GU #2 Flashcards
Prostatitis
-What is it?
-Etiologies of Acute (<35, >35)
-Etiologies of Chronic (> 3 months time)
-Symptoms
-Exam Findings
-Diagnostics
-Prostate gland inflammation secondary to an ascending infection
-Acute < 35: Chlamydia and Gonorrhea MC
-Acute > 35: E. Coli MC
-Chronic: E. Coli MC, Proteus
-Symptoms: Irritative voiding symptoms, Obstructive voiding symptoms (hesitancy, straining to void, incomplete emptying)
-Acute: Fever, chills, perineal pain. Lower back pain.
-Chronic: Recurrent UTI’s or intermittent dysfunction. Fever NOT common.
-Exam Findings: Boggy Prostate!!!, Acute = exquisitely tender, normal or hot, boggy prostate. Chronic = usually nontender, boggy prostate.
-Diagnostics = UA and urine culture. Prostatic massage done in chronic to increase bacterial yield, but AVOID in acute.
What should you avoid in acute prostatitis?
Prostatic massage because it may cause bacteremia!
Acute Prostatitis Management
-Acute > 35
-Acute < 35
-Chronic
-Refractory Chronic
-Fluoroquinolones or Bactrim x 4-6 weeks
-Ceftriaxone + Doxycycline (Azithromycin alternative)
-Fluoroquinolones or Bactrim x 6-12 weeks
-TURP
Epididymitis
-Etiologies (< 35, > 35)
-Symptoms
-Diagnostics
-Management
- < 35: Chlamydia and Gonorrhea
- > 35: E. Coli MCC
- Gradual onset of localized testicular pain and swelling. Groin, flank, or abdominal pain. Fever, chills, irritative symptoms. Scrotal swelling and tenderness. Positive Prehn Sign (relief of pain with scrotal elevation). Positive (normal) cremasteric reflex (elevation of testicle after stroking inner thigh).
-DX: Scrotal US best initial test = enlarged epididymis and increased testicular blood flow. NAAT for gonorrhea and chlamydia.
-Tx: Scrotal elevation, NSAIDs, cool compresses.
–< 35 (STI likely): Doxycycline + Ceftriaxone
–> 35: Fluoroquinolones or Bactrim.
Testicular Torsion
-Pathophysiology
-Symptoms
-Diagnostics
-Management
-Insufficient fixation of the lower pole of the testis to the tunica vaginalis (bell clapper deformity)
-Abrupt onset of scrotal, inguinal, or lower abdominal pain. Nausea, vomiting***. Negative Prehn Sign (no pain relief with scrotal elevation). Negative (absent) cremasteric reflex.
-DX: Clinical. Testicular Doppler US (decreased or absent testicular blood flow). Emergency surgical exploration = Definitive
-Management: Urgent detorsion and orchiopexy within 6 hours of pain onset.
Testicular Cancer
-MC in men age….
-Risk Factors
-2 Major Types
-Symptoms
-MC in men age 15-35 years old
-RF: Cryptorchidism (most significant), Caucasians, Klinefelter Syndrome, Hypospadias
-Germinal Cell Tumors (MC) = Nonseminomas (increased alpha-fetoprotein and beta-HCG and resistance to radiation) and Seminomas (Simple = lacks afp tumor marker, Sensitive = to radiation, Slower growing, Stepwise spread).
-Symptoms: Painless testicular mass. Dull pain or testicular heaviness. Firm, hard, fixed mass that does not transilluminate.
Testicular Cancer
-Diagnostics
-Management
-Scrotal US (initial DOC): Seminoma (hypo echoic) and Nonseminoma (cystic, non homogenous)
-Increased alpha-fetoprotein and beta HcG in nonseminomas
Radical orchiectomy with chemotherapy and radiation is the treatment.
Bladder Carcinoma
-MC malignancy of the genitourinary system
-MC type
-Risk Factors
-Symptoms
-Diagnostics (GOLD STANDARD)
-Management
–Localized/superficial
–Invasive Disease
–Recurrent?
-MC type is urothelial (transitional cell) carcinoma
-RF: Smoking, occupational exposure to dyes, leather, rubber. Age >40, Caucasian, Cyclophosphamide, Pioglitazone, long-term indwelling catheter use
-Painless gross hematuria in a smoker. Irritative symptoms.
-Cystoscopy with biopsy is GOLD can be both diagnostic and curative.
-Management
–Localized: Transurethral resection of bladder tumor (electrocautery) and follow up every 3 months.
–Invasive: Radical cystectomy.
–Recurrent: BCG vaccine if electrocautery unsuccessful.
Urethral Strictures
-Narrowing of the urethral lumen
-Symptoms
-Management
-Chronic obstructive voiding symptoms (weak urinary stream, incomplete emptying, recurrent UTIs, urinary spraying, dysuria).
-Endoscopic treatment (dilation, cold knife incision), intermittent catheter dilation, surgical reconstruction
Varicocele
-What is it?
-MC surgically correctable cause of male infertility
-Symptoms
-Exam Findings
-Diagnostics
-Associations (right side vs left side)
-Cystic testicular mass of varicose veins (pampiniform plexus and internal spermatic vein)
-Painless, but may cause a dull ache. Soft scrotal mass with bag of worms feel superior to the testicle. Dilation worsens when patient is upright or with valsalva. Less apparent when patient supine.
-US is the initial test of choice = dilation of the pampiniform plexus > 2 mm.
-Observation in most for treatment. Surgical if infertility or delayed testicular growth.
-Right side may be due to retroperitoneal or abdominal malignancy. Left-sided in older man may be due to renal cell carcinoma.
Paraphimosis
-What is it?
-Urological emergency?
-Etiologies (in infants, in adults)
-Symptoms
-Management
-Retracted foreskin that cannot be returned to the normal position
-Infants = congenital, iatrogenic
-Adults = penile inflammation (DM or after sex)
-Severe penile pain and swelling, enlarged with constricting band of foreskin behind the glans.
-Manual reduction, cool compress. Pharm therapy = granulated sugar, injection of hyaluronidase. Definitive = incision or circumcision.
Phimosis
-What is it?
-Not a urological emergency
-Pathophysiology
-Management
-Inability to retract the foreskin over the glans
-Distal scarring of the foreskin (after trauma, inflammation, infection)
-Proper hygiene, stretching exercises. Most spontaneously resolve. Circumcision is definitive.
Benign Prostatic Hyperplasia (BPH)
-What is it?
-Symptoms
-Diagnostics
–DRE
–PSA (Normal < 4)
-Management
-Prostate hyperplasia leading to bladder outlet obstruction
-Irritative symptoms (frequency, urgency, nocturia) and obstructive symptoms (hesitancy, weak stream, incomplete emptying, dribbling)
-DRE = uniformly enlarged, firm, nontender, rubbery prostate.
-PSA correlated with risk of progression.
-Management
–Observation if mild
–Alpha blockers (best initial tx) Tamsulosin, Doxazosin, Terazosin
–5 alpha reductase inhibitors (to reduce size of prostate over time) = Finasteride, Dutasteride.
–Surgical if refractory over 6-12 months
—-TURP to remove excess prostate tissue
—-Laser prostatectomy
True or False: Alpha blockers do NOT reduce the size of the prostate?
True
Alpha 1 blocker
-Names
-MOA
-Adv Effects
-Tamsulosin, Terazosin, Doxazosin
-MOA: Smooth muscle relaxation of prostate and bladder neck, leading to decreased urethral resistance, obstruction relief, and increased urinary outflow.
-Dizziness and orthostatic hypotension. Retrogade ejaculation.
