Genitourinary Cases Flashcards
DDx for decreaesd force of stream when urinating
• Benign prostatic hyperplasia
- Urethral stricture
- Bladder atony
- Prostatitis acute v chronic
- Prostate cancer
What symptoms would pt present with that would require surgery?
urinary retention, recurrent UTI, recurrent or persistant gross hemuria, bladder stones, renal insufficiency
- Decreased FOS
- Hesitancy
- Incomplete emptying
- Nocturia
- Straining
All examples of lower urinary tract symptoms that are OBSTRUCTIVE
- Urgency
- Frequency
- Dysuria
All LUTS related to Irritative
• BPH is characterized by proliferation of :
benign stromal and glandular elements
_____, an androgen derived from testosterone, is the major hormonal stimulus for proliferation in BPH
DHT
BPH most commonly affects the______zone of the prostate, producing nodules that compress the prostatic urethra. On microscopic examination, the nodules exhibit variable proportions of stroma and glands.
inner periuretheral
What is appropriate therapy for BPH?
anti-cholinergic
alpha-blocker therapy to shrink prostate
trans-urethral resection of prostate
alpha blocker to relax prostate smooth muscle
Alpha-blocker to relax the prostate muscle
What are the two medical tx options for BPH
what about surgery?
Alpha-blocker therapy to relax smooth muscles or
5-alpha reductase inhibitors to decrease growth of gland
surgery: decrease gland size via transurethral surgery or open
How can you tell the differnce between prostate cancer and BPH?
PSA will be much more elevated in cancer which often presents much later in pts. Cancer doesn’t present till its much more advanced
Serine protease that functions to degrade semicoagulation produced by prostate cells of both benign and malignant
PSA
If you have elevated PSA, what do you need to check for?
need to do transrectal ultrasound with 12 core biopsies
Key for prostate cancer screening guidelines:
average at risk men screen at _____
men with baseline PSA or family hx start screening at ____
55
40
What are the tx options for health men with low risk prostate cancer?
Active surveillance, radical prostectomy, external beam radiation therapy, brachytherapy and cryosurgery
- 21 yo male complaining of right scrotal swelling x 2 weeks • PMHx: None
- PSHx: Right hernia repair
- SocHx: No tobacco, social EtOH
- Meds: None
- Allergies: none
Differntial Diagnosis?
• Epididymo-orchitis • Orchitis• Hydrocele• Spermatocele• Vericocele • Torsion• Hematoma • Hernia• Tumor
• Exam:• GU 10cm firm mass right hemiscrotum, does not transilluminate
- Scrotal US:
- Right testes:10 cm heterogeneous echogenic mass • Left testes: normal
What are we concerened about?
testicular cancer
- Most common cancer men ____
- Average age is 34
- 90% of testicular tumors are ________
20-39
germ cell cancers
• Tumors with more than one subtype are considered ______
non-seminomas
- Staging of testicular cancer is based on____________
- Classic presentation is a ______ but 30-50% present with pain
• 10% of patients present with _______
imaging and tumor markers
painless mass
metastatic symptoms
3 weeks after an orchiectomy for pure seminoma,a 33 yo has a HCG of 0 and an AFP or 152. Pre op HCG was 22 and AFP was 152. Staging CT is negative. What is the next step?
Chemo with BEP bc the orchiectomy didn’t cure the cancer.
tumor marker with a half-life 5-7 days
•Not present in pure seminomas or choriocarcinomas
Alpha-feto protein (AFP)
Tumor marker Not detectable in normal males
Present in choriocarcinomas, embryonal and some seminomas
Half life is 24-36 hours
Beta human chorionic gonadotropin
non specific tumor marker, correlates with volume of tumor
LDH
