UROLOGY Flashcards
(161 cards)
1
Q
What is the first line investigation for scrotal lumps?
A
Ultrasound scan (assess for cancer)
2
Q
What are the tumour makers for testicular cancer?
A
Lactate dehydrogenase
AFP
beta-HCG
3
Q
Where is the fluid in hydrocoele?
A
Peritoneal fluid between parietal and visceral layers of tunica vaginalis
4
Q
What is a varicocoele?
A
Dilatation of the pampiniform plexus
5
Q
What are the consequences of a varicocoele?
A
Infertility and testicular atrophy
6
Q
How is a varicocoele managed?
A
Embolisation (examine abdo for renal cancer)
7
Q
What are epididymal cysts?
A
Benign fluid filled sac
8
Q
How is the pain on epididymitis relieved?
A
Elevation of the testes
9
Q
How is a testicular lymph caused by inguinal hernia presenting?
A
Cannot ‘get above’
10
Q
What is the most common malignancy in men 20-40?
A
Testicular cancer
11
Q
How does testicular torsion present?
A
•Tender
•Raised
•Swollen
12
Q
What is the main cause of orchitis?
A
Mumps
13
Q
What causes acute urinary retention?
A
BPH
Constipation (compresses urethra)
Anti-muscarinics
14
Q
What are the clinical features of acute urinary retention?
A
Suprapubic pain
- *Palpable** bladder
- *PR** for prostate / constipation
15
Q
What are the investigations for acute urinary retention?
A
Post-void bedside bladder scan
16
Q
What is high pressure urinary retention?
A
Back up into the renal tract
17
Q
What is the management of acute retention?
A
Urethral catheterisation
Treat underlying cause
18
Q
What causes chronic urinary retention?
A
BPH
Pelvic prolapse
Upper motor neurone disease (MS or Parkinson’s)
19
Q
How does chronic urinary retention present?
A
- Painless urinary retention
- Weak stream
- Hesitancy
- Overflow incontinence (worse at night- nocturnal enuresis)
20
Q
What are the investigations for urinary retention?
A
Post coid bladder scan showing retained urine
Bloods: FBC, U&Es, CRP
21
Q
What is the management of chronic retention?
A
- Catheterisation (>1L)
- NO TWOC (long term catheter till definitive management)
22
Q
What are some complications of chronic urinary retention?
A
UTI
Bladder calculi
23
Q
What is pseudohaematuria?
A
Red/brown urine not secondary to haaemoglobin
Causes incl. rifampicin, hyperbilirubinuria, myoglobinuria
24
Q
What are some urology differentials for haematuria?
A
- Infection (pyelonephritis, cystitis or prostatitis)
- Malignancy (prostate adenocarcinoma)
- Renal calculi
- Trauma / recent surgery
- Radiation cystitis
- Parasitic, commonly schistosomiasis
25
What does terminal haematuria suggest?
Severe bladder irritation
26
Why are work/travel questions added for haematuria?
Work (**dye** industry)
Travel = **schistosomiasis**
27
What are the investigations for haematemesis?
- **Urinalysis** (nitrites/leukocytes = infection)
- **Bloods** (FBC, U&Es, clotting)
- **Prostate specific antigen** (PSA)
(1+ blood on dipstick is required for certainty - not trace)
28
When should haematuria be referred for urgent referral?
**Aged \> 45** with unexplained visible haematuria
**Aged \> 60** with unexplained non-visible haematuria (with dysuria/ raised WCC)
29
What is the gold standard for assessing lower urinary tract?
**Flexible cystoscopy** (local anaesthetic)
30
What are common causes of LUTS in men and women?
**Men =** BPH, UTI, malignancy, detrusor muscle weakness
**Women =** UTI, menopause, malignancy, stricture
31
What are the two categories of LUTS?
**Storage** = urgency, frequency, nocturia, urgency incontinence
**Voiding** = hesitancy, intermittency, straining, terminal dribbling
32
What associated questions can be added about LUTS?
- Visible haematuria
- Suprapubic discomfort
- Colicky pain
Digital rectal exam
33
What specialist investigations are there for LUTS?
Urodynamic studies
Upper urinary tract imaging (ultrasound / CT scanning)
34
What conservative options are there for LUTS?
- **Regulate fluid** intake (no caffeine/alcohol)
- **Urethral milking** (mabually empty bulbar urethra)
- **Double voiding** (voiding immediately again after)
- **Pelvic floor exercises**
35
What medication can be used for over active bladder?
Anticholinergics (e.g. **oxybutynin, tolterodine**)
B3 andrenic agonist (e.g. **mirabegron**)
36
What medication can be used for BPH?
**Alpha blockers** (tamsulosin)
## Footnote
**5α-reductase inhibitors (finasteride)**
37
What can be used to aid reducing nocturia?
**Desmopressin**
38
What is a complicated (vs uncomplicated) pylonephritis?
**Uncomplicated** = **structurally** / functionally **normal** urinary tract in **non-immunocompromised** host (complicated when opposite is true)
39
What are the top 3 organisms for pyelonephritis?
**Escherichia coli**
**Klebsiella**
**Proteus**
40
What are some risk factors of pyelonephritis?
**Flow obstruction**: BPH, neuropathic bladder from spinal cord injury
**Bacterial access**: Female, indwelling catheter, vesico-ureteric reflux
**Immunocompromise:** Diabetes, corticosteroid use, HIV infection
**Bacterial colonisation****:** calculi, intercourse
41
What is the classical triad for pyelonephritis?
- **Fever**
- **Loin pain**
- **Nausea and vomiting**
42
What are some differentials for back pain?
- **Pyelonephritis**
- Renal **calculi**
- Acute **cholecystitis**
- Ecopic **pregnancy**
- **Pelvic inflammatory disease**
- **Lower lobe pneumonia**
43
What are the investigations for pyelonephritis?
- **Urinalysis** (nitrites and leucocytes)
- Urinary **beta-hCG**
**-** Urine culture
- FBC, CRP (inflammation)
- U&Es
44
What is the management of pyelonephritis?
A-E
IV **fluids**
**Analgesia**
**Antiemetics**
**Catheterisation**
**Early CT**
SEVERE = NEPHROSTOMY INSERTION / PERCUTANEOUS DRAINAGE
45
What are some complications of pyelonephritis?
- Sepsis
- Renal scarring
- Pyonephritis
- Preterm labour
46
What is the most common form of adult renal tumour?
**Renal cell carcinoma** (\<15% incl TCC)
47
What are the risk factors of renal cell carinoma?
- Smoking
- Dialysis
- HTN
- Obesity
48
How does RCC present?
- Haematuria
- Flank pain / mass
- Lethargy
- Weight loss
- Left varicocoele
49
What are some paraneoplastic syndromes caused by ectopic secretion of hormones by RCC?
Polycythaemia due to **erythropoetin**
Hypercalcaemia due to **parathyroid hormone**
Hypertension due to **renin**
50
What is the imaging for suspected RCC?
Ultrasound or **CT with IV contrast is gold standard**
51
What are some risk factors for developing renal cysts?
Increasing age
Smoking
HTN
Male
ADPCD
52
What is ADPKD associated with in the head? (and elsewhere)
**Berry aneurysm formation** (subarachnoid haemorrhage), mitral valve disease, liver cysts
53
What are the features of renal cysts?
Incidentally on abdo imaging
Flank pain (infected/rupture)
Haematuria
**Uncontrolled hypertension** (ADPKD)
54
What is the imaging for renal cysts?
**CT or MRI** imaging (pre and post **enhancement** scans)
55
How are cysts managed?
**Simple** = no further follow up
**Complicated** = analgesia or needle aspiration
56
What is the only radiolucent stone?
**Urate** stones
57
What causes urate stones?
High levels of **purine** in the blood (red meats)
58
What are the location where ureteric stones lodge?
PUJ
Crossing pelvic brim
VUJ (vesicoureteric junction)
59
How do renal stones present?
- Ureteric colic
- Haematuria
- Flank tenderness
60
What are differentials for flank pain?
- Renal **stone**
- **Pyelonephritis**
- Ruptured **AAA**
- **Biliary pathology**
- **Bowel obstruction**
- Lower lobe pneumonia
61
What are some investigations for renal stone?
- Urine dip (haematuria)
- Bloods (FBC, CRP - infection)
- U&Es (renal function)
- Urate and calcium levels
**NON CONTRAST CT KUB**
Ultrasound scan for hydronephritis
62
How to manage patients with renal stones?
Fluid resus (patients are often dehydrated)
Stones normally pass spontaneously
**ANALGESIA** (NSAIDs per rectum)
63
When should a patient with a stone be admitted?
- AKI
- Uncontrolled pain
- Evidence of infected stone
- Large stone \>5mm
64
How are patients with obstruction and renal calculi managed?
Nephrostomy (temporarily drain) or retrograde stent insertion
65
What are some definitive treatments of stones?
- Extracorrporeal Shock Wave Lithotripsy (ESWL) (contraindications are pregnancy or stone over bony landmark)
- Percutaneous nephrolithotomy (PCNL) (larger stones)
-
66
What are some complicatins from urteric stones?
**Infection** and post renal **AKI**
67
What foods should patients who get oxolate stones be warned against?
**High oxalate foods** (nuts, rubarb and sesame)
68
When can bladder stones be seen?
Chronic **urinary retention**
**Schistosomiasis**
69
What is the definitive treatment of bladder stones?
**Cytoscopy** allowing stones to drain/lithotripsy
70
What are some risk factors for SCC of the bladder?
Schistosomiasis
Bladder stones
71
What epithelium lines the bladder?
**Urothelium** (transitional)
72
What are the biggest risk factors for bladder cancer?
**- Smoking**
**- Increasing age**
- Industrial dyes
- Schistosomiasis infection
73
How does bladder cancer present?
Painless **haematuria**
Recurrent **UTIs**
74
What is the investigation for bladder cancer?
Urgent **cytoscopy**
(initally flexible under local then rigid under general - if suspicious, with biopsy taken)
75
What is the surgery for bladder cancer?
**TURBT** (transurethral resection of carcinoma in situ)
**Radical cystectomy** (high risk disease)
76
What are the different types of incontinence?
**Stress** (intraabdominal presure increases - weak pelvic floor)
**Urge** (overactive detrusor - neurogenic i.e. stroke, infection, malignancy)
**Mixed**
**Overflow** (from chronic urinary retention)
77
What are some risk factors for stress urge incontinence?
- Post partum
- Constipation
- Obesity
- Post-menopausal
78
What are the investigations for incontinence?
- Midstream urine dip (infection/haematuria)
- Post void bladder scan
- Cytoscopy
79
What are the non-surgical options for urge incontinence?
- **Weight loss**
- **Reduce caffeine** intake
- **Avoid drinking excessive** fluid volumes
- **Smoking** cessation
80
What are the managment options for stress UI?
- **Pelvic floor** muscle training (3 months)
- **Duloxetine** (SSRI) to cause stronger urethral contractions
81
What are the treatment options for urge urinary incontinence?
**Anti-muscarinic drugs** e.g. oxybutynin or tolterodine and **bladder training**
82
What are the surgical options for urinary incontinence?
**Urge** = botulinum toxin A injection
**Stress** = tension free vaginal tape
83
What does the prostate do?
Converts testosterone to dihydrotestosterone (DHT) using 5α-reductase.
MECHANISM OF BPH IS NOT UNDERSTOOD
84
What are the risk factors for BPH?
Age
Family history
Afro-caribbean
85
How do patients with BPH present?
* Hesitancy
* Weak steam
* Terminal dribbling
* Urinary frequency
* Nocturia
* Nocturnal enuresis
86
What scoring system is used to evaluate LUTS in BPH
IPSS
87
What are the investigations for BPH?
- Dipstick
- Post-void bladder scan
- PSA
- Ultrasound scan (for hydronephrosis)
88
What are the medical options for BPH? How do they work and any side effects?
**α-blockers** (e.g. tamsulosin) - relax prostatic smooth muscle (postural hypotension, retrograde ejaculation)
**5α-reductase inhibitors** (e.g. finasteride) - prevent conversion to DHT, decresing volume of prostate
89
What is the surgical management of prostate enlargement? What are some complications?
**Transurethral resection of the prostate**
Haemorrhage, sexual dysfunction, retrograde ejaculation
90
What is the main complication for BPH?
High-pressure **retention**
**Recurrent UTIs**
Significant **haematuria**
91
What type of cancer affects the prostate?
Adenocarcinoma
92
Where do prostate cancers typically affect?
Peripheral zone
93
What are the main risk factors for prostate cancer?
**Age**
**Ethnicity** (black / caribbean men are twice as likely to get it)
**FH**
94
What are some modifiable risk factors for prostate cancer?
- Obesity
- Diabetes
- Smoking
95
How does prostate cancer present?
- LUTs
- Haematuria
- Dysuria
- Incontinence
- Haematospermia
96
What are the differentials for enlarged prostate with LUTs?
- BPH
- Prostate cancer
- Prostatitis
97
What investigations are there for prostate cancer?
- **PSA**
**- DRE**
-
98
When can the PSA be artifically raised?
- BPH
- Prostatitis
- Vigorous exercise
- Ejaculation
- Recent DRE
99
How is prostate cancer diagnosed?
Biopsies of tissue
100
What scoring system is used for prostate cancers?
**Gleason** grading system
101
What is the surgical treatment for prostate cancer?
**Radical prostatectomy**
102
What are the side effects of radical prostatectomy?
- Erectile dysfunction
- Stress incontinence
- Bladder neck stenosis
103
What are the common organisms in prostatitis?
E. Coli
Enterobacter
Proteus
Chlamydia/gonorrhoea
104
What are risk factors for acute bacterial prostatitis?
- Indwelling catheters
- Phimosis
- Recent transrectal biopsy
- Immunoscompromised
105
How does acute bacterial prostatis present?
- LUTs
- Pyrexia
- Perineal pain
- Tender prostate
- Inguinal lymphadenopathy
106
What is the 1st line investigation for prostatitis?
Urine **culture**
107
What are some other investigations for prostatitis?
- **STI** screen
- Routine **bloods**
- **Prostate abscess** ruled out by transrectal prostatic ultrasound
108
What is the management of acute bacterial prostatitis?
- Prolonged antibiotic therapy (normally **quinolone**)
- **Analgesia**
- Medications used for BPH
109
What are the organisms in epididymitis on \<35 and \>35?
\<35 = N. gonorrhoeae and C. trachomatis
\>35 = E. Coli, proteus spp, Klebsiella pneumoniae
110
What typically causes orchitis?
Viral cause - **mumps**
111
What is the disease course of mumps?
Parotitis then orchitis
Self-resolving disease (can lead to testicular atrophy)
112
What are some risk factors for epididymitis?
- MSM
- Multiple sexual partners
- Catheterisation
- BPH
113
How does epididymitis present?
- Dysuria
- Red and swollen
- Tender to palpate
- Associated hydrocoele
- Intact cremasteric reflex
- Prehn's sign (pain in alleviated by raising)
114
What are the differentials for a painful and swollen testicle?
- Testicular torsion (pain is sudden)
- Epididymitis
- Testicualr abscess
- Epididymal cyst
-
115
What are the investigations for epididymitis?
- Urine dipstick
- First-void urine for STIs
- FBC and CRP for infection
116
What imaging for epididymitis?
**Normally clinical diagnosis** however **ultrasound imaging** can be used
117
What is the management for epididymitis?
**Abx**
**Abstinence from sex** until abx complete
118
What are the types of testicular cancer?
**Germ cell** tumours (95%)
**Non germ cell** tumours (seminomas/non-seminomas)
119
What cells comprise NGCT?
**Leydig/sertoli** cells.
USUALLY BENIGN
120
What is a teratoma an example of?
**Non-seminomatous GCT** (along with yolk sac, choriocarcinoma, etc)
121
What are some risk factors for testicular cancer?
**Cryptorchidism** (undescended testis)
Previous **testicular malignancy**
Positive **family history**
122
How does a testicular tumour appear?
Unilateral painless testicular lump
Irregular, firm and fixed
123
Where is the lump drainage from the testes?
**Para-aortic** nodes
124
Name some differentials for a scrotal lump?
- Epididymal cyst
- Haematoma
- Epididymitis
- Hydrocoele
- Testicular cancer
125
What are the investigations for testicular cancer? Incl. tumour markers
Tumour markers = bHCG, AFP, LDH
**Scrotal ultrasound**
Staging with **CT**
**No trans-scrotal percutaneous** biopsy as can cause **seeding**
126
What is the surgery option for testicular cancer?
**Inguinal radical orchidectomy**
127
What is testicular torsion?
Spermatic cord and contents twists within the **tunica vaginalis**
128
What deformity leads to an increased risk of torsion?
Males with horizontal lie of testes aka **bell-clapper deformity**
129
What are the risk factors for torsion?
**Age**
**Previous testicular torsion**
**FH**
**Undescended testes**
130
How does the testes appear with torsion?
Unilateral testicular pain
High lying postion with **absent cremasteric reflex**
Negative **prehns sign** (pain doesnt go away)
131
What are the investigations for torsion?
Normally clinical diagnosis (**urgent surgical exploration**)
**Doppler ultrasound** can be used to investigate **blood flow to the testis**
132
What term is used for the fixing of testes after torsion?
Bilateral **orchidopexy**
133
What are the main risk factors for urethritis?
\< 25 years old
MSM
Previous STIs
Recent new sexual partner
More than 1 partner in past year
134
How does urethritis present?
- Dysuria
- Penile irritation
- Discharge
135
What is reactive arthritis?
**Sterile** inflammatory arthritis caused by autoimmune response to distant joints
136
What is reactive arthritis commonly caused by?
Clamydia Teachomatis
Campylobacter spp
Shigella
137
What is the triad in reactive arthritis?
Conjunctivits
Arthritis
Urethritis
138
What are some differentials for dysuria?
**Balanitis** (inflammation of glans penis)
**Acute prostatitis** (ejaculatory pain, LUTs)
**Cystitis** (dysuria / freqency)
139
What are the investigations for urethritis?
**Culture** of urethral swabs
**Gold** standard is **first-void urine** sent for **nucleic acid amplification test**
140
What is the treatment for urethritis?
Gonococcal = ceftriaxone
Non-gonococcal = Doxy or Azithromycin
141
What is Fournier's gangrene?
**Necrotising fasciitis** affecting the **perineum**
142
Where does necrotising fasciitis infect?
- Subcut tissue
- Fascia
143
What are the alpha-haemolytic and beta haemolytic streps?
**Alpha** = S. pneumoniae, S. Viridans
**Beta**:
* Group A = S. Pyogenes
* Group B = S. Agalactiae (harmlessly colonises)
144
Name 2 risk factors for Fournier's gangrene?
- Diabetes
- Excess alcohol
- Poor nutritional state
145
How does Fourn'ers Gangrene present?
Severe pain, out of proportion
Pyrexia
Skin necrosis
146
What organisms typically cause Fournier's gangrene?
E. Coli
S. Pyogenes
147
What is the management for Founier's gangrene?
Urgent surgical debridgement
148
What is **paraphimosis**?
Inability to pull forward a retracted foreskin
149
What are some risk factors for paraphimosis?
- **Phimosis**
- Urethral **catheter**
- **Poor hygiene**
150
What are the management options of paraphimosis?
- **Analgesia**
- **Manual pressure** on glans to reduce oedema then reduction
- Dorsal slit/emergency **circumcision**
151
What virus is penile cancer associated with?
HPV 16, 6 and 18
152
What is the most common penil malignancy?
**Squamous cell carcinoma**
153
Name some risk factors for penile cancer?
HPV infection 6, 16, 18
Phimosis
Smoking
Lichen sclerosis
154
How does penile cancer present?
**Ulcerating lesion** on the penis (painless)
**Inguinal lymphadenopathy**
155
What are the differentials for ulcerations on the penis?
Infection: Herpes simplx / Syphilis
Inflammation: Psoriasis, balanitis
156
How is penile cancer diagnosed?
Penile biopsy
157
What is priapism?
Unwanted painful erection for more than 4 hours
158
What are the two forms of priapism?
**High flow**: blood enters corpus cavernosum more quickly than it can be drained (through trauma usually)
**Low flow** (ischaemic): veno-occlusive caused by blocking of the venous drainage
159
What is a penile fracture?
Traumatic **rupture** of **corpus cavernosa** and **tunica albuginea**
160
How does a penis fracture present?
- Snap followed by pain and cessation of erection
- Pain and swelling, deviation to opposite side
161
What is the management of penile fractures?
**Analgesia**
**Anti-emetics**
Surgical exploration and repair
