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Urology Flashcards

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1
Q

What is BPH?

Which areas enlarge?

A

Benign, nodular or diffuse proliferation of musculofibrous and glandular layers of the prostate

Enlarged inner TZ

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2
Q

LUTS from BPH are caused by what 2 components?

A

Static - increased tissue bulk –> narrow urethral lumen

Dynamic –> prostate smooth muscle tone increased

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3
Q

What are LUTS?

A

Storage = FUN
Frequency, urgency, nocturia

Voiding = HIP
Hesitancy, incomplete emptying, poor-flow

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4
Q

Ix in BPH?

A

DRE, TRUSS +/- biopsy, PSA

Urinalysis, USS KUB

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5
Q

Scoring system for BPH?

A

IPSS - International prostate symptom score (/35)

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6
Q

Behavioural mx for BPH?

A

Avoid caffeine, alcohol
Void twice
Bladder training
Limit fuilds

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7
Q

Mx in BPH?

A

W+W

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8
Q

Pharma mx in BPH?

A

Alpha-blocker (tamsulosin, doxazosin)

5-alpha reductase inhibitor (finasteride)

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9
Q

Mechanism of alpha-blocker?

SEs?

A

Smooth muscle relaxation

Post hypo, dry mouth

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10
Q

Mechanism of 5-a reductase inhibitors?

A

Reduced conversion of testosterone to dihydrotestosterone

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11
Q

Mx of abnormal DRE / PSA?

A

Surgical referral

If prostate small - TURP / TUVP

If big - open prostatectomy

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12
Q

Comps of BPH

A

Progression
Sexual dysfunction
Urinary retention
TURP

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13
Q

Causes of urinary retention?

A 
BPH / Ca
Calculi
Bladder cancer
Faecal impaction
Infection
Anticholinergics
Alcohol
Neurological
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14
Q

Ix in acute urinary retention?

A 
USS bladder (post-voidal)
Urinalysis
CT abdo pelvis
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15
Q

Mx of acute urinary retention

A

Immediate bladder decompression –> catheter

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16
Q

What type of Ca is prostate?

A

adenocarcinoma

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17
Q

Spread of prostate cancer?

A

Haematogenous [bone, lung, liver]

Local [seminal vesicles, bladder, rectum]

Lymph nodes

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18
Q

Prostate Ca grading?

A

Gleason score [level of differentiation]

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19
Q

Screening for prostate Ca?

A

PSA

look this up*

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20
Q

Pres of prostate Ca?

A

LUTS, haematuria

if mets –> bone pain, wt loss, anorexia, lethargy

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21
Q

Ix in prostate cancer?

A

PSA
DRE
TRUSS + biopsy
MRI / CT for staging

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22
Q

Mx for prostate Ca?

A

Radiotherapy (external or brachy)

Prostatectomy

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23
Q

Mx of mets in prostate Ca?

A

Androgen deprivation therapy –> goserelin, castration
Bisphosphonates
Palliative radio

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24
Q

Usual ca in bladder?

A

Transitional cell carcinoma (90%)

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25
RFs for bladder Ca?
Smoking Occupational (rubber + dye) Age HNPCC
26
Ix in bladder ca?
Urine dip, MC+S KUB USS Cystoscopy CT urogram
27
Comps of bladder ca?
Hydronephrosis Spread Retention Recurrence
28
Mx of bladder ca?
Cystectomy + chemo
29
Causes of haematuria?
``` UTI Warfarin Coagulopathy Menstruation contamination Pyelonephritis Trauma ``` Stones Malignancy BPH
30
Ix in haematuria?
Urine dip, MC+S DRE Bloods [FBC, coag, PSA] Imaging [USS KUB,
31
Causes of UTI?
E.coli | Staph. saprophyticus
32
Abx in UTI?
Women --> Trimethoprim/nitrofurantoin Men --> ciprofloxacin
33
When is UTI complicated?
``` Functional impairment Structural impairment Kidney involved Pregnancy Catheter Immunosuppressed ```
34
Complicated hospital admission UTI mx?
IV gentamicin
35
Prostatitis causative organism?
E. coli
36
o/e prostatitis?
Warm, soft, exquisitely boggy
37
ix in prostatitis?
Urinalysis, MC+S PSA STI screen TRUSS
38
Mx of prostatitis?
Ciprofloxacin + NSAID + relieve obstruction
39
Urethritis cause?
Post unprotected sex --> N. gonorrhoea, C. trachomatis
40
If urethritis untreated?
Reactive arthritis, meningitis, IE
41
DDx in epididymo-orchitis that you must r/o!
torsion
42
ix in epididymo orchitis
USS | First catch urine for NAAT + gram stain
43
Mx of epididymo orchitis?
STI - Ceftriaxone IM + doxycycline | UTI - levofloxacin
44
Most common types of renal stone?
Calcium oxalate
45
Ix for nephrolithiasis?
``` NCCT Urinalysis FBC (?infection) U+Es KUB USS ```
46
Mx of nephrolithiasis?
Medical [Hydration, Pain relief, Anti emetic] | Surgical [ESWL, nephrostolithotomy]
47
``` Epididymal cyst Pres? Ix? Assos w? Mx? ```
Small painless cyst, b/l USS - transilluminates CF Benign, needs no mx
48
Varicocele? Pres? Ix? Mx?
Abnormal dilation of internal spermatic veins and pampniform plexus Painless mass 'bag of worms' Examination, USS Reassurance, if large --> surgery
49
Hydrocele? Pres? Ix? Mx?
Collection of serous fluid between layers of tunica vaginalis/spermatic cord Testicular swelling, enlarged post activity. Not separate to testis and will transilluminate. USS W+W
50
Testicular Ca? Pres? Ix? Mx?
Seminoma (30-65yo) Teratoma (20-30yo) Painless nodule. Haemospermia. ``` BALUC B-HCG AFP LDH USS CT ``` Radical orchidectomy +/- chemo / radio
51
Mx of stress incontinence?
Pelvic floor Physio Surgery Sling (TVT, TOT) Male --> artificial sphincter, male sling
52
Mx of urge incontinence?
Behavioural [F/V chart, avoid caffeine + alcohol] Drugs [antichoinergics (oxybutinin), B3 agonists (mirabegron), botulinum toxin] Bladder augmentation [detrusor myectomy, cystoplasty (from small bowel)]
53
Neurogenic bladder Pathophys? Leads to..? Pres?
Peripheral nerve/spinal nerve damage at S2-4 Leads to hypotonic bladder; high residual volume, predisposes to infection and overflow Overflow incontinence (can be flaccid or spastic); increased UTI + calculi; hydronephrosis
54
Aims of mx of neurogenic bladder?
Bladder safety --> protect the kidneys Continence control Preserve body image
55
Complications of transurethral resection of prostate?
TURP TUR syndrome Urethral stricture/UTI Retrograde ejaculation Perforation of prostate
56
Features of TUR sydnrome?
Hyponatraemia: dilutional Fluid overload Glycine toxicity
57
How does rhabdomyolysis cause AKI?
Acute tubular necrosis
58
Causes of raised PSA?
BPH / Ca Prostatitis / UTI Ejaculation Urinary retention
59
Gold standard ix for stones?
Non-contrast CT
60
Gold standard ix for bladder Ca?
flexible cystoscopy
61
Mx of acute upper urinary tract obstruction due to stone?
Nephrostomy ESWL for smaller stones
62
Causes of hydronephrosis? u/l b/l
Uni - PACT [Pelvic uereteric obstruction, Aberrant renal vessels, Calculi, Tumours] Bilat - SUPER [Stenosis of urethra, Urethral valve, Prostatic enlartgement, Extensive bladder tumour, Retro-peritoneal fibrosis]
63
Mx of chronic urinary tract obstruction?
Ureteric stent or pyeloplasty
64
RCC usual pres? | Paraneoplastic features?
Haematuria | HTN + polycythaemia
65
Nephroblastoma vs neuroblastoma on imaging?
Neuroblastoma is usually calcified
66
CI to circumcision?
Hypospadias
67
Most common renal malignancy?
Renal adenocarcinoma
68
DDx of testicular torsion? | What test can you do o/e to differentiate?
Torsion of testicular appendage --> cremasteric reflex is preserved when torsion affects the appendage ONLY

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