Genitourinary #3 Flashcards
Paraphimosis is
Retracted foreskin that cannot be returned to the normal position
-A urological emergency
Treatment for paraphimosis
- Manual reduction
- Pharm therapy: granulated sugar, injection of hyaluronidase
- Definitive management: incision or circumcision
Phimosis is
inability to retract foreskin over the glans
MC type of prostate cancer
Adenocarcinoma
Risk factors for prostate cancer
- Increasing age (HIGHEST RISK FACTOR)
- Genetics
- AA
- Diet
Symptoms of prostate cancer
- Most are asymptomatic
- Back or bone pain: increased incidence of METS to bone, weight loss
Diagnostics for prostate cancer
- DRE: hard, indurated, nodular, enlarged asymmetrical prostate
- PSA: > 4 is abnormal
- TURP: most accurate test
What grading system determines aggressiveness or malignant potential of prostate cancer?
Gleason Grading System
Adverse effects of prostatectomy
Incontinence and erectile dysfunction
For advanced disease in prostate cancer, what is the treatment?
Androgen deprivation
-External beam radiation therapy
MCC of microscopic hematuria in men
BPH
MC type of nephrolithiasis
-Calcium oxalate
Struvite nephrolithiasis is composed of
Magnesium ammonium phosphate
Symptoms of nephrolithiasis
- Renal colic: sudden, constant upper lateral back or flank pain radiating to groin
- CVA tenderness
- Afebrile
- Hematuria
- N/V
Diagnostics for nephrolithiasis
- UA: hematuria.
- -Acidic urine (pH < 5) = Uric acid and cystine
- -Alkaline urine (pH > 7.2) = Struvite stones
- Noncontrast CT of abdomen and pelvis (Imaging of choice)
- KUB
On KUB radiographs, which stones are radiopaque?
Calcium and Struvite
-This means that they are visible on radiographs
Management for Nephrolithiasis < 5-mm in diameter
- 80% chance of passage
- IVF and analgesics
- Tamsulosin may facilitate passage
If the stone is ______ it may make passage of smaller stones more difficult
At ureterovesicular junction
stones 5-10 mm in diameter, what is the treatment?
- 20% chance of passage
- Shock wave lithotripsy
- Ureteroscopy with or without stent: obstructed stone
- Percutaneous nephrolithotomy: large stones > 10 mm, struvite
Risk factors for Calcium Nephrolithiasis
- Decreased fluid intake (MC)
- Males
- High animal protein intake
- PKD
- Increased Vitamin C intake in men
MC type of penile cancer
Squamous cell carcinoma
Penile cancer is associated with
- HPV 16, 6, 18
- Lack of circumcision
- Smoking
- HIV
Treatment for erectile dysfunction
- Phosphodiesterase 5- inhibitors
- -Sildenafil, Tadalafil, Vardenafil
How do PD-5 inhibitors work? MOA
-Nitric oxide mediated penile smooth muscle relaxation, leading to ability to generate and maintain an erection
True or False: PD5 inhibitors should not be used in patients with CV disease?
True; may cause severe hypotension
What is hypospadias?
Abnormal ventral placement of urethral opening
Pathophysiology of hypospadias
-Failure of urogenital folds to fuse during development
Treatment for hypospadias
- DO NOT CIRCUMCISE during neonatal period because foreskin can be used to repair the defect
- Elective arthroplasty correction: between 6 months and 1 year old
What is epispadias?
Abnormal dorsal placement of urethral opening
Epispadias is often associated with
Bladder exstrophy (protrusion of bladder wall through defect in abdominal wall)
pathophysiology of epispadias
-Failure of midline penile fusion
Diagnostic of choice for urethral injuries
-Retrograde urethrogram (done prior to transurethral catheterization)
Hallmark triad of symptoms for urethral injuries
-Blood at urethral meatus, inability to void, distended bladder
How do urethral injuries most commonly occur?
Blunt trauma: straddle-type falls
Symptoms of urethral injuries
- Gross hematuria
- Blood at urethral meatus
- Swelling, ecchymosis
- High-riding prostate
Peyronie Disease is associated with
- Vitamin E deficiency
- Beta Blockers
- Increased serotonin levels
- Dupuytren’s Contracture
- HLA-B7
- Obesity, Smoking, DM, dyslipidemia
What is another clinical intervention for Peyronie Disease?
- Vitamin E and potassium amino benzoate (PABA)
- Colchicine
- Injection of collagenase clostridium histolyticum
- Surgery
Treatment for premature ejaculation
- Topical desensitizing agents (Lidocaine, Benzocaine, Prilocaine)
- SSRI’s
- PDE-5 Inhibitors
- Others: Pindolol, Tramadol