (particularly squamous cell carcinoma)
127
Infections secondary to immunosuppressant meds
- Pneumocystis jiroveci pneumonia (PCP/PJP) - Cytomegalovirus (CMV) - Tuberculosis (TB)
128
Cause of phimosis
- Balanitis Xerotica Obliterans (lichen sclerosis

Finals (26 decks)

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