Brian Miller - Pediatric/Adult Urology Flashcards
1
Q
common peds urology dx
A
congenital hydronephrosis
ureterocele
UTI
vesicoureteral reflux
dysfxn voiding
hypospadias
chordee/torsion
circumcision topics
preputial/labial adhesions
undescended testicles
testicle pain
2
Q
normal urination
A
detrusor muscle contraction plus relaxation of urethral sphincter → passage of urine
3
Q
dysfunctional urination
A
contraction of both detrusor and urethral sphincter → interrupted stream
4
Q
dysfunctional voiding increases risk for (3)
A
UTIs
enuresis
incomplete bladder emptying
5
Q
majority of dysfunctional voiding pt’s are identified
A
following PCP referral for:
recurrent UTI
AND/OR
intractable daytime enuresis
6
Q
dysfunctional voiding is a common problem and accounts for up to __% of peds urology clinic visits
A
40%
7
Q
mc cause of dysfunctional voiding
A
learned behaviors → holding
8
Q
2 ex of learned behaviors/holding
A
response to potty training
environmental
9
Q
3 other causes of dysfunctional voiding
A
infectious
detrusor over-activity
neurologic
10
Q
sx of dysfunctional voiding
A
enuresis
interrupted stream
frequency
urgency
dysuria
malodorous urine
post-void dribbling
hematuria
abd/pelvis discomfort
hesitancy
11
Q
symptoms of dysfunctional voiding often mimic
A
UTI
12
Q
dysfunctional elimination syndrome
A
dysfunctional voiding
PLUS
constipation/encopresis
13
Q
what is encopresis
A
fecal incontinence
14
Q
imaging for dysfunctional voiding
A
KUB
15
Q
dx procedure for dysfunctional voiding
A
- uroflow → measures voided urine over time
- bladder scan → after uroflow
16
Q
labs for dysfunctional voiding
A
UA
urine culture
17
Q
tx for dysfunctional voiding (5)
A
timed voiding
double voiding
good water intake
avoidance of bladder irritants
avoidance of constipation
18
Q
pharm for dysfunctional voiding
A
alpha-blockers
anticholinergics
19
Q
ex of alpha blockers
A
doxazosin
flomax → older kids
20
Q
indications for anticholinergics for dysfunctional voiding
A
kids w. irritative voiding sx → urgency, frequency, enuresis
21
Q
contraindications for anticholinergics for dysfunctional voiding
A
any kid w. elevated PVR (post void residual)
22
Q
anticholinergics are better tolerated in __ version
A
extended release
23
Q
imaging to help evaluate recurrent UTI
A
renal US
24
Q
imaging to help evaluate constipation
A
KUB
25
imaging to help evaluate febrile UTI
voiding cystourethrogram (VCUG)
26
uroflow evaluates (3)
volume
voiding pressure
presence of staccato stream
27
bladder scan evaluates
incomplete bladder emptying → c.o urgency
28
what is this showing
large stool volume
29
bladder program involves (4)
timed voiding
double voiding
good water intake
avoidance of bladder irritants
30
bladder irritants (5)
citrus
caffeine
chocolate
carbonation
artificial red/purple dyes
31
UTIs are mc in males during \_\_
and females \_\_
males: 1st year of life
females: after 1st year of life
32
uncircumcised is rf for UTI during \_\_
circumcised is rf for UTI \_\_
uncircumcised: 1st year of life
circumcised: after 1st year of life
33
etiology of UTI in infants (3)
urinary stasis
constipation
neurogenic bladder
34
causes of UTI in older kids (3)
voiding dysfunction
constipation
upper tract pathology
35
hx clue for UTI
irritative voiding symptoms
36
ex of irritative voiding sx (6)
dysuria
enuresis
frequency
urgency
hematuria
hesitancy
37
first line lab to evaluate UTI
urinalysis
38
urinalysis is only a __ tool
screening
39
UA point of care test
UA dipstick
40
what UA test is more reliable than UA dipstick
UA microscopic
41
UA microscopic should be ordered if evaluating
hematuria
42
diagnostic test for UTI
urine culture
43
2 tests for UTI eval
1. UA → screening
2. urine culture → diagnosis
44
UTI + __ is more suggestive of renal involvment
fever
45
febrile UTI might indicate
pyelonephritis →
*⅔ of infants \< 2yo*
46
imaging for all pt w. diagnosed UTI (febrile or non febrile)
RBUS
47
imaging for all pt. w. diagnosed UTI \> 4 yo
KUB
48
indications for VCUG (voiding cystouretrogram) for UTI (3)
recurrent febrile UTI
1st UTI in circumcised male
atypical bacteria
49
tx for UTI
1. targeted abx based on culture
2. address underlying issues
50
3 conditions associated w. UTI
dysfunctional voiding
VUR
constipation
51
reflex of urine from the bladder, up the ureters, +/- to the kidney
vesicoureteral reflux
52
what is this showing
grade 2 VUR
53
what is this showing
grade 5 VUR
54
tx for VUR
obs vs abx vs surgery
55
most cases of VUR are found
after febrile UTI → VCUG ordered
56
imaging for VUR
renal US
MAG 3 renal scan
57
abx prophylaxis been associated w. \_\_% reduction in incidence of recurrent UTI
35%
58
antimicrobial prophylaxis for kids w. vesicoureteral reflux has been associated w. \_\_% reduction in incidence of recurrent UTI
45
59
consider circumcision in kid w.
VUR
PLUS
recurrent UTI
60
indications for surgery for VUR (3)
breakthrough UTI
UTI following d/c of pabx
family preference
61
if possible, avoid surgical intervention for VUR until after
1 yo
62
religions associated w. circumcision
muslim
jewish
63
\_\_% of muslim men are circumcised globally
68.8
64
prevalence of circumcision in US
75%
65
global prevalence of circumcision
30#
66
there has been a __ trend in circumcisions in the US
downward
67
t/f: circumcision has minimal benefits on decreased HIV transmission and risk of penile ca
T!
68
it takes __ circumcisions to prevent 1 UTI
100
69
circumcision indication recs (2)
recurrent UTIs
at risk pt
70
what pt's are at risk for recurrent UTIs and may benefit from circumcision (3)
PUV (posterior urethral valves)
high grade VUR
neuropathic bladder
71
penile carcinoma is associated w. (2)
phimosis
genital infxns
72
3 contraindications for circumcision
no vit K at birth
fam hx bleeding d.o
anatomic anomalies
73
what do you think when you see: meatus malpositioned, chordee, dorsal hooded ventral foreskin
hypospadias → anatomic anomaly
74
ventral penile curvature
chordee
75
incomplete ventral foreskin
dorsal hooded foreskin
76
what is this showing
hypospadias
77
you will almost never see __ on initial exam for hypospadias
complete prepuce
78
other common penile abnormalities (4)
chordee → ventral curvature
penile torsion
hidden/buried penis
webbed penis
79
2 tools used for circumcision
gomco clamp
pastibell
80
2 tools used for circumcision
gomco clamp
pastibell
81
which circumcision tool is quicker and has less bleeding risk
pastibell
82
bleeding w. circumcision mc results from
disruption of frenular vessels in response to excessive force of frenulum
83
other causes of bleeding w. circumcision (3)
mismatched gomco bell and late
premature removal of clamps
loose pastibell string
84
\_\_ should never be used in conjunction w.
\_\_ bc devastating penile loss can occur
electrocautery
metal clamps
85
rf for undescended testes
**prematurity**
**fam hx**
low birth wt
maternal dm
small for gestational age
86
\_\_% of undescended testes will spontaneously descend by 4 mo old
35-43%
87
classification of undescended testes
undescended → true
retractile
ascended → previously descended
88
types of undescended/true undescended testes
palpable
non-palpable
89
best practice for undescended testes work up
do NOT obtain imaging for non palpable
90
undescended testes should be referred to specialist if not descended by
6 mo
91
2 concerns w. undescended testes
infertility
malignancy → 2-3 x normal risk
92
adult urology conditions
nephrolithiasis
bph
hematuria
ED
priapism
trauma
urinary retention
incontinence
male infertility
hpogonadism
varicocele
hydrocele
spermatocele
93
histologic dx that refers to proliferation of smooth muscle and epithelial cells w.in prostatic transition zone
bph
94
normal prostate is __ g
20
95
what scoring system is used for bph
IPSS: international prostate symptom score
96
\_\_ and
\_\_ are crucial in bph evaluation
detailed h&p
97
imaging for bph
cystoscopy
uroflow
bladder scan
98
1st and 2nd line pharm for bph
1. alpha-1 blockers (ABs)
2. 5-alpha-reductase inhibitors (5-ARIs)
99
suffix for alpha-1 blockers
-osin
100
suffix for 5-ARIs
-teride
101
2 mc used ABs
flomax
rapaflo
102
s.e of ABs (5)
hypotn
syncope
dizziness
retrograde ejaculation
arrhythmias
103
AB moa
relax smooth m (urethral sphincter)
104
5-ARI moa
reduce size of prostate
105
5-ARIs need to be used for __ to achieve results
6-12 mo
106
s.e of 5-ARIs
decreased libido
ejaculatory dysfxn
possible bone loss
dpn
decreased psa levels
107
3 non first line meds for bph
anticholinergics
beta-3 adrenergic agonists
phosphodiesterase type 5 (PDE-5( inhibitors
108
indications for anthicholinergics for bph
irritative sx *if they empty their bladder well*
109
pro of beta-3 adrenergic agonists
fewer s.e than anticholinergics
110
ex of beta-3 adrenergic agonist
mirabegron (myrbetriq)
111
indications for PDE-5 inhibitor for bph
concurrent bph and ed
112
PDE 5 suffix
-afil
ex sidenafil (viagra)
113
mc type of kidney stone
calcium oxalate
114
other types of kidney stones
calcium phosphate
uric acid
struvite
cystine
115
imaging for nephrolithiasis
renal us
non-contrast CT abd/pelvis → 96-100% sensitive
KUB
116
indications for surgical intervention of nephrolithiasis
UTI
intractable pain
solitary kidney
failed trial of MET x 2-4 weeks
asymptomatic calculus 5 mm or larger
117
what is MET
medical expulsive therapy →
tamsulosin (flomax)
118
prevention of nephrolithiasis (6)
water!!
calcium foods
minimize oxalate
minimize animal pro
minimize
sat
119
why are varicoceles almost always on the left
bc of 90 degree angle of drainage and valve failure on left
120
what type of varicocele is concerning (2)
bilateral
right sided
121
pain w. varicocele is aggravated by \_\_
and worse at \_\_
standing
end of the day
122
imaging for left sided varicocele
abdominal us
123
varicocele grading
1-3
124
varicocele only palpable w. valsalva
grade 1
125
varicocele that is nonvisible on inspection but palpable upon standing
grade 2
126
varicocele that is visible on gross inspection
grade 3
