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Phase 3b > Urology > Flashcards

Urology Flashcards

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1
Q

Causes of acute urinary retention

A 
BPH
Prostate cancer
Urethral strictures
Prolapse - cystocele, rectocele, uterine
Fibroids
Ovarian cyst
Bladder cancer
Infection - prostatitis, cystitis
Anticholinergics
Alcohol
Constipation
Cauda equina syndrome
Multiple sclerosis
Spinal cord compression
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2
Q

Investigations for acute urinary retention

A 
USS bladder
Urinalysis
MSU
FBC
PSA
MRI spine - cauda equina/cord compression
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3
Q

Management for acute urinary retention

A

Catheterise
alpha blocker - tamsulosin
TWOC - trial without catheter

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4
Q

What zone of the prostate enlarges in benign prostatic hyperplasia?

A

Inner (transitional) zone

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5
Q

Symptoms for benign prostatic hyperplasia

A 
Frequency
Urgency
Nocturia
Hesitancy
Poor stream/flow
Terminal dribbling
Bladder stones
Haematuria
Overflow incontinence
UTI
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6
Q

Investigations for benign prostatic hyperplasia

A

PSA - rule out prostate cancer
Rectal examination - smooth, symmetrical and soft, maintained central sulcus
Urine dipstick

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7
Q

What conditions is PSA raised in?

A 
BPH
Prostate cancer
Urinary retention
UTI
Vigorous exercise
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8
Q

Management for benign prostatic hyperplasia

A

Lifestyle - avoid caffeine and alcohol, train bladder

Alpha blockers - Tamsulosin
5alpha-reductase inhibitors - Finasteride

Surgery - TURP

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9
Q

How do alpha blockers (tamsulosin) work?

A

Relaxes smooth muscles

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10
Q

Side effects of tamsulosin

A

Postural hypotension
Dizziness
Dry mouth

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11
Q

How does 5alpha-reductase inhibitors (finasteride) work?

A

Block conversion of testosterone to dihydroxysterone

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12
Q

Side effects of finasteride

A

Impotence

Low libido

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13
Q

Side effects of TURP surgery

A

Incontinence
Retrograde ejaculation
Erectile dysfunction
Strictures

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14
Q

Risk factors for prostate cancer

A 
Old age
Family history - BRCA, HPC-1
Tall
Use of steroids
Increased testosterone
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15
Q

Symptoms of prostate cancer

A 
Nocturia
Hesistency
Poor stream
Terminal dribble
Obstruction
Haematuria
Erectile dysfunction
Weight loss
Fatigue
Bone pain
Anorexia
Palpable lymph nodes
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16
Q

Where does prostate cancer metastase to?

A

Bone
Lung
Liver
Lymph nodes

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17
Q

Investigations for prostate cancer

A

PSA - elevated
DRE - firm/hard, asymmetrical, irregular
Transrectal USS and biopsy

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18
Q

What grading system is used to grade prostate cancer

A

Gleason grading system

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19
Q

Name the grades in the grading system used for prostate cancer

A

Grade 1 = Well differentiated cancer
Grade 2&3 = Moderately differentiated
Grade 4 = Poorly differentiated
Grade 5 = Anaplastic

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20
Q

Management for prostate cancer

A

Disease confined to prostate - radical prostatectomy, radical radiotherapy, brachytherapy, hormone treatment

Metastatic disease - Hormonal drugs e.g. Goserelin, bilateral orchidectomy

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21
Q

Where does renal cell carcinoma arise from?

A

Proximal renal tubular epithelium

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22
Q

Symptoms of renal cell carcinoma

A

Classic TRIAD:
Haematuria
Loin pain
Abdominal mass

Anorexia
Weight loss
Fatigue
Night sweats

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23
Q

Risk factors for renal cell carcinoma

A 
Smoking
Obesity
Hypertension
Long term dialysis
Von Hippel-Lindau disease
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24
Q

Investigations for renal cell carcinoma

A

Increased BP
FBC - polycythaemia from EPO secretion
Chest x-ray “cannon ball” metastases

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25
Treatment for renal cell carcinoma
Partial nephrectomy - 1st line | Radiotherapy + chemotherapy -> Sunitumab, bevacizumab, sorafenib
26
What is the main type of bladder cancer?
Transition cell carcinoma (90%)
27
What are other types of bladder cancer?
Squamous cell carcinoma (10%) Adenocarcinoma Sarcoma Small cell
28
What organism causes squamous cell carcinomas?
Schistosomiasis
29
Causes of bladder cancer
Smoking Rubber industry/dyes Schistosomiasis -> squamous cell carcinomas
30
Symptoms of bladder cancer
``` Painless haematuria Recurrent UTI's Voiding irritability Weight loss Bone pain ``` "Dye factory worker with painless haematuria"
31
Investigations for bladder cancer
Cystoscopy with biopsy - diagnostic Urine - microscopy/cytology CT urogram Urine dipstick - haematuria
32
Treatment for bladder cancer
Transurethral resection of a bladder tumour (TURBT) Chemotherapy - mitomycin + doxorubicin + cisplatin Radical cystectomy - gold standard Palliative chemo-radiotherapy
33
Complications of cystectomy
Sexual and urinary malformation Urinary retention Hydronephrosis
34
Which locations are renal stones commonly located?
Pelvic brim Pelviuteric junction Vesicouteric junction
35
What is the most common type of renal stone?
Calcium oxalate
36
What are other types of renal stone?
Calcium phosphate Magnesium ammonium phosphate (struvite) Urate Cysteine
37
Where is urate renal stones seen?
In hyperuricaemia seen in leukaemia
38
Causes of renal stones
``` Recurrent UTIs Hypercalcaemia Hyperparathyroidism Sarcoidosis Hyperthyroidism Addison's Cushing's Renal tubular acidosis Medications - Diuretics, antacids, corticosteroids, aspirin Foreign body - stents, catheters ```
39
Symptoms of renal stones
``` Renal colic Loin to groin pain Colicky Nausea and vomiting Cannot lie still Haematuria Fever Rigors ```
40
Investigations for renal stones
Urine dipstick - haematuria FBC, U&E's Non-contrast KUB - gold standard
41
Treatment for renal stones
Diclofenac - risk of CV disease Antiemetic if nausea and vomiting Fluids Stones <5mm = pass spontaneously Stones >5mm = Medical explusive therapy - tamsulosin, nifedipine Extracorporeal shockwave lithotripsy - contraindicated in pregnancy Ureteroscopy in pregnancy
42
Define pyelonephritis
Infection in the renal pelvis (between the kidney and ureter and parenchyma)
43
Risk factors for pyelonephritis
Female Structural urological deformities Diabetes
44
Common organisms causing pyelonephritis?
E.coli Klebsiella Enterococcus Pseudomonas
45
Symptoms of pyelonephritis
``` High fever Loin to groin pain Haematuria Rigors Dysuria and urinary frequency Pain on bimanual palpation of the renal angle (over kidney) ```
46
Investigations for pyelonephritis
Urine dipstick - haematuria, proteinuria, leukocyte esterase, nitrite CT scan Ultrasound scan DMSA scans - shows renal scarring
47
Management for pyelonephritis
Broad spectrum antibiotics e.g. co-amoxiclav IV rehydration Analgesia Antipyretics
48
Name the two types of testicular tumours
Seminoma | Teratoma
49
Which type of testicular tumour is most common in the young (20-30 year olds)?
Teratoma
50
What age group are seminomas common in?
30-65 years old
51
Risk factors for testicular tumours
Infant hernia Infertility Undescended testes
52
Signs in testicular tumours
Painless testis lump Haemospermia Secondary hydrocele Dyspnoea - lung mets
53
What are the tumour markers found in testicular tumours
Alpha fetoprotein Beta-hCG Lactate dehydrogenase
54
What tumour markers are raised in teratomas?
Alpha fetoprotein | Beta-hCG
55
What tumour markers are raised in seminomas?
Beta-hCG
56
How does testicular tumours spread to the lymph nodes
Via para-aortic node
57
Where do testicular tumours metastasise?
Lymphatics Lung Liver Brain
58
Treatment for testicular tumours
Radical orchiectomy | Chemo/radiotherapy
59
Define hydrocele
Fluid within the tunica vaginalis | Treatment: Aspiration, surgery
60
Define varicocele
Dilated veins of pampiniform plexus (testicular veins) Feels like 'a bag of worms' Left side more commonly affected Dullache, dragging or soreness
61
What can cause a varicocele
Renal cell carcinoma (RCC) - compression of the renal vein
62
Define epididymal cyst
Small painless cysts, bilateral | USS for confirmation - milky fluid = spermatocele
63
Define epididymo-orchitis
``` Epididymitis = inflammation of epididymis Orchitis = inflammation of teste ```
64
Causes of epididymo-orchitis
``` Chlamydia (in under 35 year olds) E.coli Mumps N. gonorrhoea (in under 35 year olds) TB ```
65
Features of epididymo-orchitis
``` sudden-onset swelling Dysuria Sweats/fever Unilateral Urethral discharge Dragging/heavy sensation ```
66
Investigations for epididymo-orchitis
First catch urine sample - chlamydia/gonorrhoea USS Urine culture
67
Treatment for epididymo-orchitis
Doxycycline - Chlamydia Ceftriaxone - Gonorrhoea Antibiotics Analgesia
68
Define testicular torsion
Acute/sudden onset of unilateral testicular pain Often triggered by activity (e.g. playing sports) 6 hour window after onset before damage is irreversible
69
Symptoms of testicular torsion
``` Sudden onset of pain in one testis Abdominal pain Nausea and vomiting Tender, hot and swollen Abnormal lie - horizontal, rotated and elevated Absent cremasteric reflex ```
70
Differential diagnoses for testicular torsion
Epididymo-orchitis - has symptoms of UTI and more gradual onset
71
Management for testicular torsion
Untwist the testicle | Possible orchiectomy
72
Define urinary incontinence
Involuntary leakage of urine
73
Define urge/overactive bladder
Overactivity of the detrusor muscle of the bladder | Suddenly feeling the urge to pass urine
74
Symptoms of urge/overactive bladder
Urgency Frequency Nocturia Key in door - latchkey incontinence
75
Causes of urge/overactive bladder
``` Stroke Parkinson's Dementia Urinary infection Diabetes Diuretics Atrophic vaginitis Urethritis ```
76
Define stress incontinence
Weakness of the sphincter muscles | Occurs when coughing, laughing, lifting and exercise
77
Causes of stress incontinence
Pregnancy Following birth Post-menopausal women - low oestrogen - weakening pelvic support
78
Define mixed incontinence
Combination of urge and stress incontinence
79
Define overflow incontinence
Due to obstruction to the outflow of urine
80
Causes of overflow incontinence
``` Prostate enlargement Anticholinergics Fibroids Pelvic tumours Multiple sclerosis Diabetic neuropathy Spinal cord injuries ```
81
Risk factors for incontinence
``` Increased age Postmenopausal status Increased BMI Previous pregnancies Pelvic organ prolapse Pelvic floor surgery Multiple sclerosis Cognitive impairment and dementia ```
82
Investigations for incontinence
Urinalysis - UTI check Frequency volume chart Post-void residual bladder volume Urodynamic testing
83
Medical management for stress incontinence
Duloxetine - SNRI
84
Surgical management for stress incontinence
Tension free vaginal tape Sling Colposuspension
85
Non-pharmalogical management for stress incontinence
Pelvic floor exercises
86
Medical management for urge incontinence
Anticholinergics - Oxybutynin, tolteridone, solifenacin Mirabegron - Beta3 adrenergic agonist Botox
87
Non-pharmacological management for urge incontinence
Bladder training
88
Side effects of oxybutynin
Blurred vision Constipation Retention Dry mouth

Phase 3b (18 decks)

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