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Flashcards in Urology Deck (157)
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1

Define Symptomatic non-visible haematuria (s-NVH)

microscopic haematuria or dipstick-positive haematuria with associated symptoms

including lower urinary tract symptoms (LUTS): hesitancy, frequency, urgency, dysuria

2

What are the common causes of haematuria

UTI,
bladder tumours,
urinary tract stones,
urethritis,
benign prostatic hypertrophy (BPH)
prostate cancer.

3

How can you classify causes of haematuria

Infection: cystitis, tuberculosis, prostatitis, urethritis, schistosomiasis, infective endocarditis.

Tumour: renal carcinoma, Wilms' tumour, carcinoma of the bladder, prostate cancer, urethral cancer or endometrial cancer.

Trauma: renal tract trauma due to accidents, catheter or foreign body, prolonged severe exercise, rapid emptying of an overdistended bladder (eg, after catheterisation for acute retention).

Inflammation: glomerulonephritis, Henoch-Schönlein purpura, IgA nephropathy, Goodpasture's syndrome, polyarteritis, post-irradiation.

Structural: calculi (renal, bladder, ureteric), simple cysts, polycystic renal disease, congenital vascular anomalies

Haematological: sickle cell disease, coagulation disorders, anticoagulation therapy.

Surgery: invasive procedures to the prostate or bladder.

Toxins: sulfonamides, cyclophosphamide, non-steroidal anti-inflammatory drugs

4

What questions are important to ask in a haematuria history

LUTS symptoms - dysuria, freq, hesitancy, urgency
where - in urine/on wiping
pain - intermittent, constant, loin to groin
TURP in past?
DH - anticoag
smoking
jobs - carcinogens

5

How would you investigate haematuria?

urine dip - ?UTI
eGFR, U+E, FBC, ?PSA
MSU
USS KUB, flexible cystoscopy
TURB

6

What kinds of bladder cancer are there? What percentage of each kind?

transitional - 90%
squamous 10%

7

What are hte risk factors for bladder cancer?

Transitional:
Smoking
Exposure to aniline dyes in the printing and textile industry: examples are 2-naphthylamine and benzidine
Rubber manufacture
Cyclophosphamide

squamous:
Schistosomiasis
Calmette-Guérin (BCG) treatment
Smoking
recurrent UTI
bladder stones
long term catheter

8

What are the criteria for a 2 week wait bladder cancer referral?

Aged 45 and over and have:
Unexplained visible haematuria without urinary tract infection or
Visible haematuria that persists or recurs after successful treatment of urinary tract infection

Aged 60 and over
and have unexplained non-visible haematuria
and either dysuria or a raised white cell count on a blood test

9

What are the symptoms of bladder cancer?

painless haematura
voiding problems

10

What can cause a false positive for blood on a dipstick?

menses
exercise
myoglobin-

11

What investigations need to be done to stage bladder cancer?

CT with contrast enhancement

For patients with confirmed muscle-invasive bladder cancer, CT of the chest, abdomen and pelvis is the optimal form of staging, including CT urography for complete examination of the upper urinary tracts

12

What is the difference between papillary and non-papillary bladder cancer

a non-invasive, papillary tumour protruding from the mucosal surface is less aggressive

a solid, non-papillary tumour that invades the bladder wall has a high propensity for metastasis.

13

What is considered when deciding on the management of bladder cancer

whether it invades the muscle layer or not
staging TNM
PS

14

What is the treatment of low risk non-invasive bladder cancer

TURBT = transurethral resection of bladder tumour
ensuring that detrusor muscle is obtained

give a single dose of intravesical mitomycin C

15

What is the treatment of intermediate risk non-invasive bladder cancer

TURBT

at least 6 doses of intravesical mitomycin C

16

What is the treatment of high risk non-invasive bladder cancer

TURBT

radical cystectomy
or
intravesical BCG

17

What is the treatment for muscle invasive bladder cancer

neoadjuvant chemotherapy using a cisplatin combination regimen

radical cystectomy or radical radiotherapy

or palliative chemo/radio

18

What happen to the urine after a radical cystectomy?

ileal conduit
- to form urostomy
ureters plumbed into part of ileum

bladder reconstruction
- continent cutaneous diversion (catheterisable stoma to pouch of bowel containing urine)
- orthoptic neobladder (segment of the small intestine forms reservoir for urine. The ureters and urethra are attached to the neobladder, allowing voiding)

19

What are the risks of radical cystectomy

bowel obstruction,
obstruction of the ureter,
pyelonephritis
infection of the wound.
damage to the S2,3,4 outlet causing complete erectile dysfunction
Orthotopic bladders have a risk of urinary incontinence.

20

What are the risk factors for prostate cancer

age
family history
ethnicity - black>white>asian
FH - breast, ovarian, prostate (BRCA2)

21

Explain the screening of prostate cancer

no formal screening program
instead NHS Prostate Cancer Risk Management Programme
patients can ask for a PSA, but there needs to be informed consent

22

What are the problems with screening for prostate cancer

Most men with prostate cancer detected by PSA testing have tumours that will not cause health problems (over-diagnosed)
but almost all undergo early treatment (over-treated)
treatment leads to reduced quality of life
not cost effective

23

What is PSA

serine protease enzyme produced by normal and malignant prostate epithelial cells
liquefies semen

24

What can cause a raised PSA

Acute urinary retention.
Benign prostatic hyperplasia.
Old age.
Prostatitis.
Prostate cancer.
Transurethral resection of the prostate.
Urinary catheterisation.`

25

Why is PSA raised in prostate cancer

disordered glands
more PSA leaks into semen

26

What are the symptoms of prostate cancer

bladder outlet obstruction: hesitancy, urinary retention
haematuria, haematospermia
pain: back, perineal or testicular
erectile dysfunction

27

Why is prostate cancer often asymptomatic

cancers tend to develop in the periphery of the prostate
therefore don't cause obstructive symptoms early on.

28

What would prostate cancer feel like on DRE

asymmetrical, hard, nodular enlargement with loss of median sulcus, lack of mobility

29

What investigations are done in suspected prostate cancer

DRE
PSA, U+E, eGFR
TRUS biopsy

30

How is the TRUS biopsy carried out

trans rectal USS
take biopsy of 12 cores