GU Flashcards
2 types of BPH
obstructive: hesitancy, decreased force of stream, sensation of incomplete emptying, double voiding, straining
irritative: urgency, frequency, nocturia
tx BPH
alpha blockers: prazosin, tamulosin
5 alpha reductase inhibitors: finasteride
phosphodiesterase 5 inhibitor: tadalafil
surgeries and indications for BPH
indications: refractory urinary retention, bladder stones, large bladder diverticula, recurrent UTIs and gross hematuria, CKD
surgeries: TURP, TUIP, TUNA, prostatectomy if >100g (too big for TURP)
severe flank pain, N&V, referred pain to testis or labium
nephrolithiasis
nephrolithiasis DX
non contrast CT, KUB xray or US–also get a UA
most common urinary stone
calcium (radiopaque), uric acid is radiolucent. cystine: smooth edged ground glass appearance
urinary pH of calcium stone
5.5-6.8
urinary pH of uric acid or cystine stone
<5.5
other lab values to obtain for stones
blood CA, uric acid, electrolytes, PTH if hypercalciuria on 24 hr urine
shock wave lithrotripsy?
<1.5cm. otherwise need percutaneous nepthrolithotomy
physical exam findings of testicular torsion
asymmetrically high-riding testis on affected side. swelling/erythema. cremasteric reflex is absent
gram stain of pyelonephritis causative organisms
usually gram negative. (ecoli, proteus, klebsiella, enterobacter, pseudomonas)
physical exam of pyelonephritis
fever, tachycardia, CVA tenderness
lab for peylonephritis
CBC shows left shift, UA: pyuria, bacteruria, hematuria, white cell casts
tx of pyelonephritis
IV ampicillin, aminoglycoside. outpatient = quinolones (get culture and sensitivity and change according to that)
onset of testicular pain, inflammation, redness and warmth in the scrotum
epididymitis
how to differentiate epididymitis from testicular torsion
US shows increased blood flow to epididymis with epididymitis and the cremasteric reflex is present.
tx epididymitis
if due to chlamydia, azithro. if due to gonorrhea, ceftriaxone.
acute cystitis lab finding
UA: pyuria, hematuria, bacteriuria
painless enlargement of testis
testicular cancer
types of testicular cancer
germ cell tumors most common. nonseminomas or seminomas (leydig, sertolic cell)
tx of testicular cancer
radical orchiectomy by inguinal exploration with early vascular control of the spermatic cord structures is the initial intervention.
first step in DX testicular CA
scrotal ultrasound to determine whether mass is intratesticular or extratesticular. also check hCg, alphafeto protein (never elevated in seminoma) and LDH, LFTs.
later do CT of abdomen/chest/pelvis
most common type of bladder cancer
epithelial (urothelial cell carcinomas)
