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39 Cards in this Set
- Front
- Back
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Complications of untreated urinary tract obstruction |
Infection (cystitis, pyelonephritis, abscess formation and sepsis) Urinary extravasation Fistula formation Renal insufficiency or chronic kidney disease. Bladder dysfunction Pain |
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investigations in primary care for male lower urinary tract symptoms |
Urine dipstick +/- culture Serum creatinine, eGFR, PSA Frequency-Volume chart |
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investigations in secondary care for male lower urinary tract symptoms |
Renal tract USS ± KUB x-ray Urine flowmetry - for bladder outflow obstruction Cystometry (urodynamics) - detrusor pressure Flexible cystoscopy if urethral or bladder pathology is suspected |
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non-surgical management of BPH |
Alter oral fluid intake, reduce caffeine intake Stop anti-cholinergic, sympathomimetic and opioid drugs α1-Adrenergic receptor blockers (e.g. tamsulosin) 5α-reductase inhibitors (e.g. finasteride) anticholinergic if persistent symptoms of overactive bladder (OAB) Catheterisation |
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complications of TURP / open prostatectomy |
Postoperative haemorrhage and clot retention UTI TURP syndrome - hyponatraemia, hypotension and metabolic acidosis (2%) Erectile dysfunction - retrograde ejaculation, impotence (5-35%) Incontinence - 1% Urethral stricture |
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presentation of renal cell carcinoma |
haematuria flank pain abdominal mass hypertension (↑renin) polycythaemia (↑EPO) ectopic hormone production: ACTH, ADH, PTHrp |
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renal cancer spread |
Direct into renal vein and perirenal tissue Lymphatic to periaortic and hilar nodes Haematogenous to lung (large, ‘cannon-ball’ metastases), bones and contralateral kidney |
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bladder cancer spread |
Direct into pelvic viscera (prostate, uterus, vagina, colon, rectum) Lymphatic to periaortic nodes Haematogenous to liver and lung |
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presentation of bladder cancer |
Painless intermittent gross haematuria (95%) Dysuria, urgency or frequency (10%) In a smoker |
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treatment for bladder cancer |
1. TURBT (resection of tumour) 2. Further management depends on type, stage, gradeand patient age |
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investigation for bladder cancer |
flexible cystoscopy |
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prostate cancer spread |
Direct into remainder of gland and seminal vesicles. Lymphatic to iliac and periaortic nodes. Haematogenous to bone (usually osteosclerotic lesions), liver, lung |
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PSA for prostate biopsy |
PSA > 4 → prostatic biopsy |
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hormonal treatment used in management of advanced prostate cancer |
1. anti-androgens 2. Androgen deprivation therapy (ADT) - LHRH agonists or bilateral orchidectomy 3. ADT + docetaxel chemotherapy (if metastatic) |
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2nd/3rd line Hormone therapy for those unfit for docetaxel |
1. Combination LHRH agonist + anti-androgen 2. Steroids 3. Oestrogen 4. Bisphosphonates |
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types of testicular tumours |
1. Germ cell tumours (95%) - seminoma, non-seminoma (embryonal, teratoma) 2. Non germ cell tumours (5%) 3. Metastatic tumours |
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testicular tumour markers |
AFP, β-HCG and LDH |
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management of testicular cancer |
Radicalorchidectomy (via groin incision) +/- radiotherapy / chemotherapy |
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clinical presentation of renal tract stones |
pain - can be in waves (colic), flank, lower abdomen, groin haematuria passing gravel nauseaor vomiting pain with urination urgent need to urinate |
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types of renal tract stones |
calcium oxalate (60%) phosphate (30%) - struvite uric acid (5%) cystine (1%) |
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imaging for renal tract stones |
spiral CT |
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initial management of renal tract stones |
Pain relief High fluid intake Antiemetics |
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interventional procedures for renal tract stones |
to drain urine: ureteric stent or percutaneous nephrostomy to shrink stones: Extracorporeal shock wave lithotripsy (ESWL) to remove stones: percutaneous nephrolithotomy or therapeutic ureteroscopy |
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differential diagnosis of scrotal mass |
hernia, carcinoma, hydrocoele, epidydimal cyst, varicocoele, torsion, epididymoorchitis |
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indications for empirical antibiotic treatment for suspected UTI in non-pregnant women <65 years |
severe or ≥ 3 symptoms of UTI without symptoms of pyelonephritis treat with 3 days nitrofurantoin |
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indication for dipstick tests for suspected UTI in non-pregnant women <65 years |
≤2 or mild symptoms of UTI if dipstick positive treat with 3 days nitrofurantoin |
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indication for urine culture in non-pregnant women <65 years with UTI |
urine culture if no response to trimethoprim or nitrofurantoin to guide change of antibiotic |
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indication for urine culture for men |
symptoms of UTI |
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indication for urine dipstick test in older people |
do not use dipsticks tests to diagnose UTIs in older people |
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treatment of UTI in men |
nitrofurantoin PO for 7 days |
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treatment of UTI in patients with renal failure |
avoid nitrofurantoin & tetracyclines use trimethoprim or reduced dose amoxicillin |
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treatment of acute pyelonephritis |
co-amoxiclav 1.2g TDS IV for 7 days severe sepsis, add single dose gentamicin |
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treatment of acute prostatitis |
co-amoxiclav 1.2g TDS IV for 28 days + gentamicin single dose |
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causes of haematuria |
Upper tract causes: kidney stones, Renal cancer Lower tract causes: inflammation or infection of the prostate or bladder, Stones, Bladder cancer, benign prostatic hyperplasia (BPH) Top 3: ureteric stone, bladder carcinoma (TCC), BPH |
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investigations for non-visible haematuria |
<40 years: USS & KUB x-ray >40 years: CT-KUB |
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Investigations for visible haematuria |
<40 years - CT KUB >40 years - CT urogram |
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causes of retention of urine |
bladder outflow obstruction, neurological, drugs, constipation |
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complications of bladder decompression via catheterisation |
Haematuria Transient hypotension Post-obstructive diuresis |
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Indications for 2ww referral - NICE cancer referral guidelines (2015) for haematuria |
1. Visible haematuria >45 years 2. Non-visible haematuria + raised WCC or dysuria,>60 years |
