Urology Flashcards
(143 cards)
1
Q
What does the prostate secrete?
A
An alkaline fluid with clotting enzymes and zinc
2
Q
What is the approximate size of a normal prostate?
A
Walnut shaped, around 20g
3
Q
What is benign prostatic hyperplasia?
A
Irregular proliferation of glandular and stromal tissue of the prostate
4
Q
Where does BPH commonly occur?
A
Transitional zone
5
Q
What are risk factors for developing BPH?
A
Age, black ethnicity
6
Q
How does BPH present?
A
Poor flow, straining, hesitancy, incomplete emptying, urgency, frequency, dribbling, recurrent UTI, retention
7
Q
What investigations should you do if you suspect BPH?
A
PR exam, MSSU, U&Es.
PSA, Transrectal USS +/- biopsy
8
Q
Why should you do bloods for PSA before a PR exam?
A
PR exam can falsely elevate the PSA
9
Q
What is PSA?
A
An enzyme produced by the secretory cells of the prostate
10
Q
What can elevate the PSA?
A
Malignancy, BPH, UTI, ejaculation, vigorous exercise, urinary retention
11
Q
What is a normal PSA?
A
Less than or equal to 4
12
Q
What are some conservative management options for BPH?
A
Decreasing alcohol and caffeine intake
13
Q
What is the first line medical treatment for BPH?
A
Alpha blocker - tamsulosin
14
Q
How does tamsulosin work?
A
Decreases smooth muscle tone
15
Q
What are some side effects of tamsulosin?
A
Dizziness, postural hypotension, dry mouth, depression
16
Q
What is the second line medical treatment for BPH?
A
5-alpha-reductase inhibitor - finasteride
17
Q
How does finasteride work?
A
Blocks conversion of testosterone to DHT which reduces prostate volume
18
Q
How long may finasteride take to work?
A
A few months but slows the progression of BPH
19
Q
What are some side effects of finasteride?
A
Erectile dysfunction, reduced libido, ejaculation problems, gynaecomastia
20
Q
What surgical option is there for BPH?
A
TURP (transurethral resection of prostate)
21
Q
Is BPH pre-malignant?
A
No
22
Q
When is the peak incidence of prostate cancer?
A
60-80 years
23
Q
What is the tumour type of most prostate cancers?
A
Adenocarcinoma
24
Q
Where do most prostate cancers arise in the prostate?
A
Peripheral zone
25
Where is common sites of metastases in prostate cancer?
Pelvic lymph nodes, bone (sclerotic lesions)
26
What are symptoms of prostate cancer?
Asymptomatic or nocturia, hesitancy, poor stream, dribbling, weight loss, bone pain
27
What investigations should you do for prostate cancer?
PR exam, PSA, Transrectal USS +/- biopsies
28
What may be felt on a PR exam in prostate cancer?
A fixed hard craggy mass
29
What scoring system is used to grade prostate cancer?
Gleason's score
30
What system is used to stage prostate cancer?
TNM
31
What are the management options if the cancer is confined to the prostate?
Watch and wait
Radical prostatectomy
Radiotherapy
32
What are the management options if prostate cancer is locally advanced?
Watch and wait
Radical prostatectomy
Hormone therapy
33
What two types of hormone therapy are used?
```
GnRH analogues (Goserelin)
Anti-androgens (cyproterone)
```
34
What are the management options for metastatic prostate cancer?
Hormones
Steroids
Chemotherapy
35
What are the side effects of a radical prostatectomy?
Erectile dysfunction, incontinence, bladder neck stenosis
36
What are the side effects of radiotherapy for prostate cancer?
Irritative LUTS, haematuria, GI symptoms, erectile dysfunction, incontinence
37
What are the side effects of GnRH agonists (Goserelin)?
Loss of libido, hot flushes, sweating, weight gain, osteoporosis
38
What are the side effects of anti-androgens (Cyproterone)?
Loss of libido, erectile dysfunction, gynaecomastia, cardiac and liver toxicities
39
What is the bladder pressure during the storage phase of micturition?
Low to allow passive filling
40
What muscle increases the intravesicular pressure during the voiding phase of micturition?
Detrusor muscle
41
What nerves are involved in the micturition reflex?
Pelvic parasympathetic nerves
| Pudendal
42
What are some risk factors for urinary incontinence?
Advancing age, previous pregnancy, childbirth, high BMI, FH, hysterectomy
43
What causes overflow incontinence?
Bladder outlet obstruction
44
What are the causes of overflow incontinence?
BPH, prostate cancer, urethral narrowing
45
How does overflow incontinence present?
Chronic retention, incontinence, wet at night, huge palpable bladder
46
How is overflow incontinence managed?
Assess renal function, try address underlying cause
| Intermittent self-catheterisation to retrain the bladder
47
What is urge incontinence?
Sudden urge to empty the bladder often followed by uncontrollable and complete emptying
48
What can precipitate urge incontinence episodes?
Sound of running water, lock in door, obesity, caffeine
49
What is the underlying cause of urge incontinence?
Detrusor instability (due to stress, infection, tumour, paraplegia, pelvic surgery)
50
What investigations should you do for urge incontinence?
Bladder diary, MSSU, urodynamic studies
51
How is urge incontinence managed conservatively?
```
Diet and weight loss
Bladder retraining (minimum of 6 weeks)
```
52
How is urge incontinence managed medically?
Anti-muscarinics (e.g. oxybutynin and tolterodine)
53
How is urge incontinence managed surgically?
Botox, neuromodulation, surgery on detrusor muscle
54
What is stress incontinence?
Involuntary leakage of urine when intra-abdominal pressure is increased e.g cough sneeze
55
Does stress incontinence involve the detrusor muscle?
NO - leakage of urine occurs without detrusor contraction
56
What are some causes of stress incontinence?
Pregnancy, child birth, postmenopause
57
What investigations should you do for stress incontinence?
Bladder diary
PV exam (check for prolapse)
MSSU
Urodynamic studies
58
How is stress incontinence managed conservatively?
Weight loss, stop smoking, pelvic floor physiotherapy and biofeedback
59
How can stress incontinence be managed medically?
Duloxetine - only offered second line when woman does not want surgery
60
What is mixed urinary incontinence?
Features of both stress and urge incontinence
61
What causes mixed urinary incontinence?
Often mutlifactorial - immobility, dementia, neuropathy, pelvic floor weakness
62
What are extra-urethral causes of urinary incontinence?
Ectopic ureter
| Vesico-vaginal fistula
63
What is defined as a complicated UTI?
UTI with systemic symptoms or there is a structural abnormality
64
What are risk factors for UTI?
Female sex, sexual intercourse, incontinence
65
What are some common organisms causing UTI?
E.Coli, Klebsiella, Enterococcus, Proteus, Staph saphrophyticus, pseudomonas
66
What are signs and symptoms of UTI?
Dysuria, frequency, nocturia, haematuira, loin pain, fever, rigors
67
What would an MSSU in UTI show?
Leukocytes and nitrites +ve - pure growth of organism
68
What is the treatment of an uncomplicated female UTI?
Nitrofurantoin or trimethoprim (3 days)
69
What is the treatment of an uncomplicated male UTI?
Nitrofurantoin or trimethoprim (7 days)
70
How is UTI treated in the first 2 trimesters of pregnancy?
Nitrofurantoin (7 days)
71
How is UTI treated in the 3rd trimester of pregnancy?
Trimethoprim (7 days)
72
How is a complicated UTI treated in the community?
Co-trimoxazole/co-amoxiclav (7 days)
73
How is a complicated UTI treated in the hospital?
IV amoxicillin + gentamicin step down to PO co-trimoxazole (IV/PO 7 days)
74
What is a recurrent UTI defined as?
2 or more UTIs in 6 months or 3 or more UTIs in one year
75
How can recurrent UTI be treated?
Nitrofurantoin or trimethoprim taken every evening or post coital (review after 6 months)
76
What are some causes of acute urinary retention?
Obstruction (e.g. BPH, tumour)
| Decreased detrusor power
77
What are some symptoms of acute urinary retention?
Pain, distention
78
What examinations should you do on someone with acute urinary retention?
Abdominal exam
| PR and perineal sensation to rule out cauda equina
79
How is acute urinary retention treated?
Catheterise patient. Trial without catheter done after 7 days - can give alpha blocker prior to this to aid success
80
What is the commonest type of renal stone made of?
Calcium oxalate
81
Where are the commonest sites for kidney stones to get stuck?
Vesio-ureteric junction (COMMONEST)
Pelvicureteric junction
Pelvic brim
82
What are some risk factors for kidney stones?
Recurrent UTIs, metabolic abnormalities, urinary tract abnormalities, FH, foreign bodies, some drugs (diuretic, antacids, aspirin, allopurinol)
83
What are symptoms of kidney stones?
Renal colic, loin to groin pain, nausea and vomiting, haematuria, proteinuria, anuria
84
What may be found on examination of a patient with kidney stones?
Renal angle tendernes
| MSSU - Blood ++
85
What is the imaging of choice for kidney stones?
Non-contrast CT KUB
86
What is the imaging of choice for kidney stones during pregnancy?
USS/MRI
87
How are kidney stones managed initially?
```
NSAID for pain relief (IM Diclofenac)
Anti-emetic
Hydration
Alpha blocker for small stones to help them pass
If not passed in 1 month - intervene
```
88
What surgical options can be given to remove kidney stones?
Ureteric stent + fragmentation
Shockwave lithotripsy
Percutaneous nephrolithotomy
Percutaneous nephrostomy
89
At what age is testicular torsion commonest and why?
Puberty due to increase in size of testes
90
What are some causes of testicular torsion?
Trauma, athletic injury, spontaneous
91
What are symptoms of testicular torsion?
Sudden onset pain, walking uncomfortable, abdominal pain, nausea and vomiting
92
What are signs of testicular torsion?
Tender, hot, swollen testis
High in scrotum, lying transversely
Cremasteric reflex absent
93
How is testcular torsion investigated?
Colour doppler USS - lack of blood flow to testis
94
How is testicular torsion treated?
Prompt exploration
Surgery to expose testes and untwist
If necrotic - remove
If good colour return and fix BOTH testes to the scrotum
95
How does torsion of the appendage present?
More insidiously than testicular torsion
Testis mobile
Present cremasteric reflex
Blue dot sign
96
What is priapism?
Prolonged erection (>4hrs) often painful and not associated with sexual arousal
97
What can cause priapism?
Erectile dysfunction drugs, trauma, haematological conditions, sickle cell crisis, idiopathic
98
What is ischaemic priapism due to?
Venous stasis - essentially compartment syndrome
99
What is non-ischaemic priapism due to?
Traumatic disruption of penile vasculature
100
What is Fourniers gangrene?
Form of necrotizing fasciitis occurring around the male genitalia
101
What are risk factors for Fourniers gangrene?
Diabetes, trauma, perineal infection
102
How does Fourniers gangrene present?
Often starts as a cellulitis (erythematous, swollen, tender)
Swelling and crepitus of the scrotum
Dark purple areas
103
What are the pathogens of Fourniers gangrene?
Aerobes and anaerobes
| Often beta-haemolytic strep
104
How is Fourniers gangrene diagnosed?
Plain X-ray or USS to confirm gas in the tissues
105
How is Fourniers gangrene treated?
Antibiotics and debridement
106
What are some types of benign renal tumours?
Cysts, angiomyolipomas
107
What condition are angiomyolipomas associated with?
Tuberous sclerosis
108
What are angiomyolipomas composed of?
Tumours composed of blood vessels, smooth muscle and fat
109
What can rupture of an angiomyolipoma lead to?
Wunderlich's syndrome
110
What is the commonest type of renal cancer?
Renall Cell Carcinoma
111
Where do renal cell carcinomas arise from?
Proximal renal tubular epithelium
112
What are renal cell carcinomas associated with?
Smoking, Von-Hippel-Lindeau, Tuberous Sclerosis
113
What is the classic triad of symptoms of renal cell carcinoma?
Haematuria
Loin Pain
Loin Mass
114
What other symptoms are associated with RCC?
Pyrexia of unknown origin, left varicocele, polycythaemia, symptoms of hypercalcaemia
115
How does RCC spread?
Haematogenously
116
Where are common metastases sites for RCC?
Lung - Cannon Ball Mets
117
What is the definitive imaging for RCC?
CT with triple phase contrast
118
What staging system is used in RCC?
Robson's staging
119
How is RCC treated?
Radical/partial nephrectomy
| Adjuvant biologics, interferon alpha
120
What other type of cancer can arise in the kidneys?
Transitional cell carcinoma
121
What is transitional cell carcinoma of the kidney associated with?
Industrial dyes/rubber
122
How is transitional cell carcinoma of the kidney treated?
Radical nephroureterectomy
123
What is Wilm's tumour
Nephroblastoma - renal tumour of childhood
124
How does Wilm's tumour present?
Abdominal mass, haematuria, high BP, fever
125
How is a Wilm's tumour treated?
Resection + chemotherapy
126
Which demographic commonly get bladder cancer?
Males aged 50-80
127
What are risk factors for bladder cancer?
Smoking, exposure to rubber/dyes/hydrocarbons, schistosomysis
128
What is the commonest histological type of bladder cancer?
Transitional cell carcinoma (>90%)
129
How does bladder cancer present?
Painless, macroscopic haematuria, recurrent UTI, voiding irritability
130
What imaging modality is used to diagnosed bladder cancer?
Cytoscopy with biopsies
131
What imaging modality is used to stage bladder cancer?
CT/MRI
132
How is bladder cancer treated?
TURBT (transurethral resection of bladder tumour) - if superficial
Radical cystectomy + ileal conduit +/- radiotherapy
If recurs or is high grade - chemotherapy
133
What is the commonest malignancy in men aged 20-30?
Testicular cancer
134
What are risk factors for testicular cancer?
Cryptodorchidism, infertility, FH, Kleinfelters, mumps orchitis
135
How does testicular cancer present?
Painless lump, gynaecomastia, hydrocele
136
How is testicular cancer investigated?
USS
| Tumour markers
137
What are the two main types of testicular tumours?
Seminoma
| Teratoma
138
Which testicular tumour occurs in older men around 40?
Seminoma
139
Which testicular tumour causes a raised AFP and HCG?
Teratoma
140
Which testicular tumour has a homogenous potato like appearance?
Seminoma
141
Which testicular tumour has a heteregenous texture with ectopic tissue?
Teratoma
142
How is a seminoma treated?
Chemo and radiotherapy
143
How is a teratoma treated?
Surveillance and chemotherapy
