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Urology Flashcards

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1
Q

What is the most common type of renal cancer?

A

Renal clear cell carcinoma

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2
Q

What metastases are commonly associated with renal cell carcinoma?

A

Cannon ball mets in lungs

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3
Q

What is the clinical triad which is suggestive of renal cancer?

A

Haematuria
Loin pain
Abdominal mass

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4
Q

What are risk factors for the development of renal cancer?

A 
Smoking
Obesity
HTN
LT dialysis
Von-Hippel-Lindau disease
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5
Q

Why does renal cancer cause a varicocele?

A

Compression of the renal artery causes back pressure on there testicular vessels

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6
Q

What are the different subtypes of renal cancer?

A 
Clear cell
Papillary
Chromophobe
Collecting duct carcinoma
Wilms Tumour - children <5
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7
Q

How can renal cancer be managed?

A

Surgery - partial/radical nephrectomy

+/- chemotherapy/radiotherapy

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8
Q

What paraneoplastic features are associated with renal cancer?

A

Polycythaemia - RCC secretes EPO

Hypercalcaemia - RCC secretes a hormone which mimics PTH

Stauffer syndrome

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9
Q

What is Stauffer syndrome?

A

Abnormal LFTs indicating an obstructive jaundice without any localised hepatic/biliary metastasis

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10
Q

What are the two main types of bladder cancer?

A

90% transitional

10% squamous cell

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11
Q

What are the main risk factors for transitional cell?

A

Smoking
Aromatic amines
Polycyclic aromatic hydrocarbons
Arsenic

(Hair dye, industrial paint, rubber)

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12
Q

What are the main risk factors for squamous cell carcinoma of the bladder?

A

Smoking

Schistosomiasis

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13
Q

How do bladder cancers present?

A

Painless haematuria

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14
Q

How are bladder cancers diagnosed?

A

Cystoscopy and biospy

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15
Q

Following a neobladder reconstruction, what type of cancer are people most at risk of?

A

Adenocarcinoma

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16
Q

How can a bladder cancer that does not invade the muscle be treated?

A

Transurethral Resection of Bladder Tumour (TURBT)

Chemo into bladder

Weekly treatments of BCG vaccine into bladder via catheter for 6 weeks, then every 6 months for 3 years

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17
Q

How can a bladder cancer that invades into the detrusor muscle be managed?

A

Radical cystectomy with ileal conduits
Radiotherapy
Chemotherapy

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18
Q

What is BPH?

A

Hyperplasia of stromal and epithelial cells of the prostate

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19
Q

How should BPH be investigated?

A

Urine dipstick
PSA prior to DRE
DRE - size, shape, characteristics of prostate

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20
Q

How can BPH be managed?

A

Reassurance and monitoring

Meds:
alpha blockers - tamsulosin
5a reducase inhibitors - finasteride

Surgery:
TURP (transurethral resection of prostate)
Open prostatectomy via abdo/perineal

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21
Q

What is a TURP, and what complications are associated with a TURP?

A

Shave off part of the prostate to create a wider space for urine to flow

Bleeding
Infection
Incontinence
Retrograde ejaculation
Urethral strictures
Erectile dysfunction
Failure to resolve symptoms
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22
Q

What is TURP syndrome?

A

Irrigation fluid enters systemic circulation causing:

  1. Dilutional hyponatraemia
  2. Fluid overload
  3. Glycine toxicity
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23
Q

What can cause PSA levels to be elevated?

A 
BPH
Prostatis and UTI 
Ejaculation
Vigorous exercise
Urinary retention
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24
Q

What is the most common type of prostate cancer?

Study These Flashcards
A

Adenocarcinoma

25
How can BPH present?
``` Lower Urinary Tract Symptoms (LUTS) Hesitancy Frequency Dribbling Incomplete voiding Nocturia ```
26
How can prostate cancer present?
Similar to BPH + Haematuria + Erectile dysfunction + General signs of cancer
27
How might a malignant prostate feel on DRE?
Firm/hard Asymmetrical Craggy/irregular Loss of central sulcus
28
How is a prostate cancer graded?
Gleason Score - assess the most dominant and 2nd most dominant biopsies Grade 1: well differentiated Grade 2/3: moderately differentiated Grade 4: poor differentiated Grade 5: anaplastic Gives an overall score out of 10
29
How can prostate cancer be managed?
Watchful waiting Radiotherapy Brachytherapy - radioactive seeds implanted into prostate to deliver target, constant radiotherapy Hormonal - block androgens to slow/stop growth of prostate cancer 1. Bilateral orchidectomy - gold standard 2. LHRH agonists - causes chemical castration 3. Androgen receptor blockers Surgery - total prostectomy
30
What are complications of radical treatment of prostate cancer?
Erectile dysfunction Urinary incontinence Radiation induced enteropathy Urethral strictures
31
If starting a patient on anti-androgen therapy, what else needs to be co-prescribed and why?
Flutamide - a synthetic anti-androgen Anti-androgen drugs cause a transient increase in symptoms of prostate cancer the 'flare effect' due to the initial increase in LH production prior to receptor down regulation
32
What are causes of epididymo-orchitis?
E.coli Chlamdyia trachomatis Neisseria gonorrhoea Mumps
33
How does a patient present with epididymo-orchitis?
``` Gradual onset over minutes/hours Usually unilateral Testicular pain/tenderness Dragging/heavy sensation Urethral discharge (chlamdyia/gonorrohea) Tender on palpation Swelling of testicles and epididymus Erythema to scrotum ```
34
How should epididymo-orchitis be managed?
``` Admit if septic 2 weeks Abx - ciprofloxacin Tight underwear for scrotal support Abstain from intercourse during illness USS to exclude torsion and tumours ```
35
Describe testicular torsion
Urological emergency Sudden onset unilateral testicular pain Often triggered by activity
36
How long do you generally have to sort out a testicular torsion before the damage from ischaemia is irreversible?
6 hours
37
What is a major complication of testicular torsion?
Sub-fertility | infertility
38
What are the anticipated examination findings in a patient with testicular torsion?
``` Acutely tender testicle Firm testicle Absent cremastic reflex Abnormal lie (Horizontal lie, epididymus not in normal posterior position, testicle may be retracted) ```
39
What is a Bell-Clapper deformity?
Testicle should be fixed posteriorly to the tunica vaginalis In bell-clapper deformity, the fixation is absent, so testicles can rotate within tunica As the testicle rotates, it twists the vessels cutting off the blood supply
40
How should a testicular torsion be managed?
Emergency urological review Immediate surgical scrotal exploration (untwist the testicle, fix both testicles in correct position - orchiplexy, orchidectomy if delayed surgery/necrotic tissue)
41
Describe how a testicular cancer may feel
``` Non-tender Arises from testicle Hard without fluctuance Doesn't transilluminate Irregular ``` Commonly between 15-40
42
What is a hydrocele?
Build up of fluid in tunica vaginalis
43
How does a hydrocele feel?
Soft, fluctuant, transilluminates | Irreducible with no bowel sounds
44
What side do hydroceles commonly present on?
Left side
45
What is a varicoele?
Swollen pampiniform plexus
46
How can a varicole present?
Dragging/sore
47
Describe a epididymal cyst
Soft, fluctuant lump at top of testicle
48
Describe how an inguinal hernia presents as a testicular lump
Separated from hernia Can't get above it Bowel sounds Reducible
49
What are the main types of testicular cancer?
Seminoma (average age 25) | Teratoma (average age 35)
50
What tumour markers can be used in testicular cancer?
AFP - raised in teratomas beta-HCG - raised in termatomas and seminoma Lactate dehydrogenase
51
Where can a testicular cancer metastasis to?
Lymphatics Lungs Liver Brain
52
How is testicular cancer managed?
Orchidectomy +/- prosthesis Chemo/radiotherapy Monitor with tumour markers and imaging
53
What organisms can be responsible for pyelonephritis?
E.coli Klebsiella Enterococcus Pseudomonas
54
How can pyelonephritis present?
``` High fever + rigors Loin to groin pain Dysuria and urinary frequency Haematuria Pain on palpation of renal angle ```
55
What might be seen on dipstick in a patient with pyelonephritis?
Haematuria Proteinuria Leucocytes Nitrites
56
How can pyelonephritis be investigated?
CT-KUB MSSU - cultures DMSA scan - assess for renal scarring
57
How can pyelonephritis be managed?
``` Blood and urinary cultures Broad spectrum abx (co-amoxiclav) IVF Analgesia Anti-pyretics ```
58
What can be the result of chronic pyelonephritis?
Scarring Can cause CKD Can cause abscess formation ? Prophylactic abx

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