Finals - Surgery > Urology > Flashcards

Urology Flashcards

(66 cards)

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1
Q

Epididymitis - Definition

A

Inflammation of the epididymis

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2
Q

Epididymitis - Common age group

A

Young adults (average age 25)

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3
Q

Epididymitis - Cause

A
  • Young men: STI > UTI e.g. gonorrhoea

- Older men: UTI > STI e.g. E. coli

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4
Q

Epididymitis - Presentation

A
  • Gradual onset pain
  • Hot, red + swollen testis
  • Low grade fever
  • Urethral discharge + vomiting may present
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5
Q

What is Prehn’s sign

A

Testicular pain is relieved by elevation of scrotum

seen in epididymitis

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6
Q

Epididymitis - Investigations

A
  • Typically a clinical diagnosis
  • Ultrasound: can be used to rule out abscess
  • Surgical exploration if unsure
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7
Q

Epididymitis - Management

A

Antibiotics

  • STI: ciprofloxacin + doxycycline
  • UTI: fluoroquinolone

Scrotal support
Analgesia

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8
Q

Testicular Torsion - Definition

A

Twisting of spermatic cord around testicular artery + vein

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9
Q

Testicular Torsion - Common age groups

A

Two peaks

  • first year of life
  • 13 to 30
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10
Q

Testicular Torsion - Risk factors

A
  • Bell-clapper deformity (biggest risk factor)

- Undescended testicles

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11
Q

Testicular Torsion - Presentation

A
  • Sudden onset severe unilateral pain
  • Nausea + Vomiting
  • Abdominal pain
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12
Q

Testicular Torsion - Examination

A
  • One testicle higher than the other

- Loss of cremasteric reflex

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13
Q

Testicular Torsion - Investigations

A
  • Clinical diagnosis

- Doppler (look at blood flow) not useful

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14
Q

Testicular Torsion - Management

A
  • Immediate surgical exploration

- Fix testes - bilateral orchidopexy

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15
Q

What is the Hydatid of Morgagni

A

Remnant of mullerian duct

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16
Q

Hydatid of Morgagni Torsion - Symptoms

A
  • Sudden onset pain
  • Compared to torsion: younger, less swelling, normal lie
  • Classical sign = ‘blue dot’
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17
Q

Testicular cancer - Common demographic

A

Caucasian men aged 20-40

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18
Q

Testicular cancer - Tumour types

A
  1. Germ Cell Tumours (95%)
    - Seminomas (SGCT)
    - Non-seminomas (NSGCT)
  2. Non-germ cell tumours (NGCT) (5%)
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19
Q

Testicular cancer - Risk factors

A
  • Undescended testes
  • PMH/FH of testicular cancer
  • Klinefelter’s syndrome
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20
Q

Testicular cancer - Clinical features

A
  • Unilateral, painless testicular lump

- Lump: irregular, firm, fixed + doesnt transilluminate

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21
Q

Testicular cancer - Investigations

A
  1. Tumour markers
    - AFP + beta HCG
  2. Scrotal Ultrasound
  3. Contrast CT (for staging)
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22
Q

Testicular cancer - Management

A

NSGCT
- Surgery + chemo (based on risk score)

SGCT
- Orchidectomy + surveillance

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23
Q

Testicular cancer - Fertility

A
  • Chemo/radiotherapy can impair fertility

- Cryopreservation offered

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24
Q

Urethritis - Classification

A
  1. Gonococcal Urethritis

2. Non-gonococcal Urethritis

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25
Urethritis - Risk factors
- Age <25yrs - MSM - Previous STIs - New sexual partner/multiple sexual partners
26
Urethritis - Clinical features
- Dysuria, penile irritation + discharge | - Complications: reactive arthritis + epididymitis
27
Urethritis - Investigations
- First-void urine sample for NAAT (gold standard) - Urethral swabs - Additional STI screening: e.g. HIV, Syphillis
28
Urethritis - Management
1. Antibiotics - Gonococcal: ceftriaxone + azithromycin - Non-Gonoccocal: doxycycline or azithromycin 2. Abstinence - no sex until 7 days after symptoms + abx finished
29
Bladder Cancer - demographics
Men > Women
30
Bladder Cancer - Risk factors
- Smoking + increasing age - Exposure to industrial dyes or rubbers - Previous pelvic radiation
31
Bladder Cancer - Clinical features
- Painless Haematuria (main symptom) - Possibly recurrent UTIs - Signs of obstruction
32
Bladder Cancer - Investigations
- Flexible cystoscopy (first line) | - If mass suggested: Rigid cystoscopy (biopsy) + CT KUB
33
Bladder Cancer - Management
1. Confined to bladder - Transurethral resection of bladder tumour (TURBT) - Higher risk: radical cystectomy - Follow up imaging for several years 2. Muscle invasive - Radical cystectomy - Regular CT imaging 3. Locally advanced/Metastatic - chemotherapy + symptom relief - Palliation discussion
34
BPH - Demographic
Older men >40yrs risk = 50% >80yrs risk = 90%
35
BPH - Pathophysiology
- Exact mechanism unknown - Androgens likely play a role - Prostate retains ability to respond to testosterone for life
36
BPH - Risk factors
Age (primary risk factor) | FH, afrocaribbean ethnicity, obesity
37
BPH - Clinical features
1. Voiding symptoms - hesitancy, weak stream, terminal dribbling, incomplete emptying 2. Storage symptoms - frequency, nocturia, nocturnal enuresis, urge incontinence 3. Less commonly: haemturia/haematospermia
38
BPH - Examination
DRE: enlarged, smooth, symmetrical, firm prostate
39
BPH - Investigations
- Urinary frequency + volume chart - Post-void bladder scan (chronic rentention) - PSA (exclude malignancy - slightly raised in BPH) - Urodynamics (objective measure of symptoms)
40
BPH - Management
1. Conservative - lifestyle advice: moderate caffeine + alcohol intake 2. Medical - alpha blocker (tamsulosin) or 5-alpa-reductase inhibitor (Finesteride) 3. Surgical - Trans Urethral Resection of Prostate (TURP)
41
Prostatitis - Classification
1. Acute bacterial 2. Chronic bacterial 3. Non-bacterial 4. Prostatodynia
42
Prostatitis - Cause
Acute bacterial caused by ascending UTI | - most commonly E. coli (can also by GI + STI organisms)
43
Prostatitis - Risk factors
Acute bacterial - catheter, recent surgery, immunocompromised, urethral stricture Chronic - Same as acute - Plus: structural abnormality, bladder dysfunction
44
Prostatitis - Clinical Features
Bacterial - Lower urinary tract symptoms - Perineal + suprapubic pain - Urethral discharge - Examination: tender, boggy prostate
45
Prostatitis - Investigations
- Urine culture (first line) - Routine bloods - STI screen - Imaging (if not responding to treatment)
46
Prostatitis - Management
- Prolonged antibiotics (quinolones) - Analgesia (paracetamol + NSAIDs) - Alpha-blocker/5-ARI (2nd line)
47
Fournier’s Gangrene - Definition
Necrotising fasciitis affecting the perineum
48
Fournier’s Gangrene - Cause
Causative organisms: - Group A strep - C. Perfringes - E. coli
49
Fournier’s Gangrene - Risk Factors
- Diabetes Mellitus - Excess alcohol - Poor nutritional state - Steroid use - Haematological malignancies - Recent trauma
50
Fournier’s Gangrene - Clinical Features
- Severe pain out of proportion to findings - Pyrexia - Progresses to: skin necrosis, haemorrhagic bullae, sensory loss
51
Fournier’s Gangrene - Investigations
Clinical Diagnosis
52
Fournier’s Gangrene - Management
- Urgent Surgical Debridement - Broad spectrum antibiotics - HDU support Later - Further debridement often necessary - Secondary closure with skin grafts
53
Paraphimosis - Pathophysiology
- Usually following catheter insertion | - Often presence of tight constricting band
54
Paraphimosis - Risk factors
- Occurs in people with phimosis - Previous paraphimosis - Poor hygeine
55
Paraphimosis - Clinical features
- Progressive pain + swelling | - Inability to pull foreskin back over glans
56
Paraphimosis - Management
1. Reduction ASAP | 2. Definitive management - potentially circumcision
57
Priapism - Pathophysiology
Blood stays within corpus cavernosa
58
Priapism - Classification
1. High-flow: arterial blood enters faster than it can be drained - does not cause ischaemia 2. Low-flow: veno-occlusion prevents blood draining - can cause ischaemia
59
Priapism - Causes
- Idiopathic (in >50%) - Non-ischaemic causes: penile/perineal trauma - Ischaemic causes: iatrogenic, sick cell, leukaemia
60
Priapism - Clinical features
- Ongoing, unwanted erections - Ischaemic: painful + rigid - Non-ischaemic: painless and often not fully rigid
61
Priapism - Investigations
After initial management - Corporeal blood gas (lactate to see if ischaemic) - Routine bloods (look for cause)
62
Priapism - Management
1. Initial - corporeal needle aspiration 2. Intracavernosal injection of phenylephrine 3. Surgical - Shunt (cavernosa to glans)
63
Penile Fracture - Pathophysiology
Caused by blunt trauma - penis violently deviated away from axis - Commonly: sex with female on top or forceful masturbation
64
Penile Fracture - Clinical Features
- Reported 'popping' sensation - Followed by immediate pain, swelling and loss of erection Examination - penile swelling - discolouration (aubergine sign) - Firm, immobile haematoma
65
Penile Fracture - Investigations
Clinical diagnosis
66
Penile Fracture - Management
Urgent surgical exploration + repair Later: abstinence for 6-8 weeks
Finals - Surgery
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