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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

Orchiectomy through inguinal incision (not transscortal, do not want to disrupt lymphatics)

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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
Treatment of nonseminomatous testicular cancers?
Stage I: orchiectomy, prophylactic retroperitoneal node dissection Stage II+: orchiectomy, XRT, chemo; surgical resection of residual mets
26
What is the most common site of prostate cancer?
Posterior lobe
27
What is the most common site of mets from prostate cancer?
Bone
28
Complications of prostate resection?
Impotence, incontinence, urethral strictures
29
Where should PSA go after prostatectomy?
To 0 after 3 weeks
30
What is a normal PSH in a patient with a prostate gland?
<4
31
What does elevated alk phos indicate in a patient with prostate cancer?
Mets or extracapsular disease
32
What is the #1 tumor of kidney?
Renal cell carcinoma
33
Risk factor for RCC?
Smoking
34
What fraction of pts have metastatic disease at time of dx of RCC? Treatment for mets?
1/3 | Wedge resection of isolated lung and colon mets
35
Most common location for RCC mets?
Lung
36
What hematologic abnormality can occur with RCC?
Erythrocytosis secondary to elevated erythropoietin
37
Treatment for RCC?
Radical nephrectomy with regional nodes, XRT, chemo
38
What does a radical nephrectomy include?
Kidney, adrenal, fat, Gerota's fascia, regional nodes
39
What is done for tumor thrombus in IVC?
Pull it out
40
What is the most common tumor in the kidney?
Mets from breast
41
Paraneoplastic syndromes associated with RCC?
Erythropoietin, PTHrp, ACTH, insulin
42
Treatment for transitional cell CA of renal pelvis?
Radical nephroureterectomy
43
Tuberous sclerosis is related to what type of renal tumor?
Angiomyolipomas
44
What renal (and other) tumors are associated with Von Hippel-Lindau syndrome?
Multifocal and recurrent RCC, renal cysts, CNS tumors, pheochromocytomas
45
What is the usually bladder cancer type?
Transitional cell CA
46
Painless hematuria indicates what until proven otherwise?
Bladder cancer
47
Risk factors for bladder cancer?
Smoking, aniline dyes, cyclophosphamide
48
Treatment for bladder cancer?
Intravesical BCG or transurethral resection if muscle not involved If muscle invaded, cystectomy with ileal conduit, chemo, XRT
49
Squamous cell cancer of the bladder is related to what infection?
Schistosomiasis
50
Peak age of testicular torsion?
15
51
Treatment for testicular torsion?
Bilateral orchiopexy vs. resection and contralateral orchiopexy
52
Technique for ureteral trauma if going to repair end to end?
Spatulate ends Use absorbable suture to avoid stone formation Stent ureter Place drains Avoid stripping soft tissue, may compromise blood supply
53
Where does BPH arise?
Transitional zone
54
Initial therapy for BPH?
Alpha blockers: terazosin, doxazosin | 5-alpha-reductase inhibitors: finasteride
55
Indications for TURP?
Recurrent UTIs, gross hematuria, stones, renal insufficiency, failure of medical therapy
56
What is post-TURP syndrome?
Hyponatremia secondary to irrigation with water, can precipitate seizures from cerebral edema
57
Treatment for post-TURP syndrome?
Careful correction of Na with diuresis
58
Post-TURP ejaculatory complication?
Most patients will have retrograde ejaculation
59
What is the most common cause of neurogenic bladder?
Secondary to spinal compression
60
What level is the injury in neurogenic bladder?
Above T-12
61
What is neurogenic obstructive uropathy? Level of injury? Treatment?
Incomplete emptying Below T12 Intermittent cath
62
What is the cause of stress incontinence? Treatment?
Hypermobile urethra or loss of sphincter mechanism | Kegels, alpha-adrenergics, surgery for urethral suspension
63
What is the cause of urge incontinence? Treatment?
Sense of urgency or frequency because of involuntary detrusor contraction without neurologic disorder Anticholinergics, behavior modification, cystoplasy, urinary diversion
64
What is the cause of neuropathic incontinence? Treatment?
Urgency or frequency due to dec. bladder capacity; associated with neurologic conditions Treat underlying neurologic disorder, behavior modifications, surgical options
65
What is the cause of overflow incontinence? Treatment?
Incomplete emptying and enlarged bladder; BPH --> distention and leakage TURP
66
What is the cause of congenital incontinence? Treatment?
Continuous leakage and nocturnal enuresis; sphincter mechanism bypassed Surgical correction
67
Treatment for ureteropelvic obstruction?
Pyeloplasty
68
Treatment for vesicoureteral reflux?
Reimplantation with long bladder portion
69
What is the most common urinary tract abnormality?
Ureteral duplication
70
What is the treatment for ureterocele?
Resect and reimplant
71
Treatment for hypospadias?
(Ventral) repair at 6mo with penile skin
72
Treatment for epispadias?
(Dorsal) surgery
73
Complications of horseshoe kidney?
UTI, urolithiasis, hydronephrosis
74
What happens if there is failure of closure of the urachus? Treatment?
Connection between umbilicus and bladder; in pts with bladder outlet obstructive disease Resection of sinus/cyst, closure of bladder
75
Concern when varicocele diagnosed?
RCC: L. gonadal v inserts into L. renal v., obstruction by renal tumor causes varicocele
76
What is the most common cause of pneumaturia?
Diverticulitis and subsequent formation of colovesical fistula
77
What is indicated by WBC casts?
Pyelonephritis, glomerulonephritis
78
What is indicated by RBC casts?
Glomerulonephritis
79
How will interstitial nephritis present?
Fever, rash, arthralgias, eosinophils
80
What is the pregnancy rate after repair of vasectomy?
50%
81
What is the treatment for priapism?
Aspiration of the corpus cavernosum with dilute epi or phenylephrine
82
Risk factors for priapism?
Sickle-cell anemia, hypercoagulable states, trauma, intracorporeal injections for impotence
83
Treatment for SCC of penis?
Penectomy with 2cm margin
84
What is the treatment for phimosis found at time of laparotomy?
Dorsal slit
85
Where is a spermatocele found? Treatment?
Separate from and superior tot he testis along epididymis | Surgical removal

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