Genitourinary #5 Flashcards by Tyler Cichowski

What is paraphimosis?

Retracted foreskin that cannot be returned to the normal position

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What are the symptoms of paraphimosis?

Severe penile pain and swelling of the penis

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What is the treatment for paraphimosis?

Manual reduction. Restore original position of the foreskin. Cool compresses.

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Pharm therapy for paraphimosis

granulated sugar, injection of hyaluronidase

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What is the definitive management for paraphimosis?

incision or circumcision

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What is phimosis?

Inability to retract the foreskin over the glans`

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True or False. Paraphimosis is a urological emergency, whereas phimosis is not?

True

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What is the pathophysiology of phimosis (what causes it)?

Distal scarring of the foreskin (trauma, inflammation, or infection)

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Conservative treatment for phimosis

Proper hygiene
Stretching exercises (may spontaneously resolve)
4-8 weeks of topical corticosteroids can increase foreskin retractility

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What is the definitive treatment for phimosis?

Circumcision

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Benign prostatic hyperplasia leads to ______

bladder outlet obstruction

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BPH is common in older men. Hyperplasia is part of the normal aging process and hormonally dependent on increased ________ production

dihydrotestosterone

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Symptoms of BPH

Irritative symptoms: frequency, urgency, nocturia
Obstructive symptoms: hesitancy, weak force, incomplete emptying, dribbling.

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What is one common medication that can worsen BPH

Pseudoephedrine

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What is the prostate like on digital rectal exam in a patient with BPH?

uniformly enlarged, firm, nontender, rubbery prostate

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What is the best initial therapy to relieve symptoms of BPH?

Alpha blockers (Tamsulosin, Terazosin, Doxazosin)

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What is the MC adverse effect of alpha blockers?

Hypotension

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True or False: Alpha blockers reduce the size of the prostate

False, they do not

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5-alpha reductase inhibitors, such as _____ and ______, do reduce the size of the prostate over time

Finasterine
Dutasteride

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If BPH symptoms persist with medication for 12-24 months, what is the next step in management?

TURP: removes excess prostate tissue

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What is the MOA of Tamsulosin?

Smooth muscle relaxation of prostate and bladder neck leading to increased urinary outflow, obstruction relief, and decreased urethral resistance

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Two common side effects of Tamsulosin/Terazosin/Doxazosin/Alfuzosin (alpha-1 blockers)

Orthostatic hypotension and dizziness

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What is the MOA of 5-alpha reductase inhibitors?

Androgen inhibitor: inhibits conversion of testosterone to dihydrotestosterone suppressing prostate growth, reduces bladder outlet obstruction

What are some adverse effects of Finasteride and Dutasteride?

Sexual or ejaculatory dysfunction
Decreased libido
Breast tenderness
Breast enlargement

After _____ cancer, prostate cancer is the most common cancer in men in the US

Skin

MC type of prostate cancer

Adenocarcinoma

Risk factors for prostate cancer

-Increasing age (strongest risk factor) -Genetics -African American race -Diet

Although most patients with prostate cancer are asymptomatic, what is a common symptom and why?

Back or bone pain: increased incidence of METS to bone

What is the prostate like on exam in a patient with prostate cancer?

-hard, indurated, nodular, enlarged, asymmetrical prostate

Even though an abnormal PSA can be seen in other disorders, what is the DEFINITIVE test for prostate cancer?

Transrectal US-guided needle biopsy

When is the Transrectal US done in prostate cancer?

If PSA > 4 or palpable mass

What grading system is used to grade aggressive vs non-aggressive prostate cancer?

gleason grading system

What are three options for definitive treatment for prostate cancer?

-External beam radiation therapy -Brachytherapy -Radical prostatectomy

What are two adverse effects of a prostatectomy

-Incontinence and erectile dysfunction

For advanced prostate cancer, external beam radiation therapy is an option. What is another medical option that exists?

Androgen deprivation: Flutamide Or Chemotherapy

MCC of hematuria in a patient under 40 years old (three common causes)

-Inflammation of bladder/prostate -Infection of bladder/prostate -Nephrolithiasis

MCC of microscopic hematuria in men

BPH

Name three medications that can cause hematuria

-Cyclophosphamide -Rifampin -Ibuprofen

Best initial test of choice for hematuria

-Urinalysis Repeat 6 weeks of treatment for resolution of hematuria

What is the workup of choice after noninfectious UA in patients > 40 years old with hematuria?

CT urography and cystoscopy

When should you refer to nephrology with hematuria?

Gross hematuria with NO visible clots

When would US be the initial test of choice AFTER Urinalysis in hematuria?

If the patient is pregnant and cannot handle contrast (such as in CT urography)

What type of kidney stone is the MC type?

Calcium oxalate

Struvite kidney stones, made of ______, may form ______ in the renal pelvis due to urea-splitting organisms such as _____

Magnesium phosphate Staghorn calculi Protein, Klebsiella, Pseudomonas

Symptoms of nephrolithiasis

-Renal colic: sudden, constant upper lateral back or flank pain over the CVA radiating to the groin or anteriorly -May be difficult to find a comfortable position -Nausea, vomiting -Frequency, urgency, hematuria -Pain varies based on location of stone

After a UA, what is the initial imaging of choice for a kidney stone?

Noncontrast CT abdomen and pelvis

On UA, there is hematuria usually present with a kidney stone. What type of urine is associated with the types of kidney stones?

Acidic urine (ph<5.0): uric acid and cystine Alkaline urine (ph > 7.2): struvite

When is a renal US used in diagnosing kidney stones?

In children or if CT contraindicated (pregnancy)

On KUB radiographs, what type of stones are radiopaque (visible on radiographs)?

-Calcium -Struvite

Management of kidney stones if < 5 mm in diameter

-80% chance of spontaneous passage --IVF and analgesics, antiemetics --Tamsulosin to facilitate passage

Where is the location that may make passage of kidney stones difficult?

At the ureterovesicular junction (narrow point of the urinary tract)

Management for stones 5-10 mm in diameter

20% chance of spontaneous passage --Extracorporeal shock wave lithotripsy: break up larger stones --Ureteroscopy with or without stent: immediate relief --Percutaneous nephrolithotomy: used for large stones > 10 mm, struvite, or if other methods fail

What should you do if the stone is uric acid in nature?

Alkalize the urine to pH to > 6.5 to help dissolve the stone

MC risk factor for calcium kidney stones

Decreased fluid intake

Other risk factors for calcium stones

-Males -Medications (loop diuretics, antacids, chemotherapy drugs, topiramate) -High animal protein intake -Increased Vitamin C intake in men

How do you PREVENT calcium kidney stones?

-Increase fluid intake -Thiazide diuretics -Low sodium diet -Citrate -Decreased animal protein diet