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Urology Notes

Urology

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mudhalvan.palanisamy.nov2021
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83 views9 pages

Urology Notes

Urology

Uploaded by

mudhalvan.palanisamy.nov2021
Copyright
© All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF or read online on Scribd
reve) 2 es al eee oe) a Cre Teco Urolgy Prostate cancer ak tactors > ket er romana be + ere Cts itorse enue Mie, lack Aro Cabean > tar mens The +28 degree relative with prostate cancer ‘homed tea Presentation ecient ph > Lower urinary trac symptoms (LUT) ae NOT speci or acre na wet + LUTSincude voiding obstructing symptoms such as hestancy, urgency, peor and/or intermittent stream, raining, prolonged micturiton feting of incomplete badder emptying, ribbing Investigation +n > DRE (hard, regular & nodular) + psa | Seperated eotiis 2 ng/ml at age 4049 years TE oman stg Sshurmiseaoe sos evs inmuneconerom one sense 25 nef at age 70 yearsor older + Definitive» Biopsy mre a Gr aioe Management + esein pate ton+ ant > Leuprolde, sed in 3 comtioucus manner ered ncn fin tog ore ‘+ Faised PSAonscreening « Hematura ‘+ Bone metastasis hypercalcemia thst + wis “+ Hematospermia + Bone pan or seatica + oun ‘+ Obsinctionof ureters,» Paraplegia 2" to spinal cord compresion Causing loin pai anus, LNenlargement symetomsof AKI or CKD «Lethargy (anemia, uremia) + Wight ss > xuous > ma Metastatic spinal cord compression > anoncolgical emergency and an urgent MRI shouldbe Fequested within 245 > 20% of patents with pina metastasis 1+ Neurological symptoms like redclsr pai, limb weakness, tfc in walking, sensory lssor bladder oF bowel dysfunction 4 Newrolgical signs of spinal cord or caudaequina compression > DONOT contse between metastatic spinal cord compresion and spinal [5 Spnaimsnsnn mamas ‘metastasis. Spinal metastasis presents with pain nthe thoracic or per |” cecamreaon ms cerca sane progressive lumbar spine pain or nocturnal spinal pain | © Speaimetatais MTHOUT setons reverting sleep, Spinal metastasis st considered emergency compression Hotape san > Most frequent tes for metastasis for prostate cancer are bone (by hematogenous read) and mph nodes of ‘he obturator fot intemal excernal and common lic aeias and presacral eepons 1+ Testicular eaneor + UN Lungs RNeasy ee Dau rea) Coren Seer Urology Benign Prostatic Hyperplasia (BPH) > An old male complaining of LTS RE reveals large, fm ana smooth prostate ‘+ Worsened by blade filing ‘¢ Relieved ty voiding but returns when bladder fils again © LUTS-urne frequency, urgency & nocturia ‘+ Inwomen, symptoms are often worse during menstruation Investigation ‘= Oystoscopy to exclude bladder malignancy = 10%have Hunner’s lees, they're reddened mucosal areas associated with small vessels radiating toward 2 central sear ‘Glomecuatians(petechial red areas) Management © PHline = ladder raining ~ Pelvic floor relaxation techniques (avoid pelvic floor exercises) Avoid triggers ike cole, crus fits or smoking which can exacerbate symptoms = Analgesic suchas NSAIDS + PMtine = Aamiteiptyline = Oxybutynin = Gabapentin Pyogenie cystitis wrs [Nierotes ond evkocyts in urine ‘Blodéer stones re rare in women TAKE NOTES ory) rs Gna Cte Teco Urology Bladder cancer > Mostly transitional cell carcinoma > whenever yousee ales 8 > Presents with poles visible hematuria heratuainan ty me you shod ‘redial be hein of anar Risk actors ‘+ Smoking ~the mojor cause ‘+ Occupational exposure (industrial plants processing paint, ye (aniline), metal nd petroleum products) + Male 1+ Increasing age Investigations of Hematuria ‘© Aftera UT|has been excluded or treated al patents with persistent micrescepic or macroscopic hematuria require investigation oftheir upper tracts, bladder and urethra 40+ frank hematuria > Cystoscopy, CTU (CT-arography) & cytology 40+ non-visible hematuria OR CF-KUB for stones Forrenal and ureteric malignancy ~+ TU ‘+ CTUssfasterthan US oF Un detecting renal and ureteric tumors, However, it carries higher radiation ‘dose and is more expensive, CTU also detects Some bladder tumors, but may overcll ladder wall hypertrophy a tumor and will mis flat CIS and urethral pathology so it cannot replace cystoscopy > Abnormal enlargement ofthe testicular veins > Incompetent valves ofthe Internal spermatic veins lead to retrograde blood flo, vessel dataton and tortusity ofthe pampiniform plexus > > dorwon the left side the left testicular vein opens ata right angle tothe left renal vein > "varicocele can be caused by a kney tumor (causing obstruction of the lft testicular ven) Features ‘+ Classcally described asa bag of worms ‘+ Subfotity (due to elevated scrotal temperature sesteyet\| sane which affects spermatogenesis) ‘+ Usually aymatomaic (rarely causes pain, if so scrotal heaviness) ‘+ Swelling from varicocele may demonstrate cough Impulse lke hernia and they also tend to disappear when ying down (gravity allows Serotal doppler US i dagnorte Management ‘+ Usually conservative > Reassure ‘© Surgery is occasionally considered if there's significant ongoing pain, debatable in managing fectility > Newly dlognoted varicocele over the age of 40 years ke very suggestive TEES 10:58 PM rs Brac t Cte Teco Porte Ur Testicular torsion Keytenres rr 1 Seuee sudden one test pan 2 tel red ond | Usually affects adolescents and young mates (<20 years) fowintetinder artery posse sory fauna ce i — nt ‘Could be recurrent — testis twisting and then spontaneously mers reohng > thecmtaceni ah pt © On examination testis is tender and pain not eased by eeetatetiedaeatite ip mem aeeelpesartoion — iting thetestsupovertne | age ‘mein crt Sound inept ~ sly oleves pn ite aogement > Urgent exploratory surgery (detorson & orchidopery) is needed to prevent ischemia ofthe testicle within 6h idymo-orchi > Aninfecion of te epididymis with or without an infection of the testes resulting in pan and swelling > ost commonly caused by local spread of infections from the genital tract (eg. chlamydia & gonorrhea) ‘where there's a retrograde spread from the prostatic urethra and eminal vesicles > talso could be caused by non-sexualy transmitted organism causing UTI fg. Ecol) Features ‘© Unilateral serotal pain and sling Ensteme ors mens Sabine in women ‘+ Tenderness is usually localized to epididymis (may help distinguish rom testicular torsion) ‘Urethral discharge may be present, but urethritis is often asymptomatic + Leukocytes & nitrates posite (eg. eo) ayer and rigors in severe cases Tenderness may be relieved by elevating the scrotum = ve Pret’ sen Management > Antibiotics Reiter's syndrome [AUC] 1. Urethis| 2 aris 3. Conjunctivitis > Triggered by cham infection, and usually in conjugation with HLA B27 TAKE NOTES ory) rs Brac t Cte Teco Per Urology Testicular cancer > Germ celtumer mosty 1 Seminoma — the most common 2. Non-eminoma > Usually present at earlier age (30:24 years ola Risk actors *# Cytorchidsm (undescended testis, increases the risk 10 times higher —» Orchidopexy at age 6 months Features ‘+ Painless lump inthe body ofthe testis the most common presentation nosis ‘© USis the ine —+ [This shouldbe fs line for ny Srote ump 8 ch forstaping i ‘+ Tumor markers — LDH (seminoma), B-HEG Or AFP (non-seminom) Complications + onal testlr cncr oreo 1 2" spread to the para-aortic LN rather than the inguinal LN secre > Metastasis is are, i happens —> LNs, lungs ged atin dace Epididymal cyst 2 Derived from the collecting tubules ofthe epididymis and contains clear uid > They develop owl, le within the scrotum & often multiple (muttloculated) > Most common cause ofsrotal swelling seen in primary care Features ‘pada et bein and above Painless acne reir ma beiow ‘+ Le behind and above the testis be the test > epdymat ot ole nate cating Diagnosis {rom ests Hwee hye, es es > us statenstestng mae nero Management ‘© Usually supportive but surgical removal may be attempted for larger or symptomatic cysts TAKE NOTES or) cre Brac t Cte Teco Porte Nephrolithiasis Risk actors Features Investigations Management «+ 2em (large andcomples stone) — percutaneous man ets tr nephroithotomy OE paw) ‘+ Staghorn —> surgery See) ‘An urgent percutaneous nephrostomy or ueticstent (i) may be needed 1 > Forureteral stones Urclosy Dehydration Hypercalcemia (ether due to bupesparathyroidism or sarcoidosis raised vitamin D produced by macrophages) ‘ADPKD Gout —> uric acid stones Loop diuretics —» Ca excretion —» hypercalcuria Sudden onset lank pan, radiating te the loin/groin Nausea and vomiting 7 Res aes jontaain— we aed tne Hematuria (painful adot eau avs» neoattooh a oxalate — most common Unie eid (adlucen}) Struvite stone (staghorn stone) — alkaline urine (infection with irease producing bacteria, proteus & ebsiela) Cysteine — a child with recurent episodes of renal colic Intat —Xeray It suspect a radioucent stone — US ‘Most accurate — non-contrast CT can ako exclude other causes of acute abdomen (og. euptured AAA) Infection + obstruction (fever tenderloin & pyria) _Uxosenss altered mental state systole blood pressure S100 mmHg, respiratory rate >22 breath/ni) Anteactable ain or voriting Impending At (o2otemia or elevated creatinine and BUN) (Obstruction na sotary kidney {Blatral obstructing stones <5mm > conservative >5 mm CCB and Tomlin, most poss in 48h, ifpot > ESWLor ureteroscope Larger stones, multiple or complex ~ percutaneous nephroithotomy TAKE NOTES or) cre Cte Teco rr Urology Post-op ureteric injury > May present inthe fist few days folowing surgery but it may aso be delayed by weeks > one of the most serious complications during gunecological & abdominal surgeries > Ureter could be dhvided, igated, angulated by a structure or damaged by a diathermy Features “lous (due to urine inthe pertonesl cavity) ‘+ Flank pin ifthe ureter has been gated) Deviation mvoing cars med ANNOT 2 ecomnol pan Seger eve ofimparedrenl anion 4+ Abdominal distension ‘+ Retroperitoneal urinoma a collection of urine) 1+ _Utinary leakage (vaginally or via abdominal wound) Investigations ‘+ Intravenous wrography (WVU) ‘hows an obstucted ureter, extravasation ofthe dye from the se of injury or hydronephrosis The best imaging modality to evaluate the continuity ofthe ureter in cases of ureteral injury after an oper + Renal US ‘Best nan invasive method to visualize the kidney Best when renal function impaired ‘hows hydronephrosis or retroperitoneal uinomas. However, it CANNOT assess the ureteric continuity + crwth contrast ‘+ Retrograde urethrogram Vesicovaginal fistula > A continuous involuntary discharge of uring int the vaginal vault > A possible complication ater gynecological procedures (hysterectomy) > A swab test could dent avescovaginal fistula {3 gauze swaps placed into the vagina using 2 speculum (top, middle bottom) ‘Blue dye is inserted tothe bladder bypassing through a catheter Catheters removed and the patients asked to walk around Foran hour without urinating ‘Then, swabs are taken and evaluated fr blue éye Three swab test Result of 3 swab test orm ab > serraainl ela SUreerovogna tla 2. Diestourntonot lover most | Sebbauecrteosas al remaindey > Uretvovagina tle TAKE NOTES rT) rrr Cte Teco rr Urclosy ‘Syphilis An STi caused by Treponema pallidum Move common in homosexuals > Acquired syphilis is characterized by primary, secondary and tertiary features Incubation period + Around 3 weeks Features 1 Primary features ‘Chanete, pales ulcer atthe site of sexual contact Local non-tende lymphadenopathy Inwomen,they'e found on the vulva labia and canals be found on the cervix or within the anal canal 2 Secondary features ‘Appears 6 weeks after begioning of the primary lesion but may overlap ont appear for several months Systemic symptoms: fever, lymphadenopathy, headache, malaise ‘generalized polymarphic ash often aflect the palms, soles and face Papules enlarge into condvlomata lata (pink or grey ss) n moist warm areas 13. Tertiary features ‘Gummas (granulomatous lesions can occur in any organ but most commonly affect bone and skin) vascular syphils—» ascending aortic aneurysms, AR Neurological syphilis + tabos dorsalis, dementia Investigations ‘+ Visible ulcer or infected LN -> (GP —» PER // GUM physician ~» Dak eld microscopy) ‘+ Heald ulcer > Serology (ORL, TPHA or treponemal antibody absorption) Management > Bentathine penielin + oral aithromycin + Sil pile goal Spe Sle pin ee Deeg + Mute santllers— nSv oss of humic case pales kee + ortnganlamasanss + uterens re ose nS 0 of rash on palms and soles 1.2” Syphilis by Teeponema palsdum 2. Hand, foot, mouth disease by Coxsackie vir 3. Rocky mountain spoted fever by ricketisia Genital Herpes Simplex > May be asymptomatic. or may remain doriant for months or even years > When symptoms occur after infection, they tend tobe severe > Iteanbe a chronic lifelong infection > Mostly caused by HSV-1 (most common cause of both arlabal and genital herpes) Presentation ‘+ luke prodrome, followed by grouped vesices/papules around genitals ‘+ They burst and form shalow ulcers ‘+ Dysutaisoften present Investigations “+ NAAT (nucleic aid amplifiestion test) PCRS via culture ‘+ Recurrent/atypical geital ulers with ve culture or CR + AntLHSV antibodies Management + Oral acyctovir TAKE NOTES eC Genital warts Management TURP S$ Purple urine bag $ Urge incontinence overactive bladder (one) tres incontinence Mixedincontinence —- Incontinence Urethrovaginal ‘fistula > Ws 6weske to several months Usctosy > Benign epithelial skin tumors commonly seen a caulilowsrke growths > Most commonly caused by HPV 6 & 12 > Around 30% can resolve spontaneously — > Transmitted by sexual itercourse 1 68 810 reporie or mos cael ‘+ Solitary, kratinized warts > Gardasil protects against HPV 6.1.16 & 18 ‘+ Multiple, non-keratinzed > Pedophyltoxin ‘+ Ablative (eg. cryotherapy & eacsion under anesthesia) ‘+ Occurs when ierigation fd enters the iystemic ceulaton. W's caused by venous destruction and absorption of the ligation fu and itcanbe life threatening ‘+ characterzed by diutlonal hyponatremia ‘+ Managed by fd eostriction 4 Resulted from co-exstent UTL ‘+ One ofthe most common causing bacteria is Provdencia stuart ‘+ Managed by betadine lavage ofthe urethra and catheter change Infected indwelling urinary catheter = Action — change the catheter symptoms of UTI Ant ies Due to detrusor overactivity “winen | have to goto the tol, eally have to go" “sometimes urine passes before reaching the tol” ‘Treatment > Bladder retvinin, antimuscarinics (Oxybtynin,toterodine or dorfenacin) Leaking small amounts of urine when coughing or laughing Usually witha history of many vaginal deliveries 25 this would weaken the pelvic floor muscles ‘Treatment > eivicfloar exercise tension-fee vaginal ane eiragubic mid-uretheal tape procedures, Duloxetine ‘Amin of both stress and urge incontinence Involuntary release of urine from an overful urinary bladder, often inthe absence of any urge to urinate ‘Occurs in patents who have blockage ofthe bladder outlet (BPH, prostate cancer or natrowing af the urethra or when the muscle that expels rin from the bladder ie too weak to empty the bladder normally ‘Opening between vagina and urethra ‘Continual leakage of urine from the vagina Vagina would have afoulsmeling

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