GU Flashcards
Urge incontinence do what first
Check UA
What is the problem with urge incontinence
Detrusor muscle over activity
Sensation proceeding urination
Age is a large risk factor ;; obesity ;; neuro ;; pregnancy
Pharm therapy two big meds for URGE incontinence
Oxybutin
Mirabegron
THINK ANTICHOLINERGIC CLASS
OVERFLOW INC. = WHAT SXS
Poor stream
Incomplete
Involuntary loss of pee
Bladder Distention
Overflow incontinence best test
Post void residual
Pee more than remaining = normal flow
Management of overflow incontinence
Self cath
Cholinergic agents = bethenachol
MC cause of hydrocele
Extension of the peritoneum from patent processes vaginalis
Open channel
is hydrocele painful
NO!
Communicating vs. non communicatin
Comm = expands with rising abdominal pressure
Non -comm = independent of abdominal pressure
Varicocele leads most commonly to what if untreated
Infertility
PAMPANIFORM PLEXUS
Is varicocele painful // does it illuminate
It can be dull ; Left is worse than the right
IT DOES NOT ILLUMINATE
Varicocele on the right =
Malignancy - abdominal mass
Definitive mangement of torsion
Surgical de torsion and orchiopexy
Tetsticular torsion has what testicular finding
Swelling in the scrotum
High riding testicle = risk factor
Reflexes lost in torsion
Cremaster = thigh ball rise
Prehn sign = rise the testicul = decrease in pain [this is not going to work in torsion]
Time to get de torsion in testicular torsion
6 hours
Epididymitis before age 35 is usually
C/G - STI
Over 35 = E. Coli
Epididymal pain is ;; U/S flow?
GRADUAL ;; slow ish
U/S = more blood flow
Epididymitis E. Coli antibiotic
FQ or Bactrim
BPH treatment of choice is
Alpha blockers -“zosin” = initial;
But Finasteride will shrink it!
Chronic bacterial prostatitis
Recurrent UTI
Usually no fever
Normal UA
At least 6 weeks
MC cause of acute cystitis
E Coli
Suprapubic discomfort think what
Cystitis
+ urine culture = how many CFUs
100,000
Complicated UTI think pregnancy think what drugs
Oral FQ or Bactrim
Pregnancy Cephalexin
how long can you use phenazopyridine
2 days
Organism in pyelo MC
E. Coli
It’s ascending infection
Type of casts in Pyelo
WBC casts ; nephron is effected.
Outpatient pyelo vs. in patient pyelo
PO FQ
In patient = IV Ceftriaxone// Cipro
Confirmatory test in pyelo
CT
MC presenting sxs of bladder cancer
Painless hematuria
Type of bladder cancer most common
Transitional cell carcinoma = 1st
Then SCC, adeno
Bladder cancer is pretty common in what job
Hair care ; because they work with chemicals
Gold standard imaging for bladder cancer
Cystoscopy
Prostate cancer most common cancer type
Adenocarcinoma
Prostate cancer most common in
AA
Most common risk factor = AGE
Prostate cancer with bone pain think what
Metastatic
What does a cancer prostate feel like ; get what for dx
Lumpy bumpy irregularly shaped
GET : BX
How do you stage prostate cancer
Gleason score
PSA screening in what ages
55-69
Men with family history of prostate cancer with AA race or have BRCA or BRCA1
Risk factors that high risk in prostate cancer
Men with family history of prostate cancer with AA race or have BRCA or BRCA1
MC type of testicular cancer
Germ cell
Testicular cancer effects what age ; what sxs
Med 15-35 ;dull to no pain with test mass ; negative illumination
2 markers elevated in testicular cancer
bHCG and AFP
MC type of kidney stone
Calcium oxalate
MC location for developing kidney stones
The UVJ = uterovesicular junction at the narrowest point
Recurrent UTI stone is what type usually
Struvite
Kidney pain is what
Sudden persistent and with hematuria
Stones = cant sit still!
Management of kidney stone
Less than 5 mm = on its own
5-10 mm less likely to pass its on its own
Initial management :
-alpha blocker
Lithotomy or Lithotripsy = definitive for large stones over 10mm
Treatment for paraphimosis commonly
Surgical reduction
Para vs. Phimosis
Para = around the base of the glands with swollen fore skin
Phimosis = cant pull the fore skin back
2 labs to understand why they have phimosis
Diabetes
A1C and Serum glucose
Which foreskin patholog you is a urological emergency
Paraphimosis
With neurogenic bladder think brain cause for
Overflow incontinence
DRE for BPH and characteristics
Smooth rubbery prostate that is symmetric
Benign tumor
FUD sxs
Management BPH
Alpha blockers
5 alpha reductase
PDE-5 - tadalafil
Surgery = TURP , Laser, Prostatectomy
What type of waste is built up in AKI
Nephrotoxic —> nitrogenous waste
6 nephrotoxins to be aware of
ACE/ARBs
NSAIDs
Lithium
Some ABX
IV contrast dye
Loop and Thiazide diuretics
Defintion of oliguria
Greater 15 mL/hour
What can detect AKI 1-2 days before Creatinine
Serum cystatin C
MC location for AKI
Pre renal
MC cause of prerenal Azotemia
Volume Depletion = (Dehydration, Burns, GI losses, Hemorrhage)
↓ Effective Circulating Volume = (CHF, Ascites, Nephrotic Syndrome)
Impaired Renal Blood Flow = (ACEI’s, NSAID’s, Renal Artery
Stenosis)
Systemic Vasodilation = (Sepsis, Vasodilatory Drugs)
Post renal Azotemia think what
BPH
Nephrolithiasis/Bladder Outlet Obstruction BILATERALLY
Endogenous vs. Exogenous causes of ATN
Endogenous = rhabdo; hemolysis
Exogenous = cisplatin , amphotericin B , contrast Dye
ischemia and sepsis
Main cause of interstitial nephritis =
Drugs = Penicillin, cephalosporins, sulfa, NSAID’s
Glomerulonephritis think what 4 causes
IgA Nephropathy
Post Strep
GPA/Goodpastures
HUS - Hemolytic Uremic Syndrome
MC UA finding for ATN
Muddy brown casts
Renal tubular epithelial cells/ granular casts
ATN Labs =
BUN : Cr < 20:1
ATN treatment
Prevent Further Kidney Injury: Remove Toxins, Treat Cause
Loop Diuretics
Low protein diet
Correct electrolytes
Dialysis if necessary
Reversible unless cortical necrosis (rare and assoc with anuria)
UA and labs for Interistial nephritis ?
UA = Eosinophils and WBC casts
Labs = peripheral blood EOSINOPHILIA
think drug reaction
Assoc. with URI symptoms,(H flu), gastroenteritis
Presents with intermittent hematuria
Most common cause worldwide
IgA Nephropathy/ Bergers
Glomerulonephritis
(+) ASO Titer, ↑C3
Develops 2-6 wks post-impetigo and 1-3 wks post-strep pharyngitis
Prognosis good in children, not as good in adults
PSGN
TXM = Low protein, Low sodium diet, manage HTN,
Steroids NOT
helpful for PSGN
Good pasture syndrome treatment =
Plasma exchange
Formerly known as Wegener’s Granulomatosis
Effects small and medium sized vessels
Associated w/granuloma formation airway, lung, skin ↑ c-ANCA
Associated with URI sx’s; Rhinitis most common first symptom
GPA !
2 associations other than uremia for hemolytic uremic syndrome
Hemolytic anemia
Low platelets
Symptoms related to underlying cause
Hematuria, HTN & Edema: periorbital and scrotal edema, flank
pain
Glomeruloneprhitis
Urinalysis: Tea-colored/Coca Cola urine with Red Cell Casts,
proteinuria, hematuria
Other labs depend on cause: CBC, Complement levels, ASO
Titer, anti-GBM antibodies, ANCA, ANA
Glomerulonephritis
Glomerulonephritis can be treated with what
High dose steriods
Few Hyaline Casts, Possible RBC, No
protein
<1 Early
>1 Late
None or Trace Oligo- / Anuria
+/- HTN
Post renal Azotemia think : BPH
What metabolic waste is MC built up in CKD
Uremia
Think : Metallic taste and Edema !
Lab findings consistent with CKD
U/S Finidings ?
Renal Function: ↑ BUN/Cr, ↑ creat,↓ GFR (for 3 or more mo.)
Other lab abn: Anemia, ↑ K, ↑Phos, ↓ Ca2+ , met acidosis
Urinalysis: proteinuria
U/S may show echogenic kidneys
TXM vs. Prevention for CKD
TXM = low protein, sodium water potassium phosphate diet
Dialysis // Transplant
Prevention = Treat HTN , ACE-I or ARB to delay progression
What GFR is indicated for hemolysis and what is normal?
Hemolysis = 15
Normal = above 90
Bilateral hydronephrosis will do what
Drop GFR
6 causes of hydronephrosis commonly
BPH
Congenital (VUR)
Nephrolithiasis- esp. ureteropelvic junction
Pregnancy
Large Fibroids
Neurogenic Bladder
Treatment of ACUTE hydronephrosis based on etiology :
BPH
Neurogenic Bladder
Infection
Treat Cause!
Catheter (If BPH),
Meds (Anticholinergic if neurogenic
bladder)
Procedures: IF INFECTION, NEED EMERGENT STENTING
OR NEPHROSTOMY
Stenting, Pyeloplasty, Percutaneous Nephrostomy
3 primary causes of nephrotic syndrome
Minimal change disease -KIDS!!!!!!!!!
Focal GMN
Membranous Nephropathy
2 secondary causes of nephrotic syndrome
DM
Amyloidosis
Diangsostivs// Labs for nephrotic syndrome
Proteinuria >3gm/day
Oval fat bodies: Lipids are passed into urine
Maltese Crosses: Appearance of the oval fat bodies under
microscope with polarized light
↓Albumin, Hyperlipidemia, anemia
Renal bx – useful for idiopathic,
NOT necessary in DM and HTN
Nephrotic syndrome mgmt
Diet: Low protein, restrict salt
Tx of hyperlipidemia, Tx hypercoaguability
Diuretics (thiazide/loop) and ACE inhibitors early on
Genetics of PCKDz
Most common hereditary disease in U.S. (Autosomal Dom)
Usually presents age 30’s-40’s, 50% will have ESRD by age 60
Signs/Symptoms:
Gross hematuria + Abdominal/flank pain + Secondary HTN
Large palpable kidneys
UTI’s and nephrolithiasis are frequent
PCKDz
25 % of PCKDz folks also have what cardiac valvular abnormality
MVP
What medical mangement can delay ESRD in PCKDz
Vasopressin
Horseshoe kidney has increased risk of what
Increased risk of renal calculi
and infection
What happens to pts with RAS when given ACE
Rapid increase in creatinine
Screening and Gold Standards Dx for RAS
Screening = U/S
Dx = Renal arteriography
PCo2 feeds the ___ and HCO3 feeds the ___
PCo2 = acidic
HCO3 = basic
Cut off numbers for PCO2 and HCO3
PCO2 should be 40
HCO3 should be 24
Respiratory vs. Metabolic affects on PC02 and HCO3
Respiratory: Alterations in pCO2
Metabolic: Alterations in
HCO
Metabolic acidosis can occur with what type of anion gap
Over 12 — or high normal
Anion gap equation
Anion Gap = Na+ - (HCO3- + Cl-)
Causes of increaesd anion gap MUDPILES
Methanol,
Uremia,
DKA,
Propylene Glycol,
Isoniazid,
Lactic Acidosis,
Ethanol,
Salicylates
Low HCO3 is likely to occur with what type of breathing
Kussmauls
Shallow low depth; retained PC02
Low bicarbonate associated with diarrhea often results in what type of ABG defecit
Metabolic acidosis w/ normal anion gap
What is the compensation for metabolic acidosis
Increased ventilation
To blow off CO2
Causes of metabolic alkalosis
Vomiting, Aggressive suctioning of gastric contents
Diuretics
Overcorrection of met acidosis or ingestion of bicarb
What is the compensation for metabolic alkalosis
Decreased ventilation to increase PCo2
Metabolic disturbances assoc with metabolic alkalosis
Hypocalcemia
Hypokalemia
Causes assoc with respiratory acidosis
Causes:
Anything that decreases respiration/The lungs fail to blow off CO2
effectively
COPD, paralysis of chest from neuromuscular disorders, Narcotic
OD
Compensation for respiratory acidosis
Incr reabsorption of HCO3
- by kidneys
Respiratory acidosis treatment
Treatment:
Fix underlying cause
Assist ventilation
Try naloxone if all else fails
Causes of respiratory alkalosis
Key SXS
Causes: anything that ↑ resp/blows off too much CO2
Hysterical hyperventilation (most common)
Salicylate intoxication
Pulmonary Embolism
SXS = Rapid breathing
Lightheadedness
Perioral paresthesias
Compensation in respiratory alkalosis
Compensation: Increased elimination of HCO3
- by kidneys
When do people have sxs with hyponatremia
Less than 125
Low sodium would cause what to DTR’s
Decrease them
Causes: Prolonged Vomiting, Diarrhea, Diuretic use, Addisons
Disease
Sx: Dehydrated
UA: Urine Sodium is LOW
Think what type of hyponatremia?
TXM?
Hypovolemic
“Water and Sodium lost; ADH causing water retention; but Na+ still low”
TXM = volume replacement ; to decrease ADH
Causes: SIADH, Hypothyroidism, psychogenic polydipsia
Sx: NO signs of volume overload
UA: Urine Sodium HIGH (>20 mEqu/L), unless psychogenic
polydipsia
Think what type of hyponatremia ?
TXM?
Euvolemic
“Kidneys conserving too much water”
Water restriction = TXM
↑↑↑extracellular water compared with Na+
Causes: Cirrhosis, CHF, Nephrotic Syndrome, Renal Failure
Sx: Edema, volume overload
UA: Urine Sodium LOW ( <20mEq/L)
What type of hyponatremia?
TXM
Hypervolemic
TXM = water restriction +/- diuretics
Mc cause of hypertonic hyponatremia
Hyperglycemia
If you correct sodium too quickly what can happen
Central pontine mylenolysis
Hypernatremia is defined as
Sodium over 145
2 causes of hypernatremia
Impaired thirst mechanism or lack of access to water
Meds : Lactulose and Mannitol
Diabetes Insipidus
Decrease sodium by no more than what to prevent what?
1meq/L/Hr
Prevents cerebral edema
Definition of SIADH
Continued excretion of (ADH) despite normal or increased plasma volume.
Too much ADH for an inappropriate reason.
-Guilin Barre / Infxn ‘
-Small cell cancer/Cancer
-PNA/TB
-SSRIs / Chemo
SIADH is what type of hyponatremia
TXM
Euvolemic ;
TXM = fluid restriction ; furosemide
What is severe Hypokalemia
Less than 2.5
Reflex and muscle changes with Hypokalemia
Flaccid paralysis, hyporeflexia, tetany, rhabdo
EKG findings of Hypokalemia
Flattened or inverted T waves, U waves, freq PVC’s
1 Cause of hyperkalemia
Renal disease
4 drug causes of hyperkalemia
Spironolactone
ACE/ARBs
NSAIDs
Severe hyperkalemia sxs
Hyperreflexia —> flaccid paralysis —> Vfib —> death.
3 treatment goals for hyperkalemia
Stabilize the heart:
1. Calcium Gluconate
Drive K+ back into cells:
1. Insulin + Glucose
2. Albuterol
3. Sodium Bicarb
Excrete K+
1. Kayexalate and Hemodialysis
CBIGK
CA2+ is defined low as =
Causes =
Less than 8.5 mg/dL
Causes = hypoparathyrodism ; hypoalbuminemia ; Vit D deficiency
Most Asx. Muscle cramping, paresthesias, ↑DTR’s, confusion, seizures
Chvostek Sign: Facial muscles contract when tap facial nerve
Trousseau Sign: Carpal spasm when BP cuff inflated for 3
min.
EKG: Prolonged QT interval→ Ventricular Arrhythmias]
Think?
LOW CALCIUM
Hypercalcemia is defined as =
Causes =
Over 10.5 mg/dL
Causes
90% Hyperparathyroidism
Cancer: Renal cell carcinoma, Multiple Myeloma, Lung Cancer: All
produce PTH
Only if >12mg/dL: Anorexia, constipation, polyuria, dehydration,
lethargy, coma
EKG: Shortened QT intervals
Think?
TXM?
Hypercalcemia
TXM = IV Fluids and Loop Diuretics
4 causes of LOW Magnesium
Chronic Alcoholism,
Chronic Diarrhea,
Hypoparathyroidism,
Hyperaldosteronism
Hypomagnesia may lead to what
Refractory Hypokalemia / hypocalcemia
Think what arrythmia for low magnesium
Torsades or Long QT
Diets associated with kidney stones
Diets high in oxalate rich foods:
Leafy veggies, nuts, tea, coffee
Diets high in purines
Kidney stone gold standard
CT non con
Kidney stone management based on size
Less 5; 5-10 ; and over 10mm
If < 5mm: passable; Give strainer to catch stone for analysis.
If 5-10mm: Less likely to pass spontaneously
If >10mm: Will not pass; Admit, stent/nephrostomy/lithotripsy
Kidney stone mgmt based on location
Urethral vs. Renal
If Ureteral* – basket ureteroscopy OR laser lithotripsy
If Renal – shock-wave lithotripsy
Struvite stones are assoc with what ? (2)
Infections
Staghorn stones ; ABx dont penetrate ; increased risk of sepsis
Unique image findings of uric acid stones
Radiolucent and not seen on KUB
Urge incontenince think
Gotta go now!
Increased detrusor muscle function
Urge in continence treatment
Treatment: Bladder training #1
Oxybutinin (Ditropan XL),
Stress incontinence think what ?
Due to ↑ abdominal pressure. Dysfunction of urethral sphincter
Leak with cough l sneeze I valsalva
TXM = Kegels, estrogen, surgery (mid-urethral sling 80-90%
effective)
Outlfow incontenince think
Outlet Obstruction → Distention → Overflow
Think BPH; high PVR exam
TXM = relieve obstruction / catherterize
3 risk factors for cystocele
• Vaginal birth
• Advanced age
• Pelvic surgery
Supportive and surgical treatment for cystocele
• Supportive: weight loss, Kegel
exercises, pessary
• Surgical: colpopexy
What location of the prostate is effected by BPH
Cells in the transitional zone
Obstructive vs irritative sxs vs DRE for BPH
Obstructive Symptoms: Hesitancy- slow, weak stream; dribbling
Irritative Symptoms: Frequency, dysuria, urgency, nocturia
On DRE: smooth, elastic, symmetric enlargement in men over 50
yo
BPH meds mainstay
α Blockers (tamsulosin, doxazosin, terazosin): Relaxes smooth
muscles
5α reductase Inhibitors (finasteride, dutasteride): Blocks
formation of DHT
How do 5a reductase inhibitors effect PSA
Reduces score by 50% ; must double the reported number of
What PSA score is usually surgerized
Over 100
Medical conditions associated with with erectile dysfunction
Medical Conditions: DM, HTN, Androgen Deficiency, CAD, High chol
Medications associated with erectile dysfunction
α blockers, β Blockers, diuretics, tobacco, ETOH
Mgmt of erectile dysfunction
Vasoactive Therapy: Oral PDE-5 inhibitors (sildenafil)- NEVER with Nitro!
Hormonal replacement: gel, patch, injectable. Never with Prostate CA
Assistive Devices: Vacuum Erection device and Penile Prosthesis
Priapism is defined as lasting longer than when
4 hours
Medical conditions and drugs assoc with priapism
Conditions : sickle cell ; leukemia ; MM
Drugs : cocaine and ecstasy
Priapism treatment
Terbutaline. If this fails…
Aspiration of corpus cavernosum- Aspirate from 2 or 10 o’clock
Peyronies has a plaque where ?
Tunica Albuginea
Peyronies txm
Intraplaque injection of Verapamil or Interferon
Surgery to remove plaque- NO guarantee of normal function
2 things helpful for dx urethral stricture
Retrograde Urethrogram (RUG) or voiding cystourethrogram
• Red/purple annular mass at urethral meatus
• Bleeding, dysuria, friable tissue
Think? And what TXM?
Urethral prolapse
TXM = sitz bath ; topical estrogen
Balanitis what to know what bout it?
Swelling of the foreskin and glans penis
Causes:
Poor hygiene
More likely in uncircumcised
More likely to be fungal in diabetics
Treatment
Children: None
Adults: topical steroids
topical antifungal
Phimosis ; what to know bout it?
Foreskin is unable to be retracted over the glans penis.
Cause
Children: Physiologic mostly, no intervention
Adult: Often due to chronic low grade infection, Lichen
sclerosis
Treatment
Betamethazone cream
Stretching of foreskin
Circumcision
Paraphimosis; what to know bout it?
Foreskin is trapped in a retracted position.
Edema → Compromised Blood
Supply→ Necrosis.
Cause
Pts w/ long-term Foley are at risk
Treatment
Manual reduction or emergent
dorsal slit// SURGICAL EMERGENCY
3 important facts about hypospadia
Urethra meatus is ventral & proximal to normal position
Repair before the child is 18 months old
Hypospadias + Bilateral Cryptorchidism =Sex Hormone
abnormality
BELOW
1 fact of Epispadia
Urethra meatus is dorsal & proximal to normal position
Surgery
ABOVE
Chordee [ventral curvature] is assoc with what other congenital abnormality
Hypospadia
VUR ; 4 important facts
Urine passes retrograde from bladder to kidneys during voiding.
Result of an incompetent vesicoureteral sphincter
30-60% will have Reflux Nephropathy at time of diagnosis
Typical patient: Child with recurrent UTI’
TXM for VUR
Treat HTN, ACE inhib, Abx and freq urine cx, Surgery for Severe Reflux
Reflux Nephropathy leads to what
HTN
Definition of cryptordchidism and what are you at risk for with this
Testes are still inside abdomen have not descended , distend usually at 7 mos gestation
Testicular cancer = risk
4 risk factors for cryptorchidism
Prematurity,
Low birth weight
Maternal exposure to estrogens in the 1st trimester
Family History
Bilateral with cryptorchidism hypospadias indicates
—> other sex hormone
abnormalities.
Usually only RIGHT sided
Mgmt cryptorchidism
HCG injections or surgical correction at 1 year
Varicosities within scrotum that feel like a “bag of worms”.
May have an achy feeling. L>R
Increases with Valsalva, Decreases when lying supine.
Rarely treated unless indicated by infertility.
Varicocele
Retention cyst of the head of the epididymis
Painless, (+) Transillumination
No treatment; only removed if causing discomfort
Spermatocele confirmed by U/S
1 RF for testicular torsion
Bell clapper deformity
Ages 10-20
Prehns and cremaster reflex in TESTICULAR TORSION
(-) Prehn’s sign=
NO relief with elevation of testicle
(-) Cremasteric Reflex=
NO retraction of ipsilateral testis when medial thigh is stroked
Learning points on epidymtitis (3)
Pathogens vary by age and sexual history
<35 yo/sexually active men:
Usually STD (GC and Chlamydia)
Not sexually active, young and older:
Usually uropathogens (E Coli)
If chronic (>6 weeks): Inflammation not
infection
3 findings in epidymitis
Scrotal inflammation, redness, enlargement, and/or reactive
Hydrocele
Urethral discharge and Irritative voiding symptoms possible
(+) Prehn’s sign, (+) Cremasteric Reflex
—> GET U/S to R/o Torsion
ABX management for epidydmitis
Uropathogen
Vs.
G/C STD
If Uropathogen: Ofloxacin or Levofloxacin Abx if infection
If STD: Ceftriaxone 250 mg IM + Doxycycline for 10 days.
TREAT PARTNER
4 common sxs in orchitis
Develop 1 week after onset of mumps parotitis
Marked pain and swelling in one or both testicles
N/V, fever, Urinary symptoms +/- proteinuria and hematuria
Testes are enlarged, tender and indurated
Gonnorhea
//
Chlymadia treatment
Ceftriaxone 250 mg IM [Gonnorhea] + Doxycycline for 7days [chlamydia]
Cystitis in men is associated with [4]
Prostatis
FOB
Obstruction
Infxn stones
When do you get an U/S vs. CT for pyelo
U/S = if you think obstruction
CT = if you think stone involvement / infxn
Pyelo management
Admit: elderly/ pregnant/ co-morbid/ obstructed/ not tolerating PO
IV for 24 hours after fever: Ampicillin plus Aminoglycoside prior to
sensitivity
Uncomplicated: Oral abx x 14 days: Ciprofloxacin or other Quinolone
What do you not do in septic prostatitis
Prostate massage = can cause septicemia
What study can you get for bacterial prostatitis
Transrectal U/S or CT to r/o abscess
CBC
UA
Mangement for acute bacterial prostatitis
4-6 weeks of TMP/SMX or a fluoroquinolone.
Analgesia, fluids, rest.
If septic, hospitalize for IV Abx (ampicillin and aminoglycoside) x14 days [2 days IV —> PO]
DRE findings in chronic bacterial prostatitis
Normal
Boggy
Tender
Expressed Prostatic Secretions (EPS) =
↑ WBC’s, “Lipid Ladden Macrophages”, (+) cultures
Chronic bacterial prostatitis management
TMP/SMZ, Quinolones x 6-12weeks, NSAID’s, α
Blockers, Hot sitz baths
Prostatodynia is negative for what
Fever
UA findings
UA culture
Prostatic secretion growth
Type of testicular cancer most common
GERM CELL
-seminomas
-nonseminomas
2 common fxs of testicular cancer
Painless testicular mass
Testicular enlargement, R>L.
Non seminomas labs that indicate testicular cancer
AFP high
LDH high
BHCG high
Testicular cancer management
Radical orchiectomy for everyone
Seminomas: Add external beam radiotherapy +/-
Chemo (cisplatin)
Nonseminomas: Surveillance, May add Chemo.
Nonseminomas are NOT responsive to XBRT
What type of bone is susceptible to Prostate cancer Metz
Axial skeleton
What score is used for tissue differentiation with respect to prostate cancer
Gleason score
higher score = less diff. = Poorer Prognosis
Medication class used in the treatment of prostate cancer
Leuprolide Goserelin = LNRH agonists
SMOKING #1 Risk Factor.
Occupational exposures: dyes, solvents, petroleum, leather,
printing.
Male (3:1)
>40yo
90% of cases are Transitional Cell Carcinoma aka Urothelial
Cell Carcinomas
THINK ? TXM ?
Bladder cancer
PAINLESS HEMATURIA/ ESP. SMOKER
TXM = Location Based :
Does not invade bladder wall = transurtheral resection
Does invade = radical cystectomy
What are 3 risk factors for Renal cell carcinoma
Risk factors:
Smoking
Men (3:1)
Obesity, HTN
Renal cell carcinoma patients are at an increased risk for what
Paraneoplastic syndromes
Producing occlusive thrombi in renal veins and IVC
Peak Incidence 2-3 yo
#1 common solid renal tumor in kids
5% of childhood cancers
Signs and Symptoms
Palpable Abdominal Mass (60%)
Abdominal pain
Hematuria
N/V, anorexia, fever
THINK?
TXM?
Wilms Tumor
no Bx as this will spread tumor cells
TXM =
Surgical resection
Nephrectomy
Chemotherapy
Radiation
