Computer generated transcript

Warning!
The following transcript was generated automatically from the content and has not been checked or corrected manually.

TCD 18: HaematuriaSignupform→receiveemailwithfeedbackform→filloutfeedbackwithin24hrs→receiveslides+recording@scrubbedup_ *Disclaimer* The content of this presentation was created by med students for med students. This session isn’t intended to replace any formal education provided by the uni of mani, so make sure to review all the cases on 1Med and read your ILOs and attend at least 40 hours/week of clinical experience ;)Admin Stuff - Youknowthedrill - Anyadminstuffpleaseemailscrubbed-up@outlook.comrather thanmessagingoneofuspersonally:)) - Stopcomplainingabouttheheatingomlenjoyitwe’relegitina costoflivingcrisisrntellmeurrichwithouttellingmeurrichSo what is this teaching exactly? Covers the main pathologies mentioned in each week’s TCD Progress Test, CCA/OSCE, DDx, top notch medics basically NOT HERE TO HOLD YOUR HAND THROUGH THE 1MED CASES SUCCINCT, HIGH YIELD, SHARP and ACCO IT’S نﺎﺳﺣإ SEASON PEOPLE !! "You don’t become confident by shouting affirmations in the mirror. But instead by having a stack of undeniable proof that you are who you say you are. Outwork your self doubt.” Alex Hormozi Contents ❏ Urine Hx ❏ BPH ❏ Prostate Cancer ❏ Bladder Cancer ❏ Renal Cancer ❏ Schistomaiiaiaisisissis ❏ Renal Calculi ❏ UTI ❏ Haematuria ❏ Testicular Cancer ❏ Testicular TorsionTaking a Urinary Hx Case Time😜 66 year old female, presenting with haematuria → take the hx ○ MUSTBESYSTEMATIC,FOLLOWCALGARY-CAMBRIDGEMODEL ■ (don’taskaboutFHxifuhvntevenconfirmeddurationof symptomsygm) ■ (alsowriteyourquestionsinsentencespls,don’tjustsay:“Yo SHx?SOCRATES?PMHx?”inthechat) PMH ● RecurrentUTIs Taking a Urological History ● Prostate,renalissues ● Surgery Storage Voiding Haematuria Other Redflags(tolookfor inmen) ● Pain-SOCRATES ● Frequency ● Terminaly, ● Stained ● Flankpain ● Painlessss ● Urgency dribbling ● Initial ● Burning haematuria ● Nocturia ● Weakstream ● Terminal ● Fever/rigors ● Trauma ● Polyuria ● Straining ● Colour ● nausea/vomiting ● Smoking ● Incomplete ● Weightloss ● Workingindye ● Oliguria/anuria emptying ● Occupation factory ● Incontinence ● ICE DRUGS ● Diuretics ● Alpha-blockers ● Nephrotoxics ● Antibiotics ● TCAs ● AntihistaminesBPH - Benign Prostatic Hyperplasia 11.15Benign Prostatic Hyperplasia ● StorageSymptoms: ● Mostcommonlyover60s ● Bytheageof80,90%ofmenwillhavethis ○ Frequency ● Rareinasianmen,mostcommonlyaffectsafrican ○ Nocturia men ● LUTS(lowerurinarytractsymptoms)causedby ○ Urgency obstructionfromhyperplasiaofstromaland epithelialprostatictissue-transitionalzone ● VoidingSymptoms: ● Theprostatenaturallygrowsinresponseto ○ Post-voiddribble dihydrotestosterone(incinoldage) ● BPHisthoughttobethefailureofapoptosis,so ○ Weakstream somedrugsactonstoppingthisfailure ○ Excessivestrain ● MaypresentsimilarlytoProstatecancer ● DoesBPHincreasetheriskofProstatecancer? ○ Nosir/ma’am ● Whichpartofprostateiseffected? DRE ● Smooth,enlargednon How are wee going to investigate it? tenderprostatewitha palpabledentalsulcus ● craggyandasymmetricaleg, ● Prostatitiswouldbe ● IPSStodetermineseverityofsymptoms&QoL hot/tender/soft/boggy→ ● DRE,DIP&MSU-ruleoutinfection eitherUTI/STIcause ● AbdominalUSS–enlargedprostateandincreasedpost-voidresidualurine, ● Uroflowmetry ○ Reducedmaximalurinaryflowrate(Qmax).7-15mls/secisnormal ○ Alsotellsyouabouttheflowpattern ● Pressurestudy/Urodynamics ○ Measuresthepressureduringvoiding ● PSA-goodforscreeningforprostatecancer ○ Canbeelevatedin/afterurinaryorprostaticinfectionsor6weekspostprostaticbiopsy ○ Canbeloweredinpatientson5alphareductaseinhibitorsHow are wee going to treat it? Lifestylemodification - avoidnightdrinking,caffeineand constipation,bladdertrainingand pelvicfloorexercises Medicaltreatment 1.alphablockerse.galfuzosin, doxazosin,tamsulosin-whatelseisthis drugusedfor? 2.5-alphareductaseinhibitorse.g. finasterideandother (parasympatholyticse.g.oxybutynin, phosphodiesterase-5-inhib.)Whatis thisdrugalsousedfor?MPB ResectionoftheProstateTransurethral - 15%recurrence - theurethrarostateiscutoutthrough - Doneundergeneralorlocalanaesthetic - Complications:recurrentUTIs,urinary retention,bladdercalculi, hydronephrosis,CKD,retroejac(75%) Side effects Retrogradeejac AlphaBlockers Orthostatichypo ED Avoidifwaitingforcataractsurgery 5-alphareductaseinhibitors Diminishedlibido Erectiledysfunction Ejaculatorydysfunction Cantakeupto6monthstohaveclinicallyapparenteffect(wtff) CancauseafallinPSA -badinPCscreeningProstate Cancer 11.35Prostate Cancer- adenocarcinoma of peripheral prostate Advancedstage: ● Fatigue, ● MostcommonmalignancyaffectingmeninUK ● 95%adenocarcinoma-70%peripheralzone ● Weightloss ● Urinaryretention ● RiskFactors: ○ Advancedage75-79yo ● Haematuria ● Incontinence ○ FamilyHistory,BRCA-2orLynch ○ Afro-Caribbean ● Hydronephrosis ● Erectiledysfunction ○ Obesity ○ Animalfat-richdiet ● Bonepain(mets-axial) ● Neurologicaldeficits ● Earlystage:asymptomatic(slowprogression→ (SCC) maynotmet) ○ OnlydetectableonPSAscreening ● Lymphoedema ● Tenesmus How are wee going to investigate it? ● AnyofLUTS,EDandfrankhaematuriadoDRE andPSA ● ALPifbonemetssuspected ○ PSA isabitsticky(dependsonageandannualchange),generallyif>3inmenaged 50-69orabnormalDRE,referusing2ww(inmetdiseasecanbe>16!) ○ NormalPSA0-4 ● MultiparametricMRIisnowcommonlythe1stlineinvestigation-LikertScore(1-5) ● Ifscore≥3→MultiparametricMRI-influenceprostatebiopsy-USSguided ● CTAPtostage,spinalx-rayand99Tn-Scintigraphytodetectbonemets ● TNMclassification forstaging DRE ● Gleasonscoreforhistologicalgrade ● irregular,nodular,hard ● Enlargement ● CouldbenormalScoring System- Gleason Score ○ Prostatecancercellsareoftenamanifestationofmultipledifferentcell types ○ Thisscorecombinestwoofthemostprevalenttypespresentandadds themtogether(eachoutof5) ○ 2low,10high(poorlydifferentiatedcells-worseprog) ○ TNMisalsousedlol ○ BUTascoreofGleason(3+4=7)isdifffromGleason(4+3=7),hencethe WHOandISUPmadeamiddleground:How are wee going to treat it? ○ Complex,MDT,multi-stage-notblackandwhite ○ Involves: ■ Watchfulwaiting:PSAandDREforasymplocalnon-metcancer ■ RadicalProstatectomy: ● Removaloftheprostateandsurroundingtissue ● Non-metcanceronly ● Hasmanypossibleadverseeffects(ED/Incontinence) ■ ProstactectomywithRadiotherapy:oftentogether ● EBR-cancausepost-radprostatitis ● Brachytherapy-seedsofradiationinsertedintoprostate ■ AndrogenSuppression:usedinnon-localiseddisease,reduceddisease progression-midtohighrisklocal/metastaticdisease ● Androgensuppressiondrugs–e.g.bicalutamide ● Luteinisinghormonereleasinghormoneagonist–e.g.goserelin, leuprorelin,triptorelin ○ Docetaxelchemotherapy: inhibitsmicrotubulardepolymerisation Bone Mets Lytic - esp. multiple myeloma, thyroid, renal, lung, PTH, Paget Sclerotic – esp. prostate, breast, transitional cell carcinoma, SCLC Lead Kettle : Pb KTL - Prostate, Breast, Kidney, Thyroid, LungBladder Cancer (Zakariyette) hehe 11.45● Mostcommonplaceforurothelialcancer(other:renalpelvis8%,uretersor urethra2%);11 mostcommonoverall ● 3:1male,>65(85-89),MorecommoninCaucasiandonnies ● 95%transitionalcellcarcinoma,canbesquamouscellcarcinomaindistal urethra ● Painlessgross/microhaematuriaorirritativevoidingsymptoms(clots) ● MaybesymptomssuggestiveofUTI(dys,urgency,frequency) ● RF:smoking,occupationalcarcinogens(dye,rubber,cablefactorywork), schistosomiasis(SCC),cyclophosphamide,indwellingcatheter ● Investigations:rigidcystoscopy&biopsy,USSKUB,(retrogradeurethrogram, flexibleureteroscopy),CTurogram,MRIetal●Referon2wwif: ○ >45,unexplainedfrankhaemat,noUTI ○ >45,frankhaematdespitesuccessfulRxforUTI ○ >60,unexplainedmicroscopichaemat+dysuria/raisedWCC ○ >60,recurrent/persistentunexplainedUTI● Staging:CXR,LFTs,CT(T)AP ● Treatment:stagingisweirdanddoesn’treallyfollow TNM→pTa+pT1,reliesonmuscleinvasion ○ N0M0: ■ lowrisk-TURBT±intravesicalchemo(mitomycin orgemcitabine) ■ Highrisk–TURBT+intravesicalBCGor Differentials: chemotherapy ○ Moreaggressive:detrusormuscleinvolved - Urolithiasis - UTI ○ Radicalcystectomy-replacethebladderwithbowel! - RCC, ○ Neoadjuvantchemotherapyaloneorconcurrentchemo - Glomerular diseasee.g. ○ Metastatic–palliativesystemicchemotherapy nephropathies ■ Mayneedtouseanintestinalgrafttoreplace bladderbutthishasseveraladverseimplications - Coagulopathy, - Vasculitides(e.g. SLE,GPA,HSP) - Trauma - RhabdomyolysisSchistosomiasis 11.50Schistosomiasis (what zak would be if he was a parasite) ●MostcasesinSubSaharanAfrica,SouthEastAsiaandthe MiddleEast ●P○ S.haematobium-bladdermanifestations ○ S.japonicum-intestinalmanifestations ●Eggsinwater->snails->water->mammalianhost→ SWIMMER’SITCH ●Ri○ Contactwithfreshwater-lakes,ponds,streamsorirrigation anddrainagecanals ○ Activities-swimming,bathing,fishing,farming,washing clothes● Acutepresentationdueto ● Diagnosis hypersensitivityasmaturing ○ eggsinstools organismsinblood ○ antibodydetection ○ Fever ○ PCR ○ Urticarialrash ○ serology→bladdercancerIx ○ Hepatosplenomegaly ● Complications: ○ Bronchospasm+/-cough ○ liverdamage ● Chronically: ○ kidneyfailure ○ Abdopain ○ Infertility ○ Melaenaea ○ bladdercancer ○ Bloodystool ● ?Increasedcancerriskdueto ○ Bloodinurine, chronicirritationmakingbladder liningmore(squamouscell) smokingtoothercarcinogense.g. ● Rx:praziquanteloroxamniquine nowandthen2-3monthsafter wheneggsareadults ● Prevention-accesstocleanwaterRenal Cell Carcinoma 11.55 KidneyTumours ● Renalcellcancer(RCC)–adenocarcinoma VonHippel-LindauDisease: fromtubularepithelium(usuallyclearcell);or ○ Rarelymightruninfamilies- TCCofrenalpelvis(8%) chromosome3shortarmdefect ○ TreatTCCofRenalPelvissimilarlytoMxofTCCof (3p) Bladder ○ inheritedconditionwherethere ○ Clearcell75%,Papillary10%andChromophobe5% arecystsandtumoursofthe: ○ Differentiateusingflexibleureteroscopy ■ kidney,pancreas,adrenal ● 60-80yo,male2:1,7thmostcommon gland(phaeo),epididymis, cerebellumandspinalcord ● RF:smoking,HTN,acquiredcysticdiseaseof ○ 2/3ofpatientswiththisdisease thekidney,nephrolithiasisandchronic ○ BilateralandMultifocal.ma paracetamoluse;hereditarye.g.von Hippel-Lindau,tuberoussclerosis,BirtHogg Syndrome KidneyTumours ● Haematuria,flankpainormass- these3classicallypresentfirst ○ Anaemia-duetosuppressionofEPO ○ HTN-duetooversecretionofRenin (RAAS) ● USS,Image-guidedbiopsy,CTcontrastabdomen+/-MRI ○ PUO&Weightloss ○ Varicocele-howdishappen? ● Bosniakclassification+TNM ■ TumourinvasionofLRV,affecting ● SurgicalpartialorradicalresectionasRCCnotoriously lefttesticulardrainage chemo-resistant ■ Howdispresent? ○ Forlife-sustainingfunction,allyouneedisatleastone halfofagoodkidneyintermsofGFR ○ BoneMetscommon ○ Nephrectomyevenrecommendedinmetastaticdisease ○ Rangeofpararneoplasticsyndromes ■ Canevendo2ndarysiteexcisiontoo ■ advancedisease(vchemoresistant)munotherapyinRenal Calculi 12.05 Renal Calculi/Urolithiasis/Nephrolithiasis ● Stoneformationanywherewithintheurinarytract‘ ● Occurduetoahighconcofaparticularurinaryprecipitate ○ 85%arecalcium(oxalate),10%Uricacid,5%otherrarities ● Morecommoninmenandtheelderly ● RFs: ○ Multiplecauses-thought50%casesareduetohereditaryhypercalcuria despitenormalserumca2+ ○ Hyperparathyroidalsoincreasesrisk ○ Eatinganythingbrown/red(tea/coffee/coke/rhubarb/strawberries/radish) ● LowcalciumdietisNOTgonnadoanything apartfromincreasingosteoclast activitytoraiseserumCa2+levels ● Formation→startinkidney/Rpelvis→passintoureterandgetstuck ○ <5mmpassandanythinggreatergetsstuck ○ UreteropelvicJunctionandPelvicBrimandVesicouretericJunction Presentation ○ Classicallycolickypain-ptwrithingon bedasifthey’regonnadie ○ Colicisparoxsym-20/60mins-relief ○ ‘Lointogroin’pain ■ Painwhenperistalticcontractionof ureteroverthestone ■ L1-2nerveroots→canreferas e● TipofPenisPain ● Clitoral/Vulvalpain ○ N/V ○ Haematuria ○ Dysuria ○ Urgency ○ SepticFeatures(temp,lowBP, tachycardia,dysuria) ● Prevention: ●Urinalysis(haematorsterilepyuria),AXR85%of ○ Lifestyle stonesvisible(noturicacid),Stonework-up ○ citrateum ●Imagingofchoice:Non-enhancedCTKUB(rulesout ○ Thiazides AAA) ●USSifpregnant(orgynae∆∆)ORhydronephrosis ●Mx:CONSERVATIVE ○ Analgesia (NSAIDshelpwithuretericSMC relaxation)+/-opiates+/-anti-emetics ■ PR/IMDiclofenacispotentandcanbegivenPR (N/V) ● AAA ○ SMCRelaxants ● Gallstone ■ Alphareceptorblocker-tamsulosin-review4 ● Ectopic ● Appendicitis weeks ● Pyeloneph ■ CCB-nifedipine ● Pancreatitis Conservative <5mm g Extracorporeal shockwave lithotripsy (SWL) i <20mm/pregnant h Ureteroscopy + laser lithotripsy (URS) C Complex stones/ Percutaneous nephrolithotomy (PCNL) staghorn (struvite) calculi --> assoc with Proteus M infx E M Obstruction + infection above E Indications R Procedure Nephrostomy tube (catheter --> skin --> renal pelvis) G Ureteric catheter E Ureteric stent N C YCalcium -CT--> radiopaque + spiky oxalate -RF --> o (85%) -↑↑ --> 1 renal disease/loop diuretics/steroids -↓↓ --> ↓↓ Protein/salt diet/thiazide diuretics Calcium -CT--> radiopaque + white/smooth phosphate -RF --> -↑↑ --> Alkaline urine (RTA 1/3)/1 renal disease/loop diuretics/steroids -↓↓ --> ↓↓ Protein/salt diet/thiazide diuretics Uric acid -CT--> radiolucent + brown/smooth (5-10%) -Causes --> -Excessive tissue breakdown (e.g. malignancy). -Inborn errors of metabolism. -RF --> -↑↑ --> Gout/ileostomy/acidic urine -↓↓ --> Allopurinol/HCO (alkalises urine) 3 Struvite -CT --> slighty radiopaque ~staghorn calculus (fill renal pelvis + extend into ≥2 calyces) (2-10%) -Causes --> chronic infections -RF → -Alkaline urine (RTA type 1/3). -↓↓ Dietary oxalate (spinach/nuts/rhubarb/tea). -Cholestyramine/pyridoxine (↓↓ urinary oxalate secretion)UTI 12.15● Infectionofanypartofurinarysystemfrom kidneytourethra Symptoms ● Female>>,hugeriskofrenaldiseaseifrecurrent ● Increasedfrequency& andlife-threateningsepticaemia urgency ● RF: ● Dysuria(often ○ Post-menopause describedasburning) ○ beingawoman(wahmen) ● Suprapubicpain ○ Preg ● Maybefrankhaematuria ● LUTSandsystemic ○ sexualactivity unwell ○ Incontinence ○ hygieneissues-backtofront-fronttoback DDx: ○ catheterinsitu ● Pyelonephritis ○ DMpatients ● appendicitis,pelvic ● E.Coliaccountformorethan70%ofcommunity inflammatorydisease cases ● rupturedAAA ● Canleadtopyelonephritis(lowerUTIsympt.-> ● ?ovariancancer gradualincreaseloinpain+pyrexia+feeling ● bladdercancer u○ CTshows‘wedges’ofinflammationinkidney UTIs can be categorised- according to location or presence of co-morbidities Bladder Cystitis Prostate Prostatitis RenalPelvis Pyelonephritis UncomplicatedUTI ○ Anatomynormal,nounderlyingcondition→vgood prog ComplicatedUTI ○ Calculipresent,DM,recurrentUTI→morelikelyto becomeseptic ○ MenwithaUTIiscomplicateduntilproven otherwiseHow are wee going to investigate it? Investigations: ● Dipstick–avoidifelderlyandnourinarysymptoms!: ○ Nitrite,leucocytes,blood,protein->UTI ○ SendMSUformicroscopy,cultureandsensitivityanalysis(takes 48hbutmoreaccuratethandipstick) If?pyelonephritis ● Dipstick,MSUMC&S ● Bloodcultures ● Immediateupperurinarytractimaging(CTorUSS)to excludepyonephrosis(obstructedkidneydueto stone)ascan=>sepsis ○ Nephrostomytubefordecompression How are wee going to manage it? ● SimpleUTI:3dOralAbxe.g.trimethoprim,nitrofurantoin,cephalexin ○ DependsonMSUandlocalguidelines ○ Cefalexinifpregnant,MSUMC&S,7dayregimeninMen ● Pyelonephritis:24-48hIVGentamycin/Ciproflox/Cefuroximethen7-10d oralAbx ● Prostatitis-Ciprofloxacin ThinkcomplicatedUTIif: ○ E.g.anatomical/pathologicalabnormalitylikevesico-uretericreflux,UTstones ● NotrespondingtoAbx ● Haematurianotresolvingaftersymptomscease→2ww? ● Previoushistoryofstonedisease&recurrentpyelonephritisHaematuria 12.25Haematuria (1/3) Somedifferentialsifpatientreportshaematuria ●Bladdercancer(classicallypainless) ●Renalcancer ●UTI ●Stones(Urolithiasis) ●Nephrologicaldiseasee.g.glomerulonephritis ●Prostatedisease ●Systemicdiseasee.g.SLE,GPA ●Nocausefound Haematuria (2/3) ● Non-visible/microscopicvsvisible/macroscopic/frank ● Red=/=blood! ○ Haemoglobin(e.g.glomerulonephritis,burns,malaria) ○ Rifampicin ○ myoglobin(e.g.rhabdomyolysis) ○ porphyrins(inheritedmetabolicdisorderporphyria) ○ BeetrootDwightSchruteSyndrome ● Origins: ○ Kidneys(glomerular,collectingsystem),ureter,bladder,prostate,urethra ○ Considerperinealbleeding ● History&examination ○ Pain(loins->groin?),fever,weightloss,smoking,occupationalexposures,meds,PMH (HTN,TB,procedures),FH(PKD,vHL,TS) ○ Abdoexam,flankmass,DRE,vaginalexamination(notatourstage)Haematuria (3/3) ● Urinalysis ○ Dipstick(blood,protein,nitrites,leucocytes,pH) ○ Microscopy(?dysmorphicRBC) ○ Culture ○ Cytology ● Investigations(trytothinkwhatmightbecausingit) ○ Isitarenalproblem?U&Es,eGFR,BP,urineproteinexcretion ○ Isitmalignancy?2wwreferral(ornon-urgentreferral) ■ Usuallyhave1-dayclinicsforcystoscopyandotherrelevanttestsHaematuria Guidelines (NICE 2015, update 2021) ● 2wwif45+with ○ (i)UnexplainedvisiblehaematuriawithoutUTI OR ○ (ii)Visiblehaematuriapersisting/recurringafterUTItreatment OR ○ (iii)60+withunexplainednon-visiblehaematuriaanddysuriaor raisedWCC ● (iv)Considernon-urgentreferralforbladdercancerif 60+withrecurrentorpersistentunexplainedUTI ○ (i)and(ii)are2wwfor∆∆ RCCandbladdercancer ○ (iii)and(iv)areonlyfor∆∆bladdercancer ● If<45withnon-visiblehaematuria,checkeGFR,BP, urineproteinexcretion(nouroinputneeded)TesticularTorsion 12.25TesticularTorsion (1/3) ● Testicletwistsaroundit’sspermaticcord=ouch,notideal ● Thiscanleadtoischaemiaandeventuallynecrosiswhichcanleadtosubfertilityand infertility,soTIME=TESTICLE:) ● Mainlyaffectsmales10-30yobutcanoccuratanyage ● Sudden,sharpunilateraltesticularpain,usuallyassociatedwith trauma/exercisebutcanalsopresentsimplyasabdominalpain(espinkids) ● Severepainresponse=nausea+vomiting ● CansometimeshaverecurrentsymptomswithintermittenttorsionTesticularTorsion (2/3) O/E: Investigations: ● Firm,swollentesticle ● Mainlyclinical ● Retractedupwards ● CanalsouseUSS=whirlpoolsign ● Lossofcremastericreflex ● Prehn’sSign+ve!=elevationdoesnot help Bell-ClapperDeformity: ● HorizontalLieoftesticles ● Testicleisabittoofree ● Epididymisisanteriorratherthan ● Notattachedtotunicavaginalisat posterior posterior ● Erythema ● HigherchanceoftesticulartorsionTesticularTorsion (3/3) Management: ● UrologicalEmergency ● UrgentSurgicalExploration ● SurgicalfixationWITHIN6HOURSOFPAIN ● Orchidopexy:fixationoftesticlewithinscrotum ● BOTHtesticlesfixatedduetopotentialBell-ClapperDeformitybilaterallyTesticular Cancer 12.25Testicular Cancer (1/3) ● Mostcommonmalignancyformen20-30yo O/E: ● Responsiblefor1%ofallmalecancers Usuallypresentsasapainlesstesticularlump ● PainlessTesticularLumpismostcommon PC ● Hard+irregular ● Non-translucent Types: ● (GynaecomastiainLeydigCellCa) ● SystemicCancerSymptoms ● GermCell(reproductivecells)-95% ○ Seminoma ○ Non-seminoma(embryonic,yolksac, teratomas) RiskFactors: ● Non-GermCell(non-reproductive)5% ● Infertility(3xincreasedrisk) ○ LeydigCellCarcinoma ● FamilyHistory ○ Sarcoma ● UndescendedTestes/Cryptorchidism ● Klinefelters ● PreviousTesticularCancer ● OrchitissecondarytoMumpsTesticular Cancer (2/3) Royal Marsden Staging: Investigations: ● ScrotalUltrasound1stline ● AFP:RaisedinTeratomas ● β-HCG:Raisesin Teratomas+Seminomas ● LDH:Non-specifictumour marker ● StagingCTfor?metastasisTesticular Cancer (3/3) Management: LongTermSideEffects: ● MDTApproach:) ● RadicalOrchidectomy ● Infertility ● Chemotherapy/Radiotherapy ● Hypogonadism(testosteronereplacement ● Spermbankingduetopotentialfuture infertility mayberequired) ● Peripheralneuropathy Prognosis: ● Hearingloss ● Lastingkidney,liverorheartdamage ● 1-yearsurvival:96.5% ● Increasedriskofcancerinthefuture ● 5-yearsurvival:95.3%OSCEsCase 18 and the OSCEs ● Historyiseasytocomeupforthistopic ○ Bladdercancer ○ BPH ○ UTI ○ Furtherteststorecommend:abdoexam,?DRE,urinedipstick, MC&S,bloods,USSorCT(dependsabit) ● Examination ○ Lesslikely,rememberthebladderandkidneysarepartofyourabdo exam ○ KnowhowtodoaDRE->inalllikelihoodwon’tbeOSCE’dbut comesupalotonsomeplacements ● Sharinginformation ○ PracticeconsentingapatientforaDRE ○ ExplainingUTI ● Datainterpretation ○ andCTAP)you’relookingatwithurinedipsticks,U&Es,(CTKUBOSCE Consenting Station ●https://oscestop.com/Explaining_scopes.pdf ●https://oscestop.com/Explaining.pdf ●Whattheprocedureis ●Reasonsforit ●Benefitsfromit,risksassociated ●Theirunderstandingofit ●Frequentopportunityforquestions&elicitconcerns throughout ●PlangoingforwardQuizQuizQuizQuizQuizQuizQuizQuiz (ignore the blue – that’s where my mouse was hovering)QuizQuizQuizThanks. Any Questions? Got another exam soonsooo soz lads gotta dip