genito-urinary Flashcards
prehns sign
decreased pain with scrotal elevation
+ in epididymitis
- in torsion
what is urge incontinence
bladder contractions that cannot be controlled by the brain
stress incontinence
dysfunction of the urethral sphincter, allow urine to leak with increased intra abdominal pressure
overflow incontinence
when urinary retention leads to bladder distention and overlow of urine
functional incontinence
untimely urination caused by physical or cognitve disability, preventing a person from reaching a toilet
tx for urge incontinence
anticholinergics such as oxybutynin or tolterodine
tx for stress incontinence
estrogen, kegel, electrical muscle stimulation, bladder training, pessaries or implants
sling
tx for overactive and overflow bladder
overactive: tolterodine and oxybutynin
overflow: cath with or w/out indwelling
asymptomatic abdominal mass found in childhood
do u/s then CT][po, look for wilms tumor
dactinomycin, vincristine, doxorubicin
tx for wilms tumor since it is chemo-sensitive
cystitis commonly caused by what organism
coliform bacteria (E. Coli 80-85%)
occ gram + bacteria
cystitis route of infection and gender
ascending from urethra
women
clinical findings in cystitis
irritative voiding sx(frequency, urgency, dysuria)
suprapubic discomfort
microscopic hematuria
exam nml in elderly
UA and culture for cystitis
UA: pyuria, bacteriuria, varying hematuria
culture: positive for offending organism
tx of uncomplicated cystitis in women and men
FQ or nitrofurantoin 3-5 days
resistant E coli is common, bactrim can be used
men rarely have this
phenazophridine
urinary analgesic
turns urine dark orange or red
epididymitis acquired how
retrograde spread of organisms through the vas deferens
epididymitis organisms
younger than 35 y/o: chlamydia and gonococci
older than 35 y/o: E. Coli
epididymitis presentation
history may reveal what
heaviness and dull aching discomfort which can radiate up the ipsilateral flank
maybe heavy lifting, trauma, or sex
epididymitis exam
markedly swollen and TTP
eventually warm, erythematous, enlarged scrotal mass
maybe fevers/chills
prehn sign classic, not very reliable
epididymitis UA and culture
UA: pyuria and bacteriuria
culture: positive for organism
epididymitis tx
younger than 35 y/o: ceftriaxone 250 IM plus doxy 100mg BID
or azithromycin 1 gm po 1 week. test in 1 week
older than 35 y/o: cipro 500mg BID for 10-14 days
orchitis caused by what process
in who/when
caused by ascending bacterial infection from the urinary tract
occurs in 25% postpubertal males who have mumps infection
occurs in 25% postpubertal males who have mumps infection
orchtitis
orchitis sx
testicular swelling and tenderness
usually UNIlateral
fever and tachycardia
orchitis UA, culture,
other test
UA: pyuria and bacteriuria
culture: + for organism
ultrasonography if abscess or tumor suspected to rule out testicular torsion
orchitis tx
if mumps is the cause: symptomatic relief
if bacteria is the cause: treat like epididymitis
scrotal elevation and ice
painful etiologies of scrotal swelling
epididymitis, STDs, prostatis, and testicular torsion
all prostatitis forms present how
irritative bladder symptoms: frequency, urgency, dysuria
and some obstruction
chronic pelvic pain syndrome commonly assoc with what
cause
chronic nonbacterial prostatitis
most common of the prostatitis syndromes
cause unknown
sudden onset of high fevers, chills, and low back and perineal pain
acute prostatitis
UA in prostatitis
pyuria
may have hematuria and bacteriuria
how to distinguish a chronic prostate infection from another urinary tract infection
4 glass localization test
what occurs in 25% postpubertal males who have mumps infection
orchitis
prostatitis presentation on exam
prostate swollen and tender; BOGGY
NO vigorous prostate exam because it can cause septicemia
painless etiologies of scrotal swelling
hydrocele, varicocele
prostatitis fluid
reveals leukocytosis
acute infections will have E. Coli
Chronic infections will have recurrence of same organism or enterococcus
prostatitis tx
acute
uncomplicated
chronic
hospitalize acute. treat with FQ, or gentamycin and ampicillin
uncomplicated: Cipro 500 BID or Levaquin 500 qd for 2-6 wks or
bactrim 160/800 BID for 6 weeks
do culture urine after 1 week
chronic: FQ 1-3 weeks more effective than bactrim 1-3 months
LONG TIME TREATMENT
effective analgesicis for prostatitis
what if lower urinary tract symptoms present
NSAIDs
alpha blockers
chronic, recurrent, or resistant prostatitis with or without prostatic calculi
may require transurethral resection of the prostate for ultimate resolution
pyelonephritis
acute and chronic differences
acute is an infectious inflammatory process involving the kidney parenchyma and renal pelvis
chronic is the result of progressive inflammation of the renal interstitium caused by bacterial infection.
bacteremia in pyelo
occurs in 10% of acute pyelo
more common in diabetics and elderly
organisms in pyelo
comes from where
E. Coli (85%)
proteus, klebsiella, enterobacter, pseudomonas
ascends from lower urinary tract
pyelo symptoms
fever, flank pain, shaking chills, irritative voiding symptoms
N/V and diarrhea uncommon
fever, flank pain, shaking chills, irritative voiding symptoms
N/V and diarrhea uncommon
pyelo symptoms
pyelo sx in kids
fever and abdominal discomfort in kids
fever and abdominal discomfort in kids
pyelo sx in kids
CVA tenderness!
fever and tachycardic
pyelo
pyelo
CBC
UA
culture
other tests
CBC: leukocytosis and left shift
UA: pyuria, bacteriuria, varying hematuria; maybe WBC casts
culture: obtain before antibx.
get renal ultrasonography if complicated pyelo, may show hydronephrosis secondary to obstruction
KUB!!
pyelo tx
outpatient
inpatient
outpt: FQ or bactrim 1-2 wks. treat longer in immunocompromised pts
inpt: IV FQ or ampicillin and gentamycin until afebrile. then oral for 2 weeks
most common serious medical complication of pregnancy
Pyelo
untreated bacteriuria: 20-30% of pts will develop this
gram neg diplococci
N. Gonorrhorea
epididymitis
culture in epididymitis has no visible organisms
chlamydia
boggy prostate
prostatitis
urethritis symptoms
women are usually asymtomatic
urethritis organisms
chlamydia and gonorrhorea
urethritis presentation
purulent discharge(neisseria)
or clear discharge(chlamydia)
painful voiding, frequency
testing for urethritis
urethral swab
urethritis tx
azithromycin
ceftriaxone
doxy
overactive vs underactive detruser muscle in incontinence
overactive: urge
underactive: overflow
mixed incontinence is what
stress and urge
untreated overflow incontinence can lead to what
hydronephrosis and obstructive nephropathy
diagnostic studies for incontinence
UA(glycosuria, UTI)
post void residual urine (measure urinary retention)
urodynamic studies, anatomical studies
90% of what will have hematuria on UA
nephro/uro lithiasis
paraphimosis vs phimosis
which one is more serious
para: entrapment of foreskin behind glans penis
(think rubber band)
phimosis: inability to retract foreskin over the glans penis
paraphimosis needs emergent treatment
phimosis
congenital vs acquired
- congenital is physiologic in kids and adolescents
- acquired from poor hygiene and chronic balanitis, consider DM in men with chronic infections
phimosis
dx
tx
dx:
erythema with tenderness and possible purulent drainage
cannot retract foreskin over glans penis
obstructed urinary stream, hematuria, pain of the prepuce
tx: circumcision if symptomatic
broad spectrum antibx if infected. may steroid creams or NSAID ointments
paraphimosis
1) from what
2) sx
3) tx
1) many caths without reducing foreskin, forcibly retracting a constricted foreskin for cleaning or cath, vigorous sex
2) pain, edema, tenderness, erythema of glans and foreskin
3) manual reduction: firmly squeeze glans for 5 min to reduce tissue edema and decrease size, then try to bring foreskin back over glans;
surgery, maybe cirumcision
hydrospadias
common defect where the urethra ends on the underside of the penis.
surgical correction maybe
torsion
1) ages
2) symptoms/exam
1) 12-18 years of age
2) sudden onset of unilateral severe pain and scrotal swelling
testis painful to palpation; neg prehns sign
cremasteric reflex
lightly stroke medial thigh and cremaster muscle should pull the testis up on the side that is was stroked
torsion
torsion
1) tests
2) tx
time frame?
1) doppler ultrasound, radioisotope
2) surgical emergency!
manual detorsion: twist outward and laterally
6 hour time frame
orchiopexy of both testis!
BPH age of onset
60-65 years but can occur at 45 y/o
BPH is what
proliferation of the fibrostomal tissue of the prostate that can lead to compression of the prostatic urethra
main medications for BPH
a-adrenergic agonists (prazosin) 5a-reductase inhibitors (finasteride, dutasteride) phosphodiesterase 5-inhibitors (tadalafil/Cialis, vardenafil)
LUTS secondary to BPH w/out elevated post-void residual and when LUTS are predominantly irritative
anticholinergics
LUTS and overactive bladder treatment
tamsulosin plus tolterodine extended release
what improves international prostate symptom score with symptomatic BPH
intramuscular cetrorelix (60mg, then 30 mg at 2 weeks)
surgical treatment of BPH
transurethral resection of prostate(TURP) or transurethral incision of prostate
where does BPH usually occur
in the central(periurethral) zone and may not be detected on a DRE
MOA of alpha blockers
relax smooth muscle in the prostate and bladder neck tamsulosin, prazosin, and terazosin
MOA of 5a-reductase inhibitors
inhibit the production of dihydrotestosterone
cryptorchidism 1) occurs in what percentage 2) risk factors
failure of one or both testes to fully descend 1) 1-2% of males 2) premature birth, low birth weight
cryptochidism 1) assoc with what bad thing 2)dx 3)tx
1) increased risk of testicular cancer 2) cannot be manipulated into scrotal sac 3) orchiopexy for prepubertal boys; orchiectomy if after puberty
point and shoot
Parasympathetic nervous system mediates the erection and the Sympathetic nervous system mediates the ejaculation
major predictors of ED (4)
HTN, DM, hyperlipidemia, CV disease
most ED primarily have an organic or psychogenic cause?
organic; nearly all have a secondary psychogenic component
what BP med can contribute to ED
Beta blockers
dx a ED pt with hormonal abnormalities
FSH, LH
how to differentiate organic from psychogenic cause in ED
nocturnal penile tumescence testing
how to induce an erection in men with an intact vascular system
direct injection of vasoactive substance if unsuccessful, do studies to evaluate arterial and venous vasculature like an U/S, pelvic arteriography, and cavernosonography
7 tests to initially get for ED
prolactin, serum testosterone, thyroid, lipid, CBC, UA, glucose
SE of phosphodiesterase-5 drugs
dyspepsia, rhinitis, vision, priaprism, HA, flushing
what is a hydrocele
mass of fluid filled congenital remnants of tunica vaginalis
hydrocele 1) symptoms 2) dx 3) tx
1) painless if palpable; uncomfortable if very large 2) TRANSILLUMINATE 3) elective repair
you can transilluminate what
hydrocele and spermatocele
what is a spermatocele and symptoms
benign painless cystic mass containing sperm but uncomfortable if very large
spermatocele 1) size 2) location 3) dx
1) less than 1 cm in size 2) lie superior and posterior and are distinct from testes 3) scrotal ultrasonography; will transilluminate too **NO needle aspiration
varicocele is what future problems?
formation of venous varicosity within the spermatic vein (pamphiniform plexus) can decrease sperm count due to elevated temperature
variocele 1) sx 2) dx 3) tx
1) aching, non tender mass; left side 2) does not transilluminate; increases in size with valsalva and decreases in size with elevation of scrotum or supine 3) surgery: lt spermatic vein ligation
what side does a varicocele occur
left spermatic vein has an increased incidence of varicosity b/c the vein is longer and joins the left renal vein at right angles
