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ABSITE 2022 > Chapter 39 - Urology++ > Flashcards

Chapter 39 - Urology++ Flashcards

1
Q

Where is Gerota’s fascia?

A

Around kidney

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2
Q

Does the right renal artery cross anterior or posterior to the IVC?

A

Posterior

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3
Q

Do ureters cross over or under the iliac vessels?

A

Over

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4
Q

Why can the left renal vein be easily ligated from the IVC?

A

Secondary to increased collaterals (L. adrenal, L. gonadal, L. ascending lumbar vein)

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5
Q

What is the most common cause of acute renal insufficiency following surgery?

A

Hypotension

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6
Q

Symptoms of kidney stones? UA findings?

A

Severe colicky pain, restlessness
Blood or stones

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7
Q

What are the most common type of kidney stone? Who is at risk for them?

A

Calcium oxalate - 75%
Radiopaque
Pts with terminal ileum resection due to increased oxalate absorption in colon

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8
Q

What are struvite stones? Why do they occur?

A

Mg ammonium phosphate - 15%
Infection that are urease producing - Proteus mirabilis

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9
Q

What type of stones are radiolucent?

A

Uric acid, cysteine

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10
Q

Who gets uric acid stones?

A

Pts with ileostomies, gout, myeloproliferative disorders

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11
Q

Who gets cysteine stones?

A

Congenital disorders in the reabsorption of cysteine

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12
Q

When is surgery for kidney stone indicated?

A

Intractable pain or infection, progressive obstruction, progressive renal damage, solitary kidney, >6mm not likely to pass

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13
Q

What is the #1 cancer killer in men 25-35?

A

Testicular cancer

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14
Q

Treatment for testicular mass?

A

Dx: US shows solid mass; no need for MRI
Tx: Orchiectomy through inguinal incision (not transscortal, do not want to disrupt lymphatics), and early control of the spermatic cord

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15
Q

What lab value correlates with testicular tumor bulk?

A

LDH

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16
Q

What other lab values are needed for testicular cancer?

A

B-HCG, AFP level

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17
Q

What type of tumor is most common in testicular cancer?

A

Germ cells (90%) - seminoma or nonseminoma

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18
Q

What type of cancer is most commonly associated with undescended testicle?

A

Seminoma

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19
Q

What is the #1 testicular tumor?

A

Seminoma

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20
Q

Where do seminomas spread?

A

Retroperitoneum

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21
Q

Treatment of seminoma?

A

Orchiectomy and retroperitoneal XRT

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22
Q

What are the types of nonseminomatous testicular CA?

A

Embryonal, teratoma, choriocarcinoma, yolk sac

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23
Q

What are the tumor markers of nonseminomatous testicular cancers?

A

90% have AFP and beta-HCG

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24
Q

What is the spread of nonseminomatous testicular cancer?

A

Hematogenously to lungs and retroperitoneum

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25
Q

Treatment of nonseminomatous testicular cancers?

A

Stage I: orchiectomy, prophylactic retroperitoneal node dissection
Stage II+: orchiectomy, XRT, chemo; surgical resection of residual mets

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26
Q

What is the most common site of prostate cancer?

A

Posterior lobe

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27
Q

What is the most common site of mets from prostate cancer?

A

Bone

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28
Q

Complications of prostate resection?

A

Impotence, incontinence, urethral strictures

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29
Q

Where should PSA go after prostatectomy?

A

To 0 after 3 weeks

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30
Q

What is a normal PSH in a patient with a prostate gland?

A

<4

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31
Q

What does elevated alk phos indicate in a patient with prostate cancer?

A

Mets or extracapsular disease

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32
Q

What is the #1 tumor of kidney?

A

Renal cell carcinoma

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33
Q

Risk factor for RCC?

A

Smoking

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34
Q

What fraction of pts have metastatic disease at time of dx of RCC? Treatment for mets?

A

1/3
Wedge resection of isolated lung and colon mets

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35
Q

Most common location for RCC mets?

A

Lung

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36
Q

What hematologic abnormality can occur with RCC?

A

Erythrocytosis secondary to elevated erythropoietin

37
Q

Treatment for RCC?

A

Radical nephrectomy with regional nodes, XRT, chemo
Metastatic: TKIs (sunitinib), VEGF inhx, mTOR inhx

38
Q

What does a radical nephrectomy include?

A

Kidney, adrenal, fat, Gerota’s fascia, regional nodes

39
Q

What is done for RCC tumor thrombus in IVC?

A

pull the mass out of the IVC and continue with the radical nephrectomy; RCC is poorly responsive to chemo

40
Q

What is the most common tumor in the kidney?

A

Mets from breast

41
Q

Paraneoplastic syndromes associated with RCC?

A

Erythropoietin, PTHrp, ACTH, insulin

42
Q

Treatment for transitional cell CA of renal pelvis?

A

Radical nephroureterectomy

43
Q

Tuberous sclerosis is related to what type of renal tumor?

A

Angiomyolipomas

44
Q

What renal (and other) tumors are associated with Von Hippel-Lindau syndrome?

A

Multifocal and recurrent RCC, renal cysts, CNS tumors, pheochromocytomas

45
Q

What is the usually bladder cancer type?

A

Transitional cell CA

46
Q

Painless hematuria indicates what until proven otherwise?

A

Bladder cancer

47
Q

Risk factors for bladder cancer?

A

Smoking, aniline dyes, cyclophosphamide

48
Q

Treatment for bladder cancer?

A

Muscle not involved: Intravesical BCG or transurethral resection.
If muscle invaded, node positive, mets: radical cystectomy with ileal conduit, chemo (adjuvant or neoadj), XRT

49
Q

Squamous cell cancer of the bladder is related to what infection?

A

Schistosomiasis

50
Q

Peak age of testicular torsion?

A

15

51
Q

Treatment for testicular torsion?

A

Bilateral orchiopexy vs. resection and contralateral orchiopexy

52
Q

Technique for ureteral trauma if going to repair end to end?

A

Spatulate ends
Use absorbable suture to avoid stone formation
Stent ureter
Place drains
Avoid stripping soft tissue, may compromise blood supply

53
Q

Where does BPH arise?

A

Transitional zone

54
Q

Initial therapy for BPH?

A

Alpha blockers: terazosin, doxazosin
5-alpha-reductase inhibitors: finasteride

55
Q

Indications for TURP?

A

Recurrent UTIs, gross hematuria, stones, renal insufficiency, failure of medical therapy

56
Q

What is post-TURP syndrome?

A

Hyponatremia secondary to irrigation with water, can precipitate seizures from cerebral edema

57
Q

Treatment for post-TURP syndrome?

A

Careful correction of Na with diuresis

58
Q

Post-TURP ejaculatory complication?

A

Most patients will have retrograde ejaculation

59
Q

What is the most common cause of neurogenic bladder?

A

Secondary to spinal compression

60
Q

What level is the injury in neurogenic bladder?

A

Above T-12

61
Q

What is neurogenic obstructive uropathy? Level of injury? Treatment?

A

Incomplete emptying
Below T12
Intermittent cath

62
Q

What is the cause of stress incontinence? Treatment?

A

Hypermobile urethra or loss of sphincter mechanism
Kegels, alpha-adrenergics, surgery for urethral suspension

63
Q

What is the cause of urge incontinence? Treatment?

A

Sense of urgency or frequency because of involuntary detrusor contraction without neurologic disorder
Anticholinergics, behavior modification, cystoplasy, urinary diversion

64
Q

What is the cause of neuropathic incontinence? Treatment?

A

Urgency or frequency due to dec. bladder capacity; associated with neurologic conditions
Treat underlying neurologic disorder, behavior modifications, surgical options

65
Q

What is the cause of overflow incontinence? Treatment?

A

Incomplete emptying and enlarged bladder; BPH –> distention and leakage
TURP

66
Q

What is the cause of congenital incontinence? Treatment?

A

Continuous leakage and nocturnal enuresis; sphincter mechanism bypassed
Surgical correction

67
Q

Treatment for ureteropelvic obstruction?

A

Pyeloplasty

68
Q

Treatment for vesicoureteral reflux?

A

Reimplantation with long bladder portion

69
Q

What is the most common urinary tract abnormality?

A

Ureteral duplication

70
Q

What is the treatment for ureterocele?

A

Resect and reimplant

71
Q

Treatment for hypospadias?

A

(Ventral) repair at 6mo with penile skin

72
Q

Treatment for epispadias?

A

(Dorsal) surgery

73
Q

Complications of horseshoe kidney?

A

UTI, urolithiasis, hydronephrosis

74
Q

What happens if there is failure of closure of the urachus? Treatment?

A

Connection between umbilicus and bladder; in pts with bladder outlet obstructive disease
Resection of sinus/cyst, closure of bladder

75
Q

Concern when left varicocele diagnosed?

A

RCC: L. gonadal v inserts into L. renal v., obstruction by renal tumor causes varicocele

76
Q

What is the most common cause of pneumaturia?

A

Diverticulitis and subsequent formation of colovesical fistula.
Dx: CT scan - air in bladder

77
Q

What is indicated by WBC casts?

A

Pyelonephritis, glomerulonephritis

78
Q

What is indicated by RBC casts?

A

Glomerulonephritis

79
Q

How will interstitial nephritis present?

A

Fever, rash, arthralgias, eosinophils

80
Q

What is the pregnancy rate after repair of vasectomy?

A

50%

81
Q

What is the treatment for priapism?

A

Aspiration of the corpus cavernosum with dilute epi or phenylephrine

82
Q

Risk factors for priapism?

A

Sickle-cell anemia, hypercoagulable states, trauma, intracorporeal injections for impotence

83
Q

Treatment for SCC of penis?

A

Penectomy with 2cm margin

84
Q

What is the treatment for phimosis found at time of laparotomy?

A

Dorsal slit

85
Q

Where is a spermatocele found? Treatment?

A

Separate from and superior to the testis along epididymis.
Surgical removal.

86
Q

MCC causes of UTI?

A

E coli, Enterococcus, Candida

87
Q

Finasteride MoA
Tamsulosin MoA

A

5a-reductase inhibition
a-adrenergic blocker

88
Q

Anatomy of epididymis?

A

connects the efferent ducts of the testis to the vas deferens
transport of semen and is the site for the maturation of sperm

ABSITE 2022 (50 decks)

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