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3B Specialties > Urology > Flashcards

Urology Flashcards

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1
Q

prostatitis

acute causes

A

caused by staphylococcus faecalis and E. coli, chlamydia and TB

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2
Q

prostatitis

acute features

A

UTIs
retention
haematospermia
swollen/ boggy prostate on DRE

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3
Q

prostatitis

actue treatment

A

analgesia

levofloxacin 500mg/day PO for 28/7

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4
Q

Prostatitis

Chronic

A

bacterial or non-bacterial
symptoms same as acute >3/12
Doesn’t respond to abx
anti-inflammatory drugs, alpha blockers and prostatic massage

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5
Q

Balantitis

A

acute inflammation of foreskin and glans
associated with strep and staph infections
more common in diabetics
often seen in children with tight foreskins

Rx - abx, circumcision, hygiene advice

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6
Q

Phimosis

A

foreskin occludes meatus
causes recurrent balantitis and ballooning
time and trials of retraction may prevent need for circumcision
in adults - painful intercourse, infection, ulceration and associated with balantitis xerotica obliterans

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7
Q

Paraphimosis

A

tight foreskin retracted and becomes irreplaceable
–> prevents venous return –> oedema and ischaemia of the glans
Rx –> ask pt to squeeze glans, glucose soaked swab, ice pack, lidocaine
–> may need aspiration, dorsal slit/ circumcision

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8
Q

Prostate Ca

A

commonest male cancer
increasing incidence with age
associated with positive family hx
mostly adenocarincoma arising in peripheral prostate

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9
Q

Symptoms of prostate Ca

A 
asymptomatic 
nocturia 
hesitancy
poor stream 
terminal dribbling 
obstruction
weight loss +/- bone pain suggests mets
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10
Q

DRE of prostate in Ca

A

hard irregular prostate

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11
Q

Diagnosis of Prostate Ca

A 
raised PSA 
transrectal USS & biopsy
X-rays 
bone scan 
MRI/CT
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12
Q

Treatment of Prostate Ca

Disease confined to prostate

A
  • radical prostatectomy
  • radical radiotherapy +/- neoadjuvant & adjuvant hormonal therapy
  • hormone therapy alone - delays disease progression
  • active surveillance
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13
Q

Treatment of Prostate Ca

Metastatic Disease

A
  • hormonal drugs - LHRH agonists goserelin stimulate and then inhibit pituitary gonadotrophin
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14
Q

Symptomatic treatment of Prostate Ca

A

analgesia
treat hypercalcaemia - fluids and allopurinol
radiotherapy for bone mets/ spinal cord compression

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15
Q

Penile Ca

A

rare in the UK - more common in Far East and Africa
very rare if circumcised
related to chronic irritation, viruses and smegma

Presentation: chronic, fungating ulcer, bloody/ purulent discharge - 50% spread to lymph at presentation
radiotherapy if early, amputation and lymph node dissection if late .

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16
Q

Benign Prostatic Hyperplasia

Pathology

A

benign nodular or diffuse proliferation of musculofibrous and glandular layers of the prostate

inner (transitional) zone enlarges in contrast to peripheral layer (vice versa in prostate Ca)

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17
Q

Benign Prostatic Hyperplasia

Features

A

lower urinary tract symptoms
- nocturia, frequency, urgency, post-micturition dribbling, poor stream/ flow, hesitancy, overflow incontinence, haematuria, bladder stones, UTI

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18
Q

Benign Prostatic Hyperplasia

Tests

A 
MSU
U&E
USS
Rule out Ca- PSA
Transrectal USS +/- biopsy
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19
Q

Benign Prostatic Hyperplasia

Lifestyle Management

A

Avoid caffine/ alcohol
relax when voiding
void twice in a row to aid emptying
control urgency by practicing distraction methods
train bladder by holding on to increase time between voids.

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20
Q

Benign Prostatic Hyperplasia

Drugs - alpha blockers

A

(tamulosin, alfuzosin, doxasosin, terazosin) decrease smooth muscle tone (prostate and bladder)

SE: drowsiness, depression, dizziness, low BP, dry mouth, ejaculatory failure, extra-pyrimidal signs, nasal congestio, increased weight

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21
Q

Benign Prostatic Hyperplasia

Drugs - 5alpha-reductase inhibitors

A

e.g. finasteride - decrease testosterone’s conversion to dihydrotestosterone
- excreted in semen so advice to use condoms, women should avoid handling
SE - impotence, low libido

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22
Q

Benign Prostatic Hyperplasia

Surgery

A

Transurethral resection of the prostate
Transurethral incision of the prostate- relieves pressure on urethra
Retropubic prostatectomy
Transurethral laser-induced prostatectomy

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23
Q

Acute Retention

Causes

A

Bladder usually tender (+600ml)
causes - prostatic obstruction, urethral strictures, anticholinergics, alcohol, constipation, post-op, infection, carcinoma, neurological

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24
Q

Acute Retention

MAnagement

A
  • analgesia, privacy, running taps, hot bath
  • alpha blocker
    clot–> 3 way catheter and washout
    catheter and then TWOC
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25
Acute Retention Prevention
Finasteride to decrease proste size and retention risk | tamulosin reduces risk of recatheterisation
26
Chronic Retention Presentation
more insidious and maybe painless Overflow incontinence acute on chronic retention lower abdo mass UTI or renal failure
27
Chronic Retention Causes
``` Prostatic enlargement Pelvic Malignancy Rectal Surgery DM CNS disease- transverse myelitis/MS ```
28
Chronic Retention Management
Avoid catheterising unless pain/UTI or renal impairment Institute definitive treatment promptly Intermittent self-catheterisation may be needed
29
Epididymal Cysts
develop in adulthood contain clear/milky fluid - spermatocele fluid lie above and behind testis remove if symptomatic
30
Hydrocele
fluid in the tunica vaginalis primary- patent processus vaginalis--> common, larger, younger secondary- trauma/ infection/ tumour Rx - aspiration or surgery
31
Epididymo-orchitis Causes
``` chlamydia e.coli mumps (EBV) n. gonorrhoea TB ```
32
Epididymo-orchitis | features
sudden onset tender swelling dysuria sweats/ fever
33
Epididymo-orchitis investigations
1st catch urine sample look for urethral discharge consider STI screen ward of possible infertility, symptoms may worsen before improving
34
Epididymo-orchitis Management
<35 doxycycline (treat sexual partners) (if suspect gonorrhoea --> add ceftriaxone) >35 (non-STI) ciprofloxacin or ofloxacin ALSO: analgesia, scrotal support, drainage of abscess
35
Varicocele
``` dilated veins of pampiniform plexus more commonly left-sided often visible as distended scrotal blood vessels that feel like a bag of worms Dull ache associated sub-fertility ```
36
Haematocele
blood in tunica vaginalis follows trauma may need drainage or excision
37
Testicular torsion symptoms
sudden onset of pain in one testis makes walking incomfortable pain in abdomen nausea and vomiting
38
Testicular torsion signs
inflammation in one testis- tender, hot, swollen may lie high and transversely most common 11-30
39
Testicular torsion Management
Analgesia- opioids - consent for possible orchidectomy and bilateral fixation
40
Indirect inguinal hernia
pass though internal inguinal ring and then out through the external ring
41
direct inguinal hernias
pass directly through the posterior wall of the inguinal canal into a defect in the abdominal wall Hesselback's triangle - medial to inferior epigastric vessels, lateral to rectus abdominus
42
Predisposing factors for inguinal hernias
- males - chronic cough - constipation - urinary obstruction - heavy lifting - ascites - past abdominal surgery
43
deep (internal) ring
mid-point of the inguinal ligament | 1.5cm above femoral pulse- crosses mid-inguinal point
44
superficial (external ring)
split into external oblique aponeurosis superior and medial to pubic tubercle
45
relation of the inguinal canal floor
inguinal ligament and lacunar ligament medially
46
relation of the inguinal canal | roof
fibers of transversalis, internal oblique
47
relation of the inguinal canal | anterior
external oblique aponeurosis | + internal oblique for lateral 1/3
48
relation of the inguinal canal | posterior
laterally - transversalis fascia | medially - conjoint tendon
49
Examination of inguinal hernia
-look for previous scars - feel other side - examine external genitalia - is lump visible- can pt reproduce it? ask pt to cough - repeat standing
50
Male hypogandism
failure of testes to produce testosterone, sperm or both - small testes, low libido, erectile dysfunction, loss of pubic hair, decreased muscle bulk, increase fat, gynaecomastia, osteoporosis, low mood If prepubertal - low virilization, incomplete puberty, eunuchoid body, reduced secondary sex characteristics
51
Primary male hypogonadism
``` testicular failure - trauma/ torsion/chemo/radiation Post orchitis - mumps/HIV/ brucellosis/ leprosy Leydig cell toxicity - Renal failure/ liver cirrhosis or alcohol excess Chromosome abnormality - Kleinfelters syndrome (47XXY) ```
52
Secondary hypogonadism
low gonadotrophins- LH/FSH - hypopituitarism - prolactinoma - Kallman's syndrome- isolated gonadotrophin releasing homone deficiency with associated anosmia and colour blindness - systemic illness e.g. COPD/HIV/DM - Laurence-Moon-Beidl & Prader-Willi syndrome
53
Management of hypogonadism
testosterone dermal gel CI if high calcium, polycythaemia, nephrosis, prostate/male breast/ or liver Ca - monitor PSA
54
Clinical features | acute upper urinary tract obstruction
loin pain radiating to groin | - maybe superimposed infection +/- loin tenderness or an enlarged kidney
55
Clinical features | chronic upper urinary tract obstruction
flank pain, renal failure, superimposed infection | polyuria may occur due to impaired urinary concentration
56
Clinical features | acute lower urinary tract obstruction
acute urinary retention- severe suprapubic pain preceded by symptoms of bladder outflow obstruction clincically - distended, palpable bladder, dull to percussion
57
Clinical features Chronic lower urinary tract obstruction
``` urinary frequency hesitancy poor stream terminal dribbling overflow incontinence Signs: distended, palpable bladder +/- large prostate on PR Complications: UTI, urinary retention ```
58
Luminal causes of urinary tract obstruction
stones blood clots sloughed papilla tumour --> renal/ureteric/bladder
59
Mural causes of urinary tract obstruction
congenital/acquired stricture neuromuscular dysfunction schistosomiasis
60
Extra-mural causes of urinary tract obstruction
abdominal or pelvic mass/ tumour retroperitoneal fibrosis iatrogenic - post surgery
61
Urinary Obstruction tests
U&E, creatinine MC&S USS --> CT --> radionuclear MRI
62
Treatment of upper urinary tract obstruction
nephrostomy or ureteric stent alpha-blockers for related pain pyeloplasty
63
Treatment of lower urinary tract obstruction
urethral or supra-pubic catheter | treat underlying cause if possible
64
non-gonococcal urethritis
commoner than GC - discharge is thinner and signs less acute - women typically asymptomatic - cevicitis, urethritis,or salpingitis (pain/fever/infertility)
65
non-infective urethritis
trauma chemicals cancer foreign body
66
Urothelial tumours site
transitional cell carcinomas - calyces - renal pelvis - ureter - blader - urethra
67
Urothelial tumours demographics
men | over the age of 40
68
Urothelial tumours risk factors
- cigarette smoking - exposure to industrial chemicals - benzidine - exposure to drugs (phenacetin, cyclophosphamide, ketamine) - chronic inflammation (schistosomiasis)
69
Urothelial tumours clinical features
painless haematuria LUTS (frequency, urgency, dysuria) in the absence of bacteriuria - pain from locally advance or metastatic disease but may come from clot retention TCC of kidney/ureters --> haematuria and flank pain
70
Urothelial tumours Investigations
- plasma creatinine | - renal tract imaging and cystoscopy
71
Urothelial tumours Management
Pelvic and ureteric tumours- nephrouretectomy - treatment of bladder tumour: local diathermy, cystopic resection, bladder resection, radiotherapy and local/ systemic chemo
72
ureteral stones urolithiasis causes
calcium oxalate and/ or calcium phosphate could also be uric acid, magnesium ammonium phosphate and cystine stones Form when urine becomes super saturated and begins the formation of crystal formation + Calcium stones
73
hypercalciuria | causes
- hypercalcaemia (commonly primary hyperparathyroidism) - excessive dietary intake of calcium - excessive resorption of calcium from bone e.g. prolonged immobilisation - idiopathic hypercalciuria (increased absorption from gut --> increased urinary excretion) Primary renal disease --> alkaline urine --? calcium stones (precipitation of calcium phosphate)
74
Hyperoxaluria
increased oxalate excretion --> formation of calcium oxalate, even with normal calcium excretion - dietary hyperoxaluria (spinach/rhubarb/tea) + low dietary calcium - enteric hyperoxaluria - chronic intestinal malabsorption of any cause --> low intestinal calcium for oxalate binding (2ndary cause - dehydration due to fluid loss from gut) - primary hyperoxaluria rare autosomal recessive enzyme deficiency resulting in high levels of endogenous oxalate production - widespread calcium oxalate deposition (CKD in teens/20s)
75
Uric acid stones
hyperuricaemia with or without clinical gout | pts with ileostomy at risk (loss of bicarb from GI secretions --> acid urine and reduced solubility of uric acid)
76
Infection induced stones
UTIs with urease producing organisms (proteus, klebsiella, pseudomonas) --> stones of ammonia, magnesium and calcium) urease hydrolyses urea to ammonia increasing urinary pH - large stones in pelvicalyceal system produce radiopaque staghorn calculus
77
Cystine stones
cystinuria (autosomal recessive condition affecting cystine and dibasic amino acid transport of epithelial cells of renal tubules and GI tract) --> excessive urinary excretion of cystine --> formation of crystals and calculi
78
Clinical features of urinary tract caliculi
- asymptomatic - pain most commonly - loin pain = staghorn renal caliculi - ureteric stones = renal colic Nausea, vomiting and sweating Haematuria urethral stones - bladder outflow obstruction = anuria and painful bladder distention
79
Management of stones
- strong analgesia - extracorporeal shock wave lithotripsy - endoscopy
80
Investigations of stones
MSU for culture and serum urea, electrolytes, creatinine and calcium Plain KUB x-r unenhanced helical CT
81
Prevention of stones
- normal calcium, avoid oxalate high foods - meticulous control of bacteriuria - xanthine oxidase inhibitor (allopurinol) - high fluid intake
82
Normal urinary physiology
intravesical pressure remains low due to stretching of the bladder wall and the stability of bladder muscle (detrusor) which doesn't contract involuntarily - sphincter mechanisms of bladder neck and urethral muscles - decreased sympathetic activity = sphincter relaxation and detrusor contraction - overall control in cerebral cortex and the pons
83
stress incontinence
sphincter weakness - iatrogenic (post prostatectomy) - post child birth - small leak of urine with increase in intra-abdominal pressure
84
urge incontinence
strong desire to void and inability to hold urine - usual cause detrusor instability - mild cases respond to bladder training - anticholinergic agents --> oxybutynin --> decrease detrusor excitability - may also be caused by bladder hypersensitivity from local pathology (UTI, bladder stones and tumours
85
Overflow incontinence
- prostatic hypertrophy causing outflow obstruction - leakage of small amounts of urine - distended bladder is palpable rising out the pelvis

3B Specialties (7 decks)

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