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Urology Flashcards

1
Q

Stress incontinence aetiology

A

Detrusor pressure > Closing pressure of urethra

Obesity
Menopause - Lack of oestrogen
Pelvic radiation
Childbirth / pregnancy

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2
Q

Stress incontinence presentation and investigations

A

Involuntary passage of urine with increase in intra-abdominal pressure

  • Coughing
  • Sneezing
  • Laughing

Urine dip / MC&S - Infection?
F/V chart - Normal
Urodynamics - Pre-surgery

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3
Q

Stress incontinence management

A

Conservative

  • Lose weight
  • Stop smoking
  • Pelvic floor exercises - 3 months
  • Decrease caffeine
  • Reduce fluid intake

SSRI - Duloxetine
Surgery - TVT

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4
Q

Urge incontinence aetiology

A

Overactive bladder
Overactive detrusor muscle

Obesity

Neuro disease

  • MS
  • Stroke
  • Parkinson’s
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5
Q

Urge incontinence presentation and investigations

A

Key in door syndrome!

  • Urgency
  • Frequency
  • Nocturia

Investigations

  • Urine dip / MC&S - Infection?
  • F/V chart - Increased frequency
  • Urodynamics - Pre-surgery
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6
Q

Urge incontinence management

A

Conservative - Bladder retraining!

  • Lose weight
  • Stop smoking
  • Pelvic floor exercises - 3 months
  • Decrease caffeine intake
  • Reduce fluid intake

Ach antagonist - Oxybutynin - Falls risk!
M3 agonist - Mirabegron

Botox injections

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7
Q

BPH aetiology

A

5a reductase converts testosterone into dihydrotestosterone
Hypertrophy of cells in transitional zone
Narrowing of urethra
Increase in smooth muscle contractility

50% of men aged 50 - 30% symptomatic
80% of men aged 80

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8
Q

BPH presentation

A

Voiding symptoms - Obstructive

  • Weak / intermittent flow
  • Straining
  • Hesitancy
  • Terminal dribbling
  • Incomplete emptying

Storage symptoms - Irritative

  • Urgency
  • Frequency
  • Urgency incontinence
  • Nocturia
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9
Q

BPH investigations

A
  1. PSA - Prostate cancer?
  2. DRE
  3. TRUS

Scoring system - International Prostate Scoring System

Urine dip / MC&S
USS-KUB
F/V chart

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10
Q

BPH management

A

Behavioural - E.g. fluid restriction at night

A-blocker - Tamsulosin / Doxasozin

  • Postural hypotension
  • Sexual dysfunction

5a reductase inhibitor

  • Finasteride
  • Gynaecomastia

Surgery - TURP

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11
Q

BPH complications

A

Urinary retention
Hydronephrosis
Stones
Infection

TURP syndrome!

  • Aetiology - Long surgery / Large blood loss
  • Clinical features - Fluid overload, hyponatraemia, headache
  • Management - Supporting, correct hyponatraemia
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12
Q

Prostate cancer aetiology

A

Peripheral zone
Adenocarcinoma

Family history 
Black ethnicity
Dietary fat
BRCA
HPC-1
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13
Q

Prostate cancer presentation

A

Bladder outlet obstruction

  • Nocturia
  • Frequency
  • Hesitancy

Haematuria

Pain

  • Perineal
  • Testicular
  • Back - Secondary to metastases

Weight loss

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14
Q

Prostate cancer investigations

A
  1. PSA
  2. TRUS + Biopsy
  3. DRE - Asymmetrical, hard, nodular, loss of median sulcus

+ MRI

+ CT/PET staging

Urine dip / MC&S

+ Markers

  • Serum - PSMA
  • Urinary - PCA3
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15
Q

Prostate cancer metastases and staging

A

Bone
Lung
Liver

Staging

  1. Non-palpable / non-visible
  2. Palpable / visible
  3. Beyond capsule
  4. Beyond seminal vesicles
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16
Q

Prostate cancer management

A

T1/2

  • Active monitoring
  • Brachytherapy
  • Prostatectomy

T3/4

  • Hormonal
  • Brachytherapy
  • Prostatectomy

Metastatic

  • Synthetic GnRH
  • Anti-androgen
  • Orchidectomy
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17
Q

Prostate cancer treatment complications

A

Incontinence
Sexual dysfunction
Gynaecomastia

Radiation - Cancer risk

  • Bladder
  • Colon
  • Rectal
18
Q

PSA

A

Increased…

  • Prostate cancer
  • BPH
  • Vigorous exercise
  • Ejaculation
  • Infection
  • Urinary retention

Age

  • 50-59 (< 3.0)
  • 60-69 (< 4.0)
  • > 70 (< 5.0)
19
Q

Bladder cancer pathophysiology

Blood supply + Lymph

A

Transitional cell carcinoma
Squamous cell carcinoma - Schistosomiasis

Bladder blood supply

  • Superior vesical artery
    • Umbilical artery
  • – Internal iliac artery

Lymph node spread

  • Obturator
  • Internal/external iliac
20
Q

Bladder cancer risk factors and presentation

A 
Smoking
Printing /textile industry - Aniline dyes - 2-naphthylamine
Pelvic radiation
Schistomiasis - SCC
HNPCC
Family history
Chronic bladder inflammation

Presentation - Painless haematuria!
+ Weight loss

21
Q

Bladder cancer investigations / staging / management

A

Urinalysis - Haematuria
Flexible cystoscopy + Biopsy - 2ww referral
CT/PET staging

Stage (s/r)

  1. Lamina propria (90%)
  2. Beyond muscle (60%)
  3. Beyond fat (35%)
  4. Metastases (25%

Management

  • TURBT ± Intravesical chemotherapy
  • Cystectomy ± Chemo
22
Q

Testicular torsion

A

Twisting of spermatic cord - Ischaemia + Necrosis

Risk factors - Peak incidence 13-15 years

  • Bell-clapper deformity
  • Trauma

Presentation

  • Sudden severe groin/abdo pain ± N/V
  • Absent cremasteric reflex
  • Red swollen testis
  • Elevating the testis does not relieve pain

Investigations - USS - Whirlpool sign

Management - Surgical repair - Bilateral

23
Q

Hydrocoele aetiology

A

Accumulation of fluid in tunica vaginalis
Communicating - Peritoneal fluid drains into scrotum
Non-communicating - Excessive fluid production in TV

Secondary to…

  • Epididymo-orchitis
  • Torsion/cancer
  • Failure of processus vaginalis closure
24
Q

Hydrocoele presentation / investigations / management

A

Swelling - Anterior/inferior

  • Increases with activity
  • Diurnal variation
  • Confined to scrotum - Can get above mass
  • Testis difficult to palpate

Investigations

  • Pen torch - Transilluminates
  • USS

Management - Conservative

  • Surgery if processus vaginalis defect
  • Aspiration
25
Varicocoele aetiology and clinical features
Enlargement of pampiniform plexus Aetiology - Idiopathic - Compression of venous drainage - E.g. tumour - More common on the LEFT - LTV drains into LRV Clinical features - "Bag of worms" - Dull ache / heaviness - Visible veins - More prominent on valsalva
26
Varicocoele investigations / management / complications
Investigations - Pen torch - Transilluminates - USS - Colour doppler - Investigate cause - CT Management - Conservative Complications - Increased blood flow to prostate - BPH - Increased temperature of testis - Subfertility
27
Testicular cancer aetiology
Most common malignancy in young adult men - 20-34 Germ cell - Seminoma - LDH - Non-seminoma - Teritoma, Yolk-sac - AFP + hCG Non germ cell - Leydig - Sarcoma Risk factors - Family history - Infertility - Cryptorchidism - Klinefelters - Mumps
28
Testicular cancer presentation / investigations / management / prognosis
``` Painless scrotal swelling Haematospermia Hydrocoele Varicocoele Gynaecomastia ``` Investigations - USS - CT/PET staging - bHCG - Teritoma / Yolk sac - AFP - Teritoma / Yolk sac - LDH - Seminoma Management - Orchidectomy - Chemo/Radio Prognosis - 85-95% survival Lymph node spread - Retroperitoneal - Para-aortic
29
Urolithiasis aetiology
Renal stones - Calcium oxalate - 85% - Calcium phosphate - Struvite - Magnesium, ammonia, sulphate - Urate - Gout, ileostomy - Crystine Risk factors - Dehydration - HYPER - Hypercalciuria, hyperPTH, hypercalcaemia - PKD - Obstruction - BPH Drugs causing stones - Loop diuretics - Steroids - Acetazolamide - Theophylline
30
Urolithiasis clinical features / investigations
``` Loin to groin pain - Severe ± N/V Urinary frequency / urgency Haematuria Testicular pain Fever ``` Investigations - Urine dip / MC&S - Haematuria - CTKUB - Within 14 hours - Serum calcium / urate - CRP - Infection? - U&E
31
Urolithiasis management and complications
< 5mm - Pass spontaneously - Analgesia - Diclofenac / Morphine - IV fluids - Anti-emetic < 10mm - Tamsulosin PO Shockwave lithotripsy - CI in pregnancy Ureteroscopy Percutaneous nephrolithotomy Complications - Hydronephrosis - Nephrostomy - Obstruction / retention - Rupture - Sepsis
32
Urolithiasis prophylaxis
Hypercalciuria - High fluid intake - Low animal protein - Low salt diet - Thiazides - Increased distal tubular calcium resportion Oxalate - Reduce urinary oxalate secretion - Cholestyramine - Pyridoxine Uric acid - Allopurinol - Urinary alkalinisation - Bicarbonate
33
Haematuria aetiology
``` Cancer - Prostate / Renal BPH UTI Stones Renal disease - Glomerular disease - Nephritic syndrome Bleeding disorder Catheter ```
34
Haematuria investigations
``` Urine dip / MC&S FBC Clotting U&E LFT Flexible cystoscopy CT ```
35
Urinary retention aetiology and management
Neurological - Stroke / MS Infection - UTI Obstruction - Malignancy - BPH - Stones - Strictures - Structural abnormalities - Constipation Drugs - Anti-cholinergics - Tricyclics - Antihistamines - Opioids - Benzos Management - Catheter If > 400ml urine output - Retention confirmed
36
UTI aetiology
``` E.Coli Enterobacter Klebsiella - Stones Proteus - Stones Pseudomonas ``` Risk factors - Catheter - Female - Sexually active - Structural abnormality - Immunocompromise - Pregnancy
37
UTI presentation and investigations
``` Dysuria Urgency / frequency Cloudy offensive smelling urine Suprapubic pain Fever Haematuria ``` Investigations - Septic screen? - Urine dip / MC&S - ESR / CRP - Blood cultures - KUB-USS - Check for underlying cause - MCUG - Check for underlying cause - DMSA - Check for scarring
38
UTI management and complications
Non-pregnant women - Trimethoprim / Nitro Pregnant women - Amoxicillin Men - Trimethoprim / Nitro Complications - Urinary retention - Stones - Klebsiella/Proteus - Sepsis - Abscess formation - Pyelonephritis - Give IV/PO Cef
39
Prostatitis
Aetiology - E.Coli - UTI - Post urological instrumentation - BPH Presentation - Painful perineum - Painful ejaculation - Obstructive urinary symptoms - Fever / Rigors Investigations - DRE - Boggy prostate - Urine MC&S - UTI screen - STI screen - PSA Management - Cipro
40
Epididymo-orchitis
Aetiology - STI - Chlamydia / Gonorrhoea - UTI Presentation - UTI symptoms - STI symptoms - Discharge - Unilateral pain and swelling - Cremasteric reflex present Investigations - Rule out testicular torsion! - STI screen - UTI screen - Urine MC&S - USS doppler Management - IM Cef - PO Doxy - 2 weeks

3B (23 decks)

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