Urology - LUTs, Scrotum and Genitalia Flashcards

(30 cards)

1
Q

how common is prostate cancer

A

very
most common cancer in men 50+ peak at 65-70

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2
Q

what is the function of the prostate

A

produces 30% ejaculate volume

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3
Q

what is PSA

A

prostate specific antigen

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4
Q

what are key risk factors for prostate cancer

A

age
FHx
genetics
ethnicity - afrocarribean
diet - sat fat and dairy

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5
Q

how does localised prostate cancer present

A

PSA, incidental symptoms

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6
Q

how does locally advanced prostate cancer present

A

bleeding, local pain, priapism, rectal obstruction

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7
Q

how does metastatic prostate cancer present

A

fracture, leg swelling, DVT, pain, weight loss, cord compression

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8
Q

diagnosis of prostate cancer

A

history
DRE
PSA
biopsy

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9
Q

what does a normal prostate feel

A

small, smooth, rubbery

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10
Q

how does an abnormal prostate feel

A

asymetrical, craggy, noduler

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11
Q

what 2 things should the person avoid before PSA

A

no sex
no bike riding

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12
Q

what system is used to grade prostate cancer

A

gleason score

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13
Q

what is the staing of prostate cancer

A
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14
Q

what is the scoring of low, intermediate and high risk prostate cancer

A

Low risk
PSA < 10 ng/ml
Gleason 6
Clinical stage T1c-T2a
Active surveillance may be appropriate treatment option

Intermediate risk
PSA 10-20 ng/ml
Gleason 7-8
cT2b

High risk
PSA > 20 ng/ml
Gleason 9-10
>cT2c

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15
Q

what is treatment for localised prostate cancer

A

surgery - to remove it - radical resections
watch and wait

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16
Q

what are other treatment methods for prostate cancer

A

radical radiotherapy
Cryotherapy
High intensity ultrasound
Brachytherapy – less good

17
Q

list drugs that improve survival of metastatic prostate cancer

A

Docetaxel
Cabazitaxel
Abiraterone
Enzalutamide
Sipuleucel-T
Alpharadin

18
Q

what is the bladder made of

A

detrusor muscles

19
Q

where does spinal cord finish

A

L2 (Below this is corda equina)

20
Q

what are the 2 parts of the autonomic nervous system

A

sympathetic T10-L2
parasympathetic S2-S4

21
Q

where in the brain does realisation of need to pee happen

A

cerebral cortex - doesnt really work before potty trained

22
Q

what does parasympathetic nerves causes

A

detrusor contraction
relaxation of outflow tracs

23
Q

what does sympathetic nerves cause

A

relaxation of detrusor contraction
contraction of outflow traks

24
Q

why do you pee yourself when scare

A

sympathetic - fight or flight (storage)
lymbic system can turn messages to cortex off - back to prepotty training

25
What can go wrong with The Detrusor Muscle if the neurology is disrupted?
DETRUSOR CONTRACTS TOO MUCH Failure of Detrusor to store at low pressure Sustained high pressure throughout filling – POOR COMPLIANCE Phasic rise in detrusor pressure – DETRUSOR OVERACTIVITY; Neurogenic vs. Idiopathic Leakage, high pressure transmitted to upper tracts DETRUSOR DOESN’T CONTRACT ENOUGH Failure of Detrusor to contract during emptying Incomplete emptying Urinary Retention LUTS, UTI’s, high pressure retention
26
What can go wrong with urethral sphincter mechanism if the neurology is disrupted?
DOESN’T CONTRACT ENOUGH Failure / inadequate contraction during storage phase Leakage – STRESS URINARY INCONTINENCE SPHINCTER DOESN’T RELAX Failure of sphincter to relax adequately/ in a co-ordinated fashion during emptying phase Detrusor contracts against a closed sphincter – CONTRACTS AT WRONG TIME DETRUSOR-SPHINCTER-DYSSYNERGIA Incomplete emptying (inefficient), high pressure transmitted to upper tracts
27
what causes inflammtion and stiff bladder
ketamine radiotherapy surgery and scar tissue
28
what nerve sensation for urology
S4
29
ureteric colic how do you image - good osce Q
USS - cheap, harmless - see if theres a stone ureter if blocking) x ray - lower dose - radioopaque calcium stones
30