Genitourinary #5 Flashcards
What is paraphimosis?
Retracted foreskin that cannot be returned to the normal position
What are the symptoms of paraphimosis?
Severe penile pain and swelling of the penis
What is the treatment for paraphimosis?
Manual reduction. Restore original position of the foreskin. Cool compresses.
Pharm therapy for paraphimosis
granulated sugar, injection of hyaluronidase
What is the definitive management for paraphimosis?
incision or circumcision
What is phimosis?
Inability to retract the foreskin over the glans`
True or False. Paraphimosis is a urological emergency, whereas phimosis is not?
True
What is the pathophysiology of phimosis (what causes it)?
Distal scarring of the foreskin (trauma, inflammation, or infection)
Conservative treatment for phimosis
Proper hygiene
Stretching exercises (may spontaneously resolve)
4-8 weeks of topical corticosteroids can increase foreskin retractility
What is the definitive treatment for phimosis?
Circumcision
Benign prostatic hyperplasia leads to ______
bladder outlet obstruction
BPH is common in older men. Hyperplasia is part of the normal aging process and hormonally dependent on increased ________ production
dihydrotestosterone
Symptoms of BPH
Irritative symptoms: frequency, urgency, nocturia
Obstructive symptoms: hesitancy, weak force, incomplete emptying, dribbling.
What is one common medication that can worsen BPH
Pseudoephedrine
What is the prostate like on digital rectal exam in a patient with BPH?
uniformly enlarged, firm, nontender, rubbery prostate
What is the best initial therapy to relieve symptoms of BPH?
Alpha blockers (Tamsulosin, Terazosin, Doxazosin)
What is the MC adverse effect of alpha blockers?
Hypotension
True or False: Alpha blockers reduce the size of the prostate
False, they do not
5-alpha reductase inhibitors, such as _____ and ______, do reduce the size of the prostate over time
Finasterine
Dutasteride
If BPH symptoms persist with medication for 12-24 months, what is the next step in management?
TURP: removes excess prostate tissue
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
Two common side effects of Tamsulosin/Terazosin/Doxazosin/Alfuzosin (alpha-1 blockers)
Orthostatic hypotension and dizziness
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
