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Urology > AUA Curriculum > Flashcards

AUA Curriculum Flashcards

1
Q

Micturition:
pelvic nerve
hypogastric nerve
pudendal nerve

A

pelvic nerve –> parasympathetic, activates urination, causes detrusor to contract (senses BLADDER STRETCH of detrusor muscle)

hypogastric nerve –> sympathetic, inhibits contraction of detrusor, and contracts internal sphincter = hold pee

pudendal nerve –> somatic, contract external sphincter

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2
Q

stones of < or equal to ____ will pass spontaneously

-stones > or equal to ____ are unlikely to pass spontaneously

A

< 4mm

>10 mm

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3
Q

ddx of acute scrotal pain (6)

A
  1. ischemia (torsion, infarct)
  2. Trauma
  3. Infectious
  4. Inflammatory
  5. Hernia
  6. Acute on chronic (spermatocele, hydrocele, tumor, varicocele - rupture/hemorrhage)
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4
Q

Testicular torsion

A

occurs on L>R
increased risk with bellclapper deformity

100% salvage if <6 hrs, only 20% if >12hrs

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5
Q

Testicular rupture

A

2/2 lac of tunica albuginea of testis due to blunt or penetrating trauma

tx: surgical exploration and repair

different from intratesticular hematoma because that would have an intact tunica albuginea

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6
Q

Epididymitis

A
  • pain relieved by elevation of the testicle
  • on US shows INCREASED blood flow
  • gradual onset of pain
  • <35 yrs –> gonorrhea or chlamydia
  • > 35 yrs –> gram neg rods
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7
Q

epididymoorchitis

A

when epididymitis extends into the testes and causes pain and enlargement

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8
Q

BPH - where?

A

TRANSITION ZONE surrounding urethera

PCA is in peripheral zone

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9
Q

BPH

A

proliferation of epithelial and smooth muscle cells

sx: hesitance, nocturia, decreased stream force, incomplete emptying, F/U/D

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10
Q

BPH work up

A

prostate size
urinary flow rate
PVR
AUA symptom score index (aka IPSS) - mild 0-7, mod 7-15, severe >15

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11
Q

BPH treatment

A

5a-reductase inhibitors = finasteride
a1 blockers = “zosins”

surgery - TURP, prostatectomy, laser, microwaves

combined drug therapy is > than any alone

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12
Q

diagnosis of UTI on culture

A

voided urine culture –> >10^5 CFU

catheterized urine –> > 10^3 CFU

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13
Q

when to get imaging in pediatric UTI

A

febrile kid ages 2 months -2yrs at 1st UTI

-get renal US, bladder US, VCUG

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14
Q

treatment of pediatric UTI

A

ppx - TMP/SMX or Nitrofurantoin

tx - TMP/SMX, cephalosporins, ampicillin, amoxicillin, augmentin

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15
Q

Vesico urinary reflux (VUR)

A

urine flows from the bladder up the ureter

dx - VCUG
DMSA scans monitor renal cortical function

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16
Q

UPJ obstruction

A

can be due to poor peristalis of UPJ, narrow segment, aberrant vessels, high insertion of ureter into renal pelvic

sx - flank pain worse with big diuresis

dx - renal US, VCUG

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17
Q

ureteroceles

A

cystic dilation of terminal, intravesical portion of ureter

  • often ureterocele drains upper pole of a duplex kidney
  • sx - UTI in first few months of lige
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18
Q

ectopic ureters

A

ureter lying caudal to normal ureter insertion at trigone of bladder
-often complete ureteral duplication + contralateral duplication

sx - boys –> UTI or epididymo-orchitis
girls –> UTI or continuous incontinence

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19
Q

Neuropathic bladder

A

due to myelomeningovele or trauma to the spinal cord

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20
Q

Posterior uretheral valve (PUV)

A

obstructing membranous folds within the lumen of prostatic urethra (only in boys)

dx - antenatal US –> thick bladder + hydro + oligo

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21
Q

Eagle-Barrett Syndrome

A

aka prune belly

absence of abdominal wall musculature, dilated ureter, bladder, urethra, and bilateral undescended testes

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22
Q

urachus

A

remnant of allantoic duct connecting anterior bladder wall to umbilicus

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23
Q

urachal remnants

A

sx - wet umbilicus, leaks during crying

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24
Q

risks for UTI in general (3)

A
  1. decreased urine flow
  2. promote colonization
  3. facilitate ascent (e.g. catheter)
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25
Q

E.Coli - why is it a good UTI bug?

A

Pili –> facilitate adhesion to host tissues

K antigen –> capsular polysaccharide (increased resistance to bactericidal activity)

Hemolysin –> increased tissue invasiveness

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26
Q

Urinary tract defenses

A
  1. Normal flora (decreased with low estrogen, low vaginal pH, and cervical IgA)
  2. high Osm, urea concentration, and low pH in urine (ruined by high glucose in urine)
  3. epithelium expressed TLRs –> recognize bacteria, activate innate immune system then adaptive immune response
  4. Kidney IgG production
27
Q

+ LE on UA –> ?
+ Nitrite on UA –> ?
>10 WBC per hpf –> ?

sensitivity and specificity

A

+ LE on UA –> 64-90%sensitivity and specificity

+ Nitrite on UA –> very specific, only 50% sensitive

> 10 WBC per hpf –> 95% sensitive, NOT specific

28
Q

what causes pain with kidney stones

A

ureteral dilation and/or renal capsular distension

29
Q

Progression of RBF, renal pelvic pressure (RPP), and GFR with kidney stone

1st 2 hrs –> ?

6-24 hrs –> ?

> 24 hrs –> ?

A

1st 2 hrs –> INCREASED RPP and INCREASED RBF –> DECREASED GFR

6-24 hrs –> increased RPP continues –> DECREASED RBF

> 24 hrs –> DECREASED RPP and significantly decreased RBF –> renal ischemia

30
Q

work up of kidney stones

A

non-con CT
US if pregnant
KUB if CT not available

31
Q

Stone evaluation includes…

A

24hr urine –> volume, pH, Ca, Ox, Na, uric acid, citrate, phos, Mg, sulfate, Cr, cystine

Serum –> Ca, phos, uric acid, BUN, Cr, albumin, PTH, alk phos, 1,25D

stone composition

32
Q

Indications for urgent intervention in kidney stones

A
  1. Obstructed with infection
  2. impending renal deterioration
  3. pain refractory to analgesics
  4. intractable N/V
  5. patient preference
33
Q

pros and cons: ESWL

A

not great for lower pole stones

ideal for <3cm

34
Q

ureteroscopy

A

good for distal stones

35
Q

intrcavernosal pressure during ejaculation

A

100 mm Hg

36
Q

Nerves involved in erection/ejaculation

A
  1. Pudendal –> somatic, penile sensation, contraction/relaxation of bulbo and ischiocavernosal muscles
  2. Sympathetic and parasympathetic merge to form cavernous n. –> regulate blood flow
    - sympathetic discharge during ejaculation aids in stopping erection
37
Q

Causes of ED in general

A
  1. psychogenic
  2. neurogenic (DM spinal cord, stroke)
  3. Hormonal
  4. Vasculogenic
  5. med induced
38
Q

when is a cysto recommended in hematuria

A

cysto rec for pts > 35 yrs with microhematuria and all patients with gross hematuria

39
Q

what is microscopic hematuria?

A

> 3 RBCs per HPF

40
Q

Urge incontinence due to…

A
  1. detrusor overactivity (neurogenic vs. non neuro)

2. poor compliance

41
Q

Stress incontinence

A
  1. anatomic (due to mobility of bladder neck)
  2. intrinsic sphincter deficiency due to bladder neck dysfunction
  3. Mixed incontinence
42
Q

Main types of incontinence

A
  1. Stress
  2. Overflow
  3. Urge
  4. mixed
43
Q

high PVR indicates what?

A

BOO vs. poor contractility

nml PVR is < 50 mL

44
Q

Tx of urgency incontinence

A
  1. behavioral - timed voiding, decreased fluids, decrease bladder irritants, bladder training
  2. anticholinergics/antimuscarinics vs. B3 adrenergic agonist
  3. botox, sacral nerve stimulators
45
Q

TX of overflow incontinence

A
  1. relieve obstruction vs. clean intermittent cath
46
Q

TX of stress incontinence

A
  1. pelvic floor exercises
  2. alpha-agonists
  3. pessaries
  4. surgery
47
Q

function of the prostate

A

secrete fluid into the ejaculate (acid, Zn, PSA)

48
Q

causes of increased PSA

A
  1. PCA
  2. BPH
  3. infection
  4. instrumentation
  5. inflammation of prostate
49
Q

Age adjusted PSA

A

PSA 4-10 –> 70% have negative bx

age 40-49 = 2.5
age 50-59 = 3.5
age 60-69 = 4.5
age 70-79 = 6.5

50
Q

PSA density

A

absolute PSA / prostate volume (mL)

get volume from TRUS or MRI
> 0.15 –> bx

51
Q

PSA velocity

A

3 measures over 2 years

  1. 35 ng/mL/yr for PSA <4
  2. 75 ng/mL/yr for PSA >4
52
Q

free and complexed PSA

A

complexed = complexed to protease inhibitors

PCA has INCREASED complexed PSA (decreased % free PSA)

> 25% free PSA –> no PCA usually

53
Q

post-obstructive diuresis

A

if >2,000 ccs out or >200ccs/hr out for 3 hrs

54
Q

most common sight of upper tract obstruction?

A

UPJ over iliac bifurcation OR at uretero-vesical junction

55
Q

priapism - pathophys

A

failure of corpus cavernosum (cc) to drain due to impaired relaxation or paralysis of cavernosal smooth muscle or occlusion of venous flow

56
Q

types of priapism

A

ischemic vs. non ischemic

57
Q

ischemic priapism

A

increased IC pressure –> decreased arterial blood in

  • -> hypoxia, acidosis, compartment syndrome
  • irreversible after 24hrs, 12 hrs –> 50% w/ED

causes: sickle cell, malignant tumors (leukemia), drugs, neurologic shock
dx: penile doppler, penile blood gas

58
Q

non-ischemic priapism

A

fistula between cavernosal artery and corpus cavernorsum

62% resolve without tx

59
Q

TX of priapism

A

tx: corporal aspiration w/18 or 19G needle at 3 or 9’oclock

- a1 agonist (phenylephrine) 1cc Q 15-20 min (MONITOR VITALS)

60
Q

penile fx

A

rupture of tunica albuginea of the corporal bodies

pop, pain, loss of erection, ecchymosis, swelling, “eggplant deformity”

immediate surgical repair required

61
Q

paraphimosis

A

foreskin retracted behind glans and will not return to normal position

–> necrosis 2/2 infarction = autoamputation of glans

TX: analgesia, and manual reduction vs. dorsal slit

62
Q

braided suture

A

sil, vicryl, ethibond

handle better, tie more securely, NOT good in presence of bacteria (harbor bacteria)

63
Q

monofilament sutures

A

monocryl, PDS, ethilon Nylon

Urology (3 decks)

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