Flashcards in Urology Deck (76):
what are symptoms and signs of a UTI?
- urinary frequency
- back/flank pain
why do UTI have nitrites in dipstick?
produced by gram negative bacteria
what is the first line treatment for standard UTI?
- trimethoprim or nitrofurantoin 3-7 days
what antibiotics are good for antibiotic resistance UTI?
what should be given for men with UTI?
- 7 days of nitrofurantoin or trimethoprim
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
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
what are differentials of testicular torsion?
how is epididymitis presentation different to testicular torsion?
- epididymitis is:
more gradual in onset
positive prehn sign
positive cremasteric reflex
what are causes of epididymitis?
what are signs of urinary tract stone disease?
- colicky pain
what is the emergency management of an infected obstructed kidney?
- decompression using nephrostomy to remove the urine.
what is lithotripsy?
A treatment for kidney stones
Shock waves pass through and breaks the stones up.
who cant have lithiotripsy?
- bleeding disorders
what is ureteronoscopy?
- helps large stones pass through with a laser.
- useful when lithiotripsy fails
what stones are ureteronoscopy used for?
- under 3 cm
- after lithiotripsy hasn't worked
what stones is percutaneous nephrolithotomy used for?
- large or irregular shaped stones
what is percutaneous nephrolithotomy?
a sham incision is made in the back to enter the kidney and a nephroscope threaded in.
what is stone dissolution?
- irrigation with saline, heparin or citrate via a nephrostomy tube
what is stress incontinence?
involuntary urine leakage on effort/exertion such as sneezing/ coughing. common after childbirth
what is urge incontinence?
involuntary urine leakage accompanied or immediately preceeded by urgency. due to detrusor muscle over activity.
what are differentials of urgency?
what are voiding symptoms?
weak or intermittent urinary stream, straining, hesitancy, terminal dribbling
what are storage symptoms?
what is the medical management of BPH?
- 5 alpha reductase inhibitors
what are examples of alpha blockers used for BPH?
what is first line for BPH after lifestyle changes?
- alpha blocker
what are examples of 5 alpha reductase inhibitors used for BPH?
how do 5 alpha reductase inhibitors work for BPH?
block conversion of testosterone to DHT which is responsible for prostate growth
when are 5 alpha reductase inhibitors used for BPH?
After lifestyle changes and alpha blockers have failed
what are adverse effects of 5 alpha reductase inhibitors?
inhibit hair growth
what are surgical options for BPH?
- laser therapy
- trans-urethral needle ablaton
- transurethral resection
- open prostatectomy
- holmium laser enucleation of the prostate
what is transurethral resection of the prostate?
- removing the periurethral and transitional zones of the prostate to relieve obstruction
what are complications of transurethral resection of the prostate?
- retrograde ejaculation
- blood transfusion
- failure to void
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
what are two catheter options for urinary retention?
- urethral catheter
- suprapubic catheter
what is a suprapubic catheter?
- the catheter is inserted into the abdomen via a cut in the abdomen.
when are suprapubic catheters used?
- urethral catheters are contraindicated
- urethral injury
- complete obstruction
- bladder neck mass
when are suprapubic catheters contraindicated?
no palpable distended urinary bladder
- prior abdominal or pelvic surgery
- pelvic cancer
- morbid obese
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
what are complications of bladder outlet obstruction and urinary retention?
- high pressure chronic retention
- low pressure chronic retention
- recurrent epididymitis
- bladder calculi
- recurrent haematuria from the prostate
- weakening of the bladder muscles
- detrusor hypertrophy
what is obstructive uropathy?
when urine can't drain through a ureter so backs up causing hydronephrosis
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
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
what are signs of renal cell carcinoma?
- often asymptomatic
- loin pain
- mass in the flank region
- malaise, anorexia, weight loss
- can have polycythaemia
- hypertension (renin secretion)
- lower limb oedema
what is a paraneoplastic syndrome?
Clinical featurs due to an altered immune response to a malignancy or due to substances produced by the tumour
what cancers are paraneoplastic syndromes most commonly associated with?
lung, ovarian, lymphatic, breast
what cancer is the worst for causing paraneoplastic syndrome?
small cell lung cancer
what type of cancer is often in the prostate?
where do most prostate cancers arise?
the peripheral zone
what are signs of prostatic carcinoma?
often very few symptoms
- lower urinary tract signs
- back and skeletal pain
- weight loss
what are signs of bladder cancer?
- frank macroscopic haematuria
- bleeding in urine stream
- suprapubic, urethral and penile tip pain
what are risk factors of prostate cancer?
- black population
- family history
- presence of PIN
what genes are involved with prostate cancer?
- sporadic; chromosome 8
inherited; chromosome one
BRCA 2 carriers
what grading is used for prostate adenocarcinoma?
what is PIN?
prostatic intraepithelial neoplasia
the cellular appearance of cancer but the basement membrane is still intact
what are risk factors for renal cell carcinoma?
- von hippel landau disease
- end stage renal disease
- polycystic kidneys
what is hippel landau disease?
- autosomal dominant on chromosome 3
- defect in VHL suppressor gene
- high risk of renal cell carcinoma
what are symptoms of von hippel lindau disease?
- hypervascular tumours of the CNS and retina
- pancreatic cystis
- islet cell tumours
- endolympahtic sac tumours
what is the pathology behind hereditary papillary renal cell cancer?
development of multiples RCC's
mutation in MET protooncogenes that regulates tyrosine kinase growth factors
what are risk factors for testicular cancer?
- family history
- previous testicular tumour
- klinefelters syndrome
- testicular atrophy
what are the sex chromosomes in klinefleters syndrome?
what lymph nodes does testicular cancer spread to?
0 para aortic
what is the most common type of cancer in the bladder?
transitional cell carcinoma
what are environmental causes of bladder cancer?
- 2 naphthlamine, 4 aminobipphenyl, benzidine, NNBIS, 4 chlorotoluidine, phenacetin, cyclophosphamide
what do different PSA levels mean?
>4= can be BPH or cancer
>10- over half of cases cancer
what is PSA?
a serine protease that liquefies semen
where s PSA produced?
acini in the prostate
what is AFP used to monitor?
- liver cancer
- testicular cancer
- ovarian cancer
what is first line imaging for patients with frank haematuria?
what testicle is more often affected by a varicocoele?
the left side because it drains into the renal vein
what is cryptorchidism?
failure of the testes to descend into the scrotum
what is the management of cryptochidism?
ochiopexy at 6-18 months
what are causes of Epididymo-orchitis
what are clinical featurse of Epididymo-orchitis?