UROLOGY - Bladder + Prostate

Question 1

What type of cancer are 90% of bladder cancers?

Answer 1

TCC;s

Question 2

RF bladder cancer/TCC (4)

Answer 2

Smoking
Aromatic amines
Chronic cystitis
Pelvic irradiation

Question 3

PS TCC/bladder cancer (4)

Answer 3

Painless haematuria +/- clots
Recurrent UTI/’cystitis’
Voiding Sx
Haematuria –> anaemia

Question 4

Mx TCC in situ/T1

Answer 4

TURBT @ cystoscopy _ intravesical chemotherapy

Question 5

Mx TCC T2-3

Answer 5

Radical cystectomy + pre op chemo

Question 6

Ix TCC

Answer 6

Urine MCS
Cystoscopy + biopsy = GOLD STANDARD
CT/MRI - assess spread

Question 7

Mx TCC T4

Answer 7

Palliative

Question 8

Mx of intraperitoneal bladder rupture

Answer 8

Laparotomy + suturing of bladder

Question 9

Mx of extraperitoneal bladder rupture

Answer 9

Prolonged urethral/suprapubic catheter

Question 10

Bladder outlet obstruction - luminal causes

Answer 10

Bladder tumour

Question 11

Bladder outlet obstruction - mural causes (3)

Answer 11

Urethral stricture
Congenital abnormalities
Neuropathic bladder

Question 12

Bladder outlet obstruction - extra mural causes (2)

Answer 12

BPH/carcinoma

Phimosis/paraphimosis

Question 13

CF Bladder outlet obstruction

Answer 13

Suprapubic pain 
Hesitancy + diminished force of stream 
Terminal dribbling 
Overflow incontinence 
Signs infection - stasis urine

Question 14

Signs - bladder outlet obstruction (3)

Answer 14

Palpable full bladder
Loin tenderness
Enlarged prostate PR

Question 15

Ix Bladder outlet obstruction (4)

Answer 15

Bloods - FBC/U+E
Urine dip/MCS
USS
CT/MRI

Question 16

What is BPH

Answer 16

Benign proliferation of glandular layers of the prostate –> enlargement of inner transitional zone

Question 17

What % of >70s have BPH

Answer 17

70%

Question 18

Sx BPH (8)

Answer 18

Freq (1st noticed as nocturia)
Urgency 
Hesitancy 
Poor/int stream 
Post void dribbling 
Strangury 
Retention w/ overflow incontinence/acute retention
Occasionally - haematuria

Question 19

Ix BPH (8)

Answer 19

PR
IPPS 
Freq/vol chart 
Bloods incl FBC/U+E/PSA
Urinalysis 
Uroflowmetry 
Bladder USS 
Transrectal USS + biopsy

Question 20

Norm PSA value

Answer 20

<4

Question 21

Apart from BPH/Prostate cancer, what other conditions cause PSA to rise (5)

Answer 21

Inflammation 
Infection 
Trauma 
Ejaculation 
Ageing

Question 22

Acute Mx BPH

Answer 22

Attempt urethral catheter drainage

Question 23

Lifestyle mods BPH (4)

Answer 23

Avoid alcohol
Relax when voiding
void twice in a row
Bladder retraining

Question 24

Medical Tx BPH

Answer 24

Alpha blockers 0 tamulosin, doxasosin

5a reductase inhibitors - finasteride

Question 25

SE alpha blockers (4)

Answer 25

Dizzy Drowsy HoTN Depression

Question 26

SE 5a reductase inhibitors (2)

Answer 26

Impotence | Decreased libido

Question 27

Surgical Mx BPH (2)

Answer 27

TURP - retrograde ejaculation almost universal after | HoLEP - endoscopic

Question 28

What % of >80s have prostate cancer

Answer 28

80%

Question 29

What type of cancers are the majority of prostate cancers?

Answer 29

Adenocarcinomas

Question 30

Spread - prostate cancer (34)

Answer 30

Local Lymphatic Haematogenous Bone to BONE

Question 31

Risk factors prostate cancer (2)

Answer 31

FHx | Raised testosterone levels

Question 32

PS Prostate cancer

Answer 32

Asymp often Filling/voiding Sx W loss/bone pain if mets

Question 33

O/E Prostate cancer

Answer 33

hard craggy prostate

Question 34

Ix prostate cancer (4)

Answer 34

PR PSA Transrectal USS/biopsy Bone XR/scan

Question 35

What 2 scores can be used in Prostate cancer

Answer 35

Gleason grade | D'Amico risk stratification

Question 36

How does Gleason grade work

Answer 36

2 areas of tissue are graded/5 | Indicative of prognosis

Question 37

Gleason grade 6

Answer 37

Low risk/good prognosis

Question 38

Gleason grade 8>

Answer 38

High risk/ bad prognosis

Question 39

What is D'Amico risk stratfication

Answer 39

Combines Gleason w/ clinical stage + PSA | ==> more accurate prognosis

Question 40

Mx prostate cancer - T1/2

Answer 40

Active surviellance Radiotherapy Radical prostatectomy

Question 41

Mx prostate cancer - T3/4

Answer 41

Radiotherapy or surgery

Question 42

Mx prostate cancer - mets

Answer 42

GnRH agonists - goserelin/busereline + antiandrogen (cyrpoterone acetate) Prevents early rise testosterone

Question 43

Mx - urethral trauma - partial

Answer 43

Prolonged catheter

Question 44

Mx = urethral trauma - complete tear

Answer 44

Suprapubic catheter + repair

Question 45

What is a urethral stricture

Answer 45

Scar of the urethral epithleium, which commonly extends into the underlying corpus spongiosum

Question 46

What part of the urethra is most commonly damaged in a urethral stricture

Answer 46

Bulbar urethra

Question 47

Causes urethral stricture (4)

Answer 47

Blunt perineal trauma (#/saddle injury) Iatrogenic (catheter) Gonococcal/non-gonococcal urethritis BXO

Question 48

PS urethral stricture (4)

Answer 48

Initial frequency/dysuria Hesitancy/straining Urinary retention Splayed stream

Question 49

O/E urethral stricture

Answer 49

Firm areas consistent w/ scarring

Question 50

Ix urethral stricture (3)

Answer 50

Uroflowmetry Retrograde urethrogram Urethroscopy

Question 51

Mx urethral stricture

Answer 51

Optical urethrotomy

Question 52

Mx recurrent urethral stricture

Answer 52

Urethroplasty