Bladder Cancer, Paraphimosis, Phimosis, Urethritis, Testicular Torsion

Question 1

What are the 4 most common causes of cancer death in the US in males?

Answer 1

1. Lung cancer
2. Prostate
3. Colorectal
4. Bladder

Question 2

What is the most common etiology of bladder cancer?

Answer 2

• smoking (2-4x increase)
• White
• Males

Question 3

What is the treatment for superficial bladder cancer?

Answer 3

Intravesicle (BCG, mitomycin, thiotepa, valrubicin)

Question 4

What are 2 ways urine can be rerouted after bladder is removed?

Answer 4

1. Illeal conduit

2. Neobladder

Question 5

TURBT

Answer 5

Transurethral resection of bladder tumor (TURBT)

Question 6

Paraphimosis

Answer 6

Prepuce stuck proximal to glans

-EMERGENCY!!! –> can lead to penile necrosis

Question 7

Paraphimosis: treatment

Answer 7

Reduction!

1. Squeeze glans
2. Thumbs on glans, fingers on prepuce
3. Push glans, pull prepuce

Question 8

Paraphimosis: complication with immunocompromised patients

Answer 8

Fournier’s gangrene

Question 9

Phimosis

Answer 9

• Prepuce stuck distal to glans
• hygiene issue*
• balanitis
• Difficulty voiding urine

Question 10

Phimosis: treatment

Answer 10

circumcision

Question 11

What is most typically the cause of infectious urethritis?

Answer 11

Gonococcal*

or

Chlamydia
Mycoplasma genitalium
Trichomonas vaginalis

Question 12

Urethritis presentation

Answer 12

1. Dysuria
2. Urethral discharge
3. Urethral pruritis***

Question 13

Describe the key difference in regards to discharge between Gonorrhea and Chlamydia

Answer 13

Gonorrhea - profuse and purulent

Chlamydia - clear, possibly absent discharge

Question 14

Urethritis: Labs

Answer 14

First void urinalysis: leukocyte esterase >10 WBC/hpf

Gram stain of urethral discharge >5 WBC/oil immersion field

Question 15

What are the pros and cons of the culture versus NAAT for urethritis?

Answer 15

Culture via urethral swab (>1 hr after voiding)
-pro: gives ABO sensitivities

NAAT
-Con: no sensitivities (>1 hr after last void)

Question 16

Treatment for gonnorrhea

Answer 16

Cetriaxone 250mg IM

Question 17

Treatment for chlamydia

Answer 17

Azithromycin 1 g (or Doxycyline BID for 7 days)

Question 18

Gonorrhea follow up testing

Answer 18

3 months after treatment

Question 19

Chylamidia follow up testing

Answer 19

if uncomplicated and responsive to treatment no follow up testing necessary

If pregnant –> follow up test 3-4 weeks after completing treatment

Question 20

How long does a patient need to abstain from sex after starting treatment?

Answer 20

7 days

Question 21

Treat those who had sexual contact within ____ days before onset of symptoms

Answer 21

60

Question 22

Testicular Torsion: Risk Factors

Answer 22

1. Undescended Testicle (cryptorchidism)

2. “Bell clapper” deformity

Question 23

What age group is most commonly affected by testicular torsion

Answer 23

12-18 years old

Question 24

What are 3 important physical exam findings for testicular torsion?

Answer 24

1. Absent cremasteric reflex
2. No relief with elevation of teste
3. Horizonal lie

Question 25

What would a doppler US show for testicular torsion?

Answer 25

minimal/no blood flow

epididymitis/orchiditis: increased blood flow

Question 26

For a testicular torsion, after detorsing the testis which side needs to have an ochiopexy?

Answer 26

both sides!

Question 27

Testicular torsion: time frames for viable teste versus non-viable

Answer 27

< 6 hrs = most are viable

> 24 hrs = most non-viable