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Clin med 3 - GU and Nephro > GU > Flashcards

GU Flashcards

1
Q

Testicular cancer is divided into what 2 etiologies?

A

Non-seminiferous

  • Embryonal cell carcinoma (15%)
  • Teratoma (5%)
  • Mixed cell type (40%)

•Choriocarcinoma (<1%)

Seminiferous

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2
Q

si/sx of testicular cancer

A

Painless nodule/enlargement of the testes

  • Heavy sensation/dull ache
  • Acute testicular pain
  • Gynecomastia
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3
Q

what do seminoma vs NSGCT testicular cancers look like on US?

A

•Seminoma = hypoechoic lesion w/o cystic area

•NSGCT = not homogenous w/ calcifications, cystic areas, indistinct margins

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4
Q

testocular cancer mestastes first to what LNs???

A

•metastases occur first in the retroperitoneal LN’s

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5
Q

describe how to differentiate nonseminoma from seminoma based on lab values?

AFP

B-hcG

LDH

A

AFP – warning signs for reoccurrence

  • NSGCT - stage and tx guidance
  • Never elevated w/ seminomas

Β-hCG

  • NSGCT
  • Seminomas only 20% of time elevated

LDH - Elevated with either GCT

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6
Q

Lab value that is Never elevated w/ seminomas testicular cancer??

A

AFP

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7
Q

INC AFP in testiuclar cancer means?

A

AFP – warning signs for reoccurrence

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8
Q

staging testicular CA (1-3)

A

•Stage 0 – carcinoma in situ, abnormal cells where sperm develops

  • Stage 1 – testicular cancer limited to testis
  • Stage 2 – testicular cancer that involved RPLN or para-aortic LN in the region of the kidney

•Stage 3 – spread beyond RPLN

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9
Q

•Only reliable method to ID micromets and gold standard for staging of retroperitoneum in testicular cancer??

what category ALWAYS get this??

A

RPLND

NSGCT since higher risk of nodal involvement

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10
Q

important risk factor for testicular cancer is what dx?

A

•Cryptorchism

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11
Q

How to differentiate seminef vs nonseminef testicular cancer based on LAb values?

A

Seminiferous- NORMAL AFP, sometimes ↑b-hcG

Nonsemi-↑AFP, ↑b-hcG

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12
Q

which type of testicular cancer?

  • Rarely metastasize (liver, lung, bone, brain)
  • Radiosensitive
  • Not typically marked by tumor marker elevation
A

seminef

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13
Q

tx of seminef testiuclar cancer

stage 1

stage 2

Elevated B-HCG

A

Stage 1 - Orchiectomy typically curative

  • Can also do adjuvant chemo 1-2 cycles carboplatin
  • Adjuvant retroperitoneal XRT (not chemo candidate)
  • Active surveillance w/ compliant pt

Stage 2 seminoma (RPLN/PALN noted on CT)

Stage 2a <2cm involved Lns, _Adjuvant XR_T and/or monitor w/ CT

Stage 2b (2-5cm LN’s) or c (>5cm LNs) Adjuvant chemotherapy

  • More extensive RPLN’s
  • (bleomycin, etoposide, cisplatin) BEP

Elevated B-HCG - Adjuvant Cisplatin chemotherapy

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14
Q

tx of nonseminef tsticular cancer

stage 1

stage 2 (CT vs RPLN)

A

Radical orchiectomy = histology & tx plan

Stage 1 (testicle only) – depends on RF

  • 1 or more RF = high risk disease and likely micromets
  • Active surveillance (50% relapse rate)
  • Chemotherapy (1-2 cycles BEP)
  • RPLND

Stage 2 (testicle & RPLN/PALN)

CT only

< 2cm nl markers = RPLND

>2cm or high markers = BEP 3 cycles

RPLND +

<2cm and <4 LN’s = survelliance

>2cm and/or >4 LN’s = BEP 2 cycles

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15
Q

Most common male solid malignancy 15-35yo

A

testiuclar canc

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16
Q

Second most common male cancer worldwide and cause of cancer related death

A

prostate cancer

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17
Q

Most Porstate Cancers are _______and originate in the ____ ____ of the gland

A

adenocarcinoma and originate in the peripheral zone of the gland

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18
Q

Gleason Staging is used for what dz?

explain staging

score of 2-6 =

score of 7 =

score of 8-10 =

A

Gleason Staging - Pathologist criteria for architecture of the malignant gland and used to help determine prognosis in prostate CA

  • Primary grade (largest area in the prostate) and secondary grade (2nd largest area bx in prostate) from the specimen and then sum of these grades
  • 2-10 score
  • Correlates tumor volume, pathologic stage, prognosis

score of 2-6 = low-grade or well-differentiated tumor

score of 7 =moderate grade/moderately differentiated tumor

score of 8-10 = high grade or poorly differentiated tumor

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19
Q

prostate cancer most common mets are to ???

A

most common mets are axial skeleton

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20
Q

prostate cancer staging (1-4)

A

Stage I – not palpable

Stage II – one or both lobes

Stage III – seminal vesicles

Stage IV – bladder or other or organ invasion

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21
Q

si/sx of prostate cancer

include late findings

A

Most have no symptoms

  • Urinary frequency
  • Nocturia, Hesitancy
  • Hematuria/ hematospermia

Late findings

•Bone pain - most common mets are axial skeleton (Back pain or pathologic fxs)

  • LE lymphedema
  • Urinary retention
  • Adenopathy
  • Weight loss
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22
Q

Screening for prostate ca includes?

A

PSA & DRE

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23
Q

INC PSA in prostate cancer is useful for??

A

detecting and staging prostate CA

monitoring response to tx

detecting recurrence

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24
Q

when screening for prostate cance and INC in PSA can be benign - what should you do to confirm this?

values indicative of cancer?

A

Fractionated PSA - %free PSA relative to total PSA

>30% free PSA ratio = low liklihood cancer

<10% free PSA ratio = assoc w/ CA (50%)

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25
Q

what diagnostic method in prostate cancer is Assoc w/ improved detection of CA and risk stratification

name 2 other imaging modalities and their uses?

A

TRUS guided biopsy - Assoc w/ improved detection of CA and risk stratification

•If persistently elevated PSA level in the face of negative biopsy then may repeat bx 1- 2X (include transition zone this time)

MRI - Better to stage CA than TRUS

99-technetium bone scan - For M staging or axial skeleton mets

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26
Q

Prostate cancer w/ persistently elevated PSA level in the face of negative biopsy what is next step…?

A

may repeat bx 1- 2X (include transition zone this time)

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27
Q

tx of prostate cancer

A

Active surveillance/watchful waiting

Radiation therapy: EBRT & Brachytherapy

_Hormone therap_y-Most prostate CA hormone dependent

Radical prostatectomy +/- pelvic LN dissection

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28
Q

name 2 rools for assessing prognossi of prostate cancer and rtheir uses

A

•Kattan Nomogram - Likelihood pt remains cancer-free @ 5yrs post-prostatectomy or XRT

•CAPRA Nomogram - Likelihood of PSA recurrence 3 and 5 yrs s/p prostatectomy

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29
Q

prostate cancer criteria for high intermediate and low risk

T score

Gleason

PSA

A

Low risk – T1-T2a, Gleason <6, PSA <10

•Bx only tumor or localized to one lobe of gland

Intermediate Risk – T2b, Gleason 7, PSA 10-20

•One half or bilateral prostate tumor

High Risk – T2c, Gleason 8-10, PSA >20

•Bilateral prostate lobe tumor

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30
Q

tx for prostate cancer - localized dz

low

intermediate

high risk

A

Low risk disease

Active surveillance (w/ pt comfort)- PSA, DRE

Radiation therapy

Prostatectomy +/- pelvic node dissection

Intermediate risk disease - Life expectancy >10 yrs

Radiation therapy: EBRT (+/- ADT) or Brachytherapy

•Combination of EBRT and Brachytherapy

_Prostatectomy w/ pelvic LN dissectio_n

High-Risk Disease

EBRT + ADT (2-3 yrs)

EBRT + Brachytherapy + ADT 1 yr

Prostatectomy w/ pelvic LN dissection

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31
Q

Locally and regionally advanced prostate disease is defined as

A

Advanced pathologic stage or positive margins (Imaging studies provide clear evidence of non– organ-confined disease eg, seminal vesicle or periprostatic involvement)

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32
Q

Locally and regionally advanced prostate disease TX

A

T3b-T4 w/ any Gleason or PSA: combo of modalities

  • Prostatectomy + pelvic LN dissection (+/- adjuvant XRT)
  • EBRT + ADT (2-3 yrs)
  • EBRT + Brachytherapy + ADT (long term)
  • ADT alone (select pts)

Any T, N1, M0

  • Prostatectomy + pelvic LN dissection (+XRT&ADT)
  • ADT
  • XRT + ADT (2-3 yrs)
  • LN’s usually positive obturator and internal iliac LN chains
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33
Q

tx of prostate cancer metastsic dz

what drugs cause flare and what do not

how can we prevent?

A

GnRH agonists - Preferred initial treatment

  • Chemical castration
  • Leuprolide, Goserelin, Buserelin, Triptorelin
  • Can cause temporary testosterone “flare” for short period

GnRH antagonist : Degarelix (No flare effect)

CAB (complete androgen blockade)

•Combine GnRH agonist/antagonist and anti-androgen

•Flutamide, bicalutamide

•First few weeks of tx prevent flare

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34
Q

CAB (complete androgen blockade) is used to tx what dz?

what drugb must we also give the pt and why?

A

Prostate cancer: Metastatic disease

Bisphosphonates

  • Use w/ androgen deprivation to prevent osteoporosis
  • Decrease boney pain from mets
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35
Q

causes of urinary incontinence can be remebered by this pneumonic?

A
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36
Q

name 5 types of incontinence

A

Stress

Urge

Overflow

Functional

Mixed

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37
Q

explain etiology of these types of incontinence

Stress

Urge

Overflow

Functional

Mixed

A

Stress - absence of detrusor activity

Urge -a sudden and compelling desire to urinate that is difficult to hold off and is accompanied by involuntary leakage

Overflow - dribbling of urine from overdistension or from incomplete bladder emptying

Functional - ne loss due to cognitive or physical impairment or environmental barriers that interfere with control of voiding

Mixed - combo of these

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38
Q

2 main causes of stress incontinence

A

•Urethral hypermobility – most common 80%

displacement of urethra during any sudden increase in abdominal pressure

•Descent of urethra out of the abdominal cavity causes decreased urethral pressure

•Intrinsic sphincter deficiency- inability to effectively contract the sphincter muscle

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39
Q

incontinience: Associated with increased abdominal pressure (exertion, sneezing, coughing, laughing)

what age group / pop does this most commonly effect

A

Stress incont

Most common incontinence in younger women (age 45-49)

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40
Q

test Useful in differentiating stress from urge incontinence

what are the findings that differentiate the 2?

A

Provocative stress testing - •Goal is to reproduce symptoms of incontinence under the direct visualization of the physician

  1. Patient should have a full bladder and standing
  2. Patient should be told to relax then cough vigorously
  • If urinary loss occurs simultaneously with the cough = stress
  • If urinary loss is delayed or between coughs = urge
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41
Q

•Most common cause of urinary incont in men and elderly

A

Urge

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42
Q

detruser function in incontinence

stress

urge

overflow

A

stress - absence of detrusor activity

urge - Detrusor over-activity

overflow - Detrusor underactivity

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43
Q

•Should be performed on patients with suspected urinary retention or potential obstruction

A

PVR- •Patient should be asked to empty bladder as completely as possible then residual urine is measured

•Normal PVR is <50mL

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44
Q

•PVR >200mL is consistent w/ ______ incontinence

A

overflow

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45
Q

overflow incontinence is what si/sx?

A

•Constant leakage or dribbling

•The second most common type of incontinence in men

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46
Q

si/sx of urge vs overflow incont

A

urge - a sudden and compelling desire to urinate that is difficult to hold off and is accompanied by involuntary leakage

overflow - dribbling of urine from overdistension or from incomplete bladder emptying

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47
Q

Most common combination of Mixed incontinence is

A

stress and urge

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48
Q

tx for stress incontinince

A

ALL – Kegels, diary

Pseudoephedrine

Estrogen therapy

Macroplastique - (Bulking agent injected into urethral wall to strengthen it)

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49
Q

tx of urge incont

A

Oxybutynin

Tolterodine

Trospium

50
Q

tx of overflow incont

A

need to rule out obstruction with cystoscopy

Finasteride

Bethanechol

51
Q

tx of functional & mixed incont?

A

Surgery – TVT

52
Q

overacitve bladder is defines as?

A

•Voiding 8 or more times during a 24 hours period

AND awakening 2 or more times during the night

53
Q

causes ofoveractive bladder

A

Causes:

  • Urethra obstruction in men
  • Bladder stones or tumor
  • Involuntary bladder contraction
54
Q

If incontinence is associated with overactive bladder, PVR will be??

A

no urinary retention -

•(Post Void Residual is normal)

55
Q

nondrug tx of overactive bladder

A

Bhevaioral Therapy – voiding times

Pelvic floor muscle exercises (Kegel)

Electrical Stimulation - Inhibits spasms of detrusor muscle (post-tibial/sacral) S3, TENS

Lifestyle modifications -Weight loss, Decrease caffeine intake

56
Q

medication tx of overactibe bladder

A

Medication – caution may cause retention

  • Antispasmodics
  • Oxybutynin (Ditropan) 2.5-5mg TID or QID or patch q3days
  • Tolrerodine (Detrol) 1-2 mg BID
  • Solifenacin (Vesicare) 5-10mg daily
57
Q

Neurogenic Bladder si/sx

  • Bladder or detrusor hyperactivity
  • Sphincter hyperactivity
  • Detrusor sphincter dysynergy
A
  • Bladder or detrusor hyperactivity – bladder spasms, urgency, frequency
  • Sphincter hyperactivity – incomplete emptying
  • Detrusor sphincter dysynergy– bladder contractions against a closed sphincter
58
Q

tx of nuero bladder

A

Intermittent straight catheterization vs indwelling catheters

RULE OUT INFECTION

Neuromodulation therapy for detrusor spasm

Medications depend on mechanism

•Anticholinergics (oxybutynin, tolterodine) – suppress bladder contractions

_•Alpha adrenergic_s (ephedrine, phenylpropanolamine) – increase bladder storage

•Cholinergics (bethanechol) – help complete bladder emptying

_•Alpha-blocker_s (prazosin, terazosin) – help sphincter relaxation

•Botox injected into sphincter to relax it or into detrusor to decrease spasm

59
Q

herniation of the posterior bladder wall and trigone through the anterior wall of the vagina

dx? cause?

A

cystocele ( bladder prlapse

Caused by weakening of the pelvic floor

  • Child birth – most common
  • Trauma
60
Q

si/sx of cystocele / bladder prolapse

A

Maybe asymptomatic

Vaginal bulging or fullness

Symptoms worse with Valsalva and improve with lying flat

Pain

Urinary incontinence

Incomplete emptying of bladder

Sometimes coincidental finding on exam – fullness in anterior vagina

61
Q

tx of cystocele / bladder prolapse

A

Not a medical emergency, reassurance

Avoid heavy lifting or straining

Pessary placement

Surgery

  • Colporrhaphy
  • Colpopexy
  • Transabdominal mesh taping – ONLY through abdomen
62
Q

define UTI

most commmon pathogen

A

significant bacteriuria in the setting of symptoms of cystitis or pyelonephritis

Most common cause-Escherichia Coli (approx. 86%)

63
Q

si/sx of lower vs upeer UTI

A

Signs and Symptoms of lower urinary tract infections

  • Frequency
  • Urgency
  • Nocturia
  • Hematuria
  • Dysuria
  • Pelvic or low back pain

Signs and Symptoms of upper urinary tract infections

  • Same as above PLUS may also have
  • Fever
  • Flank pain
  • Nausea/vomiting
64
Q

UTI diagnostics:

urine dip -

UA -

A

Urine dip - +nitrites, +leukocyte esterase

Urinalysis - +WBCs, +/-RBCs , look for low levels of squamous cells in clean catch

65
Q

what makes a UTI complicated?

what must ALWAYS be done w/ complicated UTI?

A

REQUIRE urine cx

  • Men
  • History of Frequent UTIs
  • Immunocompromised
  • Diabetes
  • Pregnancy §
  • ost menopausal
  • Urologic Abnormalities: Stones , Stents, Catheters , Neurogenic Bladder, H/o kidney transpant
66
Q

tx of Acute uncomplicated cystitis

A
  • Macrobid 100mg BID x 5days
  • Keflex 250mg QID x 5 days
  • Bactrim DS 1 tab po BID x 3days
  • Cipro 250mg BID x 3 days
67
Q

tx of complicated cystits

preg vs nonpreg

A

non-pregnant women and in men without evidence of prostatitis (longer course-7 days) INVREASE DSY OF TX

  • Cipro 500mg po BID x7 days
  • Macrobid 100mg po BID x 7 days

Pregnancy

  • Augmentin or Keflex x 7days
  • No Fluroquinolones
  • NO Macrobid in third trimester
68
Q

the presence of bacteria in a midstream clean catch urine sample of a patient without symptoms of an UTI

dz?

most common cause

A

Asymptomatic Bacteremia

e. coli

69
Q

criteria for asymptomatic bacteriuria by culture

  • For women:
  • For men and pregnant women
  • Catheterized specimen male or female
A

•For women: 2 consecutive specimens with at least 100,000 CFU/mL of same bacteria

•For men and pregnant women: one specimen with at least 100,000 CFU/mL

•Catheterized specimen male or female: one specimen with at least 100,000 CFU/mL

70
Q

do we tx asymp bacteremia?

A

With few exceptions, most patients do not benefit from treatment

71
Q

Asymptomatic Bacteremia tx needed if?

A

•Pregnant patients with bacteriuria - Low birth weight, preterm labor, pyelonephritis result

•Screen all pregnant patients at first prenatal visit

•Patients three months post renal transplant

•Prophylactically in patients undergoing urinary tract or prostate procedures with associated bleeding

Treat based on urine culture sensitivity.

  • Category B antibiotics in pregnancy for 3-7 days
  • Repeat urine culture to confirm clearing of bacteria in 1-2 weeks
72
Q

describe Testicular Descent

A

•Testis descent has 2 phases:

  1. transabdominal descent - dependent on insulin-like hormone 3 (INSL3).
  2. inguinoscrotal descent - dependent on androgens

•A normal hypothalamic-pituitary-gonadal axis is a prerequisite for testicular descent.

73
Q

•In patients with cryptorchidism, the______ is not firmly attached to the____, and the testis is not pulled into the scrotum.

A

Failure of testicular descent

In patients with cryptorchidism, the gubernaculum is not firmly attached to the scrotum, and the testis is not pulled into the scrotum.

74
Q

dx and tx Cryptorchidism

A

Laparoscopy (dx & tx)- Diagnostic laparoscopy has nearly 100% sensitivity and specificity and allows for concurrent surgical correction.

75
Q

tx Cryptorchidism

complications?

A

•Self-limiting (~6 months) – if not corrected then CONSULT

•Surgical referral

•Orchiopexy

•HCG® ↑ testosterone

Complication:

  • Infertility
  • ↑ risk of Testicular cancer
  • Inguinal hernia - 90 % of undescended testes due to patent processus vaginalis
76
Q

name 2 types of Hydrocele and their causes

A

Non-communicating

  • Trauma
  • Epididymitis
  • Testicular torsion
  • Varicocele
  • Testicular tumor

Communicating (patent processus vaginalis)

•­ intra-abdominal fluid/pressure

•discovered in infancy - due to patent processus vaginalis –occur following increased intra-abdominal fluid or pressure (due to shunts, peritoneal dialysis, or ascites) likely from an imbalance of secretion and reabsorption of fluid from the tunica vaginalis.

77
Q

si/sx of hydrocele

  • •Non-communicating
  • •Communicating
A

Scrotal swelling

  • •Non-communicating - constant
  • •Communicating – transient

+/- pain

•(+) transillumination - assess for fluid – differentiate from hematocele (if possible), hernia, or solid mass.

78
Q

tx of hydrocele , complications?

children

adolescants

adults

A

Children

  • Non-communicating - observation for 1-2 years +/- surgery
  • Communicating - surgery

Adolescents: non-communicating

  • R/o underlying pathology
  • Surgical consult

Adults

  • R/o underlying pathology
  • Surgery

•

Complications: Infertility

79
Q

scrotum feels like (“bag of worms”) t hat may disappear in supine position

A

Varicocele

80
Q

varicocele is caused by

more common on what vein?

A

Dilated pampiniform plexus (L>R)

  • •L spermatic vein – comes off renal vein à more pressure
  • •R spermatic vein off the vena cava
81
Q

varicoele will disappear in what position?

A

Tortuous swelling, scrotal mass “bag of worms” that may disappear in supine position, discoloration

82
Q

tx indications for varicoele

tx?

A

1) the varicocele is palpable on physical examination of the scrotum;
2) the couple has known infertility;
3) the female partner has normal fertility or a potentially treatable cause of infertility;
4) the male partner has abnormal semen parameters or abnormal results from sperm function tests.

If indicated:

  • Embolization
  • Surgical correction
83
Q

Hypospadias

causes?

RF?

A

Caused by failure of fusion of the urethral folds, endodermal differentiation, and ectodermal ingrowth in gestational weeks 8 to 20.

RF: LBW

84
Q

differentiate b/w

Hypospadias –

Severe hypospadias –

A

Hypospadias – urethra opens at underside of penis

Severe hypospadias – urethra opens at base of penis

•More of the penis is fused to the body so its smaller (micropenis)

85
Q

hypospadias surger is needed: what must you NOT do?

may need what pre-surgery?

A
  • Don’t circumcise – foreskin used in repair
  • Surgical – may need testosterone tx pre-surgery to enlarge penis
86
Q

differentiate b/w

Phimosis

Paraphimosis

A

Phimosis -Inability to fully retract the penile foreskin without complications

  • •Normal in infants and children
  • •Not normal in adults – not always pathologic

Paraphimosis - in ability to put foreskin back once retarded

87
Q

pediatric population –

acute urinary tract obstruction- obstructive voiding symptoms.

may indicated what male dz?

A

Paraphimosis

88
Q

tx of paraphi

A

Manual retraction of foreskin (time-permitting)

  • •Grade 2 or 3

If it does not respond / severe -> Dorsal slit procedure

Circumcision – ultimate tx

89
Q

tx indications and tx options for phimosis

A

Treatment Indications –

  • urinary problems
  • sexual dysfunction
  • history of paraphimosis
  • hygiene issues

If indicated:

  • Manual stretching
  • Steroid creams
  • Circumcisionv
90
Q

severe testicular pain

Negative cremasteric reflex

Dx?

A

test torsion

91
Q

what is bell clapper” deformity

significance?

A

•High riding testis with long axis oriented horizontally instead of longitudinally “bell clapper” deformity à HIGH chance to develop torsion

92
Q

tx of test torsion

A

Detorsion surgery w/ gubernacular fixation

93
Q

si/sx Fornier’s Gangrene

A

Severe pain that starts in the abdomen & migrates to the gluteal muscles, scrotum and penis

normal cremasteric reflex

Edema

blisters, bullae, subcutaneous gas

crepitus fever, Tachycardia, hypotension

94
Q

Most common cause of acute onset scrotal pain in adults males

route of infection?

A

epidiymits

Route of infection-urethra to ejaculatory duct down the vas deferens to epididymis

95
Q

Unilateral

Fever

Scrotal swelling and pain -> Radiating pain to flank

+ Phren Sign

dx?

A

Epididymitis

96
Q

name 2 types of Epididymitis

most common pathogens?

A

Sexually transmitted : N. gonorrhea, C. trachomatis

  • most common in men <35
  • associated w/ urethritis

Non-sexually transmitted : E. coli

  • most common in older men
  • associated w/ UTI & prostatitis
  • obstructive uropathy from BPH

Trauma

Autoimmune

97
Q

Epididymitis sexual vs nonsexual

  • associated w/ urethritis
  • associated w/ UTI & prostatitis
A

Sexually transmitted -associated w/ urethritis

non sex- associated w/ UTI & prostatitis

98
Q

Epididymitis Cremasteric reflex is…?

A

normal

99
Q

tx epidiymitis

sex

nonsex

A

Bed rest , Scrotal elevation , Ice

Sexually Transmitted: Gon & Chlam

•Doxycycline + Ceftriaxone

•

Non-sexually transmitted/ low-risk

  • Levoflox
  • or Bactrim
100
Q

what is phren sign?

dx?

A

Phren Sign: lift scrotum & pain is relieved

epodymitis

101
Q

Orchitis most likely caused by?

other causes?

A

Viral:

_•Mumps**_ due to decrease vaccination rates

•Cocksackie, EBV

Bacterial causes- usually in conjunction w/ epididymitis

•14-35 = N. gonorrhea

•Boys <14 & men >35 - E.coli

Older men with bacterial infection usually due to BPH

102
Q

si/sx orchitis

A

Mumps: Associated parotitis which presents 4-7 days prior

  • Unilateral in 70% of cases
  • Can mimic testicular torsion

Fever , Malaise, Myalgias

Swollen red painful testicle -> Bilateral in 14 %

103
Q

tx orchitis

A

Scrotal elevation

NSAIDS

Ice

104
Q

Acute Bacterial Prostatitis most common opathogen & route of infection

A

Gram-negative rodsMost common E coli and Pseudomonas

  • •Proteus species
  • • Enterobacteria (Klebsiella, Enterobacter, Serratia species)

Most likely route of infection-

  1. ascent up the urethra
  2. •Reflux of infected urine into prostatic ducts
105
Q

si/sx of acute bact prostatitis

A

Perineal, suprapubic, and back pain

May have obstructive sx- urinary retention

Pelvic tenderness (generalized)

DRE- exquisite (PAINFUL prostate)

•Prostate is tender, edematous, warm

106
Q

define Chronic Bacterial Prostatitis

pathogen?

route of infection?

A

Chronic or recurrent urogenital symptoms with evidence of bacterial infection of the prostate: gram – rods (E. coli)

•Entry of microorganisms into prostate gland is almost always through the urethra

107
Q

si/sx of Chronic Bacterial Prostatitis

A

Irritative voiding symptoms that won’t go away frequency, dysuria, urgency

DRE – prostate not tender

•May feel boggy, normal or firm

108
Q

labs for acute bacterial prostattis

A

Leukocytosis (↑WBC)with left shift

UA - pyuria, bacteriuria and hematuria

UC will grow offending bacteria

↑ (CRP, ESR)

↑ PSA

109
Q

labs chronic bacterial prostatis

A

UA frequently normal

•Cx grows offending pathogen

Expressed prostate secretions (usually done by urologist)

  • •Increased leukocytes
  • •Increased bacteria
110
Q

tx of acute bact prostatitis

A

Empiric antibiotics until cx

  • Ciprofloxacin 5
  • Levofloxacin
  • Trimethoprim/sulfamethoxazole (Bactrim)
  • Gentamycin 5mg/kg QD IV
111
Q

tx chronic bact prostatis

A

Abx 4-6 wks

Ciproflox

Levoflox

Trimethoprim/sulfamethoxazole (Bactrim)

  • ↑ resistance but good alternative
112
Q

Clinical syndrome in men defined by pain or discomfort in the pelvic region often accompanied by urologic symptoms or sexual dysfunction

A

Inflammatory Prostatitis

113
Q

si/sx Inflammatory Prostatitis

A

Subtle symptoms

Pain in the perineum, lower abd, testicles, penis

Voiding difficulties

Blood in semen

Identical to chronic bacterial prostatitis

Erectile dysfunction, Ejaculatory pain

Depression

114
Q

lab inflam prostatits

A

UA normal –> UC no growth

  • •No growth on Cx

Expressed prostate secretions

  • • Increase in WBC
  • •Increase in macrophages

Prostate Bx

114
Q

comapre contrast lab values

chronic bacterial prostatis

inflammatory prostatits

A

chronic bacterial prostatis

UA frequently normal

  • •Cx grows offending pathogen

Expressed prostate secretions

  • •Increased leukocytes
  • •Increased bacteria

inflammatory prostatits

UA normal –> UC no growth

  • •No growth on Cx

Expressed prostate secretions

  • • Increase in WBC
  • •Increase in macrophages
115
Q

tx Inflammatory Prostatitis

A

Tx targeted at symptoms

PT - Trigger point pelvic muscle spasm

Psychological support- CBT

Tamsulosin

Ibuprophen

Voiding difficulty: 5- apha reductase inhibitors

Sexual Dysfunction: Phosphodiesterase 5 inhibitors fo

116
Q

Urethritis classifications

A

gonococcal : N. gonorrhea

non-gonococcal (NGU): C. trachomatis (most common)

  • M. genitalium
  • Trichomonas vaginalis
  • Treponema pallidum
117
Q

si/ sx or urethritius

gon vs non gon

A

Anxiety

Burning a urethral meatus

Inguinal LAD

Meatus can be red and tender

Gonococcal: incubation 4-7 days

  • •Purulent brown/greenish discharge
  • •5-10% asymptomatic

Non-Gonococcal: incubation 5-8

  • •Dysuria (chlamydia)
  • •White – Watery discharge
  • •More likely to be asymptomatic
118
Q

labs / dx of urethritis

A

UA – gon/chly

First catch urine without cleansing

  • •+ leukocytes
  • •>10 WBC’s

Gram stain - Genital swab

  • Gram stain urethral discharge Chlamydia- PMN (Polymorphonuclear neutrophils)
  • urethral discharge Gonorrhea- intracellular gram-negative diplococci
119
Q

tx of urethritis

gon vs non gon

no cx available?

A

When cx is not available, sexually active men should be treated for both

  • •Partners within last 60 days need to be treated
  • •EPT
  • •Test of cure not needed

NGU (targets Chlamydia and M. genitalium)

  • single dose of Azithromycin 1 g
  • or Doxycycline BID 7 days

Gonorrhea: Ceftriaxone (Rocephen)

120
Q

Most common of the prostatitis syndromes

what is important to know about the dx of this condition?

A

Inflammatory Prostatitis

dx of exclusion

Clin med 3 - GU and Nephro (3 decks)

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