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Urology Flashcards

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1
Q

Prostate Ca creates what kind of bone lesions?

A

Sclerotic (blastic)

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2
Q

How many CaP patients have mets at diagnosis?

A

50%

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3
Q

What mutations are implicated in CaP?

A

BRCA1/2

HPC1/2

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4
Q

What is PSA?

A

Prostate specific antigen

Protease that dissolve prostatic coagulum to make semen thinner

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5
Q

How is CaP graded?

A

Gleason grade 1-10 (6-10)

Take the 2 biggest areas of cancer and grade those then add together

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6
Q

Describe the T staging of CaP

A

1 in 1 lobe
2 involves both lobes
3 involves seminal vesicles
4 extensive, fixed and infiltrating blood vessels

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7
Q

What are the SEs of radical radiotherapy for CaP?

A

Damage to adjacent organs eg, bowel
Chronic proctitis
Incontinence
Impotence

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8
Q

How do we treat locally advanced or met CaP?

A

Orchidectomy
LHRH agonists
+/- anti-androgens flutamide

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9
Q

What is the median survival for met CaP?

A

6-9 months

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10
Q

What is the 10 year survival for localised CaP?

A

80%

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11
Q

What is the male to female ratio of bladder/renal Ca?

A

3:1

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12
Q

What is the peak age of bladder Ca?

A

65 years

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13
Q

What are the risk factors for bladder Ca?

A 
Chronic parasite infection
Dyes and rubber exposure 
Smoking
Chromosome 9 mutations
Overexpression of EGFR
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14
Q

What are the diseases linked to renal cancer?

A

Von Hippel-Lindau Disease

Familial papillary renal carcinoma Syndrome

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15
Q

What is the mutation seen in Familial Papillary Renal carcinoma Syndrome?

A

Mutation to MET oncogene on chromosome 7q31

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16
Q

Where do Renal mets arise from?

A

Lung
Breast
Melanoma
Lymphoma

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17
Q

On diagnosis, what percentage of patients with bladder tumours have invasive disease?

A

30

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18
Q

95% of bladder cancer are what type?

A

Transitional cell carcinomas

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19
Q

Do most renal tumours arise in the cortex or medulla?

A

Cortex

Usually PCT

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20
Q

What hormones can be produced excessively from renal tumours?

A

EPO
PTHrp
Renin

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21
Q

How do most bladder cancers present?

A

Painless Haematuria

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22
Q

Where does RCC met to?

A

Lung
Liver
Bone
Brain

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23
Q

What investigations are required for painless Haematuria?

A

Urinalysis
Urine cytology
Cystoscopy +/- biopsy

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24
Q

Describe the T staging for RCC

A

1 <7cm limited to the kidney
2 >7cm limited to kidney
3 tumour extension but not beyond Gerota’s fascia
4 tumour invasion before Gerota’s fascia

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25
Describe the T staging for bladder cancer
``` Is - in situ A - non invasive papillary carcinoma 1 superficial not beyond lamina propria 2 invading muscle layer 3 involving serosal surface of bladder 4 spread to prostate/uterus/pelvic wall ```
26
What is the treatment of a superficial bladder cancer?
Transurethral resection (TURBT)
27
What factors increase the relapse rate for bladder cancer?
High grade histology Incomplete resection Multifocal disease Carcinoma in situ
28
If people have superficial bladder cancer but risk factors for relapse then what would we give?
Adjuvant BCG therapy
29
What is the treatment of muscle invasive bladder cancer?
TURBT or radical cystectomy or radical radiotherapy
30
What is used to treat bladder mets?
Combination chemotherapy: gemcitabine and cisplatin
31
What is the curative option for RCC?
Radical nephrectomy
32
What biological therapies are used in RCC?
Angiogenesis inhibitors Everolimus Temsirolimus Sunitinib
33
What immunotherapy can be used for RCCs?
Interferon | IL 2
34
What is the 5 year survival of superifical bladder cancer?
80-90%
35
What is the 5 year survival of invasive bladder cancer?
30-40%
36
What is the 5 year survival of RCC?
45%
37
Gynaecomastia can be a sign of which testicular tumour types?
Sex cord stromal | Germ cell
38
What are sex cord stromal tumours?
Tumours derived from the stormal component of ovary/testis. Comprised of granulosa and theca cells and fibrocytes
39
What are the types of germ cell tumours?
Teratomas - well encapsulated tumour from all 3 layers | Seminomas - arises from germ cell epithelium of the seminiferous tubules
40
What are the testicular tumour markers?
AFP Beta HCG LDH
41
What are the risk factors for RCC?
``` Obesity Smoking Inherited diseases Renal stones Family history Hypertension Painkillers and diuretics Dialysis Male ```
42
Beta HCG is used as a tumour marker for ...
Choriocarcinoma | Germ cell tumours
43
List some benign renal tumours
Renal cortical adenoma Metanephric adenoma Oncocytoma Angiomyolipoma
44
What is the commonest renal lesion?
Benign renal cyst
45
What are the urological red flags?
``` Haematuria LUTS Persistent or recurrent UTIs Loin pain Abdominal mass Painless lump in testis Penile ulceration or bleeding ```
46
What is the pattern of cervical screening?
25 - 49 years every 3 years | 50-64 years every 5 years
47
Give examples of LHRH agonists
Goserelin | Leuprorelin acetate
48
What is the worry with LHRH agonists?
They can cause an initial surge in testosterone which can cause the cancer to grow in response therefore must cover the first few weeks of therapy with an anti-androgen
49
What are the side effects of LHRH agonists?
``` Hot flushes Decreased libido Impotence Fatigue Osteoporosis Gynaecosmastia Muscle loss ```
50
When would you use LHRH agonists in CaP treatment?
Alongside or before radiotherapy | For advanced cancer to keep it under control
51
The apex of the bladder is connected to the umbilicus via the ...
Median umbilical ligament
52
The median umbilical ligament is a remnant of the ...
Urachus
53
The bladder receives blood supply from the ...
Internal iliac vessels
54
Which surface of the testes does the epididymis lie?
Posterolateral
55
Where are Sertoli cells found?
Lining the walls of the seminiferous tubules
56
Where are leydig cells found?
In the testicular interstitial tissue
57
What is the role of Sertoli and leydig cells?
Sertoli - Aid maturation of the spermatozoa | Leydig - produce testosterone
58
Describe the vascular supply to the testicles
Testicular artery Artery of vas deferens Cremasteric artery
59
Where does the lymph fluid of the testes drain to?
Lumbar and para-aortic LNs
60
What are the symptoms of prostatitis?
Pain passing urine or flow difficulty | Pain/discomfort around testicles, rectum or lower abdomen
61
What is the management of prostatitis?
Antibiotics - ciprofloxacin Pain killers Tamsulosin
62
What are the risk factors for prostatitis?
``` UTI indwelling catheter Biopsy STI HIV Anal sex Pelvic injury ```
63
What is Von Hippel Lindau Disease?
Rare, autosomal dominant disease with a mutation in the VHL tumour suppressor gene Predisposes to growth of benign and cancerous tumours and cysts
64
What lesions are associated with VHL?
``` Haemangioblastomas Kidney cysts RCC pancreatic neuroendocrine tumours Phaeochromocytoma ```
65
Define the AKI staging
``` 1 = creatinine 1.5-2x baseline or UO <0.5 for >6 hrs 2 = creatinine 2-3x baseline or UO <0.5 for >12 hrs 3 = creative 3+ x baseline or UO <0.3 for 12 hrs ```
66
Describe the CKD staging
``` 1 >90 2 60-90 3a 45-59 3b 30-44 4 15-29 5 <15 ```
67
Which vertebral levels do the kidney lie over?
T12 - L3
68
What is the order of kidney casing from deep to superficial?
Renal capsule Perirenal fat Renal fascia Pararenal fat
69
Give the order of blood vessels in the kidney
``` Renal artery Segmental Interlobar Arcuate Interlobular Afferent Glomerulus Efferent Peritubular network ```
70
What do we call the 3 cylinders of erectile tissue in the penis?
2 corpora cavernosa | Corpus spongiosum
71
What is the role of bulbospongisus muscles in the penis?
Contracts to empty the spongy urethra of any residual urine or semen Aids maintaining erection
72
What is the role of ischiocavernosus muscles in the penis?
Contracts to force blood from the cavernous spaces into the corpus cavernosa to maintain erection

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