Urology Flashcards

Question

Signs and symptoms of bladder cancer?

Answer 1

Painless visible haematuria Recurrent UTIs Hydronephrosis Neuropathic pain in medial thigh due to obturator nerve invasion Unintended weight loss Night sweats

Answer 2

UTIs Kidney stones BPH Interstitial cystitis

Answer 3

Urine dipstick MCS urine CT urogram Flexible cystoscopy 2WW referral criteria; 45 and over with visible haematuria without UTI or visible haematuria after successful treatment of UTI 60 and over with unexplained non visible haematuria and either dysuria or raised WCC

Answer 4

TNM system

Answer 5

Non muscle invasive bladder cancer' Surgery: Transurethral resection of the bladder tumour (TURBT) is the gold standard. Chemotherapy: The bladder can be instilled with chemotherapeutic agents such as Mitomycin C (single dose if low risk, 6 week course if intermediate risk). Immunotherapy: BCG immunotherapy can be instilled into the bladders of patients with high-risk non-muscle invasive cancers or carcinoma in situ (CIS). If there is high-risk muscle non-muscle invasive cancer/CIS a radical cystectomy may still be considered Muscle invasive bladder cancer; Radical cystectomy with urinary diversion (ileal conduit, neo-bladder, or Mitrofanoff procedure) Radiotherapy, chemotherapy

Answer 6

Consistent long term inability for the bladder to completely evacuate its contents leading to progressive bladder enlargement and may culminate in bladder contraction failure

Answer 7

Detrusor activity causes high pressure chronic retention which increases the risk of renal damage, high blood pressure and upper renal tract damage. Low pressure chronic urinary retention and detrusor inactivity, you have distension of the bladder which does not back up pressure to the kidneys to cause hydronephrosis or reduce renal function.

Answer 8

More common in older men with BPH Increases with age

Answer 9

Benign prostatic hyperplasia (BPH) (most common) Prostate cancer Certain medications such as antihistamines, anticholinergics, or antispasmodics Congenital conditions such as posterior urethral valves

Answer 10

Storage: Frequency Hesitancy Lower abdominal swelling (if the bladder becomes significantly enlarged) Voiding; Urgency Dribbling Poor urinary stream Nocturia Nocturnal enuresis Incontinence

Answer 11

Overactive bladder Bladder stones Urethral stricture Neurogenic bladder

Answer 12

Physical examination, potentially revealing a distended bladder or other physical signs correlating with the underlying cause Urinalysis to detect infection or other abnormalities Blood tests, including renal function tests Bladder ultrasound to estimate post-void residual urine volume Uroflowmetry to measure urine flow rate Cystoscopy for direct visualization of the urethra and bladder Urodynamic studies to assess bladder and sphincter functionality

Answer 13

Post obstructive diuresis CKD Hydronephrosis Bladder diverticula

Answer 14

Alleviating the obstruction, typically achieved via catheterization, surgery, or the use of specific medications. Addressing the underlying cause, which may involve changing medications contributing to urinary retention, managing prostate conditions, or correcting congenital abnormalities. Patients may also require intravenous fluids to manage post-obstructive diuresis.

Answer 15

>200ml/hr for 2 consecutive hours, or or production of >3L of urine in 24 hours.

Answer 16

Epididymo-orchitis is a clinical condition characterized by inflammation of the epididymis and the testicle

Answer 17

More common in sexually active males, especially those aged 19-35 years

Answer 18

STI infection; chlamydia, gonorrhoea UTI; E.coli Mumps Tuberculosis

Answer 19

Testicular swelling and tenderness Fever Dysuria (painful urination) Urethral discharge Prehn’s positive (lifting up testicle relieves pain due to inflammation) Cremasteric reflex is intact (this helps differentiate clinically from torsion)

Answer 20

Testicular torsion Inguinal hernia Testicular cancer

Answer 21

Clinical history and physical examination Urinalysis and urine culture to identify urinary tract infections Sexually transmitted infection screening via nucleic acid amplification tests (NAATs) Urethral swab and gram stain can also be performed. If this reveals an intracellular organism Chlamydia is the likely cause, and if it shows grame negative diplococci this suggests Gonorrhoea. Scrotal ultrasound may be needed to rule out testicular torsion`

Answer 22

Symptomatic management with analgesics for pain relief Scrotal elevation and rest Antibiotics; If it's due to any STI - treat empirically with ceftriaxone 1 g intramuscular (IM) injection as a single dose, plus oral doxycycline 100 mg twice daily for 10–14 days. Referral to sexual health clinic and contact tracing are likely necessary. If most likely due to chlamydia or other non-gonococcal organisms (if no risk factors for gonorrhoea) - treat empirically with oral doxycycline 100 mg twice daily for 10–14 days If an enteric organism (e.g. E.coli), or UTI is the most likely cause - treat with levofloxacin (10 days) or ofloxacin (14 days).

Answer 23

consistent or recurrent inability to attain and/or maintain penile erection sufficient for satisfactory sexual performance.

Answer 24

More common in older men ED is not considered a normal part of aging and can affect men at any age Affects over half the men over 60 years

Answer 25

Vascular disease: Atherosclerosis can lead to impaired blood flow to the penis, leading to ED. Autonomic neuropathy: This can cause penile denervation, most commonly seen in conditions like diabetes or with excessive alcohol intake. Medications: Certain drugs, such as antihypertensive agents, can cause ED. Psychogenic: Anxiety, depression, and other psychological factors can contribute to ED. Endocrine causes: Conditions like prolactinoma and hypogonadism can cause hormonal imbalances leading to ED. Pelvic surgery: Procedures involving the bladder, prostate, or other pelvic structures can damage nerves and blood vessels, leading to ED. Anatomical abnormalities: Conditions like Peyronie's disease, characterized by fibrous scar tissue inside the penis, can cause ED.

Answer 26

Reduced sexual desire Difficulty in ejaculation Anxiety or depression related to sexual performance Signs which suggest an organic cause is more likely - lack tumescence, slow-onset, normal libido. Signs which suggest a psychogenic cause - if situational, high levels of stress, still having early morning erections.

Answer 27

Premature ejaculation Hypogonadism Peyronie's disease

Answer 28

Sexual and psychological history Bloods; FBC, U+E, TFT, lipid profile, testosterone, prolactin

Answer 29

Psychosexual therapy to address any underlying psychological factors. Oral phosphodiesterase inhibitors, such as Sildenafil, to enhance the effect of nitric oxide, increasing blood flow to the penis. Vacuum erection devices to draw blood into the penis by applying negative pressure. Intra-cavernosal injections to directly increase blood flow. Penile prostheses for cases resistant to other treatments.

Answer 30

Individuals taking nitrates Hypertension/hypotension Arrhythmias Unstable angina Stroke Recent myocardial infarction.

Answer 31

Patients with angina Peptic ulcer Liver or kidney impairment Peyronie's disease Those on complex antihypertensive regimes

Answer 32

Macroscopic haematuria: Blood in the urine, visible to the naked eye. Microscopic haematuria: Blood in the urine, detectable only on urinalysis.

Answer 33

Kidney related causes; Glomerular: IgA nephropathy, Alport's syndrome, Glomerulonephritis. Non-glomerular: Tumours (Renal cell carcinoma, Wilm's tumour), Nephrolithiasis, Infection, Polycystic kidneys, Trauma, Urethral stricture, Vascular conditions (infarction, renal vein thrombosis), Sickle cell disease, Certain drug Ureter/ bladder related causes; Stones Tumours Strictures Infection Urethral causes Benign prostatic hypertrophy Prostate cancer Prostatitis Trauma Other causes Menstruation Post-coital Certain medications Viral illness

Answer 34

Bedside - urinalysis. Urine culture. Urine microscopy - the type of blood cells seen may indicate the cause; dysmorphic red blood cells suggest glomerular origin, if red cell casts visible this suggests renal origin (precipitate with protein made in renal tubules) Blood tests: Full Blood Count (FBC), Urea and Electrolytes (U+E), Prostate-Specific Antigen (PSA) for men, and coagulation studies. Imaging: Renal tract ultrasound, Computed Tomography of kidneys, ureters, bladder (CT KUB). Cystoscopy. Renal biopsy.

Answer 35

pathological accumulation of serous fluid in a sac-like cavity specifically around the testicle. It typically presents as an enlarged scrotum with swelling localised to one testis but can occur around both testicles

Answer 36

Most common in newborns affecting 5-10% of newborns

Answer 37

Congenital due to patency of the processus vaginalis Secondary; malignancy, trauma, infection

Answer 38

Scrotal swelling Discomfort Pain Redness

Answer 39

Inguinal hernia Varicocele Testicular torsion Epididymitis Epididymal cyst Haematocele Testicular cancer

Answer 40

Clinical diagnosis USS Screen for infection and tumour markers; CRP, ESR, FBC, AFP, LDH, HCG

Answer 41

Watch and wait; most resolve by 12 months of age Surgical correction; cord's repair

Answer 42

Recurrence of hydrocele Infection or injury to local structures during surgery

Answer 43

group of symptoms that occur as a result of abnormal storage, voiding, or post-micturition function of the bladder, prostate (in men), or urethra.

Answer 44

UTI Bladder underactivity BPH Prostate cancer Ovarian/ fibroid mass Urethral stricture

Answer 45

Voiding Symptoms; Weak or intermittent urinary stream Straining Hesitancy Terminal dribbling Incomplete emptying Storage Symptoms; Urgency Frequency Urgency incontinence Nocturia

Answer 46

Bladder outlet obstruction Overactive bladder syndrome Prostatitis Bladder cancer Urethral stricture

Answer 47

Urinalysis Digital Rectal Examination (DRE) Bladder diary Urodynamics

Answer 48

Foreskin is too tight to be retracted over the glans of the penis

Answer 49

Inability to replace foreskin to its original position after it has been retracted leading to venous congestion leading to oedema and ischaemia to the glans of the penis

Answer 50

Sexually Transmitted Infections (STIs) Eczema Psoriasis Lichen planus Lichen sclerosis Balanitis

Answer 51

Not replacing retracted foreskin

Answer 52

Inability to retract foreskin Interference with urination or sexual function

Answer 53

Swollen painful glans Tight band of foreskin behind glans

Answer 54

Balanitis Xerotica Obliterans Balanitis

Answer 55

White skin changes Pruritus Painful erections Difficulty micturition This is lichen sclerosus and is a pre-malignant condition

Answer 56

Penile fracture Penile carcinoma

Answer 57

Clinical history USS Uroflowmetry

Answer 58

Topical steroids Circumcision

Answer 59

Reduce oedema; manual pressure Dorsal sit in foreskin to relieve constriction

Answer 60

Prolonged painful erection lasting more than 2 hours after sexual activity Not related to sexual desire or stimulation

Answer 61

Priapism is a relatively rare condition, though exact prevalence rates vary. It can occur in males of all ages, including newborns, but two age peaks are most common: 5-10 years and 20-50 years. Conditions such as sickle cell disease, leukemia, and use of certain medications (like those for erectile dysfunction) can increase the risk.

Answer 62

Ischaemic (low flow) priapism; lack of venous drainage from corpora cavernosa caused by sickle cell disease, malignancy and use of medications Non ischaemic (high flow) priapism; trauma resulting in unregulated cavernous arterial inflow

Answer 63

A persistent erection lasting over two hours beyond sexual activity Erection without sexual stimulation or arousal Erection that may or may not be painful

Answer 64

Penile fracture Peyronie disease Balanitis

Answer 65

Laboratory testing: Includes full blood count, reticulocyte count, and blood gas analysis of the aspirated cavernous blood. Imaging: An arteriogram may be performed to identify arterial-lacunar fistula in cases of suspected high-flow priapism. Further investigations might be guided by suspected underlying conditions (e.g., tests for sickle cell disease)

Answer 66

Aspiration of blood in corpus cavernosa Irrigation with saline Intracavernosal injection of alpha agonist (adrenaline, phenylephrine) Surgical shunt

Answer 67

Prostate cancer is a malignant tumour that arises from the cells of the prostate, most common type being adenocarcinoma

Answer 68

Prostate cancer is responsible for approximately 48,000 new diagnoses each year in the UK, accounting for 13% of all cancer cases. It is the second most prevalent cancer among men globally, preceded only by lung cancer

Answer 69

Non modifiable; African ethnicity BRCA gene mutations Family history of prostate cancer Age Modifiable; Obesity Smoking Diet rich in animal fats and dairy products

Answer 70

Urinary symptoms, including difficulty initiating or stopping urination Poor urine stream Haematospermia (blood in semen) Pelvic discomfort Bone pain, potentially indicating metastatic disease Erectile dysfunction

Answer 71

BPH Prostatitis UTI Bladder cancer

Answer 72

DRE Urine dip PSA blood test Multi parametric MRI Biopsy and gleason grading 2WW referral; Refer if their prostate feels malignant on DRE. Consider referring a person with possible symptoms of prostate cancer using a suspected cancer pathway referral (for an appointment within 2 weeks) if their PSA level is above the threshold for their age (see above)

Answer 73

T (Tumour): T1: The tumour is not palpable or visible by imaging. T1a: Tumour found incidentally in less than 5% of tissue removed. T1b: Tumour found incidentally in more than 5% of tissue removed. T1c: Identified by needle biopsy due to elevated PSA (prostate-specific antigen) levels. T2: The tumour is confined to the prostate. T2a: Tumour involves half or less of one side of the prostate. T2b: Tumour involves more than half of one side but not both sides. T2c: Tumour involves both sides. T3: The tumour extends beyond the prostate. T3a: Tumour extends through the prostate capsule. T3b: Tumor invades seminal vesicle(s). T4: The tumour invades adjacent structures other than seminal vesicles (e.g., bladder, rectum). N (Lymph Nodes): N0: No regional lymph node involvement. N1: Regional lymph node involvement. M (Metastasis): M0: No distant metastasis. M1: Distant metastasis present. M1a: Non-regional lymph nodes. M1b: Bones. M1c: Other sites or multiple sites.

Answer 74

T1 (T1a, T1b, T1c) Active surveillance (for low-risk cases) Watchful waiting Radical prostatectomy (for selected cases) T2 (T2a, T2b, T2c) Radical prostatectomy (standard treatment) External beam radiation therapy Brachytherapy (seed implantation) Active surveillance (for low-risk cases) T3 (T3a, T3b) Hormonal therapy (to delay progression) Radical prostatectomy (selected cases) External beam radiation therapy T4 Hormonal therapy (palliative, delays progression) Radiation therapy (palliative) Symptomatic management Not Fit for Radical Prostatectomy Hormonal therapy (palliative) Metastatic (M1) Hormonal therapy (androgen deprivation) Chemotherapy (docetaxel, cabazitaxel) Targeted therapy (abiraterone, enzalutamide) Immunotherapy (sipuleucel-T)

Answer 75

Inflammation/ infection of the prostate gland

Answer 76

Commonly affects men aged 30-50 years

Answer 77

Preexisting urinary tract infection Epididymitis Catheter use Previous urethral surgery Presence of prostate stones

Answer 78

Acute; bacterial infection, STI Chronic; recurrent episodes of prostatitis with symptoms lasting >3 weeks E.coli

Answer 79

Perineal or prostatic pain Lower urinary tract symptoms including dysuria, frequency, urgency Systemic symptoms like fever and myalgia Boggy prostate on PR examination

Answer 80

UTI Epididymitis BPH

Answer 81

Focused history taking Digital rectal examination, which typically reveals a tender, warm, and swollen prostate Midstream sample of urine for culture and sensitivity Screening for sexually transmitted infections, as gonorrhoea can cause prostatitis

Answer 82

Antibiotic therapy, tailored according to the identified or suspected pathogen, usually fluoroquinolones for 2/52. Symptom relief using analgesics Management of urinary retention if present, which could involve temporary catheterisation

Answer 83

Urolithiasis refers to urinary calculi (stones) anywhere in the urinary tract. They form due to supersaturation of urine causing crystal formation, which then aggregate into larger stones

Answer 84

Common with men more commonly affected More common in 35-45 year olds

Answer 85

Obesity Chronic dehydration High ambient temperature Diet high in oxalate, urate, sodium and animal protein White ethnicity Family history Structurally abnormal renal tract (e.g. vesicoureteric reflux, horseshoe kidney) Comorbidities including diabetes, gout, hyperparathyroidism, Crohn's disease, cystinuria

Answer 86

Calcium oxalate stones Majority (approximately 70%) of stones Radiopaque Can form in any urine pH Associated with low urine volume and hypercalciuria Calcium phosphate stones Approximately 10% of stones Radiopaque Tend to form in alkaline urine Associated with renal tubular acidosis types 1 and 3 Associated with primary hyperparathyroidism Uric acid stones Approximately 10% of stones Radiolucent Only form in acidic urine (pH < 5.5) Associated with diabetes, obesity and gout May occur due to malignancy (due to high cell turnover, especially due to chemotherapy) Struvite stones Approximately 5% of stones Radiopaque Composed of magnesium, ammonium and phosphate Often occur due to urease-producing bacterial infection (e.g. Proteus, Enterobacter, Klebsiella) Associated with alkaline urine May form staghorn calculi (which involve the renal pelvis and extend into mulitple calyces) Cystine stones 1% of stones Faintly radiopaque Occur due to cystinuria (an autosomal recessive condition affecting renal reabsorption of amino acids) More likely to form in alkaline urine Often occur in young patients Medication-induced stones 1% of stones Occur due to crystallisation of medications or their compounds e.g. indinavid, ceftriaxone, allopurinol, zonisamide

Answer 87

Can be asymptomatic Ureteric colic; severe spasmodic pain that radiates loin to groin and scrotum, usually sudden onset Renal angle tenderness Visible haematuria Dysuria Urinary frequency Nausea Vomiting Fever Diaphoresis Rigors Urinary hesitance Intermittent stream

Answer 88

Pyelonephritis Appendicitis Diverticulitis Ovarian torsion Ectopic pregnancy Rupture/ dissection of abdominal aortic aneurysm

Answer 89

Bedside: Urinalysis for haematuria; nitrites and leukocytes may be present in infection (leucocytes may also be present in urine due to ureteral irritation) - urine pH may also guide the likely cause of stones Urine MC&S looking for any bacteria that may be causing a complicating infection or struvite stones 24 hour urine collection in recurrent stone formers to assess urine volume, calcium, oxalate, uric acid, citrate, sodium and creatinine Bloods: Full blood count may show raised white cell count due to infection U&Es may show deranged renal function e.g. if there is obstruction CRP which may be significantly raised in infection Bone profile looking for hypercalcaemia Serum urate if raised may increase suspicion of uric acid stones Venous blood gas may show acidosis and low bicarbonate if there is underlying renal tubular acidosis; lactate may be raised in patients systemically unwell with infection Coagulation screen to check for a bleeding diathesis prior to intervention Blood cultures in patients with suspected infection Imaging: Non-contrast CT KUB should be done urgently in patients with suspected renal colic Ultrasound KUB is an alternative that should be offered to pregnant women and under 16 year olds Abdominal X-ray also has a role e.g. to follow up radio-opaque stones that are being managed conservatively Special tests: Stone analysis to identify their composition and guide prophylactic management - sieving urine may be advised to retrieve fragments especially if there is recurrent stone formation

Answer 90

Conservative; If under 5mm wait to pass naturally Drink 2.5-3 litres of water per day Avoid carbonated drinks (may acidify urine) Add fresh lemon juice to water (contains citrate which reduces stone formation) Eat a balanced diet and maintain a healthy weight Reduce salt intake Do not restrict dietary calcium intake Medical management; analgesia (NSAIDs) are first line, PR diclofenac If over 10mm consider tamsulosin Antibiotics; gentamicin, co-amoxiclav IV fluids Medical prophylaxis; Potassium citrate is used for recurrent calcium oxalate stones Thiazide diuretics may also be used for recurrent calcium oxalate stones Surgical management; Decompression and nephrostomy insertion Extracorporeal shockwave lithotripsy Ureteroscopy Percutaneous nephrolithotomy Open stone surgery

Answer 91

Obstruction Infection Ureteric strictures Increased risk of renal cancer Renal calyx rupture

Answer 92

95% of stones < 5mm will pass spontaneously within 40 days 70% of distal ureteric stones (of all sizes) will pass spontaneously Rates of spontaneous passage are lower for more proximal stones (25% of proximal ureteric stones pass spontaneously) Recurrence rates are high - 80% at 10 years - although 50% of these people will only have one recurrence Frequent recurrence is seen in approximately 10% of patients

Answer 93

Adenocarcinoma of the renal cortex that originates from the PCT Well circumscribed with yellowish appearance denoting high fat and glycogen content Microscopic appearance shows clear cytoplasm

Answer 94

Affects renal cell carcinoma that shares properties with TCC of the bladder, ureter Macroscopically can be papillary or flat Microscopically show areas of squamous differentiation, extensive keritinisation and intracellular bridges

Answer 95

Peak age is 85-89

Answer 96

Non-modifiable risk factors for RCC: North American and European ethnicity Modifiable risk factors: Obesity Smoking Diet (low in vitamins and minerals) Hypertension

Answer 97

Haematuria (50%) Loin pain (40%) Flank mass (30%) Metastatic disease (10%) Evidence of paraneoplastic syndrome Erythropoietin (EPO) Production: Ruddy Complexion: Some patients may exhibit a ruddy or reddish complexion due to the increased production of erythropoietin, leading to polycythemia. Parathyroid Hormone-Related Peptide (PTHrP): Hypercalcemia: PTHrP secretion can result in hypercalcemia, leading to symptoms such as fatigue, weakness, and constipation. Adrenocorticotropic Hormone (ACTH): Cushing's Syndrome: ACTH secretion may lead to Cushing's syndrome, characterized by features such as central obesity, moon face, and muscle wasting.

Answer 98

Polycystic kidney disease Renal angiomyolipoma Oncoytoma

Answer 99

Ultrasound CT of kidneys MRI Imaging Intravenous Urogram Flex cystoscopy (to rule out bladder cancer) Chest X-Ray (CXR) - to look for cannonball secondaries in the lung

Answer 100

If they are aged 45 years 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.

Answer 101

RCC is relatively insensitive to chemotherapy and radiotherapy, making surgery the primary treatment. The extent of the surgery depends on the stage of cancer as well as the function of the contralateral kidney. T1 lesions: Usually managed by partial nephrectomy, providing equivalent oncological outcomes to radical nephrectomies. T2 and above: Typically managed by radical nephrectomy. A partial nephrectomy would be considered if the contralateral kidney offers insufficient function on its own.

Answer 102

TCC can be treated with both surgery and chemotherapy. Surgery: Offers the best chance of cure with a procedure called a radical nephroureterectomy, involving removal of the kidney and ureter. It is typically only offered if there is no distant disease. Lesions can also be treated with a laser, which is usually offered to individuals who only have one kidney, poor combined renal function or are not fit enough for general anaesthesia and a major operation. Chemotherapy: May be offered to patients who have an incomplete resection to reduce the chances of recurrence, or to palliative patients. Radiotherapy: Not commonly used, but can be of use in a palliative setting.

Answer 103

Testicular cancer refers to any malignant neoplasm that originates from the tissues of the testicle.

Answer 104

Germ cell account for 95%; seminomas, non seminoma subtypes Non germ cell account for 5%; leydig tumour Seminoma (55% of cases) Teratoma (33% of cases) Mixed seminoma teratoma (12% of cases)

Answer 105

Most common as a solid tumour in men aged between 20 and 45 years

Answer 106

Age under 45 years Caucasian ethnicity Previous history of testicular cancer Cryptorchidism (undescended testicles) Human Immunodeficiency Virus (HIV) infection Previous mumps orchitis infection Klinefelter's syndrome

Answer 107

The primary clinical manifestation of testicular cancer is a painless lump in the scrotum. Germ cell tumours may be hormone-producing and can increase the oestrogen:androgen ratio, resulting in gynaecomastia.

Answer 108

Epididymal cyst Tentacular torsion Epididymitis Hydrocele Varicocele Inguinal hernia

Answer 109

Scrotal USS Serum tumour markers; AFP, hCG, LDH CT TAP 2WW if non painful enlargement, change in shape/ texture of the testes

Answer 110

Radical orchidectomy: This surgical procedure involves the removal of the affected testicle, usually the initial step in management. Radiotherapy: Particularly beneficial for seminomas, which are highly sensitive to radiation. Chemotherapy: Used as adjuvant therapy or for advanced disease, with cisplatin-based regimens being the most effective.

Answer 111

Urological emergency due to twisting of the testicle around the spermatic cord due to inadequet attachment to tissues within scrotum

Answer 112

Most common between 13 and 16 years

Answer 113

Bell-Clapper deformity: An anomaly where the testis is inadequately fixed, allowing it to rotate freely. Undescended testicle: Testicles that have not descended fully into the scrotum may be more prone to torsion. Trauma: Physical injury may precipitate torsion, although it often occurs spontaneously. Prior intermittent torsion: Those who have previously experienced episodes of intermittent torsion may be at higher risk. Testicular tumour: Patients with a testicular tumour may first present with testicular torsion.

Answer 114

Sudden onset, severe pain in one testicle The event often follows minor trauma The affected testicle may be upwards and horizontally in the scrotum, associated with erythema and swelling Unilateral loss of cremaster reflex Persistent pain despite the elevation of the testicle (negative Prehn's sign) Nausea and vomiting due to pain In neonates, torsion may present as painless scrotal swelling which does not transilluminate.

Answer 115

Epiddymo- orchitis Trauma Inguinal hernia Torsion of epididymal appendage

Answer 116

Doppler USS; whirlpool sign of spiral pattern in the spermatic cord Urinalysis

Answer 117

Urgent surgical exploration and de-torsion Bilateral ochidopexy

Answer 118

Necrosis Impaired fertility Contralateral testicular torsion occurs in up to 40% of cases without bilateral fixation.

Answer 119

Testicular torsion in neonates bears a worse prognosis, as the testis is rarely viable. In older children and teenagers, testicular salvage depends on the extent and duration of the testicular torsion.

Answer 120

Stress incontinence Urge incontinence Overflow incontinence Functional incontinence Mixed incontinence

Answer 121

D - Delirium I - Infection A - Atrophic vaginitis or urethritis P - Pharmaceutical (medications) P - Psychiatric disorders E - Endocrine disorders (e.g. diabetes) R - Restricted mobility S - Stool impaction

Answer 122

Physical examination An examination will identify features of pelvic organ prolapse as well as the ability to contract pelvic floor muscles Questionnaires These are recommended in order to quantify the symptoms and assess the severity on patients quality of life which may help when deciding if a patient would benefit from more invasive treatment Bladder diary These are also useful for quantifying symptoms and documenting the number and type of episodes of incontinence. They may potentially show a relationship between causes and symptoms. Urinalysis This will help to rule out infection as an acute cause Cystometry This is an investigation which measures bladder pressure whilst voiding. It is not recommended in patients with clear histories where the diagnosis is clear. Cystogram If a fistula is suspected, contrast is instilled into the bladder and a radiological image is obtained in order to see if the contrast travels anywhere else.

Answer 123

Recurrent urinary tract infections High BMI Advancing age Smoking Caffeine

Answer 124

Sedating medications Alcohol Dementia

Answer 125

This involves an individual having the urge to pass urine, but for whatever reason they're unable to access the necessary facilities and as a result are incontinent.

Answer 126

Cryptorchidism, or undescended testes, is a congenital condition in which one or both of the testes fail to descend into the scrotum before birth.

Answer 127

Cryptorchidism is present in approximately 1-4.5% of term newborns and about 30-45% of premature newborns. By the first year of life, around two-thirds of these cases will have spontaneously descended.

Answer 128

Genetic Environmental Maternal factors; alcohol, smoking and exposure to medication Low birth weight

Answer 129

Retractile testes Inguinal hernia Ectopic testes

Answer 130

For undescended testes that are bilateral at birth, an urgent referral to a senior paediatrician within 24 hours is needed for potential endocrine or genetic investigation (e.g. congenital adrenal hyperplasia, or CAH). If these conditions are ruled out and the testes remain undescended by 3 months, the child should be referred to surgeons by 6 months of age. For undescended testes that are unilateral at birth, arrange a review at 6-8 weeks of age. If the testis remains undescended at the 3-month review, re-examine at 4-5 months At 4–5 months (corrected for gestational age), if the testis remains undescended, arrange referral to paediatric surgery or urology for specialist management depending on local referral pathways, to be seen by 6 months of age The British Association of Paediatric Surgeons (BAPS) recommends that if orchidopexy is indicated, it should be performed around 12 months of age

Answer 131

E.coli- most common Klebsiella pneumoniae Proteus mirabilis Enterococcus faecalis Staphylococcus

Answer 132

Urinary frequency Dysuria Urgency Foul-smelling urine Suprapubic pain Clinical examination may be normal or reveal suprapubic tenderness. Red flag symptoms such as haematuria, loin pain, rigors, nausea, vomiting, and altered mental state may indicate more serious infection, and these patients may have/are at risk of developing pyelonephritis (see below) and likely need referral to A&E.

Answer 133

Urine dipstick; leucocytes and nitrates Mid stream urine FBC, U+E, CRP USS KUB

Answer 134

For LUTIs: First line management is with oral nitrofurantoin or trimethoprim. Antibiotic duration can vary (see below) however in women the standard course length is 3 days. The patient should be advised on conservative measures to reduce the risk of further infection e.g. regular fluid intake, post-coital voiding. Specific situations UTI in Men: Empirical antibiotic drug treatment (if no cultures with sensitivities) with trimethoprim or nitrofurantoin for 7 days. Refer to urology if there are ongoing symptoms despite treatment, if there is an underlying risk factor for UTIs (e.g. urinary calculi, suspected obstruction, previous GU surgery), or if there are recurrent episodes of UTI. UTI during Pregnancy (with no haematuria): First-line antibiotics are nitrofurantoin (but avoid at term), for 7 days. If nitrofurantoin is not suitable due to e.g. renal function, or there is no improvement in symptoms, consider second-choice antibiotics such as amoxicillin/cefalexin for 7 days.

Answer 135

Varicocele is a condition characterized by an enlargement of the veins within the scrotum, similar in nature to varicose veins that can occur elsewhere in the body.

Answer 136

15-20% of men Slightly more common in infertile men

Answer 137

Faulty valves in spermatic vein causing blood to pool and enlarge veins

Answer 138

Aching or heavy feeling in the scrotum Visibly enlarged or twisted veins in the scrotum, often described as a "bag of worms" Testicular atrophy Impaired fertility

Answer 139

Epididymitis Testicular torsion Inguinal hernia Hydrocoele

Answer 140

Physical examination: Varicoceles can often be identified by palpation of the scrotum, especially while standing or during a Valsalva maneuver. Doppler ultrasound: This imaging modality can identify the enlarged veins and assess for retrograde blood flow, confirming the diagnosis. Hormonal assays: In cases where infertility is suspected, evaluation of testosterone, FSH, LH, and semen analysis can be useful.

Answer 141

Watchful waiting: For asymptomatic varicoceles or those not causing fertility problems. Embolization: This minimally invasive procedure involves blocking the blood flow to the enlarged veins. Surgery: Varicocele repair surgery can be performed through open surgery, laparoscopically, or with robotic assistance.

Urology Flashcards

(165 cards)