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GU2 - Urology > Benign Male GU Conditions > Flashcards

Benign Male GU Conditions Flashcards

1
Q

mesonephric duct aka Wolffian duct

A
  • becomes vas deferents and seminal vesicle

- degenerates in female

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2
Q

paramesonephric duct aka Mullerian duct

A
  • becomes fallopian tubes, uterus, vagina

- degenerates in males

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3
Q

ureteral ectopia

A
  • ureter doesn’t properly fuse into the bladder

- will almost always be above the true ureter and then dive under it

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4
Q

perinatal hydronephrosis

A
  • swelling of a kidney in a fetus/infant caused by buildup of urine in the kidney d/t poor flow or blockage
  • commonly revealed on screening US
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5
Q

first step when finding perinatal hydronephrosis

A

-refer to pediatric urologist prior to delivery

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6
Q

management of perinatal hydronephrosis

A
  • document urine output
  • if no urine in 24 hr then cath
  • renal US w/i 24 hrs after birth
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7
Q

b/l vs. unilateral perinatal hydronephrosis

A

-b/l is worse - it could be a bladder obstruction

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8
Q

checking kidney function in perinatal hydronephrosis

A

-can’t check renal fxn for 48 hrs b/c it will be the same as moms

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9
Q

abx prophylaxis in perinatal hydronephrosis

A
  • do this if you suspect ureteral reflux b/c they would be predisposed to infection
  • no sulfa drugs
  • must use cephalosporin or penicillin
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10
Q

imaging in perinatal hydronephrosis

A
  • voiding cystourethrogram
  • w/i 2-3 days of life
  • r/o bladder obstruction and ureteral reflux
  • if no reflux, dc abx
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11
Q

nuc med renogram in perinatal hydronephrosis

A
  • document function and drainage
  • if kidney fxns well, no need for surgery
  • if poor, drainage and surgery may be needed
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12
Q

vesicoureteral reflux

A
  • urine flows retrograde from the bladder into the ureters/kidneys
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13
Q

short term vs long term vesicoureteral reflux

A
  • short: allows bacteria into kidney causing febrile infections
  • long: repeated infections cause scarring and fxn loss
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14
Q

tx of vesicoureteral reflux

A
  • grades 1-3: usually resolve spontaneously or:
  • start abx and repeat studies
  • grades 4-5: commonly need early intervention:
  • hyaluronic acid bubble insertion surgery
  • reimplantion of ureter
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15
Q

what is the MC cause of hydronephrosis in newborns?

A

ureteropelvic junction obstruction

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16
Q

ureteropelvic junction obstruction (UPJ)

A
  • obstruction of the flow of urine from the renal pelvis to the proximal ureter
  • aperistaltic segment of proximal ureter
  • may resolve spontaneously
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17
Q

dx of UPJ obstruction is done by what?

A

nuclear renal scan

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18
Q

general principles of conservative management of hydronephrosis

A
  • 50% of antenatal resolve postpartum
  • unable to accurately diagnose true obstruction
  • asymptomatic hydro could resolve spontaneously
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19
Q

dismembered pyeloplasty

A
  • sx tx of hydronephrosis

- vertical incision into the ureter then approximation and closure of the pelvis

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20
Q

2nd MC cause of ESRD in children?

A

posterior urethral valves

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21
Q

what are posterior urethral valves?

A
  • obstructive membranes that develop in the urethra and can obstruct or block the outflow of urine
  • can be deadly
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22
Q

posterior urethral valves can cause what? (3)

A
  • oligohydramnios
  • b/l hydronephrosis
  • abnl development of bladder: inability to empty and incontinenece.
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23
Q

cryptorchidism

A
  • hidden testis
  • failure of testis to descend into scrotum
  • may be inhibited at any point along its pathway from abdomen to scrotum
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24
Q

fxn of the scrotum

A

-produce viable and mature spermatagonia, testis must be 1.5-2 degrees cooler than abdomen so they descend to the scrotum

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25
Q

embryology of descent of testes

A
  • develop in abdomen week 6-8
  • gubernaculum shortens
  • testis pulled slowly into scrotum after month 7
  • may not be until after birth
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26
Q

incidence of cryptorchidism

A
  • one of the MC congenital anomalies found at birth
  • more common in pre term babies
  • usually descend spontaneously by 1 year
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27
Q

what is the principal determinant of cryptorchidism at birth and 1 yo?

A

birth weight

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28
Q

what is the cause of misdiagnosis of cryptorchidism at ages 2-7?

A

retractile testes secondary to cremasteric reflex

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29
Q

if cryptorchidism is b/l, what should you consider?

A
  • intersex condition
  • esp if hypospadias
  • karyotype to determine
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30
Q

classifications of cryptorchidism

A
  • abdominal (inside internal ring)
  • canalicular (b/w internal and external rings)
  • extracanalicular (supra or infra pubic)
  • ectopic
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31
Q

what is the MC location for ectopic testes?

A

-w/i a superficial pouch b/w external oblique fascia and Scarpas

32
Q

pt has b/l nonpalpable testis what test do you want to run?

A

FSH

33
Q

if FSH is elevated in b/l nonpalpable testes, what do you suspect?

A

b/l anorchia

34
Q

if FSH is non elevated in b/l nonpalpable testes, what are the following steps?

A
  • give trial of hCG

- if no increase in testosterone, b/l anorchia

35
Q

imaging in cryptorchidism

A

-NEVER do it

36
Q

laparoscopy in cryptorchidism

A
  • if vessels end blindly, testis absent
  • if vessels enter inguinal canal, perform inguinal exploration
  • if testis is intra-abdominal, perform orchiopexy
37
Q

result of the length a testis is cryptorchid

A
  • longer = more likely to be histologically abnl
  • impaired spermatogenesis
  • Leydig cells may or may not be affected
  • higher testis CA rate
38
Q

surgical correction options for cryptorchidism

A
  • 1 stage open orchiopexy (for canalicular)
  • 1 stage laparoscopic orchiopexy (for the peeping testis) lol
  • 2 stage laparoscopic - consists of revascularization
39
Q

non surgical options for cryptorchidism

A
  • hCG

- on used in rare cases

40
Q

what sx make up the presentation of an acute scrotum?

A
  • acute scrotal pain
  • scrotal tenderness to palpation
  • swelling
  • n/v
41
Q

ddx in an acute scrotum

A
  • testicular torsion
  • epididymitis/orchitis
  • incarcerated inguinal hernia
  • torsion of testicular or epididymal appendage
42
Q

hx to take in acute scrotum

A
  • activity
  • awakened from sleep
  • onset of pain
  • duration
  • bowel habits
  • dysuria
  • referred pain
  • previous similar episodes
  • immunocompromised
43
Q

manual detorsion of testicle

A
  • gently elevate testis toward the ipsilateral inguinal ring
  • use thumb and forefinger to turn testis laterally while stabilizing cord
  • if not relieved, attempt turning medially
44
Q

how would you know if manual detorsion was successful?

A

the spermatic cord will lengthen and the testis will assume nl anatomical position w/ nearly immediate relief of pain

45
Q

cremasteric reflex is elicited by what?

A

light stroking of the superior and medial part of the thigh

46
Q

nervous pathway of the cremasteric reflex

A
  • sensory and motor fibers of L1 spinal n.

- sensory fibers of ilioinguinal n. –> spinal cord –> genitogemoral n. –> cremasteric contraction

47
Q

conditions in which the cremasteric reflex is absent

A
  • 100% of cases of testicular torsion
  • in motor neuron disorders
  • spinal injury of L1 and L2
48
Q

when you think of testicular torsion, what imaging goes hand in hand?

A

US

49
Q

US for testicular torsion

A
  • color doppler US = gold standard

- shows diminished or blocked flow

50
Q

what deformity is likely the cause of testicular torsion?

A
  • bell clapper deformity

- lack of fixation to the testicular gubernaculum during descent

51
Q

time frame for testicular torsion

A

-irreversible ischemic injury to testicular parenchyma w/i 4 hrs

52
Q

tx of testicular torsion, reguardless if it was manually detorsed or not

A

-scrotal exploration and b/l testicular fixation (orchiopexy)

53
Q

how can testicular torsion effect fertility?

A

-seriously interferes w/ 50% of pts fertility

54
Q

possible causes of UTI

A
  • infected stones
  • chronic bacterial prostatitis
  • fistulae (from gut)
  • foreign bodies . . . i can’t find my swizzle stick . . .
  • infected kidney
  • instrumentation
  • poor hygiene
55
Q

predisposing factors for UTI

A
  • urinary obstruction
  • DM
  • neurogenic bladder
  • pregnancy
  • ESRD
  • immunosuppression
  • congenital anomalies
56
Q

absolute gold standard for a certain clean catch UA sample

A

suprapubic needle aspiration

57
Q

pyocystitis commonly occurs in what pts?

A

dialysis pts w/ low UOP - bladder becomes one big abcess

58
Q

emphysematous cystitis

A
  • rare
  • gas w/i bladder
  • seen in DM, trauma, instrumentation, fistulae
59
Q

what condition is often confused with chronic prostatitis?

A

-chronic pelvic pain syndrome

60
Q

when you r/o testicular torsion, what is the likely diagnosis?

A

epididymitis or orchitis

-heaviness, aching, hemiscrotum, radiating pain upward, edema

61
Q

common causes of epididymitis/orchitis

A
  • < 35 yo: GC, chamydia

- > 35 yo: e. coli

62
Q

what is the once instance that orchitis can be caused by something other than epididymitis

A

mumpt orchitis

63
Q

tx of epididymitis/orchitis

A
  • doxy 100 mg BID x 2-3 weeks

- bactrim x 4 wks

64
Q

possible causes of urethritis in women

A
  • STD

- vaginitis

65
Q

big 3 causes of vaginits

A
  • candidal
  • bacterial
  • trachomonal
66
Q

microscopy findings for candida

A

-hyphae w/ sausage-link appearance

67
Q

clinical findings for trichomonas

A
  • strawberry cervix (only in 10% of infections)

- asymptomatic in men so if female has it tx both to prevent reinfection

68
Q

microscopy for bacterial vaginosis

A
  • clue cells (egg w/ pepper on it)

- predominance of coccobacilli

69
Q

clinical diagnosis of pyelonephritis

A
  • triad: chills, fever, flank pain

- UA consistent w/ UTI

70
Q

renal abcess arise from . .

A

focus of pyelonephritis (e.coli) or hematogenous spread (staph)

71
Q

size cutoff for renal abscess

A

> 3cm usually has to be drained

72
Q

xanthogranulomatous pyelonephritis

A
  • uncommon renal infection misdiagnosed as tumor
  • unknown etiology
  • persistent bacteriuria
  • tx: nephrectomy
73
Q

what ligaments provide external penile support?

A
  • fundiform ligament:
  • from Colles fascia
  • superficial
  • suspensory ligament:
  • from Buck’s fascia
  • attaches tunica to pubis
74
Q

major causes of ED

A
  • many are listed on slide but he mentions:
  • arterial insuffeciency (men in 50s)
  • venous leak syndrome
75
Q

systemic diseases that are risk factors for ED

A
  • HTN
  • DM
  • CRI
  • CAD
  • hyperlipidemia
  • obesity
  • liver failure
  • endocrine disorders
  • hypogonadism
  • alcoholism
  • neurologic dz

GU2 - Urology (10 decks)

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