GU Flashcards

1
Q

Urge Incontinence S/sxs & Dx

A
  • most common in elderly and nursing home residents
  • overactive detrusor muscle → increased frequency and involuntary loss of urine
  • S/sxs:
    • suddent urge to urinate (pts often unable to make it to restroom)
    • loss of LARGE volumes of urine with SMALL postvoid residual
    • nocturnal wetting
  • Dx:
    • urodynamic study → shows how well the bladder, urethra and sphincter hold and release urine
      • will have increased bladder contractions during the filling phase
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2
Q

Urge Incontinence Tx

A
  • bladder training exercises: goal is to increase the amount of time between voiding
  • limit fluids <2-2.5L/day
  • avoid bladder irritants: chocolate, caffeine, acidic fruits and juices, spicy foods, and aspirin
  • anticholinergic: oxybutynin, tolterodine, darifenacin, solifenacin, trospium, fesoterodine)
    • → reduce bladder irritability and contractility
    • SEs = retention, dry mouth, constipation, nausea, blurred vision, tachycardia, confusion, delirium, contraindicated in narrow angle glaucoma
  • 3rd line = botox
  • 4th line = neuromodulation-electrical sim → percutaneous tibial nerve stimulation
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3
Q

Stress Incontinence S/sxs & Dx

A

Most common in women (after having multiple children)

  • weakness of the pelvic diaphragm (pelvic floor) leads to loss of bladder support with resulting hypermobility of the bladder neck
  • S/sxs:
    • involuntary loss of urine (only in spurts) during activities that increase the pressure of the abdominal cavity
      • cough, sneezing, weight lifting
  • Dx: clinical diagnosis → rule out infx with urinalysis
    • urinary stress test
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4
Q

Stress Incontinence Tx

A
  • kegel exercises: 3-6 weeks of daily exercises, 200/day
  • vaginal estrogens
  • pessary
    • SEs: vaginal irritation, foul-smelling discharge, UTIs
  • surgery → mid-urethral sling
  • weight loss
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5
Q

Overflow Incontinence S/sxs, Dx, & Tx

A

Most commonly affects diabetic patients and pts with neurological disorders

  • inadequate bladder contraction (due to impaired detrusor contractility) or a bladder outlet obstruction → urinary retention and eventual overdistention
  • S/sxs:
    • nocturnal bed wetting
    • infrequent voiding (2-3x/24 hours)
    • difficulty starting urination
    • large post voiding residual volume
  • Men: bladder outlet obstruction due to BPH
  • Women: prolapse of bladder (Cystocele) or uterus; rarely urethral stricture or bladder neck contracture
  • Tx:
    • intermittent self-catheterization
    • cholinergic agents: bethanechol to increase bladder contraction
    • alpha blockers: terazosin, doxazosin to decrease sphincter resistance
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6
Q

Functional Incontinence S/sxs, Dx, & Tx

A
  • occurs in pts who have normal voiding systems but who may have difficulty reaching a toilet due to physical/mental disabilities
  • S/sxs: increased urinary volume and inability to urinate in a timely manner
  • Dx: clinical
  • Tx: scheduled voiding times
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7
Q

Overactive Bladder Etiology, S/sxs, Dx, & Tx

A
  • muscles of the bladder start to contract involuntarily even when the volume of the urine in the bladder is low
  • Risk factors: age, current smoking, hyperlipidemia, DM, cardiovascular and renal disease
  • S/sxs:
    • urgency (sudden need to urinate)
      • followed by occasional loss of urine
      • no leaking with coughing or sneezing
  • Dx:
    • urinalysis
    • post-void residual volume
    • urinary stress test
    • U/S
    • Cystoscopy and urodynamic testing
    • detrusor overactivity (overactive bladder)can be diagnosed if there is urgency or leakage with a detrusor contraction that the pt cannot suppress
  • Tx:
    • pelvic floor exercises
    • anticholinergic: oxybutynin and TCAs (Tricyclic antidepressants) imipramine
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8
Q

Cystocele Etiology, S/sxs, Dx, and Tx

A

Bladder prolapse → occurs when the supportive connective tissue separating the bladder and vagina weaken

  • Risk Factors:
    • obesity
    • chronic cough
    • can occur after childbirth or after lifting heavy objects
  • S/sxs: preceived or discovered bulge in the vagina
    • difficulty getting urine stream going
    • feeling of incomplete emptying
    • frequency or urgency
    • worsened with standing
  • Dx:
    • pelvic exam and urodynamic studies
    • urinalysis
  • Tx: minimal sxs = no tx
    • kegel exercises, pelvic floor training
    • pessaries
    • surgery → strengthen the support underneath the bladder
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9
Q

Urethral Prolapse

A

S//sxs urethral mass and vaginal bleeding

often associated with constipation, painless

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10
Q

Cryptorchidism

A
  • when the testes do not descend aka undescended testicle
  • Risk factors:
    • premature infants (30%) vs full term infants (5%)
    • most common in R testicle
  • increases risk of cancer and infertility
  • Dx:
    • referral made to urology if testicles have not descended by 3 months of age
      • surgery between 6months - 1 year of age (orchiopexy)
        *
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11
Q

Peyronie Disease Etiology, S/sxs, Dx, & Tx

A

buildup of fibrous hardened tissue in the corpus cavernosum → often caused by repeated injury (sex, physical activity) and genetic susceptibility is involved

  • S/sxs:
    • penile pain worsened with erection
    • curvature of penis on erection
    • interference with sexual function
    • thick circumferential plaque at the coronal sulcus
  • Dx:
    • hx and penile exam
  • Tx:
    • stable, mild curvature (≤ 30 degrees) with satisfactory sexual function:
      • observation = okay
    • worsening curvature or sexual dysfunction:
      • pentoxifylline (vasodilator & anti-inflammatory) = best if initial tx within 3 months of onset
      • > 3 months of deformity?
        • intralesional injection with collagenase
      • >12 months and wont respond to other txs?
        • surgical management
          *
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12
Q

Bladder Trauma

A

blunt force bladder injuries usually seen with lower abdominal trauma and pelvic fractures often with MVAs

  • ***always suspect bladder injury in pts with pelvic fracture and inability to void***
  • S/sxs:
    • bruising/edema of lower abdomen, perineum, or genitalia
  • Dx:
    • CBC, prothrombin time (PT) and activated partial thromboplastin time (aPTT) → coagulopathy
    • plain radiography of pelvis
    • retrograde cystogram → once urethral injury has been excluded and/or foley cath is place
  • Tx:
    • Ruptures:
      • intraperitoneal or large bladder rupture = surgery to close
      • extraperitoneal bladder rupture = can be treated with bladder catheter and observation
    • Contusion
      • drainage of the bladder should allow for resolution of the injury within a few days → f/u with cystography to assess integrity of bladder wall
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13
Q

Urethral Trauma

A
  • classic sign = blood at the meatus
  • anterior urethral injuries (bulbous and pendulous) = due to direct blows, straddle injuries, instrumentation
  • posterior urethral (prostatic and membranous) injuries: usually coincide with major pelvic fracture
  • Less common in women (shorter urethra and is more mobile)
  • S/sxs: high riding ballotable (can be “bounced back and forth”) prostate on digital rectal exam (DRE)
    • penile or perineal edema and/or hematoma (common in anterior injuries)
    • scrotal or peritoneal ecchymosis
  • Dx:
    • retrograde urography uses cystoscopy and ureteral catheterization to introduce a radiopaque contrast agent directly into the ureters and renal collecting system
  • Tx:
    • surgical repair for urethral injuries
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14
Q

External Genitalia Trauma

A

male external genitalia: penis, scrotum, testes and ejaculatory complex

Female: vulva, vagina, and labia majora/minora and clitoris

  • Causes: blunt mechanisms, falls, straddle injury
    • penile fractures: most commonly during sexual intercourse or masturbation
      • → hear “popping” or “snapping” sound
  • Tx:
    • Penile Injuries = close f/u care especially if skin was grafted
    • surgery = best tx for penile fractures
    • f/u hormonal studies and semen analysis with scrotal or testicular injuries
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15
Q

Kidney and Ureter Trauma general info and dx

A
  • ***significant force is needed in order to injure the kidneys***
    • → MVAs, Falls, Direct Blows, Lower Rib Fractures
    • Kids: most common cause of renal injury = bike accidents
    • adults: 75% of ureteral injuries are iatrogenic
  • Dx:
    • CT scanning with contrast
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16
Q

Vesicoureteral Reflux Etiology, S/sxs, Dx, & Tx

A

urine flow retrograde or backward from the bladder up the ureters and into the kidney

  • Two Types:
    • primary vesicoureteral reflux: most common type → when child is born with defect at the ureterovesical junction
    • secondary vesicoureteral reflux:
      • obstruction that causes increased pressure and backflow; most commonly caused by recurrent UTIs
    • At risk:
      • young females with hx of pyelonephritis or recurrent cystitis → evaluate for VUR
    • S/sxs:
      • fever
      • urine cx with E.coli
    • Dx:
      • VCUG (voiding cystourethrography) and serial U/S
    • Tx:
      • mild to moderate VUR = usually resolves on its own
      • more serious = surgery
      • recently diagnosed: give prophylactic abx that are administered nightly at ½ the normal dosage
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17
Q

Cystitis S/sxs, PE, Dx, & Tx

A

infx of bladder

  • Most common organisms: E.coli, Klebsiella, proteus, enterobacter, citrobacter
  • S/sxs:
    • hematuria, dysuria, increased urinary frequency, nocturia
    • no fever, chills or back pain
  • PE: NO CVA TENDERNESS
  • Dx:
    • urine dipstick: nitrites, leukocyte esterase
    • urinalysis: pyuria (WBCs in urine), bacteriuria, +/- blood, +/- nitrites
    • Urine Cx = GOLD STANDARD
      • → but do not need for uncomplicated cystitis
        • (non-pregnant woman)
  • Tx:
    • uncomplicated UTIs:
      • trimethoprim -sulfamethoxazole (BACTRIM) x 3 days
      • Nitrofurantoin x 5 days
      • fluoroquinolones x 3 days
    • Lower UTI in pregnancy:
      • nitrofurantoin x 7 days
      • Cephalexin (Keflex) x 7 days
    • Pediatric Cystitis:
      • 1st gen ceph (Keflex) for low risk of renal involvement
      • 2nd gen ceph (cefuroxime) or 3rd gen ceph (cefixime, cefdinir, ceftibuten) for those with high likelihood of renal involvement
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18
Q

Epididymitis S/sxs, PE, Dx, and Tx

A
  • Pathogens:
    • Men < 35 = chlamydia and gonorrhea
    • Men ≥ 35 = E.coli
  • S/sxs:
    • dull, aching scrotal pain that gradually increases
    • dysuria, unilateral scrotal pain & swelling
  • PE:
    • (+) Phren’s sign → relief of sxs with elevation = Classic Sign
    • tender scrotum on posterior
  • Dx:
    • important to r/o testicular torsion → Rapid onset, higher testis → u/s with doppler
    • urinalysis & cx + GCCTpyuria (WBCs in urine) and bacteriuria
  • Tx:
    • <35 or suspected STD: ceftriaxone IM + doxycycline
    • ≥ 35 with suspected enteric organism:
      • levofloxacin or double strength Trimethoprim-Sulfamethoxazole (Bactrim)
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19
Q

Orchitis s/sxs, PE, Dx, & Tx

A
  • Mumps = most common cuase in kids
  • orchitis without epididymitis = very uncommon in adults
  • S/sxs: unilateral scrotal pain
  • PE:
    • tender, swollen testicle
      • shininess of the overlying skin
      • scrotal edema with erythema
  • Dx:
    • r/o testicular torsion with u/s with doppler
    • urinalysis with cxs: pyuria and bacteriuria with cxs positive for suspected organisms
  • Tx:
    • rest, NSAIDS, scrotal support, ice, and abx (if bacterial)
    • Age <35 or sexuallya ctive post-pubertal males → tx like epididymitis
      • ceftriaxone IM + doxycycline
    • Age ≥ 35 (STI not suspected) →levofloxacin
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20
Q

Acute Bacterial Prostatitis S/sxs, PE, Dx, & Tx

A
  • Men < 35: chlamydia & gonorrhea
  • Men ≥ 35: E.coli
  • most common in younger men and more serious
  • S/sxs:
    • fever, chills, malaise
    • dysuria (pain with urination), urgency, frequency
    • perineal and low back pain
  • PE:
    • DRE (digital rectal exam):
      • boggy, warm, tender, enlarged prostate
    • if you suspect prostatitis DO NOT MASSAGE THE PROSTATE → can lead to SEPSIS
  • Dx:
    • urinalysis: pyuria +/- hematuria
    • urine cx: positive
    • prostatic fluid/secretions: may show leukocytosis with a cx → typically positive for E.coli
    • U/S CT scan Cystoscopy for men with significant voiding issues
    • Blood Tests: CBC, blood cx if clinical findings suggestive of bacteremia → BUN, creatinine levels for pts with urinary retention/obstruction
      • → serum PSA may be elevated
  • Tx:
    • Men < 35: ceftriaxone + doxy
    • Men ≥ 35: fluoroquinolones or Bactrim for 3-6 weels
    • URETHRAL CATHETERIZATION IS CONTRAINDICATED IN THESE PATIENTS
21
Q

Chronic Prostatitis S/sxs, PE, Dx, & Tx

A
  • usually men age 40-70
  • can be bacterial/abacterial; chronic bacterial = most common form of prostatitis
  • S/sxs:
    • can be asymptomatic
    • hx of recurrent UTIs
    • perineal/low back pain; suprapubic discomfrot
  • PE: DRE → enlarged, non-tender prostate
  • Tx: fluoroquinolones or Bactrim x 6-12 weeks
22
Q

Pyelonephritis S/sxs, PE, Dx, & Tx

A

infx of the kidneys usually by E. coli

  • S/sxs:
    • dysuria + fever + flank pain +/- nausea/vomting
  • PE: flank pain
  • Dx: urinalysis: bacteria and WBC casts
  • Tx:
    • outpatient: cipro/levo +/- ceftriaxone IM
    • inpatient: cipro/levo or imipenem for more severe disease
    • admit all pregnant patients with pyelo!
23
Q

Urethritis Etiology, S/sxs, Dx, & Tx

A

infx of the urethra

  • Etiology: STIs: chlamydia, N. gonorrhoeae, trichomonas vaginalis & HSV = common cause in both sexes
  • Sxs: dysuria
    • in men: urethral discharge → can be purulent, whitish, or mucoid
  • Dx; first void or first-catch urine sometimes with cx
    • positive leukocyte esterase on urine dipstick
      • or ≥ 10WBCs/HPF
    • nucleic acid amplification test = allows for identification of N. gonorrhoeae, C. trachomatis
  • Tx: should treat empirically for STDs in sexually active pts pending test results
  • ceftriaxone 500mg IM + doxycycline 100mg PO BID x7 days
    • → can consider replacing doxy with azithromycin 1g PO if compliance in question or pregnancy
24
Q

Bladder Cancer Etiology, S/sxs, Dx, &Tx

A
  • transitional cell carcinoma = most common type
  • 4:1 men to women
  • risk factor: SMOKING
  • S/sxs:
    • painless hematuria
  • Dx: cystoscopy with biopsy = GOLD STANDARD
    • persistent hematuria > 3RBC/HPF on ⅔ urinalysis → bladder cancer until proven otherwise!!
  • Tx:
    • endoscopic resection with cystoscopy Q 3 months thereafter
    • high recurrence rate
    • recurrent or multiple lesions can be treated with intravesical BCG vaccine injection
25
Q

Penile Cancer Etiology, Risks PE, Dx, Tx & Prevention

A

squamous cell carcinoma = most common type

  • mean age of diagnosis = 60 years old
  • Etiology: HSV & HPV 18
  • Risk factors: uncircumcised, poor hygiene
  • PE: mass or blister that can become wart-like growth that discharges blood or foul-smelling fluid
    • penile mass or ulcer, especially those who have not been circumcised
  • Dx: biopsy
  • Tx: surgery = most common
    • radiation & chemo = also options
  • Prevention:
    • condom use and HPV vaccine
26
Q

Prostate Cancer Etiology, S/sxs, PE, Dx, Tx

A
  • most are adenocarcinomas
  • associated with the BRCA1 gene
  • Risk factors: african american, old age, family hx
  • S/sxs: urinary retention (more likely sign of BPH), decrease in urine stream strength
    • back pain (metastatic disease)
    • painful ejaculation
  • PE: DRE: hard, nodular, enlarged, and asymmetrical prostate
  • Dx:
    • indications for transrectal biopsy with normal rectal exam → PSA > 10 or abnormal transrectal U/S
    • PSA > 4: U/s with needle biopsy
    • PSA >10: bone scan to r/o metastases
  • Tx;
    • radical prostatectomy → complication = erectile dysfunction & urinary incontinence
    • with metastases: need androgen deprivation therapy (leuprolide) → type of medical castration, but can be reversible
      *
27
Q

Testicular Cancer Etiology, PE, Dx, & Tx

A
  • Most common solid tumor in young men ages 15-40 (avg 42 yo)
  • 5 year survival =90%
  • most common type =germ cell tumor
    • 2 types: seminomas
      • nonseminomatous germ cell tumor (NSGCT)
    • Seminomas:
      • classic seminoma (95%)
      • spermatocytic seminoma
    • NSGCTs
      • emrbyonal carcinoma
      • yolk sac carcinoma
      • choriocarcinoma
  • PE:
    • firm, painless, nontender, fixed mass on testicle
  • Dx: Scrotal U/x
    • radiologic studies to search for metastases → most commonly in brain, belly, lungs
    • tumor markers: alpha-fetoprotein (AFP) → + in NSGCT, not seminomas
      • human chorionic gonadotropin + in both NSGCT and seminomas
      • lactate dehydrogenase (LDH)
  • Tx:
    • orchiectomy +/- chemo and radiation depending on cell type
    • NSGCT = radioresistant
    • Seminomatous tumors = radiosensitive and can be treated with radiation therapy
28
Q

Renal Cell Carcinoma Etiology, S/sxs, Dx, &Tx

A
  • transitional epithelium of the renal pelvis or ureter
  • Male to female ration 2:1 (vs bladder cancer 4:1)
  • age of occurrence 40-70 years
  • 5 year survival = 75% (vs 50% in bladder cancer)
  • etiology:
    • cigarette smoke
    • acquired:
      • Polycystic kidney disease
      • tuberous sclerosis, spontaneous mutations
    • genetic: Von Hippel-Lindau Syndrome
  • Pathology:
    • 60% are clear cell carcinoma
    • if it involves epithelial cells of the proximal tubule → VERY LIKELY TO METASTASIZE (80%)
  • S/sxs:
    • classic triad: 1. hematuria, 2. abdominal mass, 3. abdominal pain or CVA tenderness
    • fever, weight-loss
    • anemia
  • Dx:
    • CT of abdomen/pelvis and CXR
    • UA and urine cytology
    • Staging: <7cm = favorable, >10cm or local invasion→ metastasis is a concern
  • Tx:
    • radial or partial nephrectomy for localized disease
    • no chemo
    • advanced? surgery is an option
29
Q

Wilms Tumor Etiology, PE, Dx, and Tx

A
  • Most common solid renal tumor of childhood
    • arises from otherwise healthy kid’s kidneys < 4 years old
  • Risk factors: family hx, horseshoe kidney
  • Associated Conditions: WAGR syndrome
    • Wilms Tumor
    • Aniridia (no iris)
    • GU abnormalities
    • Retardation
  • PE: palpable, nontender mass on the lateral abdomen
    • mass feels smooth and firm and does NOT cross the midline
  • Dx: U/S and CT of the abdomen followed by biopsy or resection.
    • CXR to look for metastases
    • should NEVER PALPATE the abdomen of a child with Wilms tumor → increases risk of rupturing the encapsulated tumor → metastasis
  • Tx: surgical resection and chemo
    • → most cases are curable ****
30
Q

Calcium Nephrolithiasis Risk factors and Prevention

A
  • calcium oxalate = most common
  • Radiopaque
  • Risk factors: decreased fluid intake, high urinary calcium or pH, high animal protein intake, hypercalcemia, males, medications (loop diuretics, acetazolamide, antacids)
  • Prevention: increased fluid intake, thiazide diuretics, citrate, low sodium diet, decreased animal protein diet
31
Q

Uric Acid Nephrolithiasis Risk Factors and Prevention

A
  • 5-8%
  • Radiolucent (cannot see on Xray)
  • Risk Factors: excess meat, alcohol, gout, chemo (tumor lysis)
  • Prevention:
    • increased fluids, allopurinol or potassium citrate, urine alkalinization, adequate hydration prior to chemo
32
Q

Struvite Nephrolithiasis Risk Factors and Prevention

A

magnesium ammonium phosphate → can form staghorn calculi

  • formed in the renal pelvis due to urea-splitting organisms
  • Radiopaque (visible on Xray)
  • Risk factors: chronic UTI with klebsiella and proteus species
  • Prevention: control source of infx
33
Q

Cysteine Nephrolithiasis Risk Factors and Prevention

A

Rare 1-3%

  • Congenital defect in the reabsorption of the amino acid cysteine
  • Prevention:
    • dietary modification, low sodium, urine alkalinization , chelating agents in rare cases
34
Q

Nephrolithiasis Etiology, S/sxs, PE, Dx, & Tx

A
  • Types: Calcium, Uric Acid, Struvite, Cysteine
  • S/sxs: renal colic: sharp, severe, colicky flank pain at the CVA→ can radiate to groin
    • difficult to find comfortable position
    • N/V
    • discolored urine, hematuria, frequency, urgency
  • PE: CVA tenderness, usually afebrile
  • Dx:
    • acidic urin (pH <5) → uric acid and cystine stones
    • alkaline urine (pH >7.2) → struvite stones
    • IMAGING TEST OF CHOICE = Non-contrast CT of abdomen & pelvis
  • Tx:
    • <5mm? : 80% chance of spontaneous passage → IV fluids & analgesics
      • tamsulosin (alpha blocker to help facilitate passage)
    • >1cm? 20% → spontaneous passage
      • if uric acid stones → alkalinization of urine to pH >6.5 is helpful
      • extracorporeal shock wave lithotripsy: can break up stones
      • ureteroscopy +/- stent
      • percutaneous nephrolithotomy
        • used for large stones >10cm , struvite, or if less invasive options fail
35
Q

Hypospadias/Epispadias Dx and Tx

A
  • Hypospadias: when the urethral meatus open onto the ventral (bottom/underside) of the penile shaft
    • genetic heritability
    • IVF has been associated with increased risk of hypospadias
  • Epispadias: when the urethral meatus opens onto the dorsal (topside) of the penile shaft
  • Dx: usually made during the newborn exam but imaging studies (excretory urogram) can be helpful
  • Tx: surgical repair before 1-2 years of age
    • DO NOT CIRCUMCISE → may use foreskin in surgical repair
36
Q

Paraphimosis Dx & Tx

A
  • entrapment of the foreskin in the retracted position → Medical Emergency
    • Paraphimosis needs a Paramedic
  • ***always remember to reduce the foreskin after urethral catheterization***
  • Dx: clinical
  • Tx: firm circumferential compression of the glans with the hand may reduce the edema enough to allow the foreskin back to its normal position
    • → if not successful, dorsal slit using local anesthetic temporarily relieves the problem → CIRCUMCISION after edema is resolved
37
Q

Phimosis Dx and Tx

A
  • foreskin in normal position and cannot be retracted
  • adult phimosis often caused from scarring after trauma, infx (such as balanitis) or prolonged irritation
  • Dx: clinical
  • Tx: in children, will normally resolve by age 5
    • tx not usually required in absence of other issues such as balanitis, UTIs, urinary obstruction
    • betamethasone cream 0.05% BID-TID
    • gently stretch the foreskin
38
Q

When to screen for PSA

A

DISCUSS WITH PATIENT

  • men age 55-69 yo
  • 50 years old if first degree family hx
  • 45-50 if african american
39
Q

BPH S/sxs, PE, Dx, & Tx

A

Benign Prostatic Hyperplasia

  • 50% of men have BPH by age 60, >90% by age 85
  • S/sxs: difficulty starting stream, post-void dribbling, hesitancy (start and stop)
    • nocturia
    • weak urinary stream
  • PE: digital rectal exam → uniformly enlarged firm and rubber prostate
  • Dx:
    • DRE +PSA
    • PSA < 4 = normal
    • PSA > 4 → BPH, prostate cancer, prostatitis
    • UA to r/o other causes
  • Tx:
    • if mild → watchful waiting
    • alpha blockers can provide the most rapid relief (smooth muscle relaxation of porstate and bladder neck
      • tamsulosin, prazosin, terazosin (shrink size of prostate)
        • finasteride & dutasteride
    • TURP (transurethral resection of the prostate) if unresponsive to meds
    • 5-alpha reductase inhibitors
40
Q

Hydrocele PE, Dx, & Tx

A
  • mass of fluid-filled congenital remnants of the tunica vaginalis
  • infants: will usually close within the 1st year of life
  • PE:
    • painless scrotal swelling (most common cause of this)
    • + transillumination vs tumor or varicocele which both do not transilluminate
  • Dx: Scrotal U/S
  • Tx: in infants → will usually close in the 1st year of life, but may require surgery if clinically indicated
    • have parents practice watchful waiting for 1 year
41
Q

Varicocele PE, Dx & Tx

A

venous varicosity within the spermatic vein

  • PE: feels like a “bag of worms’ superior to the testicles
    • dilation worse when the pt is upright or with valsalva → decrease in size with elevation of the scrotum or supine position
    • negative transillumination → chronic non-tender mass that does not transilluminate
  • Dx: Scrotal U/s
  • Tx: surgical repair if varicocele is painful or appears to be cause of infertility
42
Q

Testicular Torsion S/sxs, PE, Dx, & Tx

A
  • Risk Factors: after vigorous activity or minor trauma
    • usually post-pubertal boys (65% in boys age 10-20)
    • more common in pts with a hx of cryptorchidism
  • S/sxs:
    • severe, acute onset lower abdominal pain, sharp pain that may radiate into thigh
    • vomiting
  • PE: negative phren’s sign
    • loss of cremasteric reflex ( elevation of the testes in response to stroking of the inner thigh)
    • Blue dot sign: tender nodule 2-3mm in diameter of the upper pole of the testicle
  • Dx: U/s with doppler = best initial test
    • Radionuclide scan demonstrates decreased uptake in the affected testes → GOLD STANDARD
  • Tx:
    • need to de-torse the testicles in < 6 hours (90% salvage rate)
    • >24 hours? <10% salvage
    • orchiopexy (permanent fixation of the testicle)
43
Q

Urethral Prolapse S/sxs, PE, Dx, & Tx

A
  • most commonly affects prepubertal girls and post-menopausal women
  • S/sxs:
    • vaginal bleeding = most common presenting symptom
  • PE: doughnut-shaped protrusion
  • Dx: clinical and is often found during a routine exam
  • Tx: estrogen creams, vaseline, and sitz baths
    • surgical excision for young patients with symptomatic urethral prolapse or with recurrent urethral prolapse
44
Q

Urinary Stricture S/sxs, Dx, & Tx

A
  • narrowing of the urethra caused by:
    • injury, instrumentation (TURP), infx etc
  • S/sxs: weak urine flow, sudden, frequent urges to urinate, UTI
    • hesitancy (stopping and starting)
  • Dx: cystourethroscopy, retrograde urethrogram (RUG), voiding cystourethrogram (VCUG)
    • RUG → helps to find location and length of stricture to guide tx
  • Tx: urethral dilation or stent placement
45
Q

Nephrolithiasis vs Urolithiasis

A
  • Nephrolithiasis:
    • is the disease of having kidney stones
  • Urolithiasis:
    • presence of stones in the urinary tract
46
Q

UTI prevention

A
  • drink adequate amount of water
  • avoid delay in voiding
  • personal hygiene
  • cranberry juice/tablets
  • abx prophylaxis for 3 UTIs/12 months
    • Bactrim/Cipro
47
Q

Pediatric Enuresis

A

generally applied to kids ≥ 5 years of age, meds for kids >6 years only

  • often hereditary
  • 3 main causes:
    • nocturnal polyuria
    • detrusor overactivity
    • increased arousal thresholds
  • Minor Enuresis: we can tx
    • daytime frequency
    • giggle incontinence
    • stress incontinence
    • post void-dribbling
    • nocturnal enuresis
  • moderate enuresis: referral to uro
    • underactive bladder
    • overactive bladder
    • dysfunctional elimination syndrome
48
Q

Nonmonosymptomatic enuresis

A
  • most often associated with Constipation
  • occurs in children with enuresis who also have other LUTS
  • primary enuresis = 85% of all cases of childhood enuresis
49
Q

Imipramine

A

anticholinergic used for overactive bladder in children > 6years