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Urology Conditions Flashcards

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1
Q

List some causes of acute urinary retention

A

Obstruction - BPH, pelvic mass, urethral stricture, constipation
Increased smooth muscle tone
Inflammation - UTI, prostatitis
Neurological - Spinal cord injury, MS, pelvic surgery
Over distension - Post-anaesthesia, drugs (adrenaline, anti-depressants), alcohol

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2
Q

What is the treatment for acute urinary retention?

A

Urgent catheterisation

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3
Q

What are the characteristics of the pain in renal colic?

A

Severe
Sudden onset
Initially in flank, then radiates to abdomen, groin and even genital area
Associated with nausea and vomiting, sometimes haematuria
Patients are unable to find a comfortable position

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4
Q

What is testicular torsion?

A

Twisting occurring at the spermatic cord which causes impaired blood flow to and from the testis. Causes oedema, ischaemia and necrosis. Needs prompt management within 4-6 hours of the onset of pain in order to preserve the testis.

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5
Q

What is paraphimosis?

A

Happens when the foreskin becomes retracted such that is unable to be reduced. This reduces blood supply to the glans of the penis and the glans then becomes swollen.

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6
Q

What is priapism?

A

Persistent penile erection after, or unrelated to, sexual stimulation

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7
Q

What types of priapism are there? What is the difference?

A 
Low flow (ischaemic) priapism - There is reduced venous and lymphatic drainage from the corpus cavernosae. It is often caused by medication / drug use. It is usually painful.
High flow (non-ischaemic) priapism - Caused by unregulated arterial blood flow. Usually caused by trauma. Usually less painful.
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8
Q

Which type of priapism is more common - low flow or high flow?

A

Low flow

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9
Q

True / False: It is common to find a bit of blood in the urine of normal, healthy people, so a finding of ‘1+’ blood on urine dipstick should be ignored.

A

False - A urine dipstick showing 1+ is considered a positive test and the patient requires further investigation. It is not uncommon to find ‘trace’ blood in normal people so often this finding can be ignored, although it’s important to take into account the individual patient who has presented to you.

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10
Q

List 4 causes of transient haematuria

A

UTI
Exercise
Menstruation
Myoglobinuria

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11
Q

What does ‘KUB’ mean in a KUB x-ray?

A

Kidneys
Ureter
Bladder

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12
Q

What investigations (basic and imaging) would you consider for a patient presenting with haematuria?

A 
Urine dipstick plus MC+S
Blood pressure
Bloods - Especially U+E, eGFR, creatinine, PSA
X-ray KUB
Flexible cystoscopy
Ultrasound
CT urogram
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13
Q

What are the 2 most common pathologies in kidney cancer?

A

Adenocarcinoma and renal cell carcinoma

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14
Q

From which cells do most renal cell carcinomas originate?

A

Tubular parenchyma (usually proximal renal tubule)

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15
Q

What is the classic ‘triad’ of symptoms with which a patient with renal cancer presents?

A

Haematuria
Loin pain
Flank mass

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16
Q

What is Stauffer’s Syndrome?

A

A paraneoplastic syndrome seen in patients with renal cancer (cause unknown, but resolves after nephrectomy). Involves deranged LFTs, low WCC, fever, areas of hepatic necrosis

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17
Q

List some paraneoplastic syndromes which might indicate an underlying renal cancer

A 
Hypertension (due to ectopic renin)
Hypercalcaemia (due to ectopic PTH)
Polycythaemia (due to ectopic EPO)
Anaemia
Stauffer's Syndrome
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18
Q

What is the gold standard of management for renal tumours?

A

Radical nephrectomy - This may be laparoscopic if tumour 7cm

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19
Q

Which part of the anatomy of the kidney is usually affected by a transitional cell carcinoma?

A

Renal pelvis

Ureters

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20
Q

List some risk factors for developing renal / urinary tract stones

A 
Male
Age 20-50
Family history
High protein diet
Low fluid intake
Sedentary lifestyle
Caucasian / Asian
N. European or from hot climate e.g. Middle East
Systemic disease e.g. sarcoidosis
Drugs (Steroids, chemotherapy)
Inflammatory bowel disease / malabsorptive states
Abnormal renal anatomy
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21
Q

List 4 different types of renal stone

A

Calcium oxalate
Uric acid
Magnesium ammonium phosphate
Cystine

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22
Q

What is the most common type of renal stone?

A

Calcium oxalate (accounts for about 80% of stones)

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23
Q

Which is the only type of renal stone which is radiolucent?

A

Uric acid stones

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24
Q

How might a patient with renal stones present?

A

Incidental finding on imaging - kidney stones are frequently asymptomatic and cause no pain thus go unnoticed unless on imaging
Loin pain
Haematuria (visible or non-visible)

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25
What treatment options are available for renal stones?
``` Observation Analgesia - Diclofenac Alpha blockers aid stone passage Extracorporeal shockwave lithotripsy Flexible ureterorenoscopy Percutaneous nephrolithotomy ```
26
What is cystinuria?
An autosomal recessive condition where there is reduced absorption of cystine in the proximal renal tubule, thus resulting in increased urinary excretion of cystine
27
What is the best advice you can give a patient who is prone to developing renal stones?
Drink plenty of water!
28
True / False: Over 50% of penile cancers are associated with HPV-16 or HPV-18
True
29
Give some risk factors for developing penile cancer
``` Male aged 50-70 Sexual history (early age at first sex, multiple sexual partners) Presence of foreskin PUVA i.e. treatment for psoriasis HPV-16 or HPV-18 infection Phimosis or poor hygiene Chronic inflammation e.g. lichen planus ```
30
What are the key symptoms in testicular torsion?
Pain, swelling, absent cremasteric reflex, unilateral (although on surgical exploration the other side may be partially torted)
31
What is the nature of the pain in testicular torsion?
Sudden onset | May be a history of pervious episodes of pain, indicating previous intermittent torsion
32
Where might testicular cancer metastasise to?
Usually in lymphatic system | If spread is in blood, can go to lungs, liver, bone, brain
33
Compare the tumour markers for seminoma and non-seminoma testicular tumours
Seminoma: AFP not raised, HCG raised in 20% | Non-seminoma: AFP and/or HCG raised in 75%
34
Compare the age of onset of seminoma and non-seminoma testicular tumours
``` Seminoma = Aged 30-40 Non-seminoma = Aged 20-30 ```
35
Which testicular tumour is more aggressive, seminoma or non-seminoma?
Non-seminoma
36
What proportion of testicular germ cell tumours are seminoma and what proportion are non-seminoma?
``` Seminoma = 60% Non-seminoma = 40% ```
37
How might a patient with testicular cancer present?
``` Testicular lump Pain Dragging sensation Gynaecomastia Inflammation History of trauma Extragonadal symptoms e.g. back pain, breathlessness ```
38
What parameters are looked at in a semen analysis, and what are the normal values for each?
Volume (2ml or more) Sperm concentration (20x10^6 spermatozoa/ml) pH 7.2-7.8 Total sperm count (40x10^6 spermatozoa or more) Morphology (30% or more with normal morphology) Motility (50% or more with forward progression, or 25% or more with rapid progression within 60 mins of collection) Vitality (75% or more alive) WBCs (Fewer than 1x10^6/ml
39
What is the most common cause of scrotal swelling seen in primary care?
Epididymal cyst
40
How is an epididymal cyst managed?
Supportive | Surgery if symptomatic
41
Give 3 conditions which might be associated with development of epididymal cysts
Cystic fibrosis Polycystic kidney disease von Hippel-Lindau syndrome
42
Which side is more commonly affected by a varicocele?
Left
43
If a patient presents with a renal stone and UTI positive for proteus infection, what is the likely composition of the stone?
Magnesium ammonium sulphate (struvite)
44
Give some complications of TURP
``` Tur syndrome Urethral stricture UTI Retrograde ejaculation Perforation of the prostate ```
45
What is Tur syndrome?
Complication of a TURP caused by infiltration of irrigation fluids into the systemic circulation: - Dilution hyponatraemia - Fluid overload (high BP) - Glycine toxicity
46
True / False: Cystine stones are common
False - They are rare, and seen in patients with the autosomal recessive condition cysteinuria
47
Give 2 key investigations in the diagnosis of renal stones
X-ray KUB | Non-contrast CT scan
48
True / False: Contrast CT scan is useful in the investigation of renal stones
FALSE - Must be a NON-contrast scan otherwise the calculi will not be visualised
49
Give 3 types of drug which might cause renal stone formation
Loop diuretic Steroids Chemotherapy
50
What size renal stone can be observed as it is likely to cause no symptoms and/or pass?
Stones under 5mm
51
How are renal stones (uncomplicated, small) managed in pregnant women?
Ureteroscopy - pregnant women are not able to have shockwave lithotripsy
52
Give an example of a 5-alpha reductase inhibitor
Finasteride
53
Give some points you would ask about in a history when a man presents with lower urinary tract symptoms
Storage: Urgency, urge incontinence, frequency, nocturne Voiding: Hesitancy, post-void dribble, post-void residual (incomplete emptying), intermittent stream, weak stream or decreased flow, straining Also ask about erectile dysfunction as often problems are concurrent
54
What is the International Prostate Symptom Score?
A validated tool which assesses frequency and severity of prostate symptoms which can be used to help decide upon management etc.
55
Give 2 examples of alpha blockers used in the treatment of bladder outflow obstruction symptoms
Tamsulosin | Alfuzosin
56
What is the mechanism of action of alpha blockers, used in the treatment of bladder outflow obstruction?
Relaxation of the muscle in the bladder neck and prostate, thus improving voiding control
57
Give some side effects of alpha blockers
``` Postural hypotension GI disturbance Ejaculatory dysfunction Nasal congestion Lethargy ```
58
How do 5-alpha reductase inhibitors work?
Inhibit conversion of testosterone to DHT (which is known to cause BPH) the slowing the growth of the prostate
59
What must you advise the patient when starting finasteride?
Takes about 6 months to show an improvement in symptoms as it takes time to reduce the prostate volume
60
Give some side effects of 5-alpha reductase inhibitors
Gynacolmastia Erectile dysfunction Ejaculatory problems Reduced libido
61
Which hormone controls the prostate?
Testosterone
62
What is the treatment of male factor infertility if caused by hypogonadotrophic hypogonadism?
Gonadotrophin drugs
63
What is Peyronie's disease?
Fibrous plaque formed on the penis in layers, such that the penis becomes deformed (curved) and is painful
64
What is intratubular germ cell neoplasia and how is it managed?
Pre-malignant form of testicular cancer - treated with prophylactic orchidectomy or external beam radiotherapy as 70% will become malignant within 5 years
65
What is the initial investigation / management of a testicular tumour?
Ultrasound scan of testes Bloods: AFP, LDH, beta-HCG Radical orchidectomy Contrast CT chest, abdo, pelvis
66
After orchidectomy, what are the possible treatment options for a Stage 1 seminoma?
1) Surveillance alone 2) Radiotherapy 3) Single cycle carboplatin
67
After orchidectomy, what are the possible treatment options for a Stage 1 non-seminoma?
1) Surveillance alone 2) Retroperitoneal lymph node dissection 3) Two cycles of BEP chemotherapy (bleomycin, etoposide, cisplatin)
68
What is BEP chemotherapy used in the treatment of testicular cancers?
Bleomycin Etoposide Cisplatin
69
What is a hydrocele?
Accumulation of fluid inside the tunica vaginalis
70
What are the 2 types of hydrocele?
Primary (communicating) - See in babies, resolves in first few months of life Secondary (non-communicating)
71
What is a varicocele?
Abnormal enlargement of the testicular veins
72
Which scrotal swelling is commonly described as a 'bag of worms'?
Varicocele
73
List some organisms which cause epididymo-orchitis
``` E. coli Chlamydia Mumps N. gonorrhoea TB ```
74
What is phimosis and what is the treatment?
Tight foreskin - requires medical circumscision
75
What type of drug is sildenafil and how does it help in the management of erectile dysfunction?
Phosphodiesterase inhibitor - Enhances smooth muscle relaxation to air erections
76
Give some side effects of sildenafil
Headache Flushing Visual disturbance
77
Give one contraindication to use of sildenafil
Concurrent use of nitrate medication
78
What is the underlying pathology in most penile cancers?
Squamous cell carcinoma
79
List some presenting features of penile cancer
Red area Painless ulcer Rapidly changing lesion
80
What is the inheritance pattern of von Hippel-Lindau syndrome?
Autosomal dominant

Urology (3 decks)

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