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06 - absite > chapter 39: urology > Flashcards

chapter 39: urology Flashcards

1
Q

fascia around the kidney

A

gerota’s fascia

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2
Q

how does the vasculature lie in the kidney?

A

anterior to posterior: renal vein, renal artery, and renal pelvis

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3
Q

how does the right renal artery lie in relation to the IVC?

A

right renal artery crosses posterior to the IVC

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4
Q

what vessels do the ureters cross?

A

ureters cross over iliac vessels

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5
Q

renal vein: right vs left ligation at the IVC

A

left renal: can be ligated from SVC secondary to increased collaterals

right renal vein lacks collaterals

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6
Q

collaterals of left renal vein

A

left adrenal vein
left gonadal vein
left ascending lumbar vein

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7
Q

how is the left renal vein associated with the aorta?

A

left renal vein usually crosses anterior aorta

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8
Q

connects to vas deferens

A

epididymis

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9
Q

most common cause of acute renal insufficiency following surgery

A

hypotension

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10
Q

symptoms: severe colicky pain, restlessness

A

kidney stones

- UA: blood or stones

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11
Q

kidney stones: abdominal CT

A

can demonstrate stones and associated hydronephrosis

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12
Q

MC stone (75%); radiopaque

A

calcium oxalate

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13
Q

why are calcium oxalate stones increased in patients with terminal ileum resection?

A

due to increased oxalate absorption in colon

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14
Q
  • magnesium ammonium phosphate
  • radiopaque
  • occur with infections (proteus mirabilis) that are urease producing; cause stag horn calculi (fill renal pelvis)
A

struvite stones

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15
Q

what are struvite stones composed of?

A

magnesium ammonium phosphate

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16
Q
  • radiolucent stones

- increased in patients with ileostomies, gout, and myelproliferative disorders

A

uric acid stones

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17
Q
  • radiolucent stones

- associated with congenital disorders in the reabsorption of cysteine

A

cysteine stones

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18
Q

surgical indications for kidney stones

A

intractable pain or infection
progressive obstruction
progressive renal damage
solitary kidney

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19
Q

size of stone not likely to pass

A

> 6 mm

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20
Q

% of kidney stones that are radiopaque

A

90%

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21
Q

tx: kidney stones

A

ESWL (extra-corporeal shock wave lithotripsy); other options: stereoscopy with stone extraction or placement of stent past obstruction, percutaneous nephrostomy tube, open nephrolithotomy

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22
Q

4 types of kidney stones

A
  • calcium oxalate (radiopaque)
  • struvite (radiopaque)
  • uric acid (radiolucent)
  • cysteine (radiolucent)
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23
Q

1 cancer killer in men 25-35

A

testicular cancer

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24
Q

symptoms: painless hard testicular mass

A

testicular cancer

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25
Q

management: testicular mass

A

patient needs an orchiectomy through an inguinal incision (not a trans-scrotal incision -> do not want to disrupt the lymphatics)
- the testicle and attached mass constitute the biopsy specimen

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26
Q

are most testicular masses benign or malignant?

A

malignant

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27
Q

how can you diagnose testicular cancer?

A
  • ultrasound can help with diagnosis

- chest and abdominal CT - to check for retroperitoneal and chest metastases

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28
Q

testicular cancer: lab value correlating with tumor bulk

A

LDH correlates with tumor bulk; also check B-HCG and AFP level

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29
Q

percent of testicular cancers that are germ cell

A

90% are germ cell - summon and nonseminoma

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30
Q

are undescended testicles (cryptorchidism) a problem?

A

increased risk of testicular cancer

- most likely to get seminoma

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31
Q

1 testicular tumor

A

seminoma

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32
Q
  • 10% have beta-hcg elevation
  • should not have AFP elevation
  • extremely sensitive to XRT
A

seminoma

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33
Q

tx: seminoma

A

all stages get orchiectomy and retroperitoneal XRT

  • chemo reserved for mets or bulky retroperitoneal disease (cisplatin, bleomycin, VP-16)
  • surgical resection of residual disease after above
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34
Q

chemo regimen: seminoma

A

cisplatin
bleomycin
VP-16

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35
Q

types of nonseminomatous testicular cancer

A

embryonal
teratoma
choriocarcinoma
yolk sac

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36
Q

90% have these markers in nonseminomatous testicular CA

A

alpha fetoprotein

beta-hcg

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37
Q

nonseminomatous testicular CA: classically this type of tumor are more likely to metastasize to the retroperitoneum

A

classically, tumors with increased teratoma components are more likely to metastasize to the retroperitoneum

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38
Q

tx: nonseminomatous testicular ca

A

all stages get orchiectomy and retroperitoneal node dissection

  • stage 2 or greater: also give chemo (cisplatin, bleomycin, BP-16)
  • surgical resection of residual disease after above
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39
Q

what part of the prostate is most common for cancer?

A

posterior lobe

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40
Q

prostate CA: most common site of metastases

A

bone

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41
Q

prostate mets to bone: XR

A

osteoblastic; xr demonstrates hyperdense areas

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42
Q

potential complication after prostate resection

A

many patients become impotent after resection; can get incontinence
- can also get urethral strictures

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43
Q

dx: prostate CA

A
  • transrectal BX
  • chest/ab/pelvic CT
  • PSA
  • alkaline phosphatase
  • possible bone scan
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44
Q

options for tx: prostate CA - intracapsular tumors and no metastases (T1 and T2)

A
  • XRT or
  • Radical prostatectomy + pelvic LN dissection (if life span > 10 years) - or -
  • nothing (depending on age and health)
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45
Q

tx: prostate CA - extracapsular invasion or metastatic disease

A

XRT and androgen ablation (leuprolide [LH-RH blocker], flutamide [testosterone blocker], or bilateral orchiectomy

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46
Q

tx: prostate CA - stage 1a disease found with TURP

A

Nothing

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47
Q

how does PSA trend with prostatectomy?

A

with prostatectomy, PSA should go to 0 after 3 weeks -> if not, get bone scan to check for metastases

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48
Q

what is a normal PSA?

A
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49
Q

what can increase PSA?

A

prostatitis, BPH, chronic catheterization

50
Q

increased alkaline phosphatase in a patient with prostate CA?

A

worrisome for metastases or extra capsular disease

51
Q

1 primary tumor of kidney (15% calcified)

A

renal cell carcinoma (RCC, hypernephroma)

52
Q

risk factor: renal cell carcinoma

A

smoking

53
Q

abdominal pain, mass, hematuria

A

renal cell carcinoma

54
Q

how does renal cell carcinoma present?

A

1/3 have metastatic disease at the time of diagnosis -> can perform wedge resection of isolated lung or colon metastases

55
Q

most common location for RCC metastases

A

lung

56
Q

what causes erythrocytosis in renal cell carcinoma?

A

secondary to increased erythropoietin (HTN)

57
Q

tx: renal cell carcinoma

A

radical nephrectomy with regional nodes; XRT; chemotherapy

58
Q

what composes radical nephrectomy?

A

takes kidney, adrenal, fat, Gerona’s basic, and regional nodes

59
Q

where does renal cell carcinoma like to grow?

A

predilection for growth in the IVC; can still resect even if going up IVC -> call pull the tumor thrombus out of the IVC

60
Q

when should you consider partial nephrectomy in management of renal cell carcinoma?

A

partial nephrectomies should be considered only for patients who would require dialysis after nephrectomy

61
Q

most common tumor in kidney

A

metastasis from the breast CA

62
Q

Renal cell carcinoma paraneoplastic syndromes

A

erythropoietin, PTHrp, ACTH, insulin

63
Q

tx: transitional cell CA of renal pelvis

A

Radical nephroureterectomy

64
Q

benign or malignant: oncocytomas

A

benign

65
Q

hamartomas; can occur with tuberous sclerosis; benign

A

angiomyolipomas

66
Q

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

A

Von Hippel-Lindau syndrome

67
Q
  • usually transitional cell CA
  • painless hematuria
  • males; prognosis based on stage and grade
A

bladder cancer

68
Q

risk factors: bladder cancer

A

smoking, aniline dyes, and cyclophosphamide

69
Q

dx: bladder cancer

A

cystoscopy

70
Q

tx: bladder cancer

A

intravesical BCG or transurethral resection if muscle is not involved (T1)

  • if muscle wall is invaded (T2 or greater) -> cystectomy with ileal conduit, chemotherapy, and XRT
  • mets: chemo
71
Q

chemo regimen: T2 or greater bladder cancer

A

MVAC:

  • methotrexate
  • vinblastine
  • adriamycin (doxorubicin)
  • cisplatin
72
Q

standard reconstruction option stage T2 or greater in bladder cancer

A

ileal conduit is standard reconstruction option

73
Q

why is ileal conduit standard reconstruction option for stage T2 or greater bladder cancer?

A

avoid stasis as this predisposes to infection, stones (calcium resorption), and ureteral reflux

74
Q

possible options for reconstruction in management of bladder cancer

A
  • ileal conduit
  • reservoirs
  • neobladders
75
Q

cause of squamous cell CA of bladder

A

schistosomiasis infection

76
Q
  • peaks in 15 year olds

- tx: bilateral orchioplexy (if testicle not viable, resection and orchioplexy of contralateral testis)

A

testicular torsion

77
Q

testicular torsion: usual location

A

torsion is usually toward the midline

78
Q

ureteral trauma: if going to repair end to end…

A
  • spatulate ends
  • use absorbable suture to avoid stone formation
  • stent the ureter to avoid stenosis
  • place drains to identify and potentially help treat leaks
79
Q

why avoid stripping soft tissue on ureter in repair of ureteral trauma?

A

avoid stripping the soft tissue on the ureter, as it will compromise blood supply

80
Q

where does BPH arise in the prostate?

A

arises in the transitional zone

81
Q

nocturia, dysuria, weak stream, urinary retention.

A

benign prostatic hypertrophy

82
Q

initial therapy: BPH

A
  • alpha blockers (terazosin, doxazosin - relaxes smooth muscle)
  • 5 alpha reductase inhibitors - finasteride (inhibits the conversion of testosterone to dihydrotestosterone -> inhibits prostate hypertrophy
83
Q

inhibits the conversion of testosterone to dihydrotestosterone -> inhibits prostate hypertrophy

A

finasteride (5-alpha reductase inhibitors)

84
Q

when do you consider TURP for BPH?

A

for recurrent UTIs, gross hematuria, stones, renal insufficiency, or failure of medical therapy

85
Q

post-TURP syndrome

A

hyponatremia secondary to irrigation with water; can precipitate seizures from cerebral edema

86
Q

tx: post-TURP syndrome

A

careful correction of Na with diuresis

87
Q

complication of most patients s/p TURP

A

retrograde ejaculation

88
Q
  • most commonly secondary to spinal compression
  • patient urinates all the time
  • nerve injury above T12
A

neurogenic bladder

89
Q

tx: neurogenic bladder

A

surgery to improve bladder resistance

90
Q
  • incomplete emptying

- nerve injury below T12; can occur with APR

A

neurogenic obstructive uropathy

91
Q

tx: neurogenic obstructive uropathy

A

intermittent catheterization

92
Q
  • incontinence due to cough, sneeze

- because of hypermobile urethra or loss of sphincter mechanism; women

A

stress incontinence

93
Q

tx: stress incontinence

A

kegel exercises, alpha-adrenergic agents, surgery for urethral suspension or pubovaginal sline

94
Q
  • incomplete emptying of an enlarged bladder
  • obstruction (BPH) leads to the distention and leakage
  • Tx: TURP
A

overflow incontinence

95
Q

tx: ureteropelvic obstruction

A

pyeloplasty

96
Q

tx: vesicoureteral reflux

A

reimplantation with long bladder portion

97
Q

most common urinary tract abnormality

A

ureteral duplication

98
Q

tx: ureteral duplication

A

reimplantation if obstruction occurs

99
Q

tx: ureterocele

A

resect and implant if symptomatic

100
Q

ventral urethral opening

A

hypospadias

101
Q

tx: hypospadias

A

repair at 6 months with penile skin

102
Q

dorsal urethral opening

A

epispadias

103
Q

tx: epispadias

A

surgery

104
Q
  • usually joined at lower poles
  • complications: UTI, urolithiasis, and hydronephrosis
  • tx: may need pyeloplasty
A

horseshoe kidney

105
Q

tx: polycystic kidney disease

A

resection only if symptomatic

106
Q
  • occurs in patients with bladder outlet obstructive disease (wet umbilicus)
  • connection between umbilicus and bladder
A

failure of closure of the urachus

107
Q

tx: failure of closure of the urachus

A

resection of sinus/cyst and closure of the bladder; relieve bladder outlet obstruction

108
Q

what can cause epididymitits?

A

sterile epididymitis can occur from increased abdominal straining

109
Q

worrisome for renal cell CA (left gonadal vein inserts into left renal vein; obstruction by renal tumor causes varicocele); could also be caused by another retroperitoneal malignancy

A

varicocele

110
Q

fluid-filled cystic structure separate from and superior to the testis along the epididymis
- tx: surgical removal if symptomatic

A

spermatocele

111
Q

management: hydrocele in adult

A

if acute, suspect tumor elsewhere (pelvic, abdominal); translucent

112
Q

MCC is diverticulitis and subsequent formation of colovesical fistula
- Dx: cystoscopy

A

pneumaturia

113
Q

cause of WBC casts

A

pyelonephritis, glomerulonephritis

114
Q

cause of RBC casts

A

glomerulonephritis

115
Q

fever, rash, arthralgias, eosinophils

A

interstitial nephritis

116
Q

pregnancy rate after repair of vasectomy

A

50%

117
Q

tx: priapism

A

aspiration of the corpus cavernosum with dilute epinephrine or phenylephrine
- may need to create a communication thru the glans with scalpel

118
Q

risk factors: priapism

A

sickle-cell anemia, hyper coagulable states, trauma, intracorporeal injections for impotence

119
Q

tx: SCC of penis

A

penectomy with 2 cm margin

120
Q

used to check for urine leak

A

indigo carmine or methylene blue

121
Q

tx: phimosis found at time of laparotomy

A

dorsal slit

122
Q

decreased production in patients with renal failure

A

erythropoietin

06 - absite (44 decks)

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