Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Phase 4 > Urology Surgery > Flashcards

Urology Surgery Flashcards

(105 cards)

Start Studying
1
Q

What are the symptoms of prostate cancer?

A

Bladder outflow obstruction

Erectile dysfunction

Haematuria

Pain in lower abdomen/ perineum

Weight loss

Reduced semen

Anaemia

  • damage to kidneys
  • Involvement of bone marrow
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What investigations should be done in prostate cancer, what is the grading system used? and outline management:

A 
PR Exam
TRUS with biopsy 
PSA levels 
U&Es 
Alkaline phosphates 
Bone scan 
MRI

Grading:
Gleason’s grading

Management:

  • watchful waiting
  • Endocrine inhibits - anti androgen, LHRH analogues, radical orchiectomy
  • Radiotherapy - Brachytherapy
  • Prostatectomy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

If there is pain in the lower abdomen and inguinal canal, when the canal is pressed, which nerve is being compressed?

A

Ilioinguinal nerve

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are the symptoms of bladder cancer? what is the most common type and what investigations should be done?

A

Frank haematuria
- painless

UTIs

Mucus in the urine

Ureteric obstruction

Lower abdominal pain
- this is a late finding

Types:

  • transitional cell carcinoma
  • squamous cell carcinoma - schistosomiasis, UTIs
  • adenocarcinomas

Investigations:

  • urine dipstick - blood
  • Flexible Cystoscopy
  • this is then followed by:
  • Rigid cystoscopy + biopsy *needs GA
  • urine microscopy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are some risk factors for developing bladder cancer?

A 
Smoking 
Hydrocarbon exposure - industrial plants/ rubber factory 
Schistosomiasis 
Trauma 
Cyclophosphamide
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are the gradings of bladder cancer?

A

T0: mucosa
T1: subconnective tissue

T2A/B: Muscle invassive

T3: Perivisceral fat invasion

T4: Local infiltration into surrounding organs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is the treatment for Bladder cancer?

A

T0 and T1 = Transurethral resection of bladder tumour (TURBT) + local chemotherapy

> T2 = radial cystectomy + M-VAC chemotherapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are the features of testicular torsion?

A

Sudden intense scrotal pain
Pain radiates into the abdomen
N&V

Hot swollen teste which may slightly retracted up
*cremaster reflex is lost

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is the diagnostic procedures in suspected testicular torsion?

A

Surgical exploration if symptoms fit.
Ultrasound if diagnosis is uncertain

Both testes should be clipped

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Which drug can be used to prevent kidney stones?

A

thiazides

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What investigation is best for kidney stones?

A

KUB CT

*non contrast CT scan

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is the most common pathogen to cause Epididymo - orchitis? and what must be excluded?

A

Chlamydia - in sexually active

those who are at low risk of STI it is more likely to be E.Coli.

Must rule out torsion.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is the treatment of epididymo- orchitis?

A

Chlamydia/ N. Gonorrhoeae:
Ceftriaxone mg IM - single dose
+
Doxycycline 100mg PO BID for one week

E.Coli suspected:
- Ciprofloxacin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What blood markers can be done for testicular cancer?

A

Alpha Fetoprotein (AFP) - teratomas

Beta HGC - seminomas and teratomas

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are the treatment options for prostate cancer?

A

T1/T2:
Watchful monitoring
Radical Prostatectomy
Radiotherapy and brachytherapy

T3/T4:
Hormonal therapy
Radical Prosectomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What type of hormonal therapies are available for prostate cancer?

A

GnRH Agonists

  • Goserelin
  • *it is important to cover with an initial anti- androgen as there is a surge of LH initially

Anti- androgens
- cyproterone acetate

Orchiectomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Men with ED should be screened for what?

A

Diabetes
Cardiovascular disease
Hypogonadism
- this will include testosterone levels. if they are low then LH and FSH should be measured.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is the blood supply to the prostate?

A

Mainly inferior vesicle
inferior rectal
pudendal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is done when assessing the risk of malignancy of the prostate?

A

Digital rectal examination
PSA levels

Transrectal ultrasound + guided biopsy
- if worried about malignancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is the treatment algorithm for benign prostate hyperplasia?

A

Watchful waiting

Alpha adrenergic antagonist
- tamsulosin

5 alpha reductase
- finestraite

*combination of these therapies.

Surgical - reserved for symptoms that don’t resolve.

  • TURP
  • Open retropubic prostatectomy
  • Bladder neck incision
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

How is prostatic cancer graded?

A

Gleason score

It will receive two numbers. first is the predominance of the grading, the second is less dominance
**important the number of the sum of the most typical appearance which is marked out of 3.
so the lowest score one can get is:
- 3+3
here in the above example the person would have a gleason score of 7.

**There is a new grading system of grades:
1 to 5
which just correlates to the degree of differentiations

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What are the risk factors for renal carcinoma?

A

Smoking
Obesity
Long term dialysis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What are the paraneoplastic effects of renal cell cancer?

A

Polycythemia
Hypercalcaemia - secretion of PTH
Stauffer syndrome - abnormal LFTs of obstruction despite being none.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What is a potentially life threatening complication of TURP treatment? how does it present?

A

TURP Syndrome
where there is damage to the venous system and absorption of the irragation fluid.
- leads to severe hyponatremia

Presents with:

  • confusion
  • agitation
  • Breathlessness

*operation >1 hours are most at risk

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
What is the gold standard for investigating potential lower urinary tract tumours?
Flexible Cystoscopy
26
What sign on the CT may indicate a stone has passed?
Stranding of periureteric fat
27
Which testicular tumour typically has normal AFP and HCG levels?
Seminoma
28
What is the best investigation for hydronephrosis?
Renal Ultrasound
29
Which testicular tumours have a better prognosis?
Seminomas
30
Which ethnicity group has the highest risk of prostatic cancer/
Afro-caribbean
31
which type of kidney stone is most likely to be associated with family history
cystine - inherited metabolic syndrome
32
When undertaking an investigation into haematuria what must be done?
The entire urinary tract system must be evaluated. Upper: - Imaging: US kidneys and CT urography (this is with contrast) for high risk Lower: - flexible cystoscopy
33
What is a complication following high pressured urine obstruction release?
Post obstructive diuresis The medully loses its ability to concentrate the urine - resulting in excessive diuresis >200ml/hour urine should result in 50% replacement IV
34
When should someone be referred following a case of haematuria? what is the gold standard for investigating these people?
>45 with asymptomatic visible haematuria with no explanation >45 with visible haematuria following successful eradication of UTI >60 with non-visible haematuria but symptoms of dysuria and raised WCC * *flexible cystoscopy - lower urinary tract * *CT urogram - upper genitourinary tract
35
What organisms are most likely to cause epididymitis?
<35 years: sexually transmitted. - Gonorrhea - Chlamydia >35 years: Enteric infections: - E.Coli *in men who practice anal sex it is E.Coli
36
What investigations should be done into epididymitis?
Bloods: FBC, CRP Urine Dipstick STI screen: NAAT from urine sample Ultrasound if diagnosis is uncertain
37
Where are stones most likely to become impacted?
Pelvic-ureteric junction Pelvic brim vesicoureteric junction
38
What symptoms are associated with the stone at the vesicoureteric junction?
Lower quadrant pain urinary urgency frequency strangulation **symptoms mimic cystitis
39
What symptoms are also associated with struvite stones?
recurrent UTIs Malaise weakness loss of appetite
40
What are some differentials for renal colic?
Pyelonephritis Lobar pneumonia acute abdomen - (appendicitis, pancreas, AAA) ectopic pregnancy radicular pain - herpes
41
What is an extremely important differential of renal colic to consider in a male >60 years with no history of renal colic?
AAA
42
How do you investigate renal colic in a pregnancy female?
USS
43
Which stones are radiolucent?
Uric Acid Xanthine
44
What are the indications for surgical interventional removal of stones?
Pain that fails to respond to analgesia Associated fever Impaired renal function >4 weeks Bilateral obstruction Obstructing calculus in the kidney
45
What are some indications and contraindications to extra- corporeal shock wave lithotripsy?
Indications: <2cm favourable anatomy Contraindications: - pregnancy - distal obstruction - uncorrected coagulopathy - pacemaker
46
When is percutaneous nephrolithotomy used?
``` Indications: > 2cm stones Staghorn multiple >1cm stones Proximal ureteral stone ``` Contraindications: - Active infection - coagulopathy - pregnancy - unsafe access hospital time is 3-4 days
47
Given contraindications to lithotripsy in certain populations, such as: - pregnancy - coagulopathies - poorly visualised stones what alternative approach can be done for large stones?
``` Ureteroscopy stones are removed via a basket. used when: - pregnancy - Coagulopathies - Stones that can easily be visualised ``` Larger stones are: - lasered - ultrasonic - electro hydraulic
48
Name 3 types of surgery that can be done for ureteric stones:
Pyelo- nephrolithotomy Ureterolithotomy Cystolithotomy
49
What are some complications of acute urinary retention?
Infection AKI Post obstruction diuresis
50
What does dyssynergia mean?
Dyssynergia = incomplete relaxation of urinary sphincter
51
What are some common causes of glomerular haematuria?
IgA nephropathy Thin glomerular basement membrane disease Alport's syndrome
52
What are some causes of upper tract haematuria?
Urolithiasis pyelonephritis Renal cell carcinoma Transitional cell carcinoma Urinary obstruction
53
Name somec causes of pseudo- haematuria?
Myoglobinuria Food colouring Menses Metronidazole
54
What are the imaging techniques done into haematuria?
Imaging studies of the upper urinary tracts: - Ultrasound - CT Urography Lower urinary tracts: - cystoscopy (direct visualisation)
55
What are the different types of torsion that can occur to the testi?
Extra- vaginal torsion Intra- vaginal torsion Appendage torsion
56
If there is any doubt regarding testicular torsion what should be done and what is a diagnostic feature?
Ultrasonography of testes - testicular perfusion
57
What is the management of testicular torsion?
Tunica vaginalis is opened. unwrapped in a warm gauze. contralateral side under goes orchidopexy. affected side is examined for perfusion. if none then: removal. if re-vascularisation: - orchidopexy
58
Why is a biopsy of a testicular lump not done?
If it is cancer, then there is a very high risk of seeding it with a biopsy Histology is only performed after an orchiectomy
59
What are the blood markers done for testicular carcinoma?
LDH AFP Beta HGC
60
Which bacterial infection are struvite stones most associated with?
Proteus these are urease agents which create alkaline conditions promoting Mg2+ PO4- formation
61
If a young person with no previous history of hydrocele presents with one, what investigation should be done?
Ultrasound | - to rule out malignancy as testicular can present with it
62
What are the symptoms of acute urinary retention? | and what physical examinations do you want to do?
Suprapubic pain Urge to void - Palpation of bladder - Percussion of bladder - PR exam * *feel for enlargement * * impaction * * Tone (cauda equina) - reflexes lower limb (cauda equina) - external penile examination * *looking for phimosis
63
What are the complications of urinary retention?
* Post obstructive diuresis * Hydronephrosis with kidney failure • UTI/ Pyelonephritis - Stagnant urine • Renal calculi - Due to the stagnant urine • Urethral trauma As the catheter is being placed in
64
Which part of the prostate is most typically affected in BPH and how does this differ to prostate cancer?
Transitional zone which is closer to urethra and thus causes symptoms quicker typically Peripheral zone in prostate cancer
65
Name some symptoms of voiding and some of storage problems:
Voiding: - hesitancy - post void dripping - incomplete emptying - weak stream Storage: - nocturia - Frequency - incontinence
66
What things can raise the PSA?
``` • Age • PSA • Ejaculation • Exercise • Medical procedures UTIs ```
67
What are the risk factors for prostate cancer?
Age Ethnicity Continually STI infection Family History BRCA1/ BRCA 2 DM Smoking
68
What other way can the PSA be used to measure likely hood of cancer?
PSA density - serum PSA/ Size of the prostate
69
What is a risk factors for testicular torsion?
Family history - Bell Clapper Deformity - horizontal lie of the testicle due to poor attachment to the tunica vaginalis making it more mobile Age Previous torsion - a pain that self resolved could of previously been a torsion Undescended testes
70
What are the differentials to testicular torsion?
Epididymitis Torsion around the epididymal appendage Acute hydrocele Trauma Incarceration of an inguinal hernia
71
What is the test called where lifting the scrotum up, reduces pain in epididymitis but in testicular torsion it remains?
Phren's test
72
Which types of testicular tumours are more common in age groups?
Teratoma - 20-30 years Seminoma - 30- 40 years Lymphoma> 60 years
73
What are the risk factors for testicular cancer?
Cryptorchidism Klinefelter's Previous malignancy Family history
74
Which lymph nodes should be taken with teratomas?
Retroperitoneal
75
Why is a renal ultrasound done in the setting of suspected renal carcinoma?
To asses between a solid and cyst
76
What are the major types of testicular tumours?
Germ cell Tumours - Seminomas Non - Seminomas Germ cell tumours - Teratomas Non Germ cell tumours: - leydig - sertoli - Lymphoma
77
Which lymph nodes do the testes drain to?
Paraaortic
78
What classification system is used for testicular cancer?
Royal Marsden Classification Stage 1 - confined to testi Stage 2 - infra diaphragmatic nodes Stage 3 - Supra- diaphragmatic nodes Stage 4 - Extra- nodal involvement
79
What are the typical clinic findings of renal cell carcinoma?
``` Loin mass Haematuria Loin pain Left varicocele Paraneoplastic effects ```
80
How long does one need to abstain from vigorous exercise or ejaculation before getting PSA measured?
48 hours
81
What is the grading system used for renal carcinoma?
Robson's grading
82
What is renal cell carcinoma?
adenocarcinoma of the renal cortex, usually from PCT
83
How can renal cell carcinoma present?
usually asymptomatic. - Loin Pain - Loin Mass - Haematuria - Weight loss - Left variceal - Shortness of breath - due to metastasis
84
What is the management for renal cell carcinoma?
Small tumour: Partial nephrectomy Large tumour: Total Nephrectomy Percutaneous radiofrequency ablation Metastatic disease: - Biological agents - Immunotherapy
85
What are the broad subtypes of renal cancer?
Renal cell carcinoma: - cell cell Transitional cell - Usually effects the pelvis Squamous cell - Schistosomiasis Wilm's tumour
86
What is the gold standard investigations for renal cell carcinoma?
CT pre and post IV contrast
87
What is the second most common type of renal cancer and how is it investigated and treated?
Transitional cell carcinoma - typically arising in the pelvis of the kidney Investigations: - urine cytology - CT pre/ post IV Treatment: - Nephrectomy - regular follow up cause of bladder cancer
88
How often should high risk bladder cancers be followed up?
Every 3 months for 2 years. Then 6 monthly afters.
89
What are the surgeries performed following a radical cystectomy?
Ileo- conduit formation - ureters put into the ileum Bladder reconstruction - using the ileum to create a new bladder
90
What is the treatment of T4 bladder cell carcinoma?
Palliative chemotherapy + radiotherapy Urinary diversion
91
What is the treatment for testicular cancer?
Seminomas: Stage 1/2: Inguinal Orchiectomy Stage >2: Inguinal orchiectomy + Radiotherapy Teratomas: Stage 1: Inguinal Orchiectomy Stage 2: Inguinal orchiectomy + para-aortic clearance Stage >3: Plus chemotherapy
92
Whats the most common malignant mass in the testicles?
<5: ALL 5-60: Seminoma >60: NHL
93
What are the different types of undescended testes? | and what is the management?
Ectopic testis - anywhere on the testicular tract Undescended - cryptorchidism. Usually unilaterally Retractile testes - can be felt usually in the inguinal canal and pulled down but retract back up Medical: - B- hCG Surgical: - Orchiopexy dartos muscle procedure
94
What investigations should be done into urinary retention and which investigation is of no use?
Bloods: - FBC - CRP - U&Es - Blood glucose Orifices: - Urinalysis * mention in catheter specimen do NOT do PSA. it will be falsely elevated
95
How does a testicular carcinoma present?
``` Painless lump Non-transluminal Hydrocele Dragging sensation Back pain ```
96
What question do you want to ask into haematuria?
Duration? Colour - dark red - Clots? Timing: - initial - urethral - total - bladder or kidney - Terminal - prostate Pain - kidney stone Associated symptoms Use of anti-coagulation/ platelets
97
What is BENCH surgery?
Removal of kidney and stone taken out. Kidney is cooled Kidney is then put back in
98
What is the surgery for a stag horn stone?
Nephropyleolithotomy
99
Where is the most common place for a stone formation?
Pelvic ureteric junction
100
Following ureteroscopy lithotripsy what should be done?
Placement of stent to avoid fragments of stones building up
101
What are the options for stones in the bladder?
Cystoscopy lithotripsy Suprapubic Percutaneous Cystolithotomy
102
What is the treatment for stone in urethral?
diagnosed via Urethroscopy - pushed back into bladder and treated as bladder stone - ultrasonic lithotripter
103
What is the typical mode of spread of prostate cancer?
Haematological spread
104
What are the complications of radical prostatectomy?
Urethral injury Erectile dysfunction Urinary incontinence Urethral stricture
105
What is the prognostic marker of testicular cancer?
LDH

Phase 4 (49 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions