Final Flashcards
1
Q
Two jobs of the testis!
A
Produce sperm Secrete hormones (testosterone)
2
Q
Scrotum (3) points
A
Contains testi at lower temperature to allow for optimal sperm production
Prone to injuries
Easy to exam (6x4cm)
3
Q
Testicular masses are (4)
A
Often firm solid
Painless
Do not trans illuminate
Usually malignant
4
Q
Scrotal masses and those in the epididymis or spermatic cord are (3)
A
Painful
Transilluminate
Usually benign
5
Q
Erecticle mechanisms
A
Corpora cavernous a
6
Q
Contains urethra
A
Corpus spongiform
7
Q
Surrounds erectile tissue
A
Tunica albuginea
8
Q
American academy of pediatrics and circumcision
A
Found links between circumcision and decreased risk of urinary tract infections, rare penile cancer, HPV, HIV and other STI’s
9
Q
Cons of circumcision (5)
A
Hemorrhage Infection Pain/trauma Diminished sensation > mother/child bonding
10
Q
What do seminal vesicles do?
A
Secretes 70% of fluid components of semen = energy/fluidity for sperm
11
Q
Hypothalamus -> ___ -> pituitary -> __ & __
A
Hypothalamus -> GnRH -> pituitary -> LH & FSH
12
Q
Leydig cells produce ?
A
Testosterone
13
Q
What acts on leydig cells to produce testosterone?
A
LH
14
Q
What two hormones stimulate spermatogenesis?
A
testosterone and FSH
15
Q
How many sperm does a man produce each day?
A
70-100 million
16
Q
Penile disorders (7)
A
Lesion (HPV, molluscum, Bowens) Balanitis Posthitis Hypospadius Peyronie's disease Priapism Tumors
17
Q
What is the peak age of tumors?
A
60.
These are rare, tend to involve the prepuce or glans
18
Q
HPV
A
Painless, enlarging wart-like growth (condylomata acuminata)
19
Q
Leukoplakia
A
Hyperkeratotitic
Scaly
White patches
On penile epithelium
20
Q
What is necessary with suspected leukoplakia?
A
Biopsy!
21
Q
Bowen’ disease (5)
A
Intraepdidermal PRECANCEROUS infuriated erythematous plaque
Ulcerated center
Development of pinkish or brownish applies covered with a thick horny layer (haha horny!?)
22
Q
What is necessary with suspected Bowen’s disease?
A
Biopsy!
Also leukoplakia
23
Q
2 skin cancers to worry about with penile lesions
A
Squamous cell carcinoma
Melanoma
24
Q
Balantis. What is it and what percentage of urology patients?
A
Inflammation of glans in 11%
25
Causes for balantis (8)
```
Uncircumcised with poor hygiene or over hygiene
Diabetes
Chemical irritants
CHF, cirrhosis, nephorsis
Drug allergies
Obesity
Infections
Penile cancers
```
26
What are 6 infections that can cause balantis?
```
Candida
HPV
Anaerobes
Treponema
Gardnerella
Trichomonas
```
27
Hyposadius
Urethral opening on ventral surface
28
Is hyposadius or episadius more common?
Hyposadius
29
What is episadius?
Urethral opening on the dorsal surface
30
What are 3 causes of hyposadius and episadius?
Exposure to PG hormone
Finesteride and lack of T in utero
Inherited
31
What are hyposadius and episadius often associated with? (2)
Inguinal hernias
| Cryptorchorchidism
32
Priapism - what is it?
Non-erotic sustained painful erection with acute onset.
33
Priapism - why?
Glans remains soft because involves the corpora cavernous a but not spongiosum
34
What is the cause of priapism? (2)
Unknown
Possible associated with leukemia, mets, local trauma, sickle cell disease, SC trauma, circulatory disturbances, medications (viagra, levitra)
35
Treatment for priapism (2)
Spontaneously resolves in few hours, ice water, enema
| Pharmaceutical intervention, drainage is rare cases
36
Peyronie's
Plaques/strands of dense fibrous tissue surrounding corpus cavernosum
This leads to deformity and painful erection; impotence
37
Signs and symptoms of peyronie's (4)
Hardened tissue
Pain during erection
Curvature with erection
Distortion (indentation, shortening)
38
Indicdence of peyronie's and common age group
1-3% of men
| MC in 45-60 years old
39
Etiology/risk factors of peyronie's (5)
```
Unknown
Trauma (surgery, injury)
Inherited HLA-B7 (SLE, scleroderma)
30% of patients develop fibrotic tissue in other area of body (Dupuytrens contracture)
Diabetics
```
40
How to diagnose peyronie's
Exam and vasoactive injection to cause erection
41
Treatment for Peyronie's (3)
Watch and wait 1-2 years, often resolves
Non-surgical treatment within 6 months of diagnosing (Calcium channel blockers, collagenase, cortisone)
Surgery in severe/persistent cases. Can cause partial loss of erectile function, penis length, urethral damage, infection, sensation
42
Symptoms of penile cancer (3)
Penile growths or sores
Abnormal penile discharge
Bleeding
43
Where is the most common site for penile cancer (2)
Glans and foreskin
44
Risk factors for penile cancer (4)
NON CIRCUMCISED DIRTY MEN
HPV infection (only certain strains, low risk factor)
Smoking
Mostly >50 years old
45
Stats for chance of penile cancer circumcised vs. uncircumcised
1/600 uncircumcised
| Circumcised 1/1500
46
Penile cancer treament (3)
Surgery (excision, laser, circumcision, partial to complete penectomy, nodal dissection)
Radiation
Chemotherapy (topical, oral/IV)
47
Scrotal masses/disease (6)
```
Hydrocele
Variococele
Inguinal hernia
Epididymitis
Orchitis
Testicular cancer
```
48
Characteristics of scrotal masses (4)
Painless or painful lump or swelling
Solid or cystic, on or around testicles
Can develop at any age
Malignant OR benign
49
How would one evaluate a scrotal mass?
ULTRASOUND!
50
What is the MC reason for visit/referral to a urologist?
SCROTAL MASSES
51
How do most men discover scrotal masses?
By touching themselves.
| I mean, by performing their own scrotal exam
52
Causes of scrotal masses (5)
```
Cysts
Infection
Inflammation
Hernia
Tumors (benign or malignant)
```
53
Where are malignant tumors of the scrotum?
MC within the testicles
54
What IS crytorchidism? (2)
```
Undescended testes
Abdominal testicle
Pubo-scrotal testicle
Femoral testicle
Perineal testicle
```
55
Preterm infants have 30% risk of what?
Cryptorchidism
56
What is cryptorchidism associated with? (3)
Risk of testicular cancer
Infertility
Torsion
57
An individual with testicular torsion will present with what? (3)
Sudden severe pain, swelling, erythema
Lower abdominal pain, N/V
Worse with lifting the testicle (ddx epididymitis)
58
How would you ddx testicular torsion from epididymitis?
Pain is worse with listening the testicle
59
Testicular torsion affects how many males before what age?
1/160 males before 25 years old
| MC 10-16 years of age
60
T/F: testicular torsion is a medical emergency
TRUE.
Surgery within 6-8 hours may prevent atrophy; 80% good prognosis.
Preservation is doubtful after 2 hours
61
What is advised if surgery is delayed for testicular torsion beyond 48 hours?
Orchiectomy.
| Take dem balls out
62
Hydrocele - what is it?
Collection of fluid in sheath (tunica) that holds the testicle
63
Cause of hydrocele?
Excess fluid production or decreased fluid absorption
64
Signs and symptoms of hydrocele (5)
```
Painless
Swollen
Soft
Uni or bilateral mass
WILL TRANSILLUINATE (ddx variocele)
```
65
What is on your ddx for a painless, swollen, soft unilateral or bilateral mass that will transilluminate? (1)
Hydrocele (varicoceles do not transilluniate)
66
These occur most often in older men
Hydrocele
67
Hydrocele etiology (4)
Trauma
Radiation therapy
Inflammation
Congenital
68
Bag of worms
Varicocele
69
Varicocele. What is it?
Blood backs up in the veins leading form the testicles due to valve dysfunction.
BENIGN PAINLESS SCROTAL SWELLING
70
Benign painless scrotal swelling
Varicocele
71
Varicoceles are most common on what side of the body?
LEFT SIDE
- left spermatic vein empties into left renal vein
- Right spermatic vein empties into inferior vena cava
72
Signs and symptoms of varicocele
```
May feel heavy
Better with lying down
Achy
Testicular atrophy
Infertility
Visibly enlarged vein
WILL NOT TRANSILLUMINATE (ddx from hydrocele)
```
73
What scrotal mass will transilluminate?
Hydrocele
74
Varicocele incidence, MC age group and what percent of infertile men?
10-20%
15-25 years
40% of infertile men (d/t increased testicular temperature)
75
Risks for varicocele (3)
Pelvic floor stress (constipation, heavy lifting)
Vascular damage
Hereditary tumor
76
Diagnostic evaluation of varicocele (2)
Ultrasound
| Venogram (dye/xray)
77
Treatment for varicocele (4)
Scrotal support (tighter underwear)
Surgical ligation (Varicocelectomy)
Embolizastion
Laparoscopy
78
Recurrence rate and what percent develops a hydrocele?
5-20% reoccur
| 2-5% develop a hydrocele
79
Inguinal hernia
Protrusion of abdominal contents (usually small bowel) through weak point of abdominal wall
- usually where vas deferens passes
80
Signs and symptoms of inguinal hernia (2)
Bulge in the groin area that may extend into the scrotum
| Painful or uncomfortable
81
Treatment for inguinal hernia
Surgical repair
82
Which inguinal hernia is more common? Direct/indirect
Indirect!
83
Epididymitis
Infection in tubular coil (epididymis)
84
What does epididymis do?
Collects sperm from testes
85
Where is pain felt with epididymitis?
Pain in top and rear of scrotum
86
What is epididymitis often a complication of? (4)
Gonorrhea/chlamydia
| Enterobacteriaceae or pseudomonas (w/ prostatitis)o
87
Signs and symptoms of epididymitis (2)
Pain is generally severe and insidious
| Fever and swelling are common
88
Treatment for epididymitis (2)
Antibiotics
| STI screen
89
Orchitis - what is it?
Inflammation of testis
90
What is orchitis d/t ? (2)
Bacterial infection
Mumps virus
- 20-35% mump cases will progress to orchitis
91
What is irreversibly damaged in 30% of mumps cases?
Spermatogenesis
92
Orchitis may be concurrent with what two conditions?
Prostatitis or epididymitis
93
What are three signs and symptoms of orchitis?
Pain
Swelling
Heaviness
94
Orchitis can cause permanent damage to testicles resulting in what 3 things?
Diminished size
Inadequate hormone production
Infertility
95
Scrotal mass differential diagnosis (6)
```
Epididymitis
Hydrocele
Variococele
Hernia
Orchitis
Cancer!
```
96
This cancer is highly treatable (95%)when detected and treated early
Testicular cancer
97
This is the MC cancer in men 15-34 years old
Testicular cancer
98
Testicular cancer risk factors (6)
```
Cryptorchidism
Genetic
Caucasian increased incidence 4-5 x
Family history (2%)
HIV
No icnreased risk with injury or vasectomy
```
99
What aspects of cryptorchidism increases your risk of testicular cancer ? (2)
Treatment of cryptorchidism
| 3-17 x higher risk if cryptorchidism is left untreated
100
What two genetic conditions increase your risk of testicular cancer
Klinefelter's syndrome (congenital XXY)
| Chromosome 12 abnormality
101
Symptoms of testicular cancer (7)
1. No symptoms
2. Unilateral enlargement or change in way it feels
3. Painless lump or swelling or collection of fluid (thus self screen every month!)
4. Dull ache in back, groin or lower abdomen!
5. Gynecomastia &/or mastalgia
6. Testicular discomfort/pain or feeling of heaviness
7. Occasionally, initial symptoms are related to mets of lungs, abdomen, pelvis or brain
102
Secondary testicular cancer (3)
Cancer metastasizes from primary cancer (ie. Hodgkins)
Testicular lymphoma = MC than testicular cancer in men
Others: prostate, lung, skin
103
Staging and 5 year survival rates in patients with testicular cancer
1 (just in testicle) - 98%
2 (mets to nodes) - 97%
3 (mets above diaphragm or to viscera) - 72%
104
How would one diagnose testicular cancer from the physical exam? (3)
Firm, non-tender testicular mass that DOESN'T TRANSILLUMINATE
Fluid collection
Regional LAD
105
Imaging for testicular cancer
| 4
1. US
2. CXR
3. Abdominal CT
4. Biopsy if other tests inconclusive
106
Blood tests for testicular cancer (DIAGNOSIS)
AFP, beta HCG, LDH
- these can also be used to monitor response to treatment
NO SCREENING TESTS
107
Treatment for testicular cancer (6)
Radical inguinal orchiectomy
Retroperitoneal lymph node dissection with metastatic disease
Testicular prosthesis available
Sperm bank before treatment
Radiation ~ adjunct treatment to orchiectomy
Chemotherapy
108
Prostate disorders (4)
Prostatitis
Prostadynia
Benign prostate hyperplasia (BPH)
Prostate cancer
109
Prostatitis types (2)
Acute
| Chronic (Bacterial and non-bacterial)
110
Prostate related complaints (3)
Pain, discomfort, urinary and sexual problems
2nd leading cause of urinary tract problems
Prostate is common cause of visits to PCP and urologists
111
Definition of prostatitis
Inflammation of the prostate
112
T/F Prostatitis is contagious and considered an STI
False: not contagious; not STI unless due to NG/Ct
113
Symptoms of prostatitis (7)
Very symptomatic (Acute) to asymptomatic (chronic)
Tender/swollen prostate
Fever, chills (in acute)
Dysuria, nocturnal, urgency, hesitancy, frequency, hematuria
Pelvic/abdominal pain
LBP, joint/muscle pain
Painful ejactulation
114
Risk factors for prostatitis (7)
```
Catheterization
Unprotected vaginal and/or rectal intercourse (GC, CT)
Abnormal urinary tract
Recent cystitis
Enlarged prostate (BPH)
Diabetes
Immunocompromised
```
115
Acute bacterial prostatitis symptoms (7)
Sudden onset, chills, fever, LBP, body aches, dysuria/frequency/urgency/nocturnal, perineal pain
116
Cause of acute bacterial prostate 'tis (2)
Overgrowth of bacterial normally found in prostatic fluid (ie escherichia coli which also causes most UTI's)
STI
117
Treatment of acute bacterial prostatitis (2)
ER referral
| Treat with antibiotics
118
PE for acute bacterial prostatitis (2)
Tender, swollen, infuriated prostate
| Purulent prostatic secretions, if obtained
119
What often accompanies acute bacterial prostatitis?
Bacteriuria
120
Chronic prostatitis two groups
```
Chronic bacterial (infectious) prostatitis
Chronic non-bacterial prostatitis
```
121
Symptoms of chronic prostatitis (6)
```
Suprapubic pain
LBP
Dysuria
Nocturnal
Intermittent
Waxing/waning
```
122
Chronic bacterial (infectious) prostatitis often follows
Episodes of acute prostatitis
123
Signs and symptoms of chronic bacterial (infectious) prostatitis
Insidious onset
Often associated with recurrent UTI's
Symptoms less severe/intermittent vs. acute prostatitis (thus no fever, although they may come and go)
124
Causes of chronic bacterial (infectious) prostatitis (2)
Chlamydia trachomatis
| Ureaplasma urealyticum
125
T/F longstanding prostatitis maybe associated with underlying prostate defect which harbors presistent bacteria (BPH, anatomical variant)
True
126
Chronic NON bacterial prostatic
MOST GENERAL AND MC = still waxes and wanes but no apparent cause
Symptoms similar to CBP WITHOUT FEVER AND BACTERIAL INFECTION
127
Pathogenesis of chronic bacterial prosatatis
Usually unknown: WBC in urine/prostatic secretions without identifiable causative agent
128
Theories for chronic non-bacterial prostatitis (5)
Infectious agents undetected by standard lab tests
Heavy lifting causing urine retention
Physical activity may irritate/inflame prostate
Pelvic muscle spasm may lead to increased prostate pressure
Structural abnormalities; urethral narrowing = pressure
129
Diagnosis of chronic non-bacterial prostatitis
DIAGNOSIS OF EXCLUSION
130
Diagnosing prostatits - Lab (5)
Prostate stripping (massage) and culture discharge (expressed prostatic secretion (EPS0
WBCs in EPS is not diagnostic of bacterial prostatitis; also associated with nonbacterial prostatitis, urethritis, prostatic stones, recent ejaculation
PH of prostatic fluid rises when infection is present, 6.5 > 8.0
Pre/post massage collection of urine for culture
PSA levels often elevated (collect pre-DRE) - repeat testing 6 weeks after resolution of prostate tissue
131
DRE in prostatitis (6)
Size, symmetry, consistency, lumps/nodules, discomfort/pain
| May palpate prostatic stones (stones may cause recurrent infections)
132
Classic presentation of prostatitis
Symptomatic patient
Enlarged, soft/boggy gland
Moderately-to-severely tender on palpation
133
Acute prostatitis lab work
WBCs and bacteria in urine/prostate fluid with acute onset and systemic symptoms
134
Chronic bacterial lab work
WBCs and bacteria in urine/prostate fluid with insidious onset
135
Chronic non-bacterial lab work
May see WBC in urine or prostate fluid
| No evidence of infection
136
Treatment of acute prostatitis
Antibiotics 7-10 days, repeat if symptoms do not resolve
137
Treatment of chronic prostatitis (3)
Antibiotics 4-12 weeks 60% will clear up
NSAIDS to palliative symptoms
Sits bath may provide symptomatic improvement
138
Treatment of non-infectious prostatitis (2)
Reduce inflammation: NSAIDs, natural COX2 inhibitors
| Relax tissue, decrease congestion
139
If recurrent prostatitis,what should you look for?
Underlying causes:
| Diabetes, encourage safe sex, test/treat STI
140
Prosatdynia - what is it?
symptoms of prostatitis-like pain occur in 11% of american men (without known cuasE)
141
T/F: Approxiamtely 95% of men diagnosed as chronic prostatitis have no evidence of bacterial infection or inflammatory cells in the prostatic fluid.
True
142
Prostadynia AKA
Chronic pelvic pain syndrome (cpps0
143
Symptoms of prostadynia (3)
Prostatits symptoms without inflammation or bacterial infection
Pain in pelvis or perineum, can extend to penis, testes, rectum
May cause voiding or sexual dysfunction
144
Cause of prostadynia:
Unknown; pain may be due to muscle spasms or MSK conditions, like nerve entrapment
145
What may be helpful in decreasing symptoms and is routinely prescribed?
Finesteride (for BPH)
146
Pudendal nerve entrapment causes (3)
Impact trauma
Surgery
Congenital malformations
147
Symptoms of pudendal nerve entrapment (4)
Pain in penis, scrotum, perineum or anorectal area
Prostatitis like pain and voiding/sexual dysfunction = hallmark of PNE
Aggravated by sitting, relieved by standing, lying
PNE is a clinical diagnosis
148
What is aggravated by sitting, relieved by standing/lying?
Pudendal nerve entrapment
149
What is the hallmark symptom of pudendal nerve entrapment?
Prostatitis like pain and voiding/sexual dysfunction
150
Diagnosis and treatment of PNE (7)
```
Imaging = no good
R/O causes of prostatitis (Urology referral)
DC (Evaluation and management)
Acupuncture
PT
Meds/supplements
Decompression surgery
```
151
Mechanism of PNE (4)
At ischial spine b/w sacrotuberous and sacrospinous ligaments
Nerve may be ensheathed by ligamentous expansions that form a perineural compartment
At pudendal canal, nerve can be compressed by falciform process of sacrotuberous ligament
If thickened, duplication of obturator fascia may act as an entrapment site
152
Benign prostate hyperplasia (BPH): malignant potential?
No - it's benign, not precancerous!
153
Incidence of BPH
25% by 40
50% by 60
75% by 70
90% over 80
154
Increased incidence of BPH in what population?
African americans
155
Etiology of BPH (4)
Unknown
AGE
Hormones (low testosterone, high estrogen; increased sensitivity to DHT in prostate)
Hyperplasia nearly always occurs in transitional zone (around prostatic urethra and extends peripherally. This is easy to feel!)
156
What percentage of patients have symptoms with BPH?
20%
157
What are some symptoms of BPH (5) and why?
Partial obstruction of lower urinary tract
- difficulty initiating urine stream (hesitancy)
- Interruption of stream
- increased frequency
- increased urgency
- Nocturia
158
What is found in the rectal exam with BPH? Vs. cancer? Vs. prostatitis?
```
BPH = Non-tender, soft, boggy
Cancer = rock-hard
Prostatitis = painful
```
159
Natural history of BPH
If untreated, it will progress!
160
Complications of BPH (4)
Decreased QOL, ADL's
Residual urine increases risk of UTI and acute urinary retention: rare but ER referral
Complete obstruction = surgery
DOES NOT, by definition increase risk of developing prostate carcinoma
161
How to diagnose BPH through history and physical
DRE
| AUA symptom index questionnaire
162
How to diagnose BPH through Labs?
PSA elevated !
163
PSA will be elevated in what conditions (4)
BPH
Prostate cancer
Recent ejaculation/DRE(~2 days)
Prostatitis
164
T/F: Anything that stimulates, bothers or runs through prostate will cause PSA to increase.
True
165
Digital rectal exam (DRE) - what is it used for?
Screening exam for colorectal cancer and prostate cancer
166
What do you do in a DRE? (4)
Palpate prostate. Normal = rubbery, walnut size 4cm, symmetricaland absent of any nodules or polyps
Evaluate rectal wall on your way out
Start at age 50 (Earlier with symptoms or risk factors)
Rectum: smooth without abnormalities or unusual lumps, swelling or tenderness
167
PSA is produced by
Cells of prostate capsule and periurethral glands.
| Increases w/ age, although normals vary with age (thus look at PSA velocity!)
168
What are normal levels of PSA?
0-4.0ng/mL
169
When do you refer patients for transracial ultrasound (TRUS) (5)
PSA 4-10ng/mL with abnormal DRE
PSA >10ng/mL, regardless of DRE
Consider PSA velocity
Palpable nodule on DRE, regardless of PSA
Patients with UTI, prostate THIS, recent biopsy should have PSA test deferred to avoid potentially unnecessary biopsy
170
Finasteride (proscar) inhibits peripheral conversion of testosterone to DHT, blocking growth effects of DHT. What is this associated with lower risk of?
Acute urinary retention and need for surgery
Note: finasteride is a 5-alpha reductase inhibitor
Other meds include alpha blockers which relax smooth muscle but don't decrease prostate size
171
What is TURP (Transurethral resection of the prostate)
Core out middle part of prostate to open lumen
172
What are other options other than TURP?
Laser/thermoablation
| Prostatectomy
173
Complementary care for BPH
Reduce hyperplasia by inhibiting conversion of T to DHT
Prevent estrogen from binding to estrogen receptors
SAW palmetto!
174
What are the benefits of SAW palmetto?
May improve urine flow and decrease symptoms while avoiding negative SE of conventional tx
DOESN'T AFFECT PSA LIKE MEDICATIONS (EXAM Q)
175
Which CAM produce doesn't affect PSA like medications?
Saw Palmetto
176
Side effects of saw palmetto? (3)
HA
Nausea
Dizziness
177
Other supplements and botanicals for BPH (4) for mild/moderate symptoms
```
Amino acids
Beta-sitosterol
Zinc picolinate
Pygeum
Nettles (urticaria diocia)
```
178
Male sexual dysfunction is 50% greater in what age group?
Men over 40
179
What do you see with male sexual dysfunction? (3) which is most common?
```
Decreased libido
Ejaculatory disturbances
Erectile dysfunction (MC)
```
180
Physical causes of male sexual dysfunction
| 4
Drugs
Blood flow abnormalities
Nerve abnormalities
Hormonal abnormalities (andropause, testosterone levels declining between 40-70 years old; SHBG increases as well)
181
Psychological causes (4)
Depression
Stress
Performance anxiety
Misinformation about sexuality
182
Androgen decline in aging men (ADAM) symptoms (5)
```
Mood dysfunction
Sexual dysfunction (libido loss, erectile dysfunction)
Osteoporosis
Muscle atrophy
Cognitive changes
```
183
Lab testing for ADAM (2)
Free and total testosterone (diurnal variation)
| LH, PRL
184
Other factors that may compound testosterone deficiency in ADAM? (5)
```
Stress: physical and psychological
Obesity
Diabetes, IR
Pituitary tumors
Drugs (cimetidine, digoxin spirnolactone)
```
185
What must you rule out with ADAM? (4)
Hypothyroid
Depression
Anemia
Prolactinoma
186
Which cancer is MC type of cancer in Men in US and the second leading cause of cancer death in men
PROSTATE CANCER!
187
1/6 men will get which cancer?
Prostate! Damn !
188
Etiology of prostate cancer
Unknown cause
| Genetic, hormonal, environmental factors may play a role
189
Carcinoma growth can be inhibited by (2)
Orchiectomy or use of estrogen therapy
| Decrease/eliminate testosterone which feeds prostate cancer cell growth
190
Risk factors for prostate cancer (6)
1. Age >50
African american (testing should begin at 40 years old) (AA>caucasian>asian)
Family history (Testing should begin at 40 years old)
High fat diet, sedentary lifestyle and obesity
Vasectomy
SMOKING
191
How to decrease the risk of prostate cancer? (4)
Annual DRE & PSA (50 w/out risk factors; 40 with)
Educate patients (finesteride reduces prevalence)
Diet (soy, vitamin E, selenium, fruits, lycopene)
Lifestyle (smoking, obesity, sedentary, ejaculation 4x's/week)
192
Majority of prostate carcinomas arise in
Peripheral tissues thus they're palpable (they feel like a pebble)
193
T/F: Prostate cancer is less likely to cause urinary obstruction
TRUE! Because it's peripheral, not central circa urethra (BPH)
194
Prostate cancer METS go where? (5)
Regional lymph nodes, seminal vesicles, spine, rectum bladder are most common
195
Prostate carcinoma clinicals are
```
Often silent (no inflammatory processes)
Peripheral not central so do not cause obstruction
```
196
15-20% prostate carcinoma are discovered in what?
TURP's (Transurethral resection of prostate)
197
When are TURP's performed?
BPH, not for cancer!
198
Signs and symptoms of prostate cancer (3)
Blood in urine or semen
Pain/stiffness in back, hips, upper thigh or pelvis
Often if patient also has BPH (nocturnal, inability to urinate, painful ejaculation, pain or burning during urination, weak or interrupted urinary flow)
199
T/F: BPH causes cancer
FALSE!
| BPH does NOT cause cancer, but CAN coexist!
200
Diagnosis for prostate cancer (6)
DRE
PSA
TRUS (transrectal ultrasound) & biopsy (Diagnosis)
PAP - prostatic acid phosphatase (increases as disease progresses)
Gleason scoring: based in size and path
CT scan, bone scan: check for mets
201
PSA is produced by (2)
Both normal and neoplasticism cells
202
PSA is elevated in
BPH
PROSTATITIS
Adenocarcinoma of prostate
203
Elevated PSA values take on much more significance when combined with (4)
DRE
Repeated PSA = velocity
TRUS
Needle biopsy
204
Serial follow up of PSA in patients with prostate cancer is useful to monitor (2)
Recurrence
| Progression
205
PSA increases accuracy of what in staging? (2)
DRE and TRUS
206
Following radical surgery or radiotherapy PSA levels should be normal after how many months?
18 months
207
Rising PSA level may indicate what?
Residual/recurrent disease and should be investigated
208
Gleason score
2 tissue samples taken from different areas of tumor. Sum of two produces gleason score:
2-4 = well differentiated
>6 = potentially indolent
5-7 = moderately differentiated
8-10 = poorly differentiated
> 10 = aggressive tumor likely requires aggressive treatment
209
Stages of prostate cancer
Stage one in one area of prostate
Stage two bigger and in two areas of prostate
Stage three in multiple areas extended passed areas of prostate
Stage four spread to lymph nodes
210
Low risk (3)
PSA <10
Gleason <6
Stage T1c, T2a
211
Intermediate risk (3)
PSA 10-20
Gleason 7
Stage T2b
212
High risk (3)
PSA>20
Gleason 8-10
stage T2c
213
T/F: when cancer is confined to prostate, disease is often curable
True:
| 85-90% 10 year survival in patients with limited disease
214
When there is metastitis, life expectancy is often less than how many years?
3 years
| 10-15% 10 year survival in patients with disseminated disease
215
Medical treatment for prostate cancer
```
Determined by stage, age, overall health
Watchful waiting (elderly, poor health, early stage)
Hormone therapy (antiandrogens, viaduct
```
216
What are side effects of hormone therapy for prostate cancer? (8)
```
Depression
Gynecomastia
HA
He matures
Hot flashes
Decreased energy
Urethral or bladder outlet obstruction
Local reaction
```
217
Treatment for bone metastasis (2)
Bone mets = hypercalcemia, fractures
| Bisphosphonates (fosamax) increases bone density and slows loss
218
What therapy is used for smaller tumors?
Brachytherapy - radioactive capsule implants "Seeds"
219
Which radiation therapy is most optimal when disease has spread to surrounding tissues?
External radiation treatment (XRT)
220
What surgical options are available for treatment of prostate cancer
Cryosurgery
Radical prostatectomy (prostate, seminal vesicles, pelvic lymphnodes)
Laparoscopic radical prostatectomy
221
What type of diet increases risk for prostate cancer
High fat diet
| Omega 6 FA stims prorstate cancer cell growth
222
What other dietary supplements or modifications are beneficial for prostate cancer? (5)
```
Soy decreases growth of prostate cancer cells (mice)
Vitamin E
Vitamin A (deficiency = risk factor)
Vitamin D (deficiency = risk factor)
Selenium = protective effect
```
223
Animal fat increases levels of what (2)
Circulating Testosterone and estrogen
224
What inhibits prostate cancer in vitro?
Soy foods (isoflavanoids)
225
Examples of lycopene
Fruits and vegetables :
| Tomatoes, pink grapefruit, watermelon
226
Vitamin E decreased incidence of prostate cancer in what demographic?
SMOKERS!
227
Which vitamin in vitro inhibited prostate cancer cells from spreading?
Vitamin C
228
Function of kidney
Waste removal!!!
| - filtering occurs in nephrons. Na+, phosphorous and K+ are removed and reabsorbed into blood
229
Kidneys produce what 3 important hormones
EPO (stimulates bone marrow to make RBCs
Renin (regulates blood pressure)
Calcitriol (active form of vitamin D to regulate calcium)
230
Renal function lower than 25% =
Serious health problems
231
Renal function <10-15% requires
Form of renal replacement therapy
- dialysis
- transplant
232
2 MC causes of kidney disease
Diabetes (increased blood glucose can't be metabolized/excreted, damages nephrons)
HTN (Damages renal microvasculature which then can't filter wastes from blood)
233
National heart, lung and blood institute (NHLBI) recommends what BP for diabetes or reduced kidney function
130/80mmHg
234
Other causes of kidney disease (6)
Glomerular disease
Autoimmune disease (IgA nephropathy - excess; SLE)
Infection (post-strep, HIV, HAV/HVC, bacterial endocarditis leading to CKD)
Sclerotic diseases (SLE, DM, focal glomerulosclerosis
Other: membranous neuropathy
Inherited and congenital kidney diseases (PKD)
Poisons/trauma (OTC: aspirin, acetaminophen and ibuprofen = MOST dangerous to kidneys!)
235
Signs and symptoms of kidney disease (6)
```
Proteinuria
He matures
Peripheral edema
Hypoproteinemia and anemia
Decreased GFR
HTN
```
236
Diagnosis of kidney disease (3)
ID causative systemic disease
US
Biopsy
237
3 MC UT disorders
1. CYstitis
2. Prostate
3. Nephrolithiasis
238
Constant suprapubic/lower abdominal pain, flank pain, pressure =
Infection
239
Intermittent suprapubic/lower abdominal pain, flank pain, pressure =
Obstruction
240
Systemic symptoms indicative of infection (4)
Chills
Fever
N/V
He matures
241
Increased urinary output could indicate (3)
DM or DI
Excess fluids
Diuretics
242
Decreased functional capacity (4)
```
Outlet obstruction (BPH)
Neurogenic causes
Extrinsic compression (tumor, fibroids, pregnancy)
Psychological factors (anxiety)
```
243
Obstructive voiding symptoms (4)
Hesitancy
Decreased stream force
Intermittency
Post - void dribbling
244
Ddx for obstructive voiding symptoms (5)
```
BPH
Urethral stricture (narrowing)
Stone
Neurogenic bladder
Carcinoma
```
245
PE and lab tests for obstructive voiding symptoms
```
BP
UA
Urine C & S
CBC
CMP (comp metabolic panel)
```
246
What is occasional the first finding in UA associated with kidney disease?
Low specific gravity
247
Positive leukocyte esterase test suggests
Pyuria = UTI
| Main cause of false positive = vaginal contamination (not a good clean catch!)
248
Gram-negative bacteria reduces nitrates to what?
Nitrites, indicating UTI
249
If bilirubin in UA =
Hepatitis
| Biliary tract obstruction
250
Urobilinogen if positive indicates what? (4)
Liver disease:
- cirrhosis
- hepatitis
- liver mets
- liver infarction
251
Proteinuria is a clinical marker for
Underlying renal disease
Kidneys fail to separate protein (albumin) form waste!
Protein/albumin:creatinine ratio more sensitive test for this!
252
If first test is postitive with proteinuria, do what?
Repeat 1-2 weeks later (rules out hard workout)
253
If second test confirms proteinuria, do what?
Refer or order more tests to eval kidney function (24-h urine, CMP (BUN, creatinine, albumin)
254
Severe proteinuria> 3.5 in 24 hours =
Glomerulonephritis
| Can be idiopathic in young adults and children
255
Renal causes of proteinuria as a symptom (6)
```
UTI
Nephrolithiasis
Acute kidney failure
Glomerulonephritis
Nephrotic syndrome
Renal mets
```
256
Functional causes of proteinuria (2)
Fever
| Exercise
257
Systemic causes for proteinuria (8)
```
SLE
Preeclampsia
Amyloidosis
Infections (EBV, typhoid)
Cardiac (HTN, CHF)
DM
Liver cirrhosis
Medications (sulfa, chemo)
```
258
RBC's in urine a sign of what (5)
```
Bleeding in GU tract
Kidneys
Ureters
Prostate gland
Bladder
Urethra
--indicates diff probs in men and women
```
259
Microscopic hematuria
Seen on UA or microscopic vision
| May be idiopathic
260
Gross hematuria
Visibly discolored
May contain small blood clots
Amount of blood doesn't necessarily reflect seriousness of underlying problem
1mL of blood will turn urine red
261
Pseudohematuria
Reddish urine not caused by blood
262
Cause of pseudohematuria
Excessive consumption of beets, berries or rhubarb
Food coloring
Certain laxatives and pain meds
263
What do you have to rule out with hematuria first and foremost?
CANCER
264
Hematuria at onset of urination (initial hematuria)
Urethra or prostate
265
Hematuria throughout urination (total hematuria) (3)
Bladder, ureter or kidneys
266
Hematuria at end of urination (terminal hematuria)
Bladder or prostate
267
Hematuria + abdominal pain
Inflammation of kidney/ureter by trauma, infection or tumor
268
Hematuria with decreased urinary force, hesitance or incomplete voiding
Lower urinary tract, BPH, tumor
269
Hematuria with fever
Infection, typically of kidney or ureter
270
Hematuria with pain in flank
Kidney infection
Trauma
Tumor
271
Hematuria with urinary urgency, pain or frequency
Bladder infection
| Cancer
272
Progress of diagnostic imaging for hematuria
+ dip -> microscopic -> cystoscopy -> IVP -> CT/US
| *IVP = intravenous pyelogram, gives a good view of whole system
273
CAUSES OF HEMATURIA
```
SITT
Stone
Infection
Trauma
Tumor
```
274
Rare diseases and genetic disorders that cause hematuria (3)
Sickle cell anemia
SLE (chronic inflammatory disorder of CT)
Von Hippel-Landau disease (benign tumors all over)
275
+ RBC casts
+ proteinuria
Indicates
RENAL DISEASE
276
Epithelial cell casts
Acute tubular necrosis
Interstitial nephritis
Eclampsia
277
RBC casts
Glomerulonephritis (may be normal in collision sports)
278
WBC casts
Pyelonphritis
Glomerulonephritis
Interstitial nephritis
279
Hyaline/mucoprotein casts
Normal finding
Chronic renal disease
Glomerulonephritis
280
Granular casts
Severe renal disease
281
Waxy casts
Severe renal disease
282
Fatty casts
Nephrotic syndrome
| Hypothyroidism
283
Serum urea nitrogen and creatinine
Not sensitive indicators of early renal disease
Associated with 50% functional loss before levels increase
Once elevated = sensitive markers for disease progression
284
BUN
Blood carries protein to cells -> cells use protein -> urea = waste products returned to blood (Contains nitrogen)
Urea eliminated in urine; stays in blood in kidney disease
285
Other possible causes of elevated BUN (5)
```
Dehydration
Heart failure
GI hemorrhage
Large protein meal
Ketoacidosis (DM)
```
286
Elevated creatinine clearance (2)
Ketoacidosis
| Drugs
287
Reduced creatinine clearance (8)
```
Advanced age
Cachexia
Liver disease
Shock
Nephrotoxicity
Acute/chronic GN
HTN nephorslcerosis
Polycystic kidneys
```
288
GFR based on creatinine clearance
GFR: calculation of how efficiently kidneys filter wastes from blood
Creatinine = waste product in blood created by normal breakdown of muscle during activity
Normally removed by urine but in kidney disease, creatinine builds up in blood
289
IVP = x-ray of what 3 structures
Kidneys, ureter, bladder to detect stones, visualize enlarged prostate, tumors in kidney, ureters or urinary bladder
290
What is best indicator of kidney function?
GFR
291
What increases risk of CKD? (5)
```
DM
HTN
family history of CKD
>65 years old
African americans
```
292
Stages of chronic kidney disease
1: kidney damage with normal GFR (90+)
2. Kidney damage w/ mild decrease in GFR (60-89)
3. Moderate decrease in GFR (30-59). CKD at this stage = anemia and bone problems
4. Severe reduction in GFR (15-29) *dialysis or transplant!*
5. Kidney failure (GFR <15): dialysis or transplant!
293
Symptoms of CKD (8)
```
Fatigue
Poor concentration
Poor appetite
Insomnia
Nocturnal muscle cramping
Peripheral and periocular edema
Dry, itchy skin
Increased frequency, nocturia
```
294
Lifestyle/diet considerations (5)
```
Protein (limit)
Cholesterol (is high)
Smoking
Sodium (limit)
Potassium (increase it)
```
295
Infection occurs where in urinary tract?
Anywhere
Urethra (urethritis, STI)
Bladder (cystitis)
Kidney (pyelonephritis)
296
Epidemiology
Infants = male>female
1-65 years = females>males (males have longer urethras)
Age>65 = male = females
297
Relapse vs. re-infection of UTI = what percent has recurrence/reinfection?
20% of treated have recurrence
| 80% treated have reinfection
298
Acute UTI symptoms
Usually disappear within 24-48 hours after treatment begins
299
Chronic/recurrent UTI (>2 in 6 months) (3)
Don't respond to usual treatment
Last longer than 2 weeks
Do not resolve in 24-48 hours after treament
300
Etiology of UTI's
90-95% of UTI are secondary to E. coli
| -- positive nitrites on UA
301
UTI risk factors (top 3)
Sexual activity (80% occur within 24 hours of intercourse)
Hygiene
Hormones (IUD)
302
Symptoms of lower tract UTI (6)
```
Sudden onset
Urgency, urge incontinence
All the freaking time!
Suprapubic, flank or LBP
Dysuria
Hematuria (microscopic)
```
303
Symptoms of upper tract UTI (5)
Systemic symptoms! Fever, chills, N/V
Flank pain/CVA tenderness
Lethargy, myalgia
Odorous urine, macroscopic hematuria
304
Diagnosis of UTI
UA
Dipstick: RBC, proteinuria, nitrites, leukocyte esterase
Microscopic: >19 wbc/hpf "too numerous to count" bacteria
305
R/O w/ UTI (6)
```
STI
IC
Stones
Epididymitis
Prostatitis
Vaginitis
```
306
Imaging to diagnose UTI (6)
```
ABD US
KUB (Frontal supine imaging of abdomen)
MRI
IVU
Cystoscope
Renogram
```
307
UTI treatment uncomplicated
3 days antibiotic treatment
308
Complicated UTI treatment (3)
Underlying abnormality or medical condition
Broad spectrum antibiotics 7-10 days; pyelo = 10 days
Must treat pregnant women, with or without symptoms!
309
UTI prevention for women (4)
Cranberry
Hydration
D-Mannose
Lactobacillus
310
UTI prevention for men with BPH (5)
```
Urinate frequently
Saw palmetto
Cranberry
Hydration
Lactobacillus
```
311
Pyelonephritis
Infection/inflammation of kidney/renal pelvis
| Gram negative is MC
312
Pyelonephritis is secondary
to ascending lower UTI.
313
Pyelonephritis signs and symptoms (top 5)
```
*similar to lower UTI*
Fever > 102F
CVA tenderness/flank pain
Chills
Tachycardia
N/V
```
314
Ddx for pyelonephritis (8)
```
Cystitis
Appendicitis
Cholecystitis
Pancreatitis
Diverticulitis
Epididymitis
Prostatitis
Ectopic pregnancy
PID
```
315
Pyelonephritis treatment
Oral or IV abx
| Renal imaging if not responding to ABX
316
Complications of pyelonephritis (4)
Recurrence of pyelonephritis
Perinephric abscess (infection around kidney)
Sepsis
Acute renal failure (=> death!)
317
Nephrolithiasis
Calculus in kidneys
318
Ureterolithiasis
Calculus in ureter
| Usually originate in kidneys
319
Incidence of urinary stones
WHITE Male
320
ETIOLOGY OF URINARY STONE
Salts can become concentrated if volume of urine is significantly reduced or if abnormal high amounts of crystal forming salts are present
321
Risk factors for urinary stones (9)
```
Pregnancy
Urinary tract abnormalities
Southern US (diet)
Specific foods (diets high in animal protein and low in fiber/fluids)
Weight
Stress
Bedridden
Medical conditions (HTN, IBD)
Medications (thyroid hormones, diuretics, antacids)
```
322
Symptoms of urinary stones (7)
Sudden onset pain; acute, colicky flank pain radiating to groin; back/flank pain
Location of pain travels with stone
Localized pain w/o rebound tenderness
Dysuria, urinary urgency and increased frequency
CVA tenderness
Hematuria
Systemic symptoms (diarrhea, N/V, diaphoresis)
323
T/F: size of stone does not predict severity of pain
True
324
Diagnosis of urinary stones (3)
Urinalysis (85% of patients with urinary calculus exhibit hematuria)
CBC (high WBC = renal/systemic infection; low RBC = chronic dz; chronic hematuria)
Serum electrolytes, creatinine, calcium, uric acid and phosphorus
If calcium elevated, PTH levels obtained to r/o hyperparathyroidism
325
Diagnosis of recurrent diagnosis stones(3)
```
24 hour urine collection
Urine output of 2-3 L decreases risk of stone formation
PH
Calcium*
Uric acid*
Oxalate*
Phosphate
Citrate
```
*elevation can indicate predisposition to stone formation
326
Imaging for urinary stones (3)
X-rays will show stone
Non-contrast spiral CT (highly sensitive and specific)
IVP = risk of increased pressure and pain and UT rupture, if stone is obstructing the tract. Can be slow
327
Ddx for urinary stones MALE (5)
```
Testicular torsion
Pyelonephritis
Acute prostate THIS
Appendicitis
Pancreatitis
```
328
Female urinary stone ddx (6)
```
Ovarian cyst
Ovarian torsion
Ectopic PG
Pyelonephritis
Appendicitis
Pancreatitis
```
329
Treatment of urinary stones
More aggressive for patients <30
After dx renal colic = r/o obstruction and infection
If neither = analgesics (stone will pass if diameter is <5mm)
If both = ER surgery is required
Medical expuslive therapy (MET)
NSAIDS
330
T/F: Analgesic therapy with MET dramatically improves stone passage, addresses pain and reduces need for surgical treatment
True
331
Diet/supplement
EFA's
332
Hypercalciuria diet/supplements
Dandelion leaf
| DON'T limit Ca intake (associated with almost 100% increase in incidence of ca-oxalate stones)
333
Hyperoxaluria diet/supplements
Magnesium can block oxalate absorption and increase solubility of calcium oxalate
Pyridoxine (b6) = reduces oxalate production by enzyme induction
Limit oxalate intake (spinach, rhubarb, beets, tea, strawberries, chocolate, wheat, bran, nuts
334
Incontinence definition
Involuntary loss of urine sufficient to be perceived as a problem by the patient
335
Who is more likely to have incontinence = women or men?
Women
336
Voiding requires
Coordination of destructor contraction with external sphincter relaxation
Many neurological disorders from CNS, spinal cord and peripheral nn. Can result in incontinence
337
Stress incontinence (MC)
Involuntary leakage from effort, exertion or sneezing or coughing
Usually related to poor sphincter function and/or increased urethral mobility
338
Urge incontinence
Involuntary leakage accompanied/proceeded by urgency
| Usually related to destructor overactivity/instability, BPH
339
Mixed incontinence
Features of both urge and stress incontinence
| More common in women >65
340
Overflow incontinence
Associated with overdisgtention/filling
341
Risk factors for incontinence(14)
```
Damage to pelvic floor muscles/nerves
Vaginal deliveries
Chronic increases in intra-abdominal pressure
Pelvic organ prolapse
Smoking
Pelvic/prostate surgery
Estrogen deficiency
BPHUTI
Bladder outlet obstruction
Foreign bodies
Neurological disorders (parkinson's, stroke, MS, SC injuries)
Diabetes
Medications
```
342
Management of incontinence (7)
```
Pelvic floor muscle evaluation and rehabilitation
Pharmaceuticals
Electric stimulation
Pessaries/urethral barriers
Behaviour also treatment/modification
Absorbent productions
Surgery
```
343
Medications for incontienence (6)
```
Anticholinergic agents
Antispasmodic medications (MC used for urge incontinence)
Tricyclics antidepressants
Calcium channel blockers
Beta agonist
Estrogen
```
344
Interstitial cystitis aka
Painful bladder syndrome
345
What is interstitial cystitis ?
A condition that results in recurring discomfort or pain in the bladder and the surrounding pelvic region
346
Prevalence of interstitial cystitis (3)
Women 90%
Caucasian
40 year olds
347
Interstitial cystitis symptoms (6)
```
Mild discomfort, pressure, tenderness or intense pain in bladder/pelvic area
Urgency
Nocturnal
Frequency
Premenstrual exacerbation
Dysparuenia
```
348
Etiology of interstitial cystitis (5)
```
Infectious
Autoimmune
Mechanical injury
Mast cell activation
Alteration in bladder lining (decreased gag's)
```
349
IC gender associations female (4)
Chronic pelvic pain
Dysparunia
Vulvodynia
Improve with pregnancy
350
IC male gender association (3)
Chronic NB prostatitis
BPH
Prostadynia
351
Must r/o what with IC/ (4)
UTI
Gynecological disease
Prostate disease
Bladder cancer
352
Confirmation of IC (2)
Cystoscope with hydrodistention
| Bladder biopsy
353
Treatment for IC
Bladder distention = diagnostic test and initial therapy
Increases capacity and interfere with pain-inducing signals transmitted by nerves in the bladder.
Symptoms may temporarily worsen 24-48 hours after distention but return in 2-4 weeks
354
Oral drugs for IC (9)
```
PE tos an polysulfate sodium
Aspirin and ibuprofen
Tricyclics antidepressants
Antihistamines
Narcotic analgesic
Calcium channel blockers
Immune suppression
Heparin
Hyaluronic acid
```
355
What foods or drinks may contribute to bladder pain and inflammation? (7)
```
Alcohol
Tomatoes
Spices
Chocolate
Caffeinated
Citrus beverages
Acidic foods
-- symptoms may worsen after eating or drinking products contains artificial sweeteners
```
356
IC lifestyle changes (4)
Smoking = worse
Exercise = relieves
Bladder training
Diet changes = eliminate alcohol caffeine, spicy foods
357
Nutrition/herbs for IC (4)
Support GAG's (N-acetyl glucosamine and chondroitin)
Decrease NO as may be linked to damage (L-arginine)
Bioflavonoids linked with decreased symptoms
IC blend 3 caps tied (vitanica)
358
Where does bladder cancer usually occur?
In bladder lining
359
Stages of bladder cancer?
```
Low stage (superficial)
High stage (muscle invasive)
```
360
Transitional cell carcinoma
90% of cases originate in the transitional epithelial cells
361
Schistosomiasis haematobium
Developing countries 75% of cases a re squamous cell carcinomas caused by this
362
Rare types of bladder cancer include(4)
Small cell carcinoma, carcinosarcoma, primary lymphoma and sarcoma
363
Primary symptom of bladder cancer
Hematuria
| Other symptoms = frequent urination and dysuria
364
Highest incidence of bladder cancer occurs where?
Industrialized countries
365
T/f incidence of bladder cancer decreases with age
False
366
Bladder cancer is 2-3x more common in what gender?
Men
4th most common type of cancer in men
8th MC in women
MC in caucasians vs. AA and hispanics
367
Carcinogens in the urine may lead to the development of bladder cancer. What else? (11)
```
Smoking (50% of cases)
Age
Chronic bladder inflammation (recurrent UTI, urinary stones)
Consumption of Aristolochia fangchi
Diet high in saturated fat
External beam radiation
Family history of bladder cancer
Gender (male)
Infection of schistosomiasis haematobium
Caucasian
Treatment with certain drugs
```
368
Prognosis of bladder cancer superficial
5 year survival rate 85%
369
Prognosis of invasive bladder cancer
~5% of patients with metastatic cancer live 2 years of diagnosis
Cases of recurrent bladder cancer i ndcate aggressive tumor and poor prognosis
370
Renal cancer accounts for what percent of all cancers
```
3%
6th leading cause of cancer death
Males 2x greater
Increased incidence in african american
50-70 years old
MC = renal cell = renal adenocarcinoma
```
371
T/f most solid kidney tumors (>90%) are malignant
True
372
Risk factors for renal carcinoma (11)
Smoking doubles risk
Obesity particularly in women
HTN
Unopposed estrogen therapy
Occupational exposure to petroleum products, heavy metals, solvents, emissions or asbestos
Abuse of phenacetin-containing analgesics
Cystic kidney disease
Renal dialysis
Tuberous sclerosis
Renal transplantation: with associated immunosuppression = 80 fold increase in the risk
VHL disease an inherited disease
373
Renal transplntation = 80 fold increase in risk of what
Renal cancer
374
Kidney tumors can cause symptoms by (3)
Compressing, stretching or invading structures near or within the kidney
375
Symptoms of renal cancer
```
Lack of symptoms
HTN
He matures
Superclavicular adenopathy
Symptoms associated with mets (lung, soft tissue, bone, liver, cutaneous sites, CNS)
Paraneopalstic syndrome
```
376
Paraneoplastic syndrome (4)
30% patients with kidney cancer can occur in any stage
Clinical symptoms = include weight loss, loss of appetite, fever, night sweats, HTN
Resolution of symptoms follows successful treatment of primary tumor or metastatic Fock
377
Lab findings with paraneoplastic syndrome (6)
```
Elevated ESR
Low RBC count (anemia)
Hyeprcaclemia
Abnormal liver function tests
Elevated ALP
Elevated WBC count
```
378
Prognosis of renal cancer
```
5 year survival rate stage 1 : 66%
2: 64%
3: 42%
4: 11%
Except for stage 1, these survival stats have remained unchanged
```
