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Urology Flashcards

1
Q

What is acute urinary retention?

A

Sudden inability to pass urine

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2
Q

What is the most common cause of acute urinary retention?

A

BPH

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3
Q

Name three other causes of acute urinary retention in men.

A

Prostate cancer
Prostatitis
Balanitis

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4
Q

Name three causes of acute urinary retention in women.

A

Prolapse
Vulvovaginitis
Pelvic mass

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5
Q

Which conditions involving the bladder can cause acute urinary retention?

A

Bladder calculi
Bladder cancer
Urethral strictures
Cystitis

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6
Q

10% of acute urinary retention is caused by drugs, such as what?

A

Anti-cholinergics
Opioids and anaesthetics
Alcohol
Alpha-adrenoreceptor agonists

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7
Q

What neurological conditions can cause acute urinary retention?

A 
Peripheral neuropathy
MS
Parkinsons'
Cerebrovascular accident
Cauda equina
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8
Q

What is found on abdominal examination in acute urinary retention?

A

Tender enlarged bladder with dullness to percussion above the symphysis pubis, almost to umbilicus.

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9
Q

What should be noted on DRE in acute urinary retention?

A

Anal tone

Prostatic size, nodules, and tenderness

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10
Q

What may be noted on examination of genitals in acute urinary retention?

A

Phimosis, discharge, inflammation, prolapse

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11
Q

How are prolapsed disc or cord compression checked on examination?

A

Lower limb power and reflexes

Perineal sensation

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12
Q

How is acute urinary retention diagnosed?

A

Routine bloods including PSA
Urinalysis for infection, haematuria, proteinuria, glycosuria
USS: post void residual volume and hydronephrosis
CT and MRI if indicated

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13
Q

How is acute urinary retention managed?

A

Immediate bladder decompression

Alpha blocker before removal of catheter

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14
Q

Define benign prostatic hyperplasia.

A

Increase in size of prostate gland without malignancy present

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15
Q

What is the pathophysiology of BPH?

A

Failure of apoptosis, hormone dependent

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16
Q

How does BPH present?

A 
Urinary frequency
Urgency
Hesitancy
Post micturition dribbling
Incomplete bladder emptying
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17
Q

How is BPH diagnosed?

A 
Check for palpable bladder
DRE
Urinanalysis and MSU for MC&S
Routine bloods
PSA
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18
Q

What should be noted on DRE for BPH?

A

Tone of anal sphincter
Size, texture, contour of prostate
Median sulcus clearly defined

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19
Q

Elevated ALP may suggest…

A

Bony metastases

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20
Q

What may a palpable bladder suggest?

A

Chronic outflow obstruction

Neurogenic bladder

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21
Q

If a BPH patient has moderate to severe voiding symptoms, what drugs can be offered?

A

Alpha blockers e.g. Tamsulosin

5-alpha reductase inhibitors (5-ARI) e.g. Finasteride

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22
Q

How do alpha blockers work?

A

Reduce the tone in the muscle of the neck of the bladder

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23
Q

When may doxazosin be described in patients with BPH?

A

It is less selective, so may be prescribed if patient also has hypertension.

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24
Q

What are the side effects of tamsulosin?

A

Rhinitis
Dizziness and headache
Intra-operative floppy iris syndrome

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25
How do 5-ARIs work?
They block the synthesis of dihydrotestosterone from testosterone.
26
What is the main side effect of 5-ARIs?
Adverse effect on sexual performance which may continue after discontinuation.
27
What is the second line treatment of BPH?
When no response to monotherapy AND prostate>30g/PSA>1.4ng/mL Combine alpha blocker and 5-ARI
28
What is the surgical management of BPH?
TURP - transurethral resection of the prostate
29
What are the risk factors for prostatitis?
HIV infection BPH and prostate cancer STI Indwelling catheters
30
What are the causes of prostatitis?
Gram negative bacteria STI If non bacterial - elevated prostatic pressures
31
What are the four types of prostatitis?
Acute bacterial Chronic bacterial Chronic prostatitis Asymptomatic inflammation
32
What are the symptoms of prostatitis?
Fever, malaise, arthralgia, myalgia LUTS including nocturia and dysuria Pain - lower back, abdo, perineal, urethral Pain on ejaculation/premature ejaculation Urethral discharge
33
What are the signs of prostatitis?
Pyrexia Nodular/boggy/tender/hot or normal gland Inguinal lymphadenopathy
34
How does the prostate gland feel in chronic prostatitis?
Hard from calcification
35
How is prostatitis diagnosed?
Urine culture and microscopy for WCC and bacterial count Oval fat bodies and lipid laden macrophages PSA may be elevated
36
What is the management of acute prostatitis?
Possibly admission Analgesia Ciprofloxacin 4 weeks
37
What is the management of chronic infective prostatitis?
Refer Ciprofloxacin 4-6 weeks, repeated courses may be necessary TURP may be required
38
What is the management of chronic abacterial prostatitis?
Analgesia | Alpha blocker plus antibiotic
39
What is neurogenic bladder?
Bladder dysfunction that may be either flaccid or spastic, which may co-exist with bladder outlet obstruction
40
What are the CNS causes of neurogenic bladder?
CVD Spinal injury ALS
41
What are the PNS causes of neurogenic bladder?
Diabetes Alcohol Vitamin B12 deficiency neuropathies Disc damage
42
What are the mixed CNS and PNS causes of neurogenic bladder?
Parkinson's | MS
43
Describe flaccid/hypotonic bladder.
Large bladder volume, pressure low, contractions absent | Damage at S2-S4
44
Describe the spastic bladder.
Normal/small volume, involuntary contractions occur Damage above T12 Detrusor-sphincter dyssnergia
45
What is the main symptom of neurogenic bladder?
Overflow incontinence, retaining of urine Spastic have LUTS too
46
How is neurogenic bladder monitored?
Renal function - serum creatinine Hydronephrosis - Renal USS 1-2 yearly Urodynamics if high risk Large post-void residual volume
47
Patients with hydronephrosis or nephropathy undergo what?
Cystography Cystoscopy Cystometrography
48
What is the management of flaccid bladder?
Intermittent self catheterization
49
What is the management of spastic bladder?
Trigger voiding with suprapubic pressures and anti-cholinergics Treat urge incontinence
50
What are prostate cancers and where do they arise?
Adenocarcinomas arising in the peripheral zone of the prostate gland
51
What are the risk factors for prostate cancer?
Increasing age Afro-Caribbean FH
52
How does prostate cancer present?
LUTS and raised PSA on screening | Locally invasive disease - haematuria, haematospermia, perineal and suprapubic pain, impotence
53
What are the signs of prostate cancer?
Irregular asymmetrical gland, induration, lack of median sulcus, lack of mobility - adhesion to surrounding tissue, palpable seminal vesicles.
54
What are the investigations for prostate cancer?
``` PSA PCA3 urine test Urinalysis Renal function tests Transrectal needle biopsy ```
55
What factors influence whether men should have a prostate biopsy?
PSA level DRE findings Comorbidities Risk factors
56
What are the possible treatments of prostate cancer?
Watchful waiting Radical prostatectomy Curative radiotherapy Brachytherapy
57
What is the most common androgen deprivation therapy?
GNRH agonists such as goserelin
58
What are the other forms of anti-androgen therapy?
Bilateral orchiectomy | Cytoproterone acetate
59
How do anti-androgens inhibit prostate cancer growth?
Inhibit androgen receptor signalling
60
What is flare phenomenon, an adverse effect of anti-androgen therapy? What is the cause, and how can it be prevented against?
Bone pain, acute bladder outlet obstruction, obstructive AKI, spinal cord compression, fatal cardiovascular events due to hypercoagulation status Caused by an initial increase in luteinizing hormone prior to receptor down regulation Flutamide can pre-emptively attenuate the tumour flare.
61
What are the other adverse effects of anti-androgen therapy?
Hot flushes Sexual dysfunction Osteoporosis Gynaecomastia
62
Define the acute scrotum.
Acute scrotal pain with or without oedema or erythema
63
What are the differentials for acute scrotum?
``` Torsion of the testes Epididymitis/orchitis Hydrocele Tumour Idiopathic scrotal oedema ```
64
What is bell-clapper testis and what is it a risk factor for?
Lack of normal fixation of posterior lateral aspect of testis to tunica vaginalis Intravaginal testicular torsion
65
Which type of testicular torsion occurs in neonates?
Extravaginal - before the testis is fixed in the scrotum by the gubernaculum
66
What are the symptoms of testicular torsion?
Left>right Sudden severe testicular pain, may be abdo N+V
67
What are the signs of testicular torsion?
Swollen tender testis retracted upwards, erythema Lifting testis up over symphysis increases pain Absence of cremasteric reflex on affected side
68
Where does the cremasteric reflex originate?
L1/L2
69
How is testicular torsion diagnosed?
Colour Doppler USS
70
How is testicular torsion managed?
Attempt manual reduction by outwards rotation of testis | Bilateral orchiopexy
71
What are the complications of testicular torsion?
Infarction of testicle | Subfertility from ischaemia-reperfusion injury
72
What are the causes of epididymo-orchitis?
STI (chlam/gono) UTI (gram neg) Mumps
73
What are the risk factors for epididymo-orchitis?
STI/UTI MSM Catheters
74
What are the symptoms of EO?
Acute unilateral scrotal pain and swelling
75
What are the signs of EO?
Tenderness, palpable swelling of epididymitis | Secondary hydrocele, erythema, pyrexia
76
How is EO diagnosed?
Gram stained urethral smear, MC&S NAAT urethral swab Exclude TT
77
How is EO treated?
Doxycycline 100mg PO BD 10-14d If STI, add IM 250mg ceftriaxone If enteric: olfloxacin 200mg PO BD 14d
78
What is a hydrocele?
An abnormal collection of fluid within the remnants of the processus vaginalis
79
What are the main types of hydoceles?
Simple (usually congenital) Communicating Non-communicating
80
What are the causes of secondary hydrocele?
``` Epididymo-orchitis TB TT Tumours Trauma Generalised oedema ```
81
What are the features of a hydrocele?
Scrotal enlargement with a non-tender smooth swelling which transilluminates. Lies anterior to and below the testis Impalpable testis
82
What are important investigations to rule out a transilluminating teratomas?
Serum AFP and hCG
83
How is a hydrocele managed?
Infancy - resolve by 2 years | Large - therapeutic aspiration
84
Where do 95% testicular tumours arise and what are the subtypes?
Germ cells Seminoma and non-seminomatous germ cell tumours (NSGCTs)
85
What are the risk factors for testicular cancer?
Cryptorchidism or testicular maldescent FH Klinefelter syndrome Malignancy in contralateral testicle
86
What are the symptoms of testicular cancer?
Painless lump Dragging sensation Hydrocele Gynaecomastia from bhCG
87
How is testicular cancer diagnosed?
Tumour marker assay Bilateral testicular USS Tissue histology
88
What is the treatment of testicular cancer?
Radical orchidectomy and prosthesis
89
What is the staging system of testicular cancer?
Royal Marsden
90
What elements produce AFP and bhCG?
AFP - yolk sac tumours | bHCG - trophoblastic elements - teratomas and seminomas
91
What are the three types of priapism?
Ischaemic (low flow) Non-ischaemic (high flow) Recurrent ischaemic (intermittent)
92
What is the most common cause of priapism?
Sickle cell disease
93
What are the consequences of priapism?
Ischaemic damage leading to erectile dysfunction, disfigurement, gangrene.
94
What does an ABG of the corpus cavernosum show in priapism?
Low pH: ischaemic | Normal pH: non-ischaemic
95
How is priapism diagnosed?
Doppler USS and ABG
96
What is the treatment of ischaemic priapism?
Aspiration of blood from corpus cavernosum, injection of normal saline Injection of phenylephrine
97
What inotrope is used in sepsis?
Adrenaline increases cardiac output | Noradrenaline causes peripheral vasoconstriction
98
Why does sepsis result in hypovolaemia?
Massive vasodilation causes hypotension
99
What is the management of an ileus?
Drip and suck | NG tube inserted to decompress all the gas and allow a period of rest for the bowel
100
Bilious vomiting and an inguinal lump =
Obstructed hernia
101
What is the pathognomic sign of torsion of testicular appendage?
Blue dot sign
102
What is the treatment of torsion of testicular appendage?
Ibruprofen and conservative management | Exclude testicular torsion
103
What imaging modality is used to image urinary tract stones?
Non-contrast (stones are white)
104
In priapism, what is done before the penis is drained?
Dorsal nerve block
105
What are the PCRMP age adjusted upper limits for PSA (ng/ml)?
50-50 years: 3.0 60-69 years: 4.0 >70 years: 5.0
106
Name some complications of radical prostatectomy.
Incontinence | Erectile dysfunction
107
Retrograde ejaculation can occur after what?
Alpha-blocker therapy | TURP
108
What is the first line investigation of a testicular mass?
Ultrasound
109
Name a life threatening complication of a TURP.
TURP syndrome | Venous destruction and absorption of the irrigation fluid
110
What causes the symptoms of TURP syndrome?
Fluid overload | Hyponatraemia
111
What are the causes of unilateral hydronephrosis?
``` PACT Pelvic-ureteric obstruction Aberrant renal vessels Calculi Tumours of renal pelvis ```
112
What are the causes of bilateral hydronephrosis?
``` SUPER Stenosis of the urethra Urethral valve Prostatic enlargement Extensive bladder tumour Retro-peritoneal fibrosis ```
113
What are four medical indications for circumcision?
Phimosis Paraphimosis Recurrent balanitis Balanitis xerotica obliterans
114
What are three causes of haematospermia?
Trauma UTI especially prostatitis STI Exclude cancer with physical examination

Phase 3B (20 decks)

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