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Flashcards in Urology Deck (76):
1

what are symptoms and signs of a UTI?

- dysuria
- urinary frequency
- haematuria
- back/flank pain
- fever

2

why do UTI have nitrites in dipstick?

produced by gram negative bacteria

3

what is the first line treatment for standard UTI?

- trimethoprim or nitrofurantoin 3-7 days

4

what antibiotics are good for antibiotic resistance UTI?

- ciprofloxacin
- levofloxacin
- amoxicillin

5

what should be given for men with UTI?

- 7 days of nitrofurantoin or trimethoprim

6

how does standard treatment of UTI change in men with signs of prostatitis?

A 4 week course of fluoroquinolone as the bacteria may penetrate the prostatic fluid

7

what are symptoms ad signs of testicular torsion?

- sudden onset of pain in one testicle
- uncomfortable to walk
- abdominal pain
- N and V
- abnormal positioning of the testicle
- negative prehn sign
- ascent cremasteric reflex

8

what are differentials of testicular torsion?

-epididymitis

9

how is epididymitis presentation different to testicular torsion?

- epididymitis is:
more gradual in onset
positive prehn sign
positive cremasteric reflex

10

what are causes of epididymitis?

young: chlamydia
old: UTI

11

what are signs of urinary tract stone disease?

- colicky pain
- haematuria
- dysuria
- frequency

12

what is the emergency management of an infected obstructed kidney?

- decompression using nephrostomy to remove the urine.

13

what is lithotripsy?

A treatment for kidney stones
Shock waves pass through and breaks the stones up.

14

who cant have lithiotripsy?

- pregnancy
- obese
- bleeding disorders

15

what is ureteronoscopy?

- helps large stones pass through with a laser.
- useful when lithiotripsy fails

16

what stones are ureteronoscopy used for?

- under 3 cm
- after lithiotripsy hasn't worked

17

what stones is percutaneous nephrolithotomy used for?

- large or irregular shaped stones

18

what is percutaneous nephrolithotomy?

a sham incision is made in the back to enter the kidney and a nephroscope threaded in.

19

what is stone dissolution?

- irrigation with saline, heparin or citrate via a nephrostomy tube

20

what is stress incontinence?

involuntary urine leakage on effort/exertion such as sneezing/ coughing. common after childbirth

21

what is urge incontinence?

involuntary urine leakage accompanied or immediately preceeded by urgency. due to detrusor muscle over activity.

22

what are differentials of urgency?

UTI
MS
parkinsons
bladder stones
malignancy
BPH
urethritis
overactive bladder
cystitis
neurogenic bladder
prostatitis
urethral stricture
ovarian cancer
acetone poisoning

23

what are voiding symptoms?

weak or intermittent urinary stream, straining, hesitancy, terminal dribbling
incomplete emptying

24

what are storage symptoms?

urgency
frequency
incontinence
nocturia

25

what is the medical management of BPH?

alpha blockers
- 5 alpha reductase inhibitors

26

what are examples of alpha blockers used for BPH?

- tamsulosin
doxazosin
alfuzosin

27

what is first line for BPH after lifestyle changes?

- alpha blocker

28

what are examples of 5 alpha reductase inhibitors used for BPH?

finasteride

29

how do 5 alpha reductase inhibitors work for BPH?

block conversion of testosterone to DHT which is responsible for prostate growth

30

when are 5 alpha reductase inhibitors used for BPH?

After lifestyle changes and alpha blockers have failed

31

what are adverse effects of 5 alpha reductase inhibitors?

- impotence
reduced libido
breast tenderness
gynaecomastia
inhibit hair growth

32

what are surgical options for BPH?

- laser therapy
- trans-urethral needle ablaton
- transurethral resection
- open prostatectomy
- holmium laser enucleation of the prostate

33

what is transurethral resection of the prostate?

- removing the periurethral and transitional zones of the prostate to relieve obstruction

34

what are complications of transurethral resection of the prostate?

- retrograde ejaculation
- impotence
- blood transfusion
- failure to void

35

what is holmium laser enucleation of the prostate?

- removes the prostate from it's capsule in larger pieces and then these are removed endoscopically from the bladder

36

what are two catheter options for urinary retention?

- urethral catheter
- suprapubic catheter

37

what is a suprapubic catheter?

- the catheter is inserted into the abdomen via a cut in the abdomen.

38

when are suprapubic catheters used?

- urethral catheters are contraindicated
- urethral injury
- complete obstruction
- bladder neck mass
- BP
prostate cancer

39

when are suprapubic catheters contraindicated?

no palpable distended urinary bladder
- coagulopathy
- prior abdominal or pelvic surgery
- pelvic cancer
- pregnancy
- morbid obese

40

other than catheterisation what else can be offered for urinary retention?

-urethral dilation by inserting a wider tube to remove a stricture
- urethral stents
- alpha blockers
- bethanechhol chloride (increases detrusor muscle activity)
- prostate resection

41

what are complications of bladder outlet obstruction and urinary retention?

- UTI
- high pressure chronic retention
- low pressure chronic retention
- recurrent epididymitis
- bladder calculi
- recurrent haematuria from the prostate
- weakening of the bladder muscles
- detrusor hypertrophy

42

what is obstructive uropathy?

when urine can't drain through a ureter so backs up causing hydronephrosis

43

what is high pressure chronic urine retention?

when the bladder is poorly complient and the intravesical pressure is >25 by the end of voiding. can result in chronic renal failure

44

what is low pressure chronic urine retention?

- the bladder is complient and the pressure remains low during filling. However complete detrusor muscle failure causes large residual volumes

45

what are signs of renal cell carcinoma?

- often asymptomatic
- haematuria
- loin pain
- mass in the flank region
- malaise, anorexia, weight loss
- can have polycythaemia
- hypertension (renin secretion)
- anaemia
- pyrexia
-paraneoplastic syndromes
- lower limb oedema

46

what is a paraneoplastic syndrome?

Clinical featurs due to an altered immune response to a malignancy or due to substances produced by the tumour

47

what cancers are paraneoplastic syndromes most commonly associated with?

lung, ovarian, lymphatic, breast

48

what cancer is the worst for causing paraneoplastic syndrome?

small cell lung cancer

49

what type of cancer is often in the prostate?

Adenocarcinoma

50

where do most prostate cancers arise?

the peripheral zone

51

what are signs of prostatic carcinoma?

often very few symptoms
- lower urinary tract signs
- back and skeletal pain
- weight loss
- anaemia
- haematuria

52

what are signs of bladder cancer?

- frank macroscopic haematuria
- bleeding in urine stream
- suprapubic, urethral and penile tip pain

53

what are risk factors of prostate cancer?

- age
- black population
- family history
- presence of PIN

54

what genes are involved with prostate cancer?

- sporadic; chromosome 8
inherited; chromosome one

BRCA 2 carriers

55

what grading is used for prostate adenocarcinoma?

gleason system

56

what is PIN?

prostatic intraepithelial neoplasia
the cellular appearance of cancer but the basement membrane is still intact

57

what are risk factors for renal cell carcinoma?

- male
- von hippel landau disease
- smoking
- obesity
- end stage renal disease
- polycystic kidneys
- hypertension

58

what is hippel landau disease?

- autosomal dominant on chromosome 3
- defect in VHL suppressor gene
- high risk of renal cell carcinoma

59

what are symptoms of von hippel lindau disease?

- hypervascular tumours of the CNS and retina
- phaeochromocytomas
- pancreatic cystis
- islet cell tumours
- endolympahtic sac tumours

60

what is the pathology behind hereditary papillary renal cell cancer?

autosomal dominant
development of multiples RCC's
mutation in MET protooncogenes that regulates tyrosine kinase growth factors

61

what are risk factors for testicular cancer?

- family history
- cryptochordism
- previous testicular tumour
- klinefelters syndrome
- testicular atrophy

62

what are the sex chromosomes in klinefleters syndrome?

XXY

63

what lymph nodes does testicular cancer spread to?

0 para aortic

64

what is the most common type of cancer in the bladder?

transitional cell carcinoma

65

what are environmental causes of bladder cancer?

- 2 naphthlamine, 4 aminobipphenyl, benzidine, NNBIS, 4 chlorotoluidine, phenacetin, cyclophosphamide

66

what do different PSA levels mean?

>4= can be BPH or cancer
>10- over half of cases cancer

67

what is PSA?

a serine protease that liquefies semen

68

where s PSA produced?

acini in the prostate

69

what is AFP used to monitor?

- liver cancer
- testicular cancer
- ovarian cancer

70

what is first line imaging for patients with frank haematuria?

CT

71

what testicle is more often affected by a varicocoele?

the left side because it drains into the renal vein

72

what is cryptorchidism?

failure of the testes to descend into the scrotum

73

what is the management of cryptochidism?

ochiopexy at 6-18 months

74

what are causes of Epididymo-orchitis

chlamydia
Ecoli
mumps
gonorrhoea

75

what are clinical featurse of Epididymo-orchitis?

- pain
- swelling
- dysuria
- fever

76

how does pregnancy change UTI treatment?

nitrofurantoin not in the 3rd trimester
trimethoprim not in the first trimester.