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Give 4 CF of Ureteric stones?
- Incidental on XR
- Loin - groin pain [Ureteric/Renal Colic]
- Painful passage of stones via urethra
Give 3 risk factors for Ureteric stones?
- Urinary stasis
- Chronic UTI -> Proteus
- Foreign body -> Catheter
- Fragments of diseased tissue
Mx of ureteric stones?
Extraction -> cystoscopically, open pyelolithotomy, percutaneous nephrostomy
For renal cell carcinoma give;
Pc -> Haematuria, mass, flank pain
RF -> smoking, HTN, obese, LT NSAIDs
Mx = nephrectomy
Transitional Cell Cancer [Of urothelum];
CF -> Painless haematuria
, clot problems [ureteric colic, hydronephrosis]
RF -> Smokers, workers in rubber industry [dye + printing]
- Bladder -> transurethral resection, intravesicular chemo, total cystectomy
- Upper tract -> uncommon, excision of tract + kidney
- Lower tract -> Urethroscopic coagulation
What is the empirical Mx for UTI?
Causes of Painless Testicular swelling?
- Malignancy [germ cell tumours]
- Chronic orchitis -> MTB/Syphillis
- Epidydmal cyst
Causes of Painful testicular swelling?
- Epidydmo-Orchitis -> STI
- Acute Orchitis -> Mumps
Causes of scrotal swelling?
- Hydrocele -> abn collection of fluid around testis -> Painless, transilluminatees
- Haematocele -> doesnt transilluminate
- Varicocele -> bag of worms, separate from epid/Test, disappears lying down
- Epidydmal cyst -> scrotal swelling
Outline the Pathophysiology of BPH?
nodular hypertrophy of para-urethral glands -> partial urethral obstruction
What symptoms indicate BPH?
- incomplete emptying after urination
- intermittent flow
- weak stream
- dificult initiation
Mx of BPH?
Finasteride -> 5a-reductase inhibitor, decreases testosterone -> Check PSA
Tamsulosin -> A1 alpha blocker, relax bladder neck -> only if prostate <50/bladder neck hypertrophy = problem
Surgical -> TURP -> transurethral resection of prostate
Outline the pathophysiology of PrCa?
- Peripheral glands tumour -> invasion of capsule + venous plexus
- loss of median grove
Pc for PrCa?
- Symptoms of outfloww obstruction [weak stream, dificult initiation etc]
- Symp of mets [change in bowel habit, back pain, recent impotence, #s]
Why is the PSA not useful?
Sensitive, but not specific. Raised in;
BPH, PrCa, recent ejaculation, recent PR, prostatitis, UTI
Mx of early PrCa?
Active monitoring -> rising PSA + PR exam
Surgical -> TURP, radical prostatectomy
Radiotherapy -> external beam, monitor PSA after
Mx of Metastatic PrCa?
Monthly Gosarelin depot -> LHRH agonist, anorchic state
Flutamide -> testosterone receptor blocker
Radiotherapy -> Palliative for bone mets
NSAIDs for bone pain
What are the signs of rethral trauma?
- Blood at meatus
- swelling + butterfly perineal haematoma
- penile haematoma
- high riding boggy prostate on PR
- sensation of voiding w/o urination