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PANRE > GE System-Panre > Flashcards

GE System-Panre Flashcards

1
Q

Acute prostatitis (Level 2)

A

Most common cause is acute bacterial prostatitis → pts are typically acutely ill
with combination of irritative &/or obstructive urinary symptoms, perineal or
pelvic pain
● Most often occurs in young & middle-aged ♂; associated with presence of acute
bacterial urinary tract infection (UTI)

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2
Q

MC organisms in Acute prostatitis (Level 2)

A

Most common organisms:
○ Escherichia coli , Proteus species
○ If associated with sexually transmitted infection (STI), most common
organisms include Neisseria gonorrhoeae & Chlamydia trachomatis

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3
Q

Acute prostatitis (Level 2) S/S

A

Fever, chills, malaise, dysuria, urgency, frequency, pelvic
or perineal pain, pain at tip of penis, cloudy urine, sensation of incomplete bladder
emptying, dribbling of urine’ Prostate is exquisitely tender, swollen & firm (prostate massage is
generally contraindicated)
○ Pts may have generalized urosepsis

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4
Q

Acute prostatitis (Level 2) DX

A

Clinical
○ Urinalysis → WBCs & bacteria
○ Urine gram stain & culture

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5
Q

Acute prostatitis (Level 2) TX

A

Nontoxic pt: Trimethoprim-sulfamethoxazole (TMP/SMX) or
fluoroquinolone (eg. ciprofloxacin), analgesics, bed rest, stool softeners,
hydration
○ Toxic pts: Hospitalize; intravenous fluoroquinolone, ± aminoglycoside (eg.
gentamicin)
○ Appropriate referral or consult

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6
Q

Bacterial cystitis (Level 2)

A

Bacterial infection & inflammation of the urinary bladder
Copyright Hippo Education 2019 - All Rights Reserved 1
● Most commonly seen in ♀

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7
Q

Bacterial cystitis (Level 2) MC organism ?

A

Escherichia coli ( E. coli )

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8
Q

Bacterial cystitis (Level 2) Risk factors

A

Sexual intercourse, diaphragm & spermicide use, recent antibiotic use,
new sex partner within past year, structural or functional abnormalities of the
urinary tract, instrumentation of the urinary tract

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9
Q

Bacterial cystitis (Level 2) Uncomplicated vs complicated UTI

A

Uncomplicated: Premenopausal adult ♀ without structural or functional
abnormality of the urinary tract; ∅ pregnancy; ∅ significant comorbid
conditions
○ Complicated: Pregnancy, ♂ sex, structural or functional urinary tract
abnormality, poorly controlled diabetes mellitus, chronic kidney disease,
recent instrumentation of the urinary tract

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10
Q

Bacterial cystitis (Level 2) CM ?

A

Dysuria, urinary urgency & frequency, sensation of bladder
fullness, suprapubic pain & tenderness

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11
Q

Bacterial cystitis (Level 2) DX

A

Clinical
○ Dipstick urinalysis: Positive leukocyte esterase, ± blood, ± protein, ± nitrite
○ Microscopic urinalysis: >8-10 white blood cells/mL in a fresh, unspun urine
sample using hemocytometer chamber; bacteria, ± red blood cells
○ Urine culture is usually performed only for pts with complicated UTI

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12
Q

Bacterial cystitis (Level 2) TX?

A

First-line: Nitrofurantoin, TMP/SMX, or fosfomycin

○ Phenazopyridine for symptomatic dysuria: Turns urine reddish-orange

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13
Q

Benign prostatic hyperplasia (BPH) (Level 2)

A

Nonmalignant adenomatous overgrowth of the periurethral prostate gland →
varying degrees of bladder outlet obstruction

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14
Q

Benign prostatic hyperplasia (BPH) (Level 2) CM?

A

Weak stream, hesitancy, urinary urgency & frequency,
nocturia, sensation of incomplete bladder emptying, terminal dribbling, overflow or
urge incontinence

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15
Q

Benign prostatic hyperplasia (BPH) (Level 2) Dx?

A

Clinical: ↑ prostate gland size, rubbery consistency, loss of median furrow
○ Urinalysis
○ Prostate-specific antigen measurement for patients between 50-69 yo after
shared decision making discussion

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16
Q

Benign prostatic hyperplasia (BPH) (Level 2) TX ?

A

5-α-reductase inhibitors (eg. finasteride)
○ α-blockers (eg. terazosin)
○ Appropriate referral as needed for further work-up & treatment

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17
Q

Bladder cancer (Level 1)

A

Carcinoma of transitional epithelium (most common type)
● High recurrence rate (70% in 5 yrs)
● 4 th most common CA in men (♂:♀=3:1)
Median age at diagnosis: 65 yo

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18
Q

Bladder cancer (Level 1) Risk factors

A

Smoking: #1 most common and most important
○ Aromatic amines (eg. aniline dyes),
○ Analgesic abuse
○ Chronic irritation (eg. chronic catheterization)

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19
Q

Bladder cancer (Level 1) CM

A

Painless gross or microscopic hematuria → most common
(classic presentation in 80-90%)
○ Also may have dysuria, urgency, frequency

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20
Q

Bladder cancer Dx:

A

Clinical

○ Urinalysis

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21
Q

Bladder cancer tx

A

Appropriate referral: cystoscopy with biopsy

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22
Q

Hydrocele

A

Fluid collection within the tunica vaginalis or processus vaginalis of the scrotum
○ Most commonly seen in boys (rare in girls)

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23
Q

Hydrocele Types ?

A

types:
○ Communicating (most common): Residual communication of the processus
vaginalis with the peritoneum → peritoneal fluid accumulation
■ Usually seen between ages: newborns~1-2 yo
○ Noncommunicating: Usually occurs in older children
■ May be idiopathic or associated with epididymitis, orchitis,
testicular torsion or tumo

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24
Q

Hydrocele CM?

A

Communicating hydroceles: Size may fluctuate throughout the day (larger
during the day, smaller at night) or with straining or crying
■ Often reducible with application of pressure
○ Noncommunicating hydroceles: Size is constant & non-reducible
○ Testis may palpable posterior to the fluid collection
○ Positive transillumination (homogeneous glow without internal shadows

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25
Q

Hydrocele DX?

A

Clinical
○ If indicated, ultrasound study (eg. inability to palpate testis, internal
shadows on transillumination)

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26
Q

Hydrocele TX?

A

Observation until 1-2 yo; possibly surgery

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27
Q

Varicocele

A

Dilation of the pampiniform venous plexus & internal spermatic vein; ~85-95%
occur on the left side
● Associated with ♂ infertility
○ ~35% of subfertile or infertile ♂ have varicocele, but only 10-15% of ♂
with varicoceles have fertility problems

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28
Q

Varicocele CM

A

Usually asymptomatic & may be discovered in a man
seeking evaluation for infertility;
○ Some patients have achy scrotal pain or heaviness especially with standing

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29
Q

Varicocele red flags?

A

Sudden onset, isolated right-sided, not reducible in supine

position

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30
Q

Varicocele Dx?

A

Clinical
○ If indicated, high-resolution color-flow Doppler ultrasonography (eg.
equivocal clinical examination, red flags

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31
Q

Varicocele Tx?

A

Usually observation & symptomatic treatment (eg. OTC analgesics);
appropriate urologic referral for adolescents or adults with significant pain or
discomfort; fertility work-up as indicated

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32
Q

Erectile dysfunction (ED) (Level 2)

A

Inability to either attain or sustain an erection satisfactory for sexual performance

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33
Q

Erectile dysfunction (ED) (Level 2) Primary ED?

A

Primary ED: ♂ who has never been able to attain or sustain an erection →
almost always due to psychological factors (eg. guilt, fear of intimacy,
depression, anxiety) or obvious anatomic abnormality

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34
Q

Erectile dysfunction (ED) (Level 2) 2nd Ed?

A

Usually acquired later in life in ♂ who have previously been
able to attain or sustain an erection and common due to:
■ Vascular disease: Atherosclerosis, HTN, DM, smoking
■ Neurologic disease: Diabetic neuropathy, stroke, multiple sclerosis,
autonomic neuropathies, spinal cord injury, complications of pelvic
(eg. prostate) surgery
■ Others: Drug effect (eg. β-blockers, alcohol), prolonged bicycle
riding, testosterone deficiency
■ Psychological factors: Performance anxiety, stress, depression

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35
Q

Erectile dysfunction (ED) (Level 2) CM?

A

Establish the presence or absence of erections:
■ Either nocturnally &/or upon awakening (psychogenic ED usually do
have these erections; organic ED often does not)
○ Examination for penile fibrous bands or plaques (eg. Peyronie disease),
testicular atrophy, rectal tone, perianal sensation, bulbocavernosus reflex,
peripheral pulses

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36
Q

ED DX?

A

Clinical: Screening for mental health (eg. depression), sexual health (eg.
satisfaction with relationship), underlying disorders (eg. DM)
○ Measure morning testosterone level: If ↓, measure prolactin & luteinizing
hormone
○ Additional laboratory testing as guided by signs & Sx

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37
Q

ED Tx?

A

Phosphodiesterase-5 inhibitors (eg. sildenafil)
■ Contraindication: Concomitant use of nitrates
○ Vacuum erection & constriction devices
○ Appropriate referral: Intraurethral or intracavernosal prostaglandin E1,
surgical implants
○ Treatment directed at any other underlying cause

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38
Q

Peyronie Disease

A

Curvature of penis from scar tissue (plaque) accumulation in tunica albuginea
● Risk factors: penile trauma, autoimmune dz, Dupuytren dz
● S/Sx: penile curvature, painful erections, erectile dysfunction, difficulty or inability to
have sexual intercourse
● PE: curvature noted on erection, palpable fibrosis, ‘hour-glass’ deformity (indentation of
shaft at plaque site)
● Labs: U/S for plaque delineation & presence of Ca++
● Tx: observation for minimal pain &/or mild curvature (<30°); otherwise, urology referral

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39
Q

Fecal incontinence (Level 1)

A

Impaired ability to control the passage of gas or stool

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40
Q

Fecal incontinence (Level 1) Etiologies?

A

Childbirth-related injury (most common), trauma to anal muscles (eg.
anal surgery), age-related loss of anal muscles strength, neurologic injury or
disease (eg. spinal cord injury, severe dementia, stroke), inflammatory diseases (eg.
ulcerative colitis), rectal tumor or prolapse

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41
Q

Fecal incontinence (Level 1) CM?

A

Range from difficulty controlling gas to inability to control
liquid & formed stools, sense of urgency

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42
Q

Fecal incontinence (Level 1) Dx?

A

Clinical

○ Evaluate sphincter function, perianal sensation on physical examination

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43
Q

Fecal incontinence (Level 1) TX?

A

Non-surgical: Bowel pattern management for enhanced predictability,
adequate fluid & dietary bulk intake, possibly constipating medications (eg.
loperamide), perianal muscle strengthening & biofeedback
○ Appropriate referral for additional work-up & treatment including surgery

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44
Q

Stones under what MM would be passed with no problem?

A

5mm

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45
Q

Nephrolithiasis:

A

Kidney stone

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46
Q

Urolithiasis

A

Stone in the genitourinary tract

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47
Q

Nephrolithiasis/urolithiasis (Level 2)

A

Precipitation of crystals in the urinary tract that can cause acute occlusion to the
passage of urine
● Most stones are calcium oxalate

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48
Q

Nephrolithiasis/urolithiasis (Level 2) CM?

A

May be asymptomatic or patients may present after
passing gravel or stone
○ ‘Classic presentation’: Nausea, vomiting, mild~excruciating pain that waxes
& wanes in severity, and develops in waves or paroxysms; stone location
often determines pain location:
■ Upper ureter or renal pelvis: Flank pain or tenderness
■ Lower ureter: Pain radiates to ipsilateral testis or labium

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49
Q

Nephrolithiasis/urolithiasis (Level 2) Dx?

A

Clinical
○ Urinalysis: Most patients will have gross or microscopic hematuria
○ CT scan of abdomen & pelvis without contrast: Preferred imaging study for
identifying stone & hydronephrosis

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50
Q

Nephrolithiasis/urolithiasis (Level 2) Tx?

A

Hydration (oral if possible; intravenous if unable)
○ Pain control: NSAIDs &/or opiates
○ Admit patients that cannot tolerate oral intake, or if they have fever &/or
uncontrollable pain
○ Possible administration of α-blocker (eg. tamsulosin) or Ca ++ -channel
blocker (eg. nifedipine) for facilitating stone passage
○ Have patient strain urine for several days & bring stone in for analysis
■ Most stones with diameter ≤ 5 mm pass spontaneously
○ Urology consult for urosepsis, acute kidney injury, anuria or intractable
pain, nausea or vomiting
■ Also for stone ≥10 mm or failure to pass stone with conservative
therapy

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51
Q

Struvite stones

A

(magnesium ammonium phosphate)
■ Form in patients with upper UTI due to urease-producing organisms
(eg. Proteus , Klebsiella ) → usually do not present with classic Sx/S;
instead, patients have recurrent UTI, mild flank pain or hematuria;
urine pH >7.0

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52
Q

Orchitis (Level 2)

A

Inflammation of the testes

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53
Q

Orchitis (Level 2) Etiologies?

A

Etiologies: Most common is viral (eg. mumps)

○ Can be bacterial secondary to epididymitis

54
Q

Orchitis (Level 2) CM

A

Constitutional Sx (eg. fever, malaise), scrotal and
testicular pain, tenderness & swelling; overlying scrotum may be taut, shiny &
erythematous
○ In mumps orchitis (unilateral or bilateral) testicular pain & swelling usually
occurs 4-7 days following parotid swelling

55
Q

Orchitis (Level 2) Dx

A

Clinical
○ Serum immunofluorescence antibody testing for mumps
○ Color Doppler ultrasonography if Dx is unclear

56
Q

Orchitis (Level 2) TX

A

Supportive: Bed rest, NSAIDs, support of testes, ice packs
○ Mumps: Susceptible contacts should be vaccinated
■ Mumps is a reportable disease
○ Directed at any underlying cause (eg. antibiotics for epididymitis)
○ Urology consult or follow-up

57
Q

Paraphimosis

A

Clinical condition occurring across the age-spectrum in either uncircumcised or
partially circumcised ♂ where the retracted foreskin becomes trapped behind the
glans penis & cannot be returned to its normal anatomic position
● If the foreskin remains retracted for an extended period of time, venous &
lymphatic obstruction can occur → edema & arterial occlusion to the glans penis
(urologic emergency!)

58
Q

Paraphimosis most common cause

A

Most common cause: Iatrogenic where foreskin is inadvertently left in the
retracted position by patient or provider (eg. following urethral catheterization)

59
Q

Paraphimosis CM

A

Pain, swelling & entrapment of foreskin in coronal sulcus

60
Q

Paraphimosis Dx?

A

Dx: Clinical

61
Q

Paraphimosis TX ?

A

Manual reduction, possibly surgery; urology consult or referral

62
Q

Phimosis

A

Clinical condition occurring across the age-spectrum in either uncircumcised or
partially circumcised ♂ where there is the inability to retract the foreskin
● Normal and physiologic in boys & usually resolves by age 5-7 yo

63
Q

Phimosis CM?

A

Usually none unless there are pathologic complicationseg. balanitis, UTI, urinary outlet obstruction, STI or penile CA)

64
Q

Phimosis Dx?

A

Clinical

65
Q

Phimosis TX

A

Conservative measures (topical corticosteroids, manual foreskin stretching),
urology consult for possible circumcision; treat any associated underlying
pathology

66
Q

Prostate cancer (Level

A

Adenocarcinoma of the prostate (most common

67
Q

Prostate cancer is most common in ?

A

men >50 yo in US; median age at diagnosis is 72 yo; MC CA in Men

68
Q

Prostate cancer’s RF?

A

African-American, family history

69
Q

Prostate cancer CM are?

A

Clinical manifestations: Asymptomatic (most common)
○ Advanced disease → Hematuria, bladder outlet obstruction, bone pain,
pathologic Fx
Screening: Variable guidelines; discussion & shared decision-making

70
Q

Prostate cancer is Dx ?

A

Clinical (digital rectal examination is often normal)
○ Possibly prostate-specific antigen
○ Transrectal ultrasound-guided needle biopsy, CT, bone scan

71
Q

Prostate cancer TX?

A

Urology referral; active surveillance, surgery, radiation therapy, chemotherapy,
androgen deprivation therapy

72
Q

Testicular cancer (Level 1)

A

Usually germ cell tumor of testis (95%) with the most common types being seminoma
& nonseminoma

73
Q

Testicular cancer (Level 1) is MC solid CA in ?

A

Most common solid CA in ♂ 15-35 yo; median age at diagnosis is 33 yo

74
Q

Testicular cancer (Level 1) RF ?

A

Cryptorchidism

75
Q

Testicular cancer (Level 1) CM?

A

Non-painful testicular mass (most common); ± dull, aching pain

76
Q

Testicular cancer (Level 1) DX

A

Clinical
○ Ultrasonography
○ α-fetoprotein, β-hCG, lactate dehydrogenase
○ Chest x-ray, CT or MRI of abdomen & pelvis

77
Q

Testicular cancer (Level 1) TX

A

Urology referral; surgery, radiation therapy, chemotherapy

78
Q

Testicular torsion (Level 2)

A

Clinical condition characterized by a twisting of the testis along the axis of the
spermatic cord with resultant strangulation of its blood supply → surgical
emergency
● Occurs most commonly in neonates & postpubertal boys

79
Q

Testicular torsion (Level 2) CM ?

A

Acute onset of scrotal pain & swelling, nausea, vomiting
○ Scrotal edema & induration, testis is tender, elevated & horizontal (bell
clapper deformity,
○ Cremasteric reflex is usually absent on affected side;
○ Prehn sign: Elevating the testicles relieves pain of epididymitis, but not pain caused by testicular torsion

80
Q

Testicular torsion (Level 2) Dx?

A

Clinical → go directly to surgery!
○ Color Doppler ultrasonography if there is low suspicion of torsion or Dx is
unclear

81
Q

Testicular torsion (Level 2) TX?

A

Attempt manual detorsion if surgical intervention is not immediately
available:
■ Classically, the testis usually rotates medially (inward or internally)
→ detorsion is performed by rotating the testicle laterally away
from the midline towards the thigh (outward or externally)
○ Emergent surgical consultation for surgical detorsion & fixation

82
Q

Urethritis (Level 2)

A

Inflammation of the urethra

83
Q

Urethritis (Level 2) Etiologies

A

Noninfectious: Chemical (eg. soaps), trauma (eg. intermittent
catheterization)
○ Infectious:
■ Gonococcal: Neisseria gonorrhoeae
■ Non-gonococcal: Chlamydia trachomatis & Mycoplasma genitalium

84
Q

Urethritis (Level 2) CM

A

Noninfectious: ± erythema at the urethral meatus, ± clear urethral
discharge
○ Infectious: May be asymptomatic – particularly in ♀ (especially with
Chlamydia )
■ Dysuria (most common Sx), urethral pruritus, burning, &/or
discharge

85
Q

Urethritis (Level 2) DX

A 
Clinical
○ Noninfectious: Depends upon etiology
○ Infectious:
■ Gram stain of urethral swab specimen (sensitive &amp; specific only for
♂)
■ Dipstick (specifically leukocyte esterase) &amp; microscopic analysis of
first-catch urine
■ NAATs
86
Q

Urethritis (Level 2) TX is ?

A

Noninfectious: Treatment directed at cause
○ Infectious:
■ Gonococcal: Ceftriaxone & azithromycin
■ Nongonococcal: Azithromycin or doxycycline

87
Q 
Urinary incontinence (Level 2)
● Involuntary loss of urine ? RF?
A

Involuntary loss of urine; ♀ sex, ↑ age, obesity, ↑ parity (especially vaginal deliveries),
smoking

88
Q 
Urinary incontinence (Level 2) 
● Involuntary loss of urine there are three types?
A

Urge, Stress, Overflow

89
Q 
Urinary incontinence (Level 2)
● Involuntary loss of urine Dx?
A

Clinical
○ For stress incontinence: Bladder stress test
○ Urinalysis; possibly BUN & creatinine

90
Q 
Urinary incontinence (Level 2)
● Involuntary loss of urine TX?
A

Lifestyle modifications:
■ Weight loss for overweight/obese patients, ↓ caffeine &/or
alcohol consumption, smoking cessation
○ Pelvic floor muscle (Kegel) exercises
■ First-line for ♀ with stress incontinence
○ Bladder training: Timed voiding with progressive ↑ time between
urination
■ First-line for ♀ with urge incontinence
○ Pharmacotherapy:
■ Topical vaginal estrogen: Useful for stress or urge incontinence in
postmenopausal women with vaginal atrophy
■ Anticholinergic agents (eg. oxybutynin): Useful for urge
incontinence &/or overactive bladder
○ Urology referral for further work-up & treatment

91
Q

Urge Urinary incontinence?

A

Associated with detrusor muscle hyperactivity (AKA: overactive
bladder)
■ Sudden & urgent need to void → uncontrollable leakage of urine
■ Nocturia

92
Q

Stress Urinary incontinence ?

A

Postmenopausal urethral atrophy
■ Loss of urethral support due to damage of pelvic support
structures (eg. multiple childbirths)
■ Activities that ↑ intra-abdominal pressure (eg. coughing,
sneezing, laughing, bearing down) → leakage of urine

93
Q

Overflow Urinary incontinence?

A

Overly full bladder due to poor bladder contraction &/or urethral
obstruction (eg. BPH)
■ Incomplete bladder emptying after passing urine followed by
continuous dribbling of urine, weak or intermittent stream,
hesitancy, frequency, nocturia

94
Q

Penile Cancer

A

Squamous cell carcinoma (most common); ~50% occur on glans & ~20% on prepuce; rare
dz in US

95
Q

Penile Cancer RF? Etiology?

A 
uncircumcised penis (neonatal [but not adult] circumcision is protective);
HIV/HPV infection, balanitis, >55 yo; Etiology: ? phimosis, smegma, virus (eg. HPV), trauma
96
Q

Penile Cancer S/S? PE?

A

S/Sx: itching or burning under foreskin (most common), lesion that does not heal
● PE: wide range – ulceration (most common), hyperemic area, induration, papule, flat or
exophytic; inguinal lymphadenopathy

97
Q

Penile Cancer Labs?

A

biopsy for dx; MRI, U/S, CT for staging

98
Q

Penile Cancer TX?

A

urology referral; possibly chemo-tx, surgery

99
Q

Peyronie Disease RF?

A

penile trauma (penile fracture-vigorous sexual activity which breaks tunica albuginea), autoimmune dz, Dupuytren dz

100
Q

Peyronie Disease S/s? PE?

A

penile curvature, painful erections, erectile dysfunction, difficulty or inability to
have sexual intercourse; curvature noted on erection, palpable fibrosis, ‘hour-glass’ deformity (indentation of
shaft at plaque site)

101
Q

Peyronie Disease Labs?

A

U/S for plaque delineation & presence of Ca++

102
Q

Peyronie Disease TX?

A

observation for minimal pain &/or mild curvature (<30°); otherwise, urology referral

103
Q

Urethral Prolapse (Urethrocele)?

A

Circumferential protrusion of distal urethra thru external urethral meatus – most
commonly seen in prepubertal girls & postmenopausal women

104
Q

Urethral Prolapse (Urethrocele) s/Sx?

A

Prepubertal: usually Ø sx, ± blood on
diaper / underwear; hematuria uncommon
o Postmenopausal: vaginal bleeding with
voiding

105
Q

Urethral Prolapse (Urethrocele) PE?

A

doughnut-shaped bulging mucosa protruding from anterior vaginal wall with centrally
located urethral meatus; tender, ulcerated & friable mucosa

106
Q

Urethral Prolapse (Urethrocele) Tx?

A

sitz baths & topical estrogen; urology referral for urinary obstruction, thrombosis,
infection or strangulation

107
Q

Urethral Stricture

A

Narrowing of urethra caused by injury (eg. pelvic Fx), instrumentation (eg. prostate
surgery), infection, or tumor → varying degrees of urine flow obstruction; most common
in ♂; Think complications of foley/catherter, STI

108
Q

Urethral Stricture s/Sx?

A

weak urinary stream (hallmark sx), incomplete bladder emptying, splaying of urine
stream, dysuria, urgency, frequency, straining; recurrent UTI, acute urinary retention

109
Q

Urethral Stricture PE?

A

cystourethroscopy, urethrography

110
Q

Urethral Stricture TX?

A

Acute urinary retention → emergent transurethral or suprapubic catheter placement
o Urology referral (dilation, urethrotomy, urethroplasty)

111
Q

Vesicoureteral Reflux

A

Retrograde flow of urine from bladder into upper urinary tract
o 1°: incompetent ureterovesical junction (most common)
o 2°: ↑ voiding pressure in bladder (obstruction, neurologic

112
Q

Vesicoureteral Reflux Most common?

A

Most commonly seen in children; + family or sibling Hx; may be associated with antenatal
or postnatal hydronephrosis

113
Q

Vesicoureteral Reflux s/S?

A

usually Ø s/sx unless associated with UTI ± fever

114
Q

Vesicoureteral Reflux Labs?

A 
voiding cystourethrogram (best initial study), U/A, urine culture, creatinine,
electrolytes, contrast renal-bladder U/S
115
Q

Vesicoureteral Reflux Tx?

A

urology referral – tx depends upon age & severity; may include prophylactic
antibiotics, correcting voiding dysfunction & follow-up radiographic studies

116
Q

Genitourinary Trauma

A

Blunt or penetrating injury to bladder, urethra or external genitalia (lower GU tract), or
kidneys & ureters (upper GU tract)
o Kidney injury&raquo_space;> bladder, urethra&raquo_space; ureters; Always be careful during PE examination do not want to make conditions worse

117
Q

Genitourinary Trauma External Genitalia?

A

S/Sx: penile, scrotal or vulvar ecchymosis, swelling; hematocele
o Dx: penile Fx, testicular rupture or torsion

118
Q

Genitourinary Trauma urethra & bladder?

A

S/Sx: suprapubic pain, blood at urethral meatus, gross or microscopic hematuria,
inability to void, absent or ‘high-riding’ prostate on digital rectal exam; vaginal
laceration; scrotal, vulvar, perineal ecchymosis or hematoma
o Dx: associated with pelvic Fx (eg. bulbomembranous junction of posterior urethra)

119
Q

Genitourinary Trauma Kidney’s urethra & bladder?

A

S/Sx: flank or abdominal bruising, pain & tenderness; posterior rib Fx, gross or
microscopic hematuria
o Dx: renal or ureteral lacerations or avulsions

120
Q

Genitourinary Trauma Kidney’s & ureters?

A

S/Sx: flank or abdominal bruising, pain & tenderness; posterior rib Fx, gross or
microscopic hematuria
o Dx: renal or ureteral lacerations or avulsions

121
Q

Genitourinary Trauma Common labs:

A

U/A, CXR, AP pelvis; testicular U/S (torsion), retrograde urethrogram
(urethral injury), retrograde cystogram (bladder injury), abdominopelvic CT scan with
contrast (renal/ureter injury)

122
Q

Genitourinary Trauma TX:

A

ABCs, treat life-threatening & other associated injuries
o Bladder catheter: caution with suspected urethra injury
o Urgent or emergent urology consultation

123
Q

Bladder Prolapse

A

Bulging of bladder into upper anterior vaginal wall → descends toward or thru vaginal
opening

124
Q

Bladder Prolapse RF?

A

Risk Factors: multiple pregnancies, ↑ BMI, straining with constipation, repeated heavy
lifting, chronic cough, previous surgery (eg. hysterectomy), other pelvic organ prolapse;
most common in older

125
Q

Bladder Prolapse Etiology?

A

injury to levator ani muscle &/or pudendal nerves (eg. childbirth) → ↓ pelvic
floor support

126
Q

Bladder Prolapse s/S?

A

see or feel a vaginal bulge (most common), urinary frequency, urgency,
incontinence or sense of incomplete voiding, back or pelvic pain, dyspareunia

127
Q

Bladder Prolapse Pe?

A

PE: prolapse may be ↑ by having pt Valsalva during pelvic exam

128
Q

Bladder Prolapse TX?

A

Tx:
o Weight management, avoiding constipation & heavy lifting, smoking cessation
o Pelvic floor muscle training (Kegel exercises)
o Mechanical support (eg. pessary)
o Estrogen replacement Tx
o Surgery

129
Q

Bladder Prolapse Complications?

A

urinary retention, incontinence, recurring UTIs

130
Q

This procedure measures the pressure in the bladder and the urethra simultaneously and is the best study for confirming the suspected diagnosis of stress incontinence.

A

Urethrocystometry

PANRE (15 decks)

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