Corr Questions Flashcards
What are the causes of SUI in the female?
Urinary retention, DO, ISD, urethral hypermobility
Is oral estrogen indicated in SUI?
NO
What is the mechanism of Duloxetine?
serotonin and norepi reuptake inhibitor
How does Duloxetine work?
by increasing serotonin and norepi at synapse (increased bladder neck contraction)
IS an anterior repair indicated for SUI
NO, anterior colporrhaphy does not improve SUI
What are the two main colposuspensions?
retropubic suspensions: Marshall-Marchetti-Krantz & Burch
What is a side effect of MMK?
osteitis pubis due to suturing the periurethral tissue to the periosteum of the symphysis pubis
Which colposuspension has longer success?
Burch
what is the effectiveness of colposuspensions compared with slings?
both treat SUI, however slings cause less complications and less voiding dysfunction
what is the complication of retropubic suspension?
pelvic organ prolapse
what percentage of patients undergoing retropubic suspension will get POP?
14%
does sling erosion into the vagina need treatment?
only when symptomatic, may try estrogen cream first
erosion of a sling into the urethra or bladder requires what treatment?
removal of sling and repair
Worsening voiding symptoms after SUI procedure should produce what ddx?
infection, obstruction, erosion
Urethral obstruction in the immediate post operative period is treated with?
CIC and observation likely to resolve because its due to inflammation
what are the signs of osteitis pubis?
suprapubic pain, fever, decreased thigh ADDuction tx: conservative
radiation induced fistula should be repaired when?
at 6 months post radiation to allow formalization of tract
how long should you wait after VVF repair to obtain a cystogram?
2-3 weeks
martius flap is supplied by the internal pudendal art. After sacrifice of what artery?
external pudendal
what is the most common cause of vesicouterine fistula?
cesarean section
what is the imaging modality of choice for diagnosing vesicouterine fistula?
VCUG
what is the most common cause of colovesical fistula?
diverticulitis
what is the most common cuase of ureterocolic fistula?
Crohn’s disease and on the right
do you have to open the peritoneum to use a peritoneal flap?
no, it is mobilized without opening the peritoneum
what is the treatment for ureterovaginal fistula?
most resolve with stent
What are the symptoms of autonomic dysreflexia?
HTN, Bradycardia, Flushing, headache
What is autonomic dysreflexia?
exaggerated sympathetic activity in response to stimuli below the level of the lesion
what spinal cord lesion is required for risk of autonomic dysreflexia?
above T8
what is the bladder finding during spinal shock?
acontractile and areflexic with closed bladder neck
What is the classic dysfunction found in spinal cord lesions above T6?
detrusor overactivity with smooth sphincter dyssynergia
what is the classic dysfunction found in spinal cord lesions below T6?
detrusor overactivity with striated sphincter dyssynergia
Ice water test is administered, what is the result?
no contractions are seen with a lesion below S2
what are the classic symptoms of Shy-Drager (multisystems atrophy)
DO, urgency with high PVR and ED in a young male
what nerve does lower abd surgery damage?
inferior hypogastric plexus (parasympathetic)
what is the result of damage to the inferior hypogastric plexus on the bladder?
detrusor areflexia and ED
what is the classic finding in lumbar disk disease?
normal bladder compliance with difficulty voiding
what nerve is damaged with inguinal hernia repair?
ilioinguinal nerve
what is the innervation of the ilioinguinal nerve?
upper thigh sensation along with base of penis and scrotum
what provides motor function to the cremasterics?
genitofemoral nerve
how is the genitofemoral nerve damaged during surgery?
it travels in the psoas and is injured during psoas hitch
what is the nerves responsible for erections?
inferior hypogastric plexus
what nerve is responsible for penile sensation?
pudendal on the dorsal surface
The cremasteric muscle is congruent with what abd muscle?
internal oblique
What kind of antibiotics can penetrate an infected renal cyst?
lipophilic antibiotics
what are the lipophilic antibiotics?
cipro, clinda, batrim, chloramphenicol
how can you treat Schistosomiasis of the bladder?
praziquantel
what is the sensory of the genitofemoral nerve?
sensation of the cord, scrotum and anterior thigh
The hypogastric artery is also known as what?
internal iliac
what is the arterial supply to the prostate?
branch of the inferior vesicle artery from the hypogastric artery
what nerves are responsible for detumescence?
T10-L3 superior hypogastric plexus
what is responsible for detumescence?
increased phospholipase C which increases inositol which increases calcium within the smooth muscle
Normal LH?
2.0-8.0
Normal FSH?
2.0-12
Normal AFP?
Normal Beta-HCG
What does the bulbocavernosus reflex test?
S2-S4 nerve roots
what happens to the ureter during bladder filling?
intramural ureteral pressure and contraction frequency increase
what is the mechanism by which a bladder decompensates?
as the bladder fills intramural tension increases, decreasing the blood flow causing hypoxia
what is the inhibitory neurotransmitter used in the cortex on the pontine
GABA
At what vertebral body does the spinal cord end?
L1-L2 (conus medullaris)
after abdominal resection injury to what nerve results in urinary retention?
inferior hypogastric plexus (parasympathetic)
what is the most common bladder finding in the elderly with incontinence?
detrussor overactivity with impaired contractility (urgency with elevated PVRs)
what is normal ureteral peristalsis pressure?
35cmH2O
What muscle does the Kegel exercise use?
pubococcygeus via Pudendal nerve(S2-S4)
What stains positive for HMB-45?
AML (&Melanoma)
what is the most common benign renal mass
papillary adenoma
what is the most common metastases to kidney
lymphoma/leukemia
name the renal pseudotumors
column of Bertin, fetal lobulation, dromedary hump, nodular compensatory hypertrophy
On a DMSA renal scan, what do true tumors look like?
decreased isotope uptake
Birt-Hogg-Dube is
autosomal dominant
BHD gene is on with what chromosome?
17
What percentage of BHD will have renal tumors?
25%
BHD may cause what other signs?
fibrofolliculomas, air filled pulmonary cysts, pneumothorax
Classic triad of Tuberous Sclerosis?
Mental retardation, seizures, adenoma sebaceum
TS is
autosomal dominant
TSC1 and TSC2 genes are located where
Chromosome 9 and Chromosome 16
what is the risk of RCC with TS?
2%
what is the risk of AML with TS?
60%
von Hippel Lindau is
autosomal dominant
VHL gene is located
Chromosome 3
name the non-urologic manifestations of VHL
cerebellar & spinal hemangioblastomas, retinal angiomas
name the urologic manifestations of VHL
renal cysts, clear cell RCC, pheochromocytomoas, epididymal cystadenomas, epididymal cysts
Clear cell RCC occurs in what percentage of VHL?
50%
oncocytoma arises from the?
Collecting duct
what type of cytoplasm does oncocytoma have?
eosinophilic
the cytoplasm is packed with what in oncocytomas?
mitochondria
what medication is FDA approved to shrink AML in patients with TS?
Everolimus
what is the risk of RCC from cysts acquired from renal failure?
1-3%
Clear cell RCC cytoplasm is full of what?
glycogen and lipids
Clear cell RCC arises from?
proximal tubule
the cytoplasm of Chromophobe RCC is filled with?
microvesicles
Chromophobe RCC arises from
collecting duct
Hale’s colloidal iron stains positive for?
Chromophobe RCC
what is the most common form of RCC in patients with acquired cystic kidney disease?
Papillary RCC
why do patients get acquired cystic kidney disease?
renal failure
what is the most common RCC of patients on dialysis?
papillary RCC
papillary RCC arises from
proximal tubule
Papillary RCC is associated with what chromosomes?
polysomy 7 & 17, c-met mutation on Chromosome 7, Loss of Y-chromosome
what tumor has hobnail cells and stromal desmoplasia?
Collecting duct carcinoma
what is another name for collecting duct carcinoma?
Bellini duct carcinoma
what percentage of collecting duct carcinoma has mets at presentation?
40%
what renal tumor is associated with sickle cell trait?
renal medullary carcinoma
renal medullary carcinoma is seen in what race?
African American
what is the only renal tumor with racial predilection?
renal medullary carcinoma
Oncocytoma is associated with what syndrome?
BHD
Furhman grade does not consider what when formulating grade?
mitotic activity
what is the preferred treatment of a recurrence after nephrectomy?
tumor resection
RCC with solitary metastatic tumor, what is the treatment?
nephrectomy and meastasis resection
What is the only drug used in non-clear cell RCC?
temsirolimus
can you give chemo for RCC brain met?
no typically ineffective, tx with surgery or radiation to brain met
what drug achieved remission in metastatic clear cell RCC?
interleukin-2 (IL-2)
IL-2 is only effective against what type of RCC?
clear cell
what is mTor?
a protein that regulates hypoxia factors (HIF) & VEGF, when mTor is decreased cells reduce angiogenesis and proliferation
which mTor inhibitor is indicated in pts with short survival?
Temsirolimus
what drug is indicated in non clear cell RCC?
Temsirolimus
after failure of Tyrosine Kinase Inhibitors what can be used?
Everolimus
metastatic clear cell the preferred initial tx is?
sunitinib or pazopanib (TKIs)
Bevacizumab inhibits what
VEGF-A
what are the predictors of short survival?
2 or more metastatic sites, low hemoglobin, Ca >10, LDH >1.5 times normal, high ECOG
what indicates hyperfiltration injury after partial?
proteinuria
after how much kidney removed would hyperfiltration likely occur?
75% removed
how can you reduce risk of hyperfiltration injury?
ACE inhibitors
how does ACE inhibitors do that?
decreasing intraglomerular pressure
What is the risk of local recurrence of RCC in renal fossa?
what is the risk of RCC in the contralateral kidney?
1.20%
greater survival is seen with timing of metastasis in RCC
a longer inteval between RN and development of met (>2yr) is accociated with longer survival
medullary sponge kidney disease is associated with what chromosome?
RET oncogene
What is the differenatial diagnosis for Nephrocalcinosis?
Medullary sponge kidney, hyperparathyroidism, distal RTA (1), renal TB, papillary necrosis, hyperoxaluria
MSK disease has what appearance on KUB?
paint brush like appearance of calyces
What is the treatment for the cysts of medullary sponge kidney?
None
Multicystic dysplastic kidneys are associated with?
contralateral vesicoureteral reflux
All familial RCC disorders are
autosomal dominant
Papillary RCC type 1
cMet chromosome 7
Papillary RCC type 2
fumarate hydratase chromosome 1
Chromophobe RCC is associated with what chromosome?
folliculin, chromosome 17
what, if found in the bladder increases risk of upper tract TCC?
Inverted papilloma
if inverted papilloma is found in the bladder, what risk is increased?
upper tract TCC
what is the most important predictor of immediate graft function in living donor transplant?
donor urine output
why should the lower pole renal artery be preserved during transplant?
because it is blood supply to the upper ureter
most immunotherapy targets what?
IL-2 production which will inhibit T-cell activation
which immunotherapy has nephrotoxicity?
Tacrolimus/cyclosporin
which immunotherapy inhibits B-cell activation?
Rituximab
is CIC safe in transplant patients?
YES
Who can get IL-2?
good ECOG, no brain mets, normal cardiac & renal function
What agent can be used for non-clear cell
Temsirolimus
How do you know if a patient has short predicted survival?
3or more of the following:2 or more metastatic sites, low hemoglobin, calcium >10, LDH >1.5 times normal, systemic therapy initiated less than 1 year after the initial RCC dx
What agent is given to short survival patients?
Temsirolimus
What is indicated in AMLs?
Everolimus-in tuberous sclerosis patients whose AML does not require surgery
Is bevacizumab approved?
you must use it with Interferon alfa-2a
What is the mechanism of action for Bevacizumab?
Monoclonal antibody inhibits angiogenisis
Which agent will prevent good wound healing?
Bevacizumab, half life is 20 days
For metastatic RCC that is predominantly clear cell, the TKI preferred is?
sunitinib or pazopanib
Everolimus is indicated when?
treated of advanced RCC after failure of TKI
What is the only drug to achieve durable remission in patients with metastatic clear cell RCC?
IL-2
When is hyperfiltration injury most likely to occur?
if more than 75% of renal tissue is removed
what is hyperfiltration injury?
focal segmental glomerulosclerosis
what is an early harbinger of hyperfiltration injury?
proteinuria
How does ACE-inhibitors help prevent hyperfiltration injury?
reduces intraglomerular pressure
what is the treatment for solitary recurrence after nephrectomy?
resection wherever the recurrence is
invasive or free floating caval thrombus has a worse prognosis?
invasive
spermatogenesis occurs where?
in seminiferous tubules in the Sertoli Cell
how long does spermatogenesis in the ST take to complete?
74 days
Where does spermatozoa maturation take place
in the epididymis
where are mature sperm stored
cauda of the epididymis
what forms the blood-testis barrier
tight junctions between Sertoli Cells
what is sperm maturation?
as they travel through the epididymis, they acquire motility and ability to fertilize
what is the most common cause of male infertility?
varicocele
what is the most important risk factors for female infertility?
age >35
Cystic fibrosis transmembrane conductance regular gene is where?
Chromosome 7
CFTR causes
bilateral abscense of vas
CBAVD is associated with CFTR mutation
70%
Where are the Y micro-deletions?
long arm of Yq11 (AZF) region
A patient has a AZFc deletion, what is his chance of successful sperm extraction?
80%
a patient has a AZFa or AZFb deletion, what is their chance?
rare
what is the most common karyotype abnormality in male infertility?
Klinefelter’s 47XXY
What does sperm agglutination denote?
antisperm antibodies
what is sperm agglutination?
refers to sperm stuck or bound together
what is the minimum endocrine eval for infertility?
Testosterone and FSH
What is the normal value for FSH?
2.0 –>12.0
based on FSH, how can you diagnose primary testicular failure?
when FSH>2 times normal
When is a transrectal ultrasound indicated?
low sperm count, low ejaculate volume, and palpable vas - suspecting obstruction
What is the indication for testis biopsy?
azospermia, normal testis size, at least one palpable vas, normal FSH
when should vasography be used?
ONLY intraop if you are going to repare a ductal obstruction
What is the treatment for anti-sperm antibodies in the serum or seminal fluid?
these are not clinically significant
Which antibodies can be found in the genital tract?
IgG and IgA, NOT IgM
most common location of fertilization
ampulla of the fallopian tube
most proximal site of motile sperm?
caudal epididymis
penile vibratory stimulation requires what nerves?
T10-S4 therefore the injury must be above this area
where does capacitation occur?
in contract with vaginal vault
what gives negative feed back on GnRH on the hypthalamus?
testosterone and estrogen
what converts testosterone to estrogen?
Aromatase
what genetic inheritence is Kallman’s
X-linked
Y-microdeletions are found on what arm of the Y chromosome?
long arm Yq11
testis determining factor is found on what arm of the Y chromosome?
short arm
what is the fertility of Sertoli-cell only syndrome?
NONE should recommend adoption
what is the most important prognostic factor in vasectomy reversal?
time since vasectomy
how long can it take for sperm to return to ejaculate after vasectomy reversal?
one year
if the female is >37 and/or its been >15 years since vasectomy consider what?
ICSI
what is the treatment for sperm without acrosome (round head sperm)
ICSI
which testicluar germ cell type is most susceptible to damage from chemo/radiation?
spermatogonia
What are the causes of SUI in the female?
Urinary retention, DO, ISD, urethral hypermobility
Is oral estrogen indicated in SUI?
NO
What is the mechanism of Duloxetine?
serotonin and norepi reuptake inhibitor
How does Duloxetine work?
by increasing serotonin and norepi at synapse (increased bladder neck contraction)
IS an anterior repair indicated for SUI
NO, anterior colporrhaphy does not improve SUI
What are the two main colposuspensions?
retropubic suspensions: Marshall-Marchetti-Krantz & Burch
What is a side effect of MMK?
osteitis pubis due to suturing the periurethral tissue to the periosteum of the symphysis pubis
Which colposuspension has longer success?
Burch
what is the effectiveness of colposuspensions compared with slings?
both treat SUI, however slings cause less complications and less voiding dysfunction
what is the complication of retropubic suspension?
pelvic organ prolapse
what percentage of patients undergoing retropubic suspension will get POP?
14%
does sling erosion into the vagina need treatment?
only when symptomatic, may try estrogen cream first
erosion of a sling into the urethra or bladder requires what treatment?
removal of sling and repair
Worsening voiding symptoms after SUI procedure should produce what ddx?
infection, obstruction, erosion
Urethral obstruction in the immediate post operative period is treated with?
CIC and observation likely to resolve because its due to inflammation
what are the signs of osteitis pubis?
suprapubic pain, fever, decreased thigh ADDuction tx: conservative
radiation induced fistula should be repaired when?
at 6 months post radiation to allow formalization of tract
how long should you wait after VVF repair to obtain a cystogram?
2-3 weeks
martius flap is supplied by the internal pudendal art. After sacrifice of what artery?
external pudendal
what is the most common cause of vesicouterine fistula?
cesarean section
what is the imaging modality of choice for diagnosing vesicouterine fistula?
VCUG
what is the most common cause of colovesical fistula?
diverticulitis
what is the most common cuase of ureterocolic fistula?
Crohn’s disease and on the right
do you have to open the peritoneum to use a peritoneal flap?
no, it is mobilized without opening the peritoneum
what is the treatment for ureterovaginal fistula?
most resolve with stent
What are the symptoms of autonomic dysreflexia?
HTN, Bradycardia, Flushing, headache
What is autonomic dysreflexia?
exaggerated sympathetic activity in response to stimuli below the level of the lesion
what spinal cord lesion is required for risk of autonomic dysreflexia?
above T8
what is the bladder finding during spinal shock?
acontractile and areflexic with closed bladder neck
What is the classic dysfunction found in spinal cord lesions above T6?
detrusor overactivity with smooth sphincter dyssynergia
what is the classic dysfunction found in spinal cord lesions below T6?
detrusor overactivity with striated sphincter dyssynergia
Ice water test is administered, what is the result?
no contractions are seen with a lesion below S2
what are the classic symptoms of Shy-Drager (multisystems atrophy)
DO, urgency with high PVR and ED in a young male
what nerve does lower abd surgery damage?
inferior hypogastric plexus (parasympathetic)
what is the result of damage to the inferior hypogastric plexus on the bladder?
detrusor areflexia and ED
what is the classic finding in lumbar disk disease?
normal bladder compliance with difficulty voiding
what nerve is damaged with inguinal hernia repair?
ilioinguinal nerve
what is the innervation of the ilioinguinal nerve?
upper thigh sensation along with base of penis and scrotum
what provides motor function to the cremasterics?
genitofemoral nerve
how is the genitofemoral nerve damaged during surgery?
it travels in the psoas and is injured during psoas hitch
