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Urology Flashcards

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1
Q

Causes of upper urinary tract obstruction

A
  • Kidney stones
  • Tumours pressing on the ureters
  • Ureter strictures (due to scar tissue narrowing the tube)
  • Retroperitoneal fibrosis (the development of scar tissue in the retroperitoneal space)
  • Bladder cancer (blocking the ureteral openings to the bladder)
  • Ureterocele (ballooning of the most distal portion of the ureter – this is usually congenital)
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2
Q

Causes of lower urinary tract obstruction

A
  • Benign prostatic hyperplasia (benign enlarged prostate)
  • Prostate cancer
  • Bladder cancer (blocking the neck of the bladder)
  • Urethral strictures (due to scar tissue)
  • Neurogenic bladder
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3
Q

6 causes of a neurogenic bladder, and what is it

A
  • MS
  • DM
  • Stroke
  • Parkinson’s disease
  • Brain or spinal cord injury
  • Spina bifida
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4
Q

What can be done to bypass an upper urinary tact obstruction ?

A

-> Nephrostomy : insering a thin tube through the skin at the back, through the kidney and into the ureter.

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5
Q

What can be done to bypass a lower urinary tract obstruction ?

A

-> Urethral or suprapubic catheter

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6
Q

Key SE of tamulosin

A
  • Postural hypOtension = leading to dizziness on standing or falls
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7
Q

How long do people require antibiotics for catheter associated infections ?

A

7 days

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8
Q

Symptoms seen in BPH

A

-> Hesitancy
-> Weak flow
-> Urgency
-> Frequency
-> Intermittency
-> Straining to pass urine
-> Terminal dribbling
-> Incomplete emptying
-> Nocturia

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9
Q

causes of a raised PSA

A
  • Prostate cancer
  • BPH
  • Prostatitis
  • Urinary tract infections
  • Vigorous exercise
  • Recent ejaculation or prostate stimulation
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10
Q

Cancerous prostate on DRE

A

Firm/hard, asymmetrical, craggy or irregular, with loss of the central sulcus

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11
Q

Medical management options of BPH

A
  1. Alpha-blockers (e.g., tamsulosin) relax smooth muscle, with rapid improvement in symptoms
  2. 5-alpha reductase inhibitors (e.g., finasteride) gradually reduce the size of the prostate
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12
Q

How do 5-alpha reductase inhibitors work ?

A
  • Converts testosterone to dihydrotestosterone (DHT), which is a more potent androgen hormone.
  • By inhibiting it, there is less DHT = reduction in prostate size
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13
Q

Four surgical treatment options for BPH

A
  1. Transurethral resection of the prostate (TURP)
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14
Q

Most common SE of finasteride

A

Sexual dysfunction (due to reduced testosterone)

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15
Q

2 classifications of prostatitis

A
  1. Acute bacterial prostatitis – acute infection in the prostate, presenting with a more rapid onset of symptoms
  2. Chronic prostatitis – symptoms lasting for at least 3 months
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16
Q

How can chronic prostatitis be classified ?

A
  1. Chronic prostatitis or chronic pelvic pain syndrome (no infection)
  2. Chronic bacterial prostatitis (infection)
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17
Q

Presentation of acute bacterial prostatitis

A
  • More acute onset of pelvic pain, LUTs, sexual dysfunction, pain with bowel movements and tender/enlarged prostate
    • Fever, myalgia, nausea, fatigue, sepsis
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18
Q

Presentation of chronic prostatitis

A
  1. Pelvic pain
  2. LUTs : dysuria, hesitancy, frequency and retention
  3. Sexual dysfunction, such as erectile dysfunction, pain on ejaculation and haematospermia (blood in the semen)
  4. Pain with bowel movements
  5. Tender and enlarged prostate on examination (although examination may be normal)
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19
Q

Management of acute prostatitis

A
  • Admission if systemically unwell
  • 14 oral quinolone (e.g ciprofloxacin)
  • Analgesia
  • Laxatives
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20
Q

Management of chronic prostatitis

A
  • Alpha blockers
  • Analgesia
  • CBT
  • Laxatives
  • Abx (if indicated)
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21
Q

5 RF for prostate cancer

A

Increasing age
Family history
Black African or Caribbean origin
Tall stature
Anabolic steroids

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22
Q

If not asymptomatic, how can prostate cancer present ?

A
  • LUTs
  • Haematuria
  • Erectile dysfunction
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23
Q

First line investigation for suspected prostate cancer

A
  • Multiparametric MRI (reported on a Likert scale)
  • > =3 prostate biopsy
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24
Q

How is prostate cancer diagnosed ?

A

Prostate biopsy

  1. Transrectal ultrasound guided biopsy (TRUS)
  2. Transperineal biopsy

(Risks : pain, bleeding, infection, urinary retention and ED)

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25
How do you assess for bone metastasis in prostate cancer ?
- Isotope bone scan
26
How is prostate cancer graded
- Gleason grading system : the greater the score = the more poorly differentiated the tumour
27
How is prostate cancer staged ?
TNM staging
28
Management options for prostate cancer
1. Surveillance or watchful waiting in early prostate cancer 2. External beam radiotherapy directed at the prostate 3. Brachytherapy 4. Hormone therapy 5. Surgery
29
Key complication of external beam radiotherapy for prostate cancer
Proctitis (inflammation in the rectum)
30
Side effects of brachytherapy
- Cystitis and proctitis - Erectile dysfunction, incontinence and increased risk of bladder or rectal cancer
31
Hormone therapies used in prostate cancer
1. Androgen-receptor blockers such as bicalutamide 2. GnRH agonists such as goserelin (Zoladex) or leuprorelin (Prostap)
32
SE of hormone therapy used in prostate cancer
Hot flushes Sexual dysfunction Gynaecomastia Fatigue Osteoporosis
33
Key complication of radical prostatectomy done for prostate cancer
Erectile dysfunction and urinary incontinence
34
- Soft, PAINLESS scrotal swelling anterior to and below testicle - Palpable testicle - Irreducible - TRANSILLUMINATED
Hydrocele
35
- Scrotal mass than feels like a bag of worms - More prominant on standing, disappears on lying - Dragging sensation - Sub/infertility
Varicocele
36
what is a varicocele
- Swelling of veins in the pampiniform plexus
37
what could be an underlying cause of a left sided varicocele ?
- Renal cell carcinoma obstructing the left testicular vein - The left testicular vein drains into the left renal vein
38
Soft, round lump Typically at the top of the testicle Associated with the epididymis Separate from the testicle
Epididymal cyst
39
Causes of epididymo-orchitis
Escherichia coli (E. coli) Chlamydia trachomatis Neisseria gonorrhoea Mumps
40
Parotid gland swelling and orchitis
MUMPS (spares the epididymis)
41
Presentation of epididymo-orchitis
Gradual onset (mins-hrs) - Unilateral : - Testicular pain and swelling - Pain relieved on elevation of tesicle
42
Key differential for epididymo-orchitis
Testicular torsion
43
what makes an STI the more likely underlying cause of epididymo-orchitis over an enteric organism like E.coli ?
- Age under 35 - Increased number of sexual partners in the last 12 months - Discharge from the urethra
44
Management of epidiymo-orchitis caused by an enteric organism
- Ofloxacin for 14 days - Send MSU
45
Two important SE of quinolone Abx (e.g ciprofloxacin)
1. Tendon damage and rupture (esp achilles tendon) 2. Lowers seizure theshold (caution in pts with epilepsy)
46
5 complications of epididymo-orchitis
Chronic pain Chronic epididymitis Testicular atrophy Sub-fertility or infertility Scrotal abscess
47
- Teenage boy with sudden onset unilateral testicular pain, triggered whilst playing sport
Testicular torsion
48
Examination findings in testicular torsion
- Firm swollen testicle - Elevated (retracted) testicle - Absent cremasteric reflex - Abnormal testicular lie (often horizontal) -Rotation, so that epididymis is not in normal posterior position
49
what is one underlying cause of testicular torsion
Bell-clapper deformity - Fixation between testicle and tunica vaginalis is absent and so testicle hangs in horizontal position
50
Management of testicular torsion
- Nil by mouth, in preparation for surgery - Analgesia as required - Urgent senior urology assessment - Surgical exploration of the scrotum - Orchiopexy (correcting the position of the testicles and fixing them in place)
51
what can be seen on USS in testicular torsion ?
Whirlpool sign -> spiral appearance to spermatic cord and blood vessels
52
4 RF for testicular cancer
Undescended testes Male infertility Family history Increased height
53
Common presentation of testicular cancer
- Typically = painless lump Arises frm the testicle Hard Irregular Not fluctuant No transillumination
54
What is a rare presentation of testicular cancer
- Gynaecomastia - Particularly = leydig cell tumour
55
Tumour markers for testicular cancer
1. Alpha-fetoprotein – may be raised in teratomas (not in pure seminomas) 2. Beta-hCG – may be raised in both teratomas and seminomas 3. Lactate dehydrogenase (LDH) is a very non-specific tumour marker
56
Diagnosis of testicular cancer
Scrotal USS
57
Staging system for testicular cancer
Royal Marsden Staging System - Stage 1 – isolated to the testicle - Stage 2 – spread to the retroperitoneal lymph nodes - Stage 3 – spread to the lymph nodes above the diaphragm - Stage 4 – metastasised to other organs
58
Common places for testicular cancer to metastasise to
Lymphatics Lungs Liver Brain
59
Course of antibiotics for UTI in men
7 days
60
Complete contraindication to mitrofurantoin
METHOTRXATE USE
61
4 RF for pyelonephritis
- Female sex - Structural urological abnormalities - Vesico-ureteric reflux (urine refluxing from the bladder to the ureters – usually in children) - Diabetes
62
Presentation of pyelonephritis
- Same Sx as lower UTI + - Fever - Loin or back pain - N&V
63
Management of pyelonephritis
7-10 days of Abx - Cefalexin - Co-amoxiclav (if culture results are available) -Trimethoprim (if culture results are available) - Ciprofloxacin (keep tendon damage and lower seizure threshold in mind)
64
Possible causes of significant symptoms of pyelonephritis or those that don't respond well to treatment
- Renal abscess - Kidney stone obstructing the ureter, causing pyelonephritis
65
How does interstitial cystitis present ?
- Persistent symptoms of a lower urinary tract infection (>6 wks) - suprapubic pain -> worse with a full bladder, relieved by emptying - Frequency - Urgency
66
what is seen on cystoscopy in 5-20% with interstitial cystitis
Hunner lesions : red, inflamed patches of the bladder mucosa associated with small blood vessels
67
RF for bladder cancer
Increased age Smoking Aromatic amines in dye / rubber
68
what kind of cancer does schistosomiasis cause
squamous cell carcinoma of the bladder
69
Most common type of bladder cancer
Transitional cell carcinoma
70
how does bladder cancer present ?
Painless haematuria
71
when is a two week wait for bladder cancer advised ?
- Aged over 45 with unexplained visible haematuria - Aged over 60 with microscopic haematuria PLUS: Dysuria or; Raised white blood cells on a full blood count
72
how is a bladder cancer diagnosed
cystoscopy
73
staging system for bladder cancer
TMN
74
Most common type of kidney stone
- Calcium based (oxalate or phosphate)
75
RF for calcium based renal stones
- Hypercalcaemia (calcium supplementation, hyperparathyroidism and cancer) - Low urine output
76
Give 3 other type of renal stone
- Uric acid : not visible on x-ray - Struvite : produced by bacteria, therefore, associated with infection - Cystine : associated with cystinuria, an autosomal recessive disease
77
what is a staghorn calculus
- The stone forms in the shape of the renal pelvis - Most commonly occurs with struvite stones
78
Presentation of renal stones
1. Renal colic (unilateral loin-groin pain, colicky) 2. Haematuria 3. N&V 4. Reduced urine outpur 5. Sepsis if infection present
79
Investigation of choice for diagnosing kidney stones
- Non contrast CT of kidneys, ureters and bladders ( CT KUB)
80
Management of kidney stones
- <5mm and asymptomatic = watchful waiting - 5-10mm = shockwave lithotripsy - 10-20mm shockwave lithotripsy or uteroscopy - >20mm = percutaneous nephrolithotomy
81
what 2 medications can be given to reduce the risk of recurrence of kideny stones
- Potassium citrate with calcium oxalate stones - Thiazide diuretics
82
Classic traid of renal cell carcinoma
Haematuria Flank pain Palpable mass
83
Sub types of renal cdell adenocarcinoma
Clear cell (80%) Papillary Chromophobe Wilm's tumour (children <5)
84
RF for renal cell carcinoma
- Smoking - Obesity - Hypertension - End-stage renal failure - Von Hippel-Lindau Disease - Tuberous sclerosis
85
Classic feature of metastatic renal cell carcinoma seen on X-ray
Cannonball metastases
86
what paraneoplastic syndromes are seen in renal cell carcinomas
1. Polycythaemia – due to secretion of unregulated erythropoietin 2. Hypercalcaemia – due to secretion of a hormone that mimics the action of parathyroid hormone 3. Hypertension – due to various factors, including increased renin secretion, polycythaemia and physical compression 4. Stauffer’s syndrome – abnormal liver function tests (raised ALT, AST, ALP and bilirubin) without liver metastasis
87
what is the specific number staging system used in renal cell carcinoma
-> Stage 1: Less than 7cm and confined to the kidney -> Stage 2: Bigger than 7cm but confined to the kidney -> Stage 3: Local spread to nearby tissues or veins, but not beyond Gerota’s fascia -> Stage 4: Spread beyond Gerota’s fascia, including metastasis
88
1st line management of renal cell carcinoma
Surgery - Partial nephrectomy (removing part of the kidney) - Radical nephrectomy (removing the entire kidney plus the surrounding tissue, lymph nodes and possibly the adrenal gland)
89
In pts not suitable for surgery, how can renal cell carcinomas be managed
-> Arterial embolisation, cutting off the blood supply to the affected kidney -> Percutaneous cryotherapy, injecting liquid nitrogen to freeze and kill the tumour cells -> Radiofrequency ablation, putting a needle in the tumour and using an electrical current to kill the tumour cells
90
what monoclonal antibody is given post renal transplant to prevent acute infection ?
Basiliximab : targets interleukin-2 receptor on T cells
91
what is used as immunosuppression following renal transplant
- Tacrolimus - Mycophenolate - Ciclosporin - Azathioprine - Prednisolone
92
Give the common SE of certain immunosuppressant agents given post renal transplants
1. Immunosuppressants cause seborrhoeic warts and skin cancers (look for scars from skin cancer removal) 2. Tacrolimus causes a tremor 3. Cyclosporine causes gum hypertrophy St4. eroids cause features of Cushing’s syndrom
93
What Abx used in bladder ifnections is unhelpful in pyelonephritis
Nitrofurantoin
94
Scrotal swelling commonly seen i nrenal cell caner
Left sided varicocele
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