Flashcards in Urology Deck (157)
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
What are the common causes of haematuria
urinary tract stones,
benign prostatic hypertrophy (BPH)
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
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
jobs - carcinogens
How would you investigate haematuria?
urine dip - ?UTI
eGFR, U+E, FBC, ?PSA
USS KUB, flexible cystoscopy
What kinds of bladder cancer are there? What percentage of each kind?
transitional - 90%
What are hte risk factors for bladder cancer?
Exposure to aniline dyes in the printing and textile industry: examples are 2-naphthylamine and benzidine
Calmette-Guérin (BCG) treatment
long term catheter
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
What are the symptoms of bladder cancer?
What can cause a false positive for blood on a dipstick?
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
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.
What is considered when deciding on the management of bladder cancer
whether it invades the muscle layer or not
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
What is the treatment of intermediate risk non-invasive bladder cancer
at least 6 doses of intravesical mitomycin C
What is the treatment of high risk non-invasive bladder cancer
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
What happen to the urine after a radical cystectomy?
- to form urostomy
ureters plumbed into part of ileum
- 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)
What are the risks of radical cystectomy
obstruction of the ureter,
infection of the wound.
damage to the S2,3,4 outlet causing complete erectile dysfunction
Orthotopic bladders have a risk of urinary incontinence.
What are the risk factors for prostate cancer
ethnicity - black>white>asian
FH - breast, ovarian, prostate (BRCA2)
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
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
What is PSA
serine protease enzyme produced by normal and malignant prostate epithelial cells
What can cause a raised PSA
Acute urinary retention.
Benign prostatic hyperplasia.
Transurethral resection of the prostate.
Why is PSA raised in prostate cancer
more PSA leaks into semen
What are the symptoms of prostate cancer
bladder outlet obstruction: hesitancy, urinary retention
pain: back, perineal or testicular
Why is prostate cancer often asymptomatic
cancers tend to develop in the periphery of the prostate
therefore don't cause obstructive symptoms early on.
What would prostate cancer feel like on DRE
asymmetrical, hard, nodular enlargement with loss of median sulcus, lack of mobility
What investigations are done in suspected prostate cancer
PSA, U+E, eGFR