Anorectal & GU Flashcards
What is transanal hemorrhoidal dearterialization (THD)
Doppler-guided arterial ligation with hemorrhoidopexy
Detection of lymphogranuloma venereum
Gram stain usually negative, can be detected by DNA probe
Management of lymphogranuloma venereum
Tetracycline immediately (to avoid fistulas and severe rectal stricture)
Evaluation of fecal incontinence due to incompetent anal sphincter
Endoanal US
Most common type of bladder injury
Extraperitoneal, usually in setting of pelvic fracture
Management of extraperitoneal bladder injury
Prolonged Foley and follow-up cysto unless: UTI, bony fragments in bladder, injury to bladder neck, female genital lacerations, or other injuries requiring laparotomy
Management of Paget disease of anus
Wide local excision (APR if concurrent malignancy of rectum/anal canal)
LN dissection if palpable lymphadenopathy
1/2 of patients have occult internal malignancy
Nigro protocol
Used for locoregional anal squamous cell cancer
5-FU + mitomycin C and radiation
Management of metastatic anal SCC
chemo + RT followed by nivolimumab/pembrolizumab
Order of addressing hilar structures in nephrectomy
Mobilize vein to obtain access to artery, ligate renal artery, then ligate renal vein
Management of a ureteral injury between ureteropelvic junction and pelvic brim
Repair by ureteroureterostomy
Treatment of perianal sepsis
Antibiotics and wide local drainage
Innervation of internal anal sphincter
Sympathetics from L5 and S2-S4
Innervation of external anal sphincter
Inferior rectal branch of pudendal nerve (S1-3 nerve roots) and perineal branch of S4 nerve root
Verrucous carcinoma
Local aggressive type of squamous cell carcinoma
Most common location of anal fissure
Posterior midline (if lateral, look for other causes)
Bowen disease
High grade squamous intraepithelial lesion - 10% progress to invasive SCC
Management of Bowen disease
Topical therapy like imiquimod (excision only for lesions that don’t respond to topical therapy)
Approach for radical orchiectomy for testicular mass
Inguinal approach (if scrotum is violated, metastatic spread to RP and inguinal nodes may occur)
Management of fecal incontinence with a confirmed sphincter defect
Overlapping sphincteroplasty
(Or sacral nerve stimulation)
Surgical treatment for chronic anal fissures
Lateral internal sphincterotomy
High risk patients for prostate cancer
African American, first degree relative <65, BRCA
Prostate cancer screening
Start at age 40-45 with PSA q1-2yrs
For standard risk patients, start at 50yrs
