MILD - Watch and wait MILD + symptomatic - Alpha blocker (tamulosisn) - 5 alpha reductase inhibitor (finasteride) - NSAID Abnormal DRE + elevated SA - surgical referral - Prostate 80g radical prostectomy

1. Progression 2. Sexual dysfunction 3. Acute urinary retention 4. TURP syndrome: absorption of irrigating fluids into prostatic venous sinuses

Urology Flashcards by Alice O'Regan

List the common anatomical sites with urolithiasis occur

Pelviureteric junction
Pelvic brim
Vesicoureteric junction

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Types of stones that causes urolithiasis

Calcium oxadate stones (spikey or smooth opaque stones)
Struvite stones (staghorn stones, linked to infection)
Urate stones (smooth brown stones)
Cystine stones (yellow crystal stones)

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Factors that predispose patients to developing stones

Dehydration 
Hypercalcaemia (1 PTH)
Increased oxalate excretion 
UTIs
 Hyperuricaemia 
Anatomical abnormalities 
Drugs: furosomide

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Presentation of urolithiasis

Acute severe flank pain Pt cannot lie still 
- renal colic 
- loin to groin 
- unilateral 
\+ n/v 
\+ worse on fluids
\+ microscopic haematuria

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Investigation for suspected urolithiasis

Spiral non contrast CT of the kidneys , gold standard
Urinalysis
- dip and Mc+s: microhaematuria, leukocytes, nitrates
Bloods
- FBC, raised WCC
- U+E, hypercalcaemia, gout
Pregnancy test
KUB USS (hydronephrosis)

Watch out for signs of sepsis

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Treatment of urolithiasis

ACUTE

Hydration
Pain control
Anti-emetics
Rectal diclofenac

Stone with no obstruction

+bacteriuria (trimethoprim/nitrofurantoin)
<10mm: medical explosion therapy (alpha blockers or CCB
> 10mm : Extracorporeal shock wave lithotripsy + ureteroscopy

Stone with obstruction
- as above + surgical decompression

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Define BPH and discuss why the lower urinary tract symptoms occur

Proliferation of musculofibrous and glandular layers
Enlargement of inner transition zone

LUTRS due to bladder outlet obstruction

Static component: increase in the tissue bulk
Dyanamic component: increase in the prostatic smooth muscle (alpha adrenergic receptors)

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List the symptoms of BPH

Frequency 
Urgency 
Nocturia 
Hesitancy 
Intermittent emptying 
Poor flow 
Post voiding dribble

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Investigations for BPH

PR examination
TRUSS +/- biopsy
PSA

Urinalysis
- rule out UTI

Volume chart

Urodynamics

USS KUB

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Treatment of BPH

MILD
- Watch and wait

MILD + symptomatic

Alpha blocker (tamulosisn)
5 alpha reductase inhibitor (finasteride)
NSAID

Abnormal DRE + elevated SA

surgical referral
Prostate <80g TURP/TUVP
Prostate > 80g radical prostectomy

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Complications of BPH

Progression
Sexual dysfunction
Acute urinary retention
TURP syndrome: absorption of irrigating fluids into prostatic venous sinuses

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Causes of urinary retention

OBSTRUCTIVE 
- Mechanical 
BPH 
Clots 
Strictures 
Stone 
Constipation

Dynamic
Drugs
Post operative pain

NEURO 
- Interruption of sensory or motor innervation 
Pelvic surgery 
MS 
DM

MYOGENIC
- Over distension of the bladder
High alcohol intakes

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Clinical features of acute urinary retention

Suprapubic tendernes 
Palpable bladder 
- Dull to percussion 
Large prostate on PR 
<1L on catheterisation

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Investigations in acute urinary retention

Blood

Urine
- Mc&s

Imaging

US bladder volume
Hydronephrosis
Pelvic XR

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Management of acute urinary retention

Conservative

Analgesia
Walking
Running water or bath

Catheterise 
- + stat gent cover 
- hourly UO 
- Tamulosin, decreased the risk of recatherterisation after retention 
- TWOC 24-72hr
if failed TWOC will need TURP

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Organisms that cause prostatitis

S.faecalis
E.coli
Chlamydia

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Clinical features associated with prostatitis

UTI 
Pain 
- low backache 
- pain on ejaculation 
Haematospermia 
Fevers 
Rigors 
Retention 
Malaise

O/E
Pyrexia
Swollen/boggy/tender prostate on PR

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Treatment of prostatitis

Sepsis

IV taz
IV gent
NSAIDs
SPC

No sepsis

Fluoroquinolone oral 2-4 weeks
Ciprofloxacin 500mg PO BD

Chronic
- 4/6 weeks of ciprofloxacin + alpha blocker + NSAIDS

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Causes of false haematuria

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Beetroot
Rifampicin
Porphyria
PV bleed

Outline the presentation of acute epididymo-orchitis

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Unilateral pain and swelling (develops over days) 
Discharge 
Fever 
LUTS 
(must rule out torsion)

List the causes of epididymo-orchitis

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<35

STI
N.Gonorrhoeae

> 35

UTI
Enteric pathogens (E.coli)

Retrograde ascent of urinary pathogens

A 24yr old male presents to A&E complain of pain and swelling in his testicles. It is sore and hot to touch.
On questioning further he mentions that he has had some LUTS symptoms in the last few days as well as some discharge.
What are you ddx?
What investigations would you perform?
How will you manage this patient?

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A) Acute epididymo-orchits from a STI
B) Acute epididymo-orchitis from a UTI

First catch urine or NAAT for STI check
Gram stain of urethral secretions
Urine dip +ve leucocyte esterase
Urine culture
Urine microscopy
Colour duplex USS
May require surgical exploration

STI : Single dose of ceftriaxone (IM) + doxycycline (100mg)
UTI levofloxacin 100mg

Presentation of testicular torsion

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Surgical emergency
Tender, swollen, hot, high and transverse lie
Morel likely in bell clapper deformity

Treatment of testicular torsion

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Ordidopexy (bilateral fixation)

Must also consent for an orchidectomy

Define erectile dysfunction

ED is difficulty in attaining, maintaining an erection or a marked decrease in rigidity Importnat Q's 1. Early morning erection 2. Foreplay 3. Masturbation

List the causes of ED

``` Age Pain Vascular Neurological ( Spinal cord injury) Horomonal (increased prolactin, low androgens) Psychological (anxiety, depression) Surgical Drugs (SSRI, B-blockers) ```

Investigations for erectile dysfunction

``` Nocturnal rigiscan Penile doppler USS Testosterone Prolactin Cholesterol BP Fasting glucose HbA1c FSH/LH TSH ```

Outline the possible treatment options for men with erectile dysfunction

Rx underlying cause 1. PDE5 inhibitor: sildenafil 2. Alprostadil: 3. Vacum pump 4. Constriction ring 5. Penile implant 6. Psychosexual therapy

Outline the pathology of prostate cancer

Commonest male Ca Adenocarcinoma Peripheral zone of prostate

Clinical features of prostate cancer

``` Asymptomatic Urinary - Nocturia - Frequency - Hesitancy - Poor stream - Dribbling Weight loss Fatigue Bone pain from mets ```

Outline the types of spread expected in prostate cancer

Local: seminal vesicles, bladder, rectum Lymph: para-aortic nodes Haem: Sclerotic bony lesions

Investigations in suspected prostate cancer

Bloods - PSA - U&Es - FBC - ALP- - Ca Imaging - XR chest and spine - Transrectal USS guided biopsy - Bone scan - Staging MRI

Outline the issues in relation to PSA

Proteolytic enzyme that is not specific to prostate Ca | Increases with age, RP, TURP and prostatitis

Name the grading system used for prostate cancer

Gleason

Outline the treatment of prostate cancer

VERY LOW RISK - Active surveillance - +/- brachytherapy or external beam radiotherapy - Check PSA/DRE/BIopsy LOW RISK - As above HIGH RISK - Radiacal prostectomy plus pelvic LN dissection - External beam radiotherapy + androgen deprivation therapy

Outline the management of metastatic disease

80% are androgen sensitive: castration leads to remission - Goserelin (GnRH analogue) may initially make things worse and will then improve. - Tamoxifen - Anti-androgen ( flutamide) If castration resistant - Bisphosphonates/ denosumab for bone pain and hypercalcaemia - Palliative radiotherapy

Complications of prostate cancer

Erectile dysfunction Hormone induced gynaecomastia Hormone induced flush Radiation induced LUTS

Define a varicocele

Abnormal dilatation of internal spermatic veins and paminiform plexus Possible due to absent valves

Management of a varicocele

Reassurance and observation | High grade: surgical repair

Define a hydrocele

Collection of serous fluid between layers of the tunica vaginalis Types: Communicating or non-communicating

Management of a hydrocele

May resolve spontaneously Surgical repair - Lord's repair

Define neurogenic bladder

Bladder function that is either flaccid or spastic and is caused by neurological damage. Main feature: OVERFLOW INCONTIENCE

Outline the innervation of the bladder

Detrusor contraction: PSNS (cholinergic) S2,3,4, pelvic splanchnic Urethral Contraction and inhibition of the detrusor: SNS T11-L2 (hypogastric) Somatic: S2,3,4 external sphincter muscle

Outline the causes of neurogenic bladder

CNS - Spinal injury - ALS PNS - Diabetes - Alcohol - VItB12 neuropathy Mixed - Parkinsons - MS - Syphillis - Tumour

Classify the different types of neurogenic bladder

Flaccid (hypotonic) - Areflexic bladder - Bladder volume is large, press sure is low - Absent contractions Spastic bladder - Brain or spinal cord damage - Detrusor-sphincter dyssynergia - Involuntary urination/defecation

Complications of neuropathic bladder

Reduced quality of life Increased UTI and calculi Hydronephrosis (problematic kidney damage) Acute bladder distension

Urology Flashcards

(46 cards)