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Year 2 Revision > Urology Investigations and Management > Flashcards

Urology Investigations and Management Flashcards

(60 cards)

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1
Q

When would you do cystoscopy with LUTS?

A 
If previous urological surgery
Haematuria
Profound symptoms
Pain
Recurrent UTIs
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2
Q

What 2 classes of drugs are used in BPH?

A

Alpha blockers first line e.g. tamsulosin

5-alpha reductase inhibitors e.g. finasteride

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3
Q

What is the main surgical option for BPH?

A

TURP

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4
Q

Investigations for bladder tumour?

A

Cystoscopy with biopsy
CT urogram (diagnostic and staging)
Can do urine microscopy or cytology
MRI can show nodal involvement

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5
Q

Management of bladder cancer not invading the muscle.

A

Diathermy/transurethral resection of bladder tumour (TURBT)

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6
Q

Management of bladder cancer invading muscle.

A

Radical cystectomy.

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7
Q

Management of stones <5mm in lower ureter.

A

90-95% pass spontaneously, give fluids.

Alpha blocker

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8
Q

Management of stones >5mm/pain not resolving.

A
  1. Extracorporeal shock wave lithotripsy (ESWL)
  2. Endoscopic retrograde laser evaporation of the stone
    Both first line
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9
Q

What are the imaging modalities for staging prostate cancer?

A

Bone scan
MRI
CT

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10
Q

List potential managements of organ-confined disease

A

Watchful waiting
Active monitoring
Radical prostatectomy
Radical radiotherapy

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11
Q

List managements of locally advanced prostate cancer

A

Radiotherapy with neo-adjuvant hormonal therapy (curative)
Watchful waiting
Hormonal therapy (palliative)

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12
Q

List managements of metastatic prostate cancer

A
  1. Androgen deprivation therapy (hormone therapy, bilateral subcapusular orchidectomy, maximal androgen blockade)
  2. Diethylstilbesterol/steroids
  3. Cytotoxic chemotherapy
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13
Q

What must be done for all patients >40 with frank haematuria?

A

Cytoscopy

CT urogram

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14
Q

Management of acute urinary obstruction

A

Catheterisation

Maybe trial without catheter afterwards (give alpha blocker before this)

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15
Q

Investigation and management of post-obstructive diuresis

A

Monitor fluid balance. Beware if output >200ml/hour

Usually resolves in 24-48 hours but may need IV fluid and sodium replacement

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16
Q

Ureteric colic management

A

NSAID and maybe opiate

Alpha blocker for small stones expected to pass

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17
Q

Indications to treat ureteric stone urgently

A

Pain unrelieved
Pyrexia
Persistent nausea/vomiting
High-grade obstruction

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18
Q

Management of acute ureteric stone

A

Ureteric stent or stone fragmentation/removal

Percutaneous nephrostomy if infected

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19
Q

Clot retention management

A

3 way catheter

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20
Q

Testicular torsion investigation

A

Doppler US sometimes helpful

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21
Q

Management of testicular torsion

A 
Prompt exploration (irreversible ischaemic injury may begin as soon as 4 hours)
2-3 point fixation with fine non-absorbable sutures (also contralateral side)
If testis necrotic then remove
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22
Q

Management of torsion of appendix testis

A

Nothing, will resolve spontaneously

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23
Q

Investigation for epididymitis

A 
Doppler US (swollen epididymis, increased bloodflow)
Urine culture and chlamydia PCR
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24
Q

Epididymitis management

A

Analgesia and scrotal support, bed rest

Ofloxacin 400mg/day for 14 days

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25
Management of paraphimosis
Iced glove, granulated sugar for 1-2 hours, multiple punctures in oedematous skin Manual compression of glans with distal traction of oedematous foreskin Dorsal slit
26
Priapism investigation
Aspirate blood from corpus cavernosum (dark, low O2, high CO2 in low flow, normal in high flow) Colour duplex USS (minimal or absent in low flow, normal to high flow in non-ischaemic)
27
Ischaemic priapism management
Aspiration and irrigation with saline Injection of alpha agonist e.g. phenylephrine Surgical shunt Unlikely to respond to intracavernosul treatment >48-72 hours Very delayed may think immediate replacement of penile prosthesis
28
Non-ischaemic priapism management
Observe, may resolve spontaneously | Selective arterial embolisation with non-permanent materials
29
Fournier's gangrene investigation
Plain x-ray or USS may confirm gas in tissues
30
Fournier's gangrene management
Antibiotics and surgical debridement
31
Emphysematous pyelonephritis investigations
KUB x-ray (gas) | CT
32
Emphysematous pyelonephritis management
Often requires nephrectomy
33
Perinephric abscess investigation
CT
34
Perinephric abscess management
Antibiotics | Percutaneous or surgical drainage
35
Renal trauma imaging indications
Frank haematuria in adults Frank or occult haematuria in child Occult haematuria and shock Penetrating injury with any degree of haematuria
36
Renal trauma investigation
CT with contrast
37
Renal trauma management
98% of blunt managed non-operatively Angiograph/embolisation Surgery (persistent renal bleeding, expanding perirenal haematoma, pulsatile perirenal haematoma, urinary extravasation, non-viable tissue, incomplete staging)
38
Bladder injury imaging
CT cystography (if extraperitoneal will have flame shaped collection of contrast in pelvis)
39
Bladder injury management
Large-bore catheter Antibiotics Repeat cystogram in 14 days If intraperitoneal will need laparotomy
40
Urethral injury investigation
Retrograde urethrogram
41
Urethral injury management
Suprapubic catheter | Delayed reconstruction after at least 3 months
42
Penile fracture management
Prompt exploration and repair | Circumcision incision with degloving of penis to expose all 3 compartments
43
Testicular injury investigation
USS to assess integrity/vascularity
44
Testicular injury management
Early exploration/repair
45
Renal tumour imaging
FBC (renal and liver functions) USS CT chest, abdomen and pelvis for staging Biopsy
46
Oncocytoma CT appearance
Spoke wheel pattern
47
Angiomyolipoma USS and CT appearance
USS: bright echo pattern CT: fatty tumour of low density
48
Management of angiomyolipoma
Treat after 4cm Elective: embolisation/partial nephrectomy Emergency: embolisation/emergency nephrectomy
49
Renal cell carcinoma management
<3cm: surveillance in elderly unfit patients, ablation techniques in fit elderly patients and selected younger patients >3cm: partial nephrectomy (robotic) or radial nephrectomy Large tumours: radical nephrectomy (laparoscopic approach gold standard)
50
Follow up from RCC
FBC/renal and liver functions CT/USS and CXR Duration 5-10 years
51
Testicular cancer investigations
``` USS testicle CT chest and abdomen for staging Serum tumour markers (aFP, b-HCG, LDH) FBC LFTs Kidney function ```
52
Testicular cancer management
Radical inguinal orchidectomy (offer sperm preservation, testicular prosthesis) Re-check tumour markers 1 week post-operative (chase CT scan if still raised) Further follow up by oncologist (chemo as adjuvant even in non-metastatic cases)
53
Penile cancer investigation
MRI (assess tumour depth) | CT abdomen, pelvis, chest in advanced disease
54
Penile cancer management
``` Circumcision Glans resurfacing Glansectomy Total penile amputation with formation of perineal urethrostomy Inguinal lymphadenectomy ```
55
Basic incontinence investigations
``` Urinalysis (and culture) Bladder diary (frequency/volume chart) Urodynamics: uroflowmetry and cystometry (more invasive) ``` Urodynamics only if surgery being considered, uncertain of diagnosis, check for voiding dysfunction or if drug treatment for urge has failed
56
Stress incontinence conservative management
Lifestyle modification Pelvic floor exercises Biofeedback
57
Stress incontinence medication
Duloxetine (SSRI)
58
Stress incontinence surgical management
Injection of bulking agents Tension free vaginal tape (or pubovaginal slings) Burch culposuspension (retropubic suspension, not used as much) Artificial urinary sphincter
59
Urge incontinence conservative management
Lifestyle advice Bladder retraining Medication (anticholinergics, B-agonists)
60
Urge incontinence invasive management
Intravesical botulinum toxin A Neuromodulation Augmentation "clam" ileocytoplasty Ileal conduit urinary diversion

Year 2 Revision (45 decks)

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