23/24: Urologic Diseases - Fang Flashcards
define microscopic hematuria
greater than 3 RBC/HPG on two of three urine samples
nephrologic/glomerular hematuria
significant proteinuria
dysmorphic RBC
red cell casts
warrants nephrology evaluation
______ of pts evaluated will be diagnosed with a urologic malignancy
10-20%
gold standard for stones imaging
CT scan of abdomen and pelvis without oral or IV contrast **
gross or microscopic hematuria present in ____ urinary stones
90%
*** indications for urgent intervention with urinary stones
obstructed upper tract with infection
impending renal deterioration
pain refractory to analgesics
intractable n/v
medical expulsion therapy
alpha blockers
calcium channel blockers
NSAIDS
oral stone dissolution
uric acid stones only
urinary alkalinization
potassium citrate, sodium bicarbonate
_____- of ureteral stones will pass w/i 4 wk onset of symptoms
2/3
if stone not passed w/i 4 wks intervention is needed
only ______ stones can be treated by shock wave
opaque
prevention =
adequate hydration
dietary modifications including low animal prtn, low sodium, low oxalate diets and citrate therapy
renal cysts present in ___ of ppl over 50
50%
typically asymptomatic - no tx unless very lg and causing pain
benign solid renal tumor containing proliferation of blood vessels, smooth m. and adipose tissue that is frequently associated with tuberous sclerosis
angiomyolipoma
typically an incidental finding
tx threshold for angiomyolipoma
observation less than 4 cm
symptomatic , greater than 4 cm or atypical appearance tx with selective embolization, or nephrectomy
presence of even a small amount of fat w/i a renal lesion on CT scan virtually excludes the diagnosis of renal cell carcinoma and is considered diagnostic of…
AML angiomyolipoma
benign tumor derived from distal tubules
oncocytoma
hard to differentiate from renal cell carcinoma - tx as if malignant
only generally accepted environmental risk factor for RCC
tobacco use
majority of cases are idiopathic
RCC tumor histotypes
clear cell RCC
papillary RCC
chromophobe RCC
loss of VHL
activation of MET
loss of multiple chromosomes - best prognosis
approx ___ RCC have metastatic dz at presentation
1/3
metastasize to: retroperitoneal lymph nodes lung liver bone brain
systemic immunotherapy for advanced RCC
interleukin 2
very toxic and requires hospitalization
risk factors for UTIs
poor fluid intake/ chronic dehydration infrequent voiding incomplete bladder emptying chronic constipation postmenopausal vaginal atrophy staghorn calculi
ascending infection caused by…
hematogenous infection caused by …
e. coli
staphylococcus
empiric tx UTIs
SMP-TMX or fluoroquinolones
urge vs. stress urinary incontinence
involuntary urine leak accompanied by or immediately preceded by strong desire to urinate - occurs when bladder pressure overcomes sphincter mechanism
involuntary urine leak with any sudden increase in abdominal pressure:cough, sneeze, lifting, straining, exercie
frequency and urgency to urinate with or without UUI
OAB overactive bladder
mainstay tx for UUi/OAB
anticholinergics
inhibit involuntary detrusor m. contraction
stress urinary incontinence tx
pelvic floor strengthening exercises
formal pelvic floor PT
pessary placement
surgery (midurethral sling placement*)
risk factor bladder dz
smoking
sites of metastasis for bladder cancer
pelvic lymph nodes
lung
liver
bone
stimulates prostate differentiation and growth
DHT
made from free testosterone by 5 apha reductase
decision to treat BPH…
determined by pt’s level of bother and wilingness/ability to comply with therapy or presence of complications
tx with alpha antagonists first**
strongest risk factor for prostate cancer
age
s/s prostate cancer
later only due to metastasis
metastasis to…
pelvic lymph node
bone
lung
greater than ___ of suspicious palpable lesions are proven to be cancer
50% on DRE
imaging does not improve cancer detection over DRE alone and is not recommended for screening
true or false: DRE is diagnostic for prostate cancer, PSA is indication to proceed with biopsy.
false neither are diagnostic, both are indications to proceed with biopsy
