39 - Urology Flashcards
Fascia around kidney
Gerota’s fascia
Anterior to posterior configuration of renal vessels
VAP (Renal vein -> artery -> pelvis)
Which renal vessel crosses posterior to the IVC
Right renal artery
Which renal vessel lies anterior to the aorta
Left renal vein
The ureters cross over _
Iliac vessels
Which renal vessel has collaterals and can thus be ligated
Left renal vein
Connects to the vas deferens (2)
Epididymis
Seminal Vesicles
The testicular artery, pampiform plexus, vas deferens, cremasteric muscle and ilioinguinal/genital nerves make up the _
Spermatic cord structures
Erection is due to _ nerve fibers
Parasympathetic
Ejaculation is due to _ nerve fibers
Sympathetic
Most common cause of acute renal insufficiency following surgery
Hypotension
Most common kidney stone type (75%)
Calcium oxalate
Radiopaque kidney stone types
Calcium oxalate
Struvite
Stone type increased with terminal ileum resection
Calcium oxalate
Stone type that occur with infections from UREASE producing bacteria (proteus mirabilis)
Struvite
Stone type that can result in staghorn calculi
Struvite
Radiolucent stone types
Uric acid
Cysteine
Stone type increased in pts with ileostomies and myeloproliferative disorders
Uric acid
Stone type associated with congenital disorders such as cystinuria
Cysteine stones
Size of stone likely not to pass
> 6mm
1 cancer killer in men 25-35
Testicular cancer
Most common symptom with testicular cancer
Painless hard mass
Surgical intervention for testicular mass and what type of incision
Orchiectomy through INGUINAL incision
Labs value correlating with tumor bulk in testicular cancer
LDH
Labs to check with testicular cancer (3)
B-HCG, AFP, LDH
Most likely type of testicular cancer with cryptorchidism
Seminoma
Seminoma should not have elevated _ (lab value)
AFP
Testicular cancer type extremely sensitive to XRT
Seminoma
Tx for seminoma
Orchiectomy and retroperitoneal XRT
Embryonal, teratoma, choriocarcinoma and yolk sac tumors are _ type of testicular cancer
Nonseminimatous
Tx for nonseminomatous tumors
Orchiectomy and retroperitoneal nodal dissection
Chemo for testiuclar cancer (3)
Cisplatin
Bleomycin
VP-16
When to give chemo for seminoma and nonseminoma testicular cancers
Seminoma - Metastatic dz or bulky retroperitoneal dz
Nonseminomas - Stage 2 or greater
Most common site of prostate cancer
Posterior lobe
Most common site of prostate cancer metastasis
Bone
Prostate Ca Tx for intracapsular tumors (no mets) - 3 options
1 - XRT
2 - Radical prostatectomy with pelvic LN dissection
3 - Nothing (depending on age/life span)
Prostate Ca Tx for extracapsular invasion or metastatic dz
XRT and adrogen ablation (leuprolide, flutamide, b/l orchiectomy)
Methods of androgen ablation for prostate cancer (3)
1 - GnRH agonist (leuprolide)
2 - Testosterone receptor blocker (flutamide)
3 - Bilateral orchietomy
With prostatectomy, PSA should go to 0 within _ weeks
3
1 primary tumor of the kidney
Renal cell carcinoma
Most common site for RCC mets
Lungs
Erythrocytosis can occur secondary to _
Increased erythropoietin (HTN)
Tx for RCC (3)
Radical nephrectomy with regional nodes, XRT, chemotx
Components of radical nephrectomy (4)
Kidney
Adrenal
Gerota’s fascia
regional nodes
Most common tumor in the kidney
Breast Ca metastasis
Tx for transitional cell CA of renal pelvis
Radical nephroureterectomy
Components of Von Hippel Lindau syndrome (3)
Renal cell carcinoma
CNS tumors
Pheochromocytoma
Dx for bladder cancer
Cystoscopy
Squamous cell CA of bladder associated with _ infection
Schistosomiasis
Tx of bladder CA with muscle invasion (>/= T2) - 3 things
Cystectomy with ileal conduit
Chemo
XRT
Chemo for bladder cancer
(MVAC) Methotrexate Vinblastine Adriamycin Cisplatin
Tx of bladder CA with no muscle invasion (2)
Intravesical BCG injection
Transurethral resection
Suturetype to use with ureter repaair
Absorbable (prevent stone formation)
Alpha blocker examples and MOA for BPH
Tamsulosin, doxazosin
Smooth muscle relaxers
5-alpha reductase inhibitor examples and MOA
Finasteride
Inhibits conversion of testosterone to DHT
Hypermobile urethra or loss of sphincter mechanism resulting in incontinence
Stress incontinence
Incomplete emptying of enlarged bladder incontinence
Overflow incontinence
Dx of vesicoureteral reflux
Voiding cystourethrogram
Most common urinary tract abnormality
Ureteral duplication
Most common reason for newborn boy not to urinate
Posterior urethral valve
Dx of posterio urethral valve
Voiding cystourethrogram
Ventral opening on penis
Hypospadias
Dorsal opening on penis
Epispadias
When to repair hypospadias
6 months
Horseshoe kidney is usually joined at _ pole
lower
Renal association with WBC casts
Pyelonephritis, glomerulonephritis
Renal association with RBC casts
Glomerulonephritis
Surigcal intervention for phimosis
Dorsal slit