GU Flashcards
Required workup for painless hematuria in an adult over 35
Assessment for bladder cancer w/ CT urogram and cystoscopy
Medication linked to hemorrhagic cystitis and bladder cancer
Cyclophosphamide
What can be used to prevent cyclophosphamide bladder toxicity?
Mesna (concentrates in bladder and forms conjugate with the toxic metabolite of cyclophosphamide, acrolein)
Diagnostic test for kidney stones
Non-contrast CT or ultrasound
Radiolucent kidney stone associated with needle-shaped crystals in the urine
Uric acid stones
Kidney stones linked to fat malabsorption
Calcium oxalate (unabsorbed fat chelates calcium in the gut, freeing oxalate to be absorbed)
Kidney stones seen in primary hyperparathyroidism and renal tubular acidosis
Calcium phosphate
Kidney stones seen with acidic urine
Uric acid stones
Kidney stones seen with increased cell turnover
Uric acid stones
Treatment of uric acid stones
Hydration, low-purine diet, and alkalinization of the urine with oral potassium citrate. (Can add allopurinol if this regimen fails)
Kidney stones seen patient with genetic defect in amino acid transporters
Cystine stones
Radioopaque kidney stones with hexagonal crystals in the urine
Cystine stones
Kidney stones associated with alkaline urine due to urease-producing bacteria
Struvite stones
Organism associated with struvite stones
Proteus (could be other urease-producing bacteria)
Management of kidney stones by size
<1 cm: may pass, give analgesia and hydration.
Larger will require surgery
Treatment for uncomplicated acute cystitis
Nitrofurantoin, TMP-SMX, or fosfomycin
(Quinolones only if all 3 of these cannot be used in uncomplicated acute cystitis - but these are primary for complicated acute cystitis)
Treatment for complicated acute cystitis
Fluoroquinolones are mainstay (sometimes broader-spectrum, like amp/gent, in more severe cases)
What makes acute cystitis “complicated?”
Patient factors: 1. Diabetes 2. Pregnancy 3. Immunosuppression 4. Renal failure 5. Urinary tract obstruction Situational factors: 6. Indwelling catheter 7. Urinary procedure 8. Hospital acquired
UTI with alkaline urine
Urease-producing bacteria, most commonly Proteus mirabillis (can lead to recurrent UTIs and struvite stones)
(Klebsiella is a less common urease-producing bacterial cause of UTI)
When does pyelonephritis need imaging?
- Symptoms persist after 48-72 hours of appropriate treatment
- History of kidney stones
- Unusual findings (gross hematuria, suspicion for obstruction)
What is complicated pyelonephritis?
Pyelonephritis with any of:
- Corticomedullary abscess
- Perinephric abscess
- Emphysematous pyelonephritis
- Papillary necrosis
Urinary incontinence with coughing and sneezing
Stress incontinence (due to pelvic floor instability)
Urinary incontinence with sudden, frequent need to empty bladder
Urge incontinence
Urinary incontinence with constant dribbling and incomplete emptying
Overflow incontinence
General treatment for all types of urinary incontinence
Lifestyle modifications and pelvic floor exercises
Treatment for stress incontinence
Pessaries, then pelvic floor surgery
Treatment for urge incontinence
Bladder training and lifestyle modification first, then oxybutynin or other antimuscarinics
Treatment for overflow incontinence
Bathanechol (cholinergic agonist) or periodic self-catheterization
Potentially reversible causes of urinary incontinence in the elderly
DIAPPERS: Delirium Infection (e.g. UTI) Atrophic urethritis/vaginitis Pharmaceuticals (alpha blockers, diuretics) Psychologic (depression) Excessive urine output (e.g. DM, CHF) Restricted mobility (e.g. post-surgery) Stool impaction
First treatment for BPH
Alpha1-blockers (e.g. tamsulosin, doxazosin, terazosin)
(5-alpha reductase inhibitors (e.g. finasteride, dutasteride) are either adjuvants or second-line if alpha1-blockers not tolerated)
Treatment for chronic prostatitis
Antibiotics, alpha-blockers, 5-alpha reductase inhibitors
Erectile dysfunction with loss of bulbocavernosus reflex
Neurogenic erectile dysfunction
Bulbocavernosus reflex: squeeze glans or tug on catheter, anal sphincter should contract
Types of causes or organic erectile dysfunction
- Vascular (most common)
- Neurogenic
- Medication-induced
- Endocrine (e.g. hypogonadism)
Medications that can lead to erectile dysfunction
- Antihypertensives (especially beta blockers and thiazides)
- SSRIs
- Anti-androgenic medications (e.g. spironolactone)
Most common cause of priaprism, especially in an adolescent
Sickle cell disease
Medications that can lead to priaprism
- Trazadone (atypical antidepressant with some alpha-block)
- Valproate
- Alpha1-blokers for BPH
- Anticoagulants
- Cocaine
First step in diagnosis of possible testicular cancer based on suggestive exam?
Next step?
First: Ultrasound
Second, if high likelihood of cancer from imaging: orchiectomy
(FNA and biopsy are CI due to risk of seeding lymphatics and blood with cancer cells)
Hormone(s) produced by Leydig cell testicular tumor
Testosterone and estrogen
Hormone(s) produced by choriocarcinoma testicular tumor
beta-HCG
Hormone(s) produced by endodermal sinus testicular tumor a.k.a. yolk sac tumor
AFP
Hormone(s) produced by seminoma testicular tumor
Usually none
UTI symptoms with perineal pain and fever and chills in a man.
Diagnosis? Key test? Treatment?
Diagnosis: Acute bacterial prostatitis
Test: Urine culture to direct antibiotics
Treatment: 4-6 weeks of antibiotics
