Urology

• #tags column:6
• Urinary incontinence most commonly affects elderly females !SprankiClinical::Urology::UrinaryIncontinence
• The main risk factor for urinary incontinence is age !SprankiClinical::Urology::UrinaryIncontinence
• Stress urinary incontinence is the involuntary leakage of urine when intra-abdominal pressure ↑ (e.g coughing, sneezing, & exercise) !SprankiClinical::Urology::UrinaryIncontinence
• Urgency urinary incontinence is the sudden, intense urge to void that cannot be deferred !SprankiClinical::Urology::UrinaryIncontinence
• If urgency and stress incontinence symptoms are both present, it is referred to as mixed incontinence !SprankiClinical::Urology::UrinaryIncontinence
• Overflow incontinence is due to incomplete bladder emptying, often caused by bladder outlet obstruction (e.g. BPH) !SprankiClinical::Urology::UrinaryIncontinence
• Functional incontinence is due to comorbid physical, cognitivie, or environmental barriers that prevent timely access to the toilet  Including mobility problems, dementia/delirium, lack of access to toilets in public spaces or home settings !SprankiClinical::Urology::UrinaryIncontinence
• "What is the initial investiagtion of urinary incontinence?Bladder diaries for a minimum of 3 days" Probs want to do a urinary dipstick first... "[© NICE [24 June 2019] Urinary incontinence and pelvic organ prolapse in women: management [NG123]. Available from https://www.nice.org.uk/guidance/ng...
• For urinary incontinence, a pevlic examination should be done to confirm pelvic floor muscle contraction  Done before the use of pelvic floor muscle training "[© NICE [24 June 2019] Urinary incontinence and pelvic organ prolapse in women: management [NG123]. Available from https://www.nice.org.uk/guidance/ng123/chapter/Recommendations<span style=""f...
• What investigations are done to determine any underlying causes/exacerbations of urinary incontinence?Urine dipstick to test for infectionsPelvic examination to identify pelvic contraction "[© NICE [24 June 2019] Urinary incontinence and pelvic organ prolapse in women: management [NG123]. Available from https://www.nice.org.uk/guidance/...
• What is the first-line management of urge incontinence?Bladder training Minimum 6 weeks "[© NICE [24 June 2019] Urinary incontinence and pelvic organ prolapse in women: management [NG123]. Available from https://www.nice.org.uk/guidance/ng123/chapter/Recommendations All rights reserved. Subject to Notice of rights</s...
• "Immediate release oxybutynin for urge incontinence should be avoided in older women, instead mirebegron is used" Oxybutynin in older patients can affect vision & cognition which may ↑ risk of falls, instead use miregbegron (beta 3 agonist) "[© NICE [24 June 2019] Urinary incontinence and pelvic organ prolapse in women: management<span style=""font...
• What is the first-line management of stress incontinence?Pelvic floor muscle training 8 contractions x3 a day 3 months "[© NICE [24 June 2019] Urinary incontinence and pelvic organ prolapse in women: management [NG123]. Available from https://www.nice.org.uk/guidance/ng123/chapter/Recommendations All...
• What is the second-line management of stress incontinence?Surgery - retropubic mid-urethral tape/sling procedures Duloxetine if they deny surgery !SprankiClinical::Urology::UrinaryIncontinence
• What is the management of stress incontinence if pelvic floor muscle training fails and surgery is declined?Duloxetine "[© NICE [24 June 2019] Urinary incontinence and pelvic organ prolapse in women: management [NG123]. Available from https://www.nice.org.uk/guidance/ng123/chapter/Recommendations&nb...
• Bladder cancer is the 2nd most common urological cancer After prostate cancer !SprankiClinical::Cancer::Bladder !SprankiClinical::Urology::BladderCancer
• Bladder cancer typically presents after age 60 !SprankiClinical::Cancer::Bladder !SprankiClinical::Urology::BladderCancer
• Bladder cancer affects males more commonly 4:1 M:F ratio !SprankiClinical::Cancer::Bladder !SprankiClinical::Urology::BladderCancer
• Bladder cancer types:Urothelial (transitional cell) carcinoma >90%Squamous cell carcinomaAdenocarcinoma !SprankiClinical::Cancer::Bladder !SprankiClinical::Urology::BladderCancer
• Urothelial (transitional cell) carcinomas can occur in any region along the urinary tract but most commonly occur in the bladder Carcinogens have greatest exposure in the bladder !SprankiClinical::Cancer::Bladder !SprankiClinical::Urology::BladderCancer
• What is the biggest risk factor for bladder cancer in Western countries?Smoking → responsible for 40% of cases !SprankiClinical::Cancer::Bladder !SprankiClinical::Urology::BladderCancer
• Urothelial (transitional cell) carcinoma is a urinary tract cancer associated with aniline (azo) dyes E.g. working in the printing & textile industries !SprankiClinical::Cancer::Bladder !SprankiClinical::Urology::BladderCancer
• What industries are aniline dyes common in (RF for urothelial carcinoma)? Printing & textiles → chemical, cable, rubber, leather, painting, & dye industries "E.g. β-naphthylamine dye & benzidine dye" !SprankiClinical::Cancer::Bladder !SprankiClinical::Urology::BladderCancer
• What drugs are risk factors for urothelial (transitional cell) carcinomas ?Cyclophosphamide, phenacetin Cyclophosphamide = cancer drugPhenacetin = analgesic + fever-reducing drug !SprankiClinical::Cancer::Bladder !SprankiClinical::Urology::BladderCancer
• Schistosoma haematobium infection is associated with squamous cell carcinoma of the bladder in Middle eastern males !SprankiClinical::Cancer::Bladder !SprankiClinical::Urology::BladderCancer
• Bladder cancer most commonly presents with painless haematuria Macroscopic haematuria !SprankiClinical::Cancer::Bladder !SprankiClinical::Urology::BladderCancer
• Urothelial (TC) carcinoma of the kidney/ureter may cause flank pain + haematuria !SprankiClinical::Cancer::Bladder !SprankiClinical::Urology::BladderCancer
• "A 2-week urgent referral for bladder cancer should be made in patients aged ≥ 45 years who present with: - Unexplained visible haematuria without a UTI<span ...
• "For patients aged ≥ 60 years, 2-week urgent referral for bladder cancer should be considered if they have unexplained non-visible haematuria along with eitherdysuria or<span style=""font-weight: 400;""...
• What is the investigation of choice for bladder cancer?Cystoscopy + biopsies Histological diagnosis & information about depth of invasion !SprankiClinical::Cancer::Bladder !SprankiClinical::Urology::BladderCancer
• What investigations may be done for bladder cancer locoregional staging & distant disease?MRI pelvis, distant CT scanning Nodes of uncertain significance can be investigated with PET CT !SprankiClinical::Cancer::Bladder !SprankiClinical::Urology::BladderCancer
• The most important factor for prognosis of a urothelial (transitional cell) carcinoma is the degree of invasion How much into the bladder wall / adjacent tissues !SprankiClinical::Cancer::Bladder !SprankiClinical::Urology::BladderCancer
• Bladder tumours are staged using TNM criteria !SprankiClinical::Cancer::Bladder !SprankiClinical::Urology::BladderCancer
• TNM for bladder cancer (urothelial carcinoma):Ta = non invasive papillary carcinomaT1 = tumour invades sub epithelial connective tissueT2 = Invades muscle layers "[Credit: Cancer Research]" !SprankiClinical::Cancer::Bladder !SprankiClinical::Urology::BladderCancer
• What is the management of Ta stage bladder tumours?Transurethral Resection of Bladder Tumour (TURBT) "Regular cystoscopy follow-up is recommended, as up to 70% of cases will recurTa = non-invasive papillary carcinoma → managed with TURBTT1 = tumour invades subepithelial connective tissue → treated with <span style=""font-w...
• What is the management of T1 stage bladder tumours?Intravesical BCG "Regular cystoscopy follow-up is recommended, as up to 70% of cases will recurTa = non-invasive papillary carcinoma → managed with TURBTT1 = tumour invades subepithelial connective tissue → treated with <span style=""font-weight: 400; t...
• What is the management of T2 stage bladder tumours?Radical cystectomy "Regular cystoscopy follow-up is recommended, as up to 70% of cases will recurTa = non-invasive papillary carcinoma → managed with TURBTT1 = tumour invades subepithelial connective tissue → treated with <span style=""font-weight: 400;...
• "Prostate cancer is a malignant growth in the prostate that has a lifetime risk of 1 in 6 men" "[https://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/prostate-cancer/risk-factors#heading-Zero]" !SprankiClinical::Cancer::Prostate::Aetiology !SprankiClinical::Urology::ProstateCancer::Aet...
• "Most prostate cancers are adenocarcinomas" !SprankiClinical::Cancer::Prostate::Aetiology !SprankiClinical::Urology::ProstateCancer::Aetiology