GU/Renal Flashcards
Uterine Fibroids definition & MC location
benign tumors of the myometrium/connective tissue of the uterus
- Intramural is MC –> within the muscle layer
- subserosal
- submucosal (extending into the uterine cavity)
- pedunculated
Most common symptom of Uterine Fibroids + others
- Abnormal uterine bleeding = MC
- chronic pelvic pain
- bulk symptoms
- Anemia
- Urinary retention
- Constipation
- Infertility/ pregnancy complications
How common are uterine fibroids?
Very common! 70-80% of women have them by the tie they are 50 yo
Maybe familial component
MC in AA women
Uterine Fibroid Diagnostics
- CBC w/ diff
- BUN/Cr
- TSH
- Transvaginal U/S»_space;»> pelvic U/S
Uterine Fibroid Management
- Routine pelvic exams to monitor
- Combo OCP (estrogen + progestin)
- NSAIDs for pain
- Surgical options –> hysterectomy vs. myomectomy
Do fibroids cause fertility issues?
Yes, they can for younger patients
Is there ever any concern for malignancy w/ fibroids?
Typically not, but satellite growths are more concerning for malignancy
What is another treatment option to reduce bleeding w/ fibroids?
Tranexamic acid
Acute Bacterial Prostatitis definition
A bacterial infection that travels up the urethra & penetrates the prostate
50% of men will have one in their lifetime
MC bacteria in Prostatitis
E. coli, Klebsiella, other gram neg bacteria
STI – Gonorrhea or Chlamydia (suspect if penile discharge)
Symptoms of Prostatitis
- Dysuria (painful urination)
- Frequency & urgency
- Nocturia
- Poor stream & Hesitancy
- blood in urine
- Perineal pain w/ radiation to back, rectum, or penis
- Fever & Chills
Severity of symptoms increases if patient also has BPH
Prostatitis Physical Exam
- Examine external genitalia for erythema or swelling of scrotum
- DRE prostate is exquisitely tender & boggy
DO NOT MILK!! Can spread infection
Prostatitis Lab Diagnostics
-Urinalysis (leukocytosis, nitrites, +/- hematuria)
-Urine Culture
-GenProbe if STI concern
-CBC + blood culture if signs of sepsis present
+/- BMP for renal function
Acute Prostatitis management
STD risk – Ceftriaxone IM x1 + Doxycycline x10 days
Low STD risk – Cipro, Levo, or Bactrim (TMP/SMX)
follow up in 7 days for repeat urine culture & change of ABX if necessary
Chronic Prostatitis management
1st line = Cipro or Levo x4 weeks
2nd line = Bactrim (TMP/SMX) x 1-3 months
Fluoroquinolone education for Prostatitis patients
- avoid antacids w/in 6 hours
- tendonitis/tendon rupture
- CNS side effects
- C. diff associated diarrhea
Patient’s at higher risk of Prostatitis
- indwelling catheter
- recent urethral surgery or prostate biopsy
- recent GU tract infection like cystitis or epididymitis
- immunocompromised (HIV)
BPH definition
proliferation of cells in the transition zone surrounding proximal urethra
usually originates in periureteral and transition zones
80% of men have evidence of BPH by 80 yo
______ is the most commonly diagnosed non-skin cancer in men
Prostate cancer
Risk Factors for Prostate Cancer
- Age >50 yo
- Serum PSA >4
- Abnormal DRE
- FMHx of prostate cancer or BRCA1/2 mutation
- AA
- Obesity
- High fat, low fiber diet
Risk Factors for BPH
- increased caffeine intake
- lack of physical activity
BPH symptoms
- Urinary hesitancy
- Decreased caliber and force of stream
- Incomplete bladder emptying
- Double voiding
- Post-void dribble
- Nocturia
- DRE = enlarged, non-tender, symmetric
- Symptom Assessment via AUA*
- AUASS > 7 = mild symptoms
- AUASS >13 = moderate symptoms
- AUASS >19 = severe symptoms