GU Flashcards
urge incontinence etiology
overactive bladder
contraction by detrusor
urge incontinence test
US to r/o UTI
urodynamic studies: confirm
urge incontinence tx
oxybutynin
mirabegron
stress incontinence test
clinical
UA r/o UTI
Q tip test
stress incontinence tx
1st: kegals, pessary
topical estrogen
surgery: bladder lift, urethral sling
overflow incontinence etiology
nerves not telling detrusor to empty
overflow incontinence test
post void residual w/ bladder US
urodynamic studies
overflow incontinence tx
clean intermittent catheterization
surgical correction
alpha adrenergic blockers
prolapse tx
conservative: kegels,
nonsurg: pessaries, estrogen tx
surgical
cryptorchidism tx
refer to surgery after 1yo, no later than 3yo
higher risk of testicular cancer if not corrected
peyronie dz etiology
plaque formation in tunic albuginea
peyronie dz tx
clostridial collagenase injection
surgery
vesicoureteral reflux sx
young pt, repeat UTIs
vesicoureteral reflux test
voiding cystourethrogram (VCUG)
US (hydronephrosis)
vesicoureteral reflux tx
prevent/tx UTI
manage HTN and renal insufficiency
surgery
tx balanitis
candida: clotrimazole or miconazole cream
allergic: hydrocortisone cream
cystitis labs
+ leukocyte esterase
+ nitrates
urine culture and sensitivity definitive
Pyridium AE
used in UTI as analgesic
AE orange urine, can cause methylglobinuria if used <48h
MCC epidymitis <35yo
urethritis, STI (chamydia, gonorrhea)
MCC epididymitis >35yo
prostatitis, BPH, UTI (e.coli, klebsiella, pseudomonas, proteus)
epididymitis sx
unilateral scrotal pain and swelling
+ Prehn sign
+ cremaster reflex
epididymitis tx
NSAIDS, cool compress
gono/chlam: azithromycin/doxycycline and ceftriaxone
bacteria: bactrim, FQ, cephalexin (child)
MCC orchitis
viral: mumps
orchitis sx
- cremasteric sign
+ prehns sign
orchitis tx
resolves in 1wk
self limited
MCC acute prostatitis
E. coli
<35yo: chlamydia/gonorrhea
acute prostatitis tx
initial: ampicillin and aminoglycoside
<35: ceftriaxone and doxy
outpt: bactrim or FQ
prostate massage CI, risk of septicemia
chronic prostatitis vs acute prostatitis
Acute: tender and boggy
Chronic: nontender and boggy
chronic prostatitis tx
bactrim
TURP if refractory
MCC pyelonephritis
E. coli
pyelonephritis sx
CVA tenderness, N/V/F, chills, tachycardia
pyelonephritis tests
WBC casts
urine culture definitive
leukocytosis
pyelonephritis tx
outpt: bactrim, FQ
urethritis MCC
chlamydia trachomatis
chlamydia culture
does not grow on culture
Urethritis most sensitive/specific test
Nucleid acid amplification test (NAAT)
urethritis tx
coinfx: ceftriaxone + azithromycin or doxy
non-gonococcal: azithromycin or doxy
test parters and tx
MC bladder cancer
transitional
bladder cancer dx
gold: cystoscopy w/ bx
CT w/ urography
penile cancer MC
SCC
penile cancer risk factors
HPV
smoking
MC prostate cancer
adenocarcinoma
prostate cancer risk factors
> 40yo, AA
Fhx, smoking
high fat diet*
PSA monitoring
annual exam after 50yo
45yo if high risk
PSA levels prostate cancer
> 4: not prostate cancer specific
10: repeat in 8-10w
prostate cancer tx
gold for mets: orchiectomy, antiandrogens +/- chemo
if PSA still increased: GnRH (leuprolide)
MC type testicular cancer
germ cell tumors: seminoma
Common cause of testicular cancer
cryptorchidism
non-seminoma GCT tests
+ AFP
high Hcg
radio resistance
MC location testicular cancer
right side
which testicular cancer doesn’t have high AFP
pure seminoma: no tumor markers, sensitive to radiation, slow growing, stepwise spread
wilms tumor sx
child
large abdomen or palpable abdominal mass
fever, abd pain, hematuria
wilms tumor BIT
US
wilms tumor tx
nephrectomy w/ chemo
nephrolithiasis risk factors
dehydration, diet, hx of stones
hyperparathyroidism
MC stone nephrolithiasis
calcium oxalate
struvite stones nephrolithiasis
F
staghorn, coffin shaped
alkaline
uric acid stones nephrolithiasis
gout, high protein diet
acidic
radiolucent
nephrolithiasis sx
acute colicky pain upper/lateral back or flank
loin to groin (radiate to groin), CVA tenderness
hematuria, F/N/V
nephrolithiasis proximal ureter presentation
flank pain,
CVA tenderness
nephrolithiasis mid ureter presentation
mid abdominal pain
nephrolithiasis distal ureter (VUJ) presentation
groin pain
nephrolithiasis BIT
spiral/helical CT w/o contrast
radiopaque stones nephrolithiasis
Calcium and struvite
first line erectile dysfunction
PDE5: sildenafil, vardenafil, tadalafil
PDE5 CI
sildenafil, tadalafil
CI in nitrate use and CV dz
1st line low flow priapism
phenylephrine
CI in CV dz
can do turbutaline if <4h
risk factor hypospadias
advanced maternal age, placenta insufficiency
preterm newborns, low birth weight
hypospadias tx
surgery before 2yo
lichen Planus associations
hep C
ACE, thiazide, diuretics
lichem planus sx
5Ps: pruritic, purple, polygonal, papules, plaques
lacy white lines (Wickham striae)
lichen Planus tx
topical high potency GC (betamethasone)
self limiting
paraphimosis tx
emergency
manual reduction
surgery
phimosis tx
topical steroids, gentle stretching
emergent: dilation w/ clamp and pain meds
definitive, circumcision
BPH tx
asx: no tx regardless of size
5 alpha reductase inhibitor (shrink prostate): finasteride, dutasteride
alpha 1 adrenergic blockers: prazosin, terazosin
TURP
5 alpha reductase inhibitor AE
finasteride
gynecomastia
alpha adrenergic blocker AE
prazosin and terazosin
hypotension (orthostatic)
hydrocele MC location
right side
hydrocele layer
tunica vaginalis
varicocele MC location
left side
varicocele right side
suspect inferior vena cava syndrome if right side only
if sudden, renal cell carcinoma
if child <10yo, retroperitoneal malignancy
varicocele right side test
CT
varicocele left side test
scrotal US/doppler
MCC testicular torsion
bell clapper deformity
testicular torsion sx
neg cremasteric reflex
neg prehns sign
testicular torsion tx
manual detorsion (<4-6h)
6+h: necrosis –> orchiectomy
surg consult 1st then US
urethral stricture test
post void residual (uroflowmetry)
urethrography
cystourethroscopy
urethral stricture tx
dilation
urethroplasty
