Male GU Flashcards
1
Q
urethral discharge dysuria, abd pain/abnml vaginal bleeding
A
Uretheritis
2
Q
NAAT or urinalysis/dipstick with positive leukocyte esterase or large amount of wbc
A
urethritis
3
Q
Chlamydia treatment
A
Azithromycin
4
Q
Gonorrhea treatment?
A
Cetriaxone
5
Q
All males with cystitis
A
complicated cystitis
6
Q
MC pathogen of cystitis
A
E. coli.
7
Q
Dysuria, bruning, frequency & urgency, hematuria, suprapubic pain, and tenderness.
A
Cystitis
8
Q
Urinalysis/dipstick with pyuria (<10 WBC/hpf), hematuria, leukocyte esterase, nitrites, cloudy urine.
A
cystitis
9
Q
Definitive diagnosis for cystitis
A
Urine culture w/ 100,000 CFUs and exact pathogen
10
Q
What diagnosis for cystitis do you do for complicated cases
A
urine culture
11
Q
First line cystitis treatment
A
Nitrofurantoin
12
Q
Complicated cystitis treatment
A
Fluoroquinolones
13
Q
Terrible dysuria treatment
A
phenazopyridine- don’t use for more than 48 hrs and orange pee
14
Q
Pregnant cystitis
A
Nitrofurantoin, fosfomycin, augmentin or amoxicillin.
15
Q
involuntary urine leakage when the bladder is full
A
overflow incontinence `
16
Q
when bladder detrusor muscle is underachieve or with bladder outlet obstruction (enlarged prostate)
A
overflow incontinence
17
Q
MCC of overflow incontinence
A
neurologic disorder or autonomic system dysfunction like MS, spinal injuries, sclerosis/stenosis
18
Q
loss of urine with no warning and leakage or dribbling in setting of incomplete bladder emptying, weak or intermittent urinary stream, hesitancy, frequency, and nocturia.
A
overflow incontinence
19
Q
Diagnose overflow incontinence
A
Post void residual > 200 ml
20
Q
First line overflow incontinence
A
intermittent or indwelling catheter
21
Q
med to increase detrusor activity
A
Cholinergics (Bethanechol)
22
Q
overflow incontinence treatment if enlarged prostate
A
alpha blockers
23
Q
involuted leakage of urine with increased abdominal pressure that is greater than urethral pressure
A
stress incontinence aka laugh n pee
24
Q
stress incontinence risk factors
A
young women who have had vaginal deliveries, surgery, estrogen loss, and prostatectomy.
25
urine leakage with no urge to urinate prior to leakage
stress incontinence
26
stress incontinence treatment
kegels, lifestyle modification- protective garments, weight losses smoking cessation, drinking less water
27
2nd line stress incontinence treatment
Pessaries, surgery (midurethral sling), alpha agonists
28
involuntary leakage preceded by or accompanied by sudden urge to urinate- strong urge to void with inability to make it to bathroom to urinate
urge incontinence
29
urge incontinence mc in
older women
30
cause of urge incontinence
detrusor muscle overactivity (involuntary contractions). Occur with increased age and bladder infections.
31
increased urgency and frequency, small volume voids, and nocturia.
urge incontinence
32
Treatment for urge incontinence
bladder training and Kegels
33
First line med treatment for urge incontinence
Antimuscarinics (oxybutynin)- antispasmics that increase bladder capacity and they are anticholinergic
34
cause bladder relaxation
Mirabegron
35
anticholinergic effect and alpha adrenergic agonist
TCAs
36
Surgery for urge incontinence
bottom to relax bladder muscle
37
bedwetting while sleeping in children 5 y/o or older
enuresis
38
enuresis primary
Absence of any period of time with nighttime dryness. May have a family history. Most common type
39
enuresis secondary
Enuresis after a dry period of at least 6 months. Usually due to a stressful event (parental divorce, birth of sibling, etc.)
40
First line enuresis
motivational therapy, education. Bladder training.
41
Most effective long term treatment for enuresis
enuresis alarm: sensor on bed pad and goes off when wet continued until min of 2 wks of consecutive dry nights
42
Desmopression in enuresis
nocturnal polyuria with normal bladder function capacity.
43
Refractory enuresis
TCAs
44
MC GU cancer
Bladder cancer
45
MC of bladder cancer
Urothelial (Transitional cell) carcinoma
46
MC risk factor for bladder cancer
smoking, male, over 40 y/o, occupational exposure to dyes, leather, rubber.
47
painless int hematuria (often gross), dysuria, urgency and frequency
Bladder cancer
48
Diagnosis for bladder cancer
urinalysis, CT urology, cystoscopy w/ biopsy --> gold standard
49
Treatment for bladder cancer
Localized or superficial = tumor resection with f/u every 3 months
Invasive = cystectomy, chemotherapy, radiation
Recurrent = injection of BCG vaccine b/c immune reaction will stimulate cross reaction with tumor antigens
50
increased estrogen or decreased androgens
gynecomastia
51
gynecomastia risk factors
high maternal estrogen, puberty, older males
52
palpable mass of tissue at least 0.5 cm in diameter and centrally located under nipple, symmetrical, tender to plapation
gynocomastia
53
management for gynocomastia
Supportive = stop offending medications
Tamoxifen = selective estrogen receptor modifier that is an estrogen antagonist in the breast
Surgery if refractory to medical therapy
54
narrowing of lumen due to infection, injury, or surgical manipulation produces a scar that reduces the caliber of urethra
urethral strictures
55
chronic obstructive voiding sxs (weak urinary cream & incomplete bladder emptying)
urethral strictures
56
urethral strictures diagnosis
Cystourethroscopy (or variation of)
57
urethral strictures treatment
Dilation or surgical reconstruction
58
MC urethral injury
men
59
MCC of urethral injury
blunt force trauma, pelvic fractures, MVA
60
gross hematuria, difficulty urinating, urinary retention, lower abd pain, blood at urethral meatus, swelling or ecchymosis of scrotum, penis or perineum or high riding prostate.
TRIAD: Blood at meatus, inability to void, distended bladder
urethral injuryq=
61
urethral injury diagnosis
Retrograde urethrogram
62
urethral injury treatment
surgery, catheter placement & healing for mild
63
hypospadias
ventral placement of urethral opening
64
MCC of hypospadias
failure of the urogenital folds to fuse during development
65
increased UTIs, erectile dysfunction, abnml foreskin with incomplete closure around glans, abnml penile curvature
hypospadias
66
hypospadias management
```
Do NOT circumcise while infant - foreskin may be used to repair later
Surgical correction (arthroplasty) which may include penile straightening. Usually performed between 6 months and 1 year
```
67
epispadias
dorsal placement of urethral opening
68
epispadias MCC
failure of midline penile fusion
69
upward curvature of penis, absent dorsal foreskin, clitoris w/ two tips, small/laterally displaced labia majora.
epispadias
70
epispadias diagnosis
prenatal US
71
retracted foreskin that can't be returned to normal position
Paraphimosis
72
Paraphimosis causes
forceful retraction of foreskin and can occur after blantitis or penil inflammation
73
severe pain and swelling for penis
Paraphimosis
74
Paraphimosis management
Manual reduction after reducing edema with cool compresses or pressure dressing
Definitive = incisions (dorsal slit) or circumcision
75
inability to retract foreskin over glans caused by scarring of foreskin after trauma
phimosis
76
phimosis management
```
Proper hygiene (wash that sucker out!), stretching exercises
4-8 weeks topical corticosteroids can increase retractility
Circumcisions for definitive management
```
77
prolonged painful erection without sexual inflammation
priapism
78
priapism causes
ischemia (decreased venous outflow)
79
Etiologies of priapism
MC- idiopathic, 2nd is sickle cells
80
priapism diagnosis
Cavernosal blood gas:
ISCHEMIC (low-flow) = hypoglycemia, hypoxemia, hypercarbia & acidemia
NON-ISCHEMIC = normal
Doppler sono = will show blood flow
81
priapism management of ischemia
Phenylephrine (found in Sudafed & Preparation H) via intracavernosal injection (OUCH!). This will cause contraction of the cavernous smooth muscle, which will allow more venous outflow.
Needle aspiration of corpus cavernosum & irrigation to remove blood, especially if erection > 4 hours, with or without phenylephrine, and ice
Surgery if not responsive to above
82
age of diagnosis for penile ca
60
83
MC type of penile ca
squamous cell, HPV 16, 6, 18
84
risks of penile ca
smoking, lack of circumcision, HIV
85
leukoplakia on shaft of penis associated with HPV 16 some will progress to squamous cell carcinoma
Bowen's Disease
86
mass or palpable lesion on penis, mc on clans, coronal sulcus, or prepuce
penile cancer
87
cryptorchidism
testicle not descended into scrotum by 4 months
88
MC cryptorchidism
right side
89
risk factors for cryptorchidism
prematurity, low birth weight, maternal obesity or DM
90
empty, small scrotum, inguinal fullness
cryptorchidism
91
Cryptorchidism diagnosis
Scrotal sono or MRI
92
Cryptorchidism treatment
Orchiopexy (bringing down the testes and attaching to scrotum) as early as 4-6 months, ideally before 1 year, must be done before 2 years
93
Cryptorchidism complication
testicular cancer
94
serous fluid collection within layers of tunica vaginalis of scrotum
hydrocele
95
MCC of what is hydrocele
painless scrotal swelling
96
MCC Of hydrocele
idiopathic,
97
fluid from abdomen enters scrotum via patent processes vaginalis that failed to close
communication hydrocele
98
fluids from mesothelial lining of tunica vaginalis
noncommunicating hydrocele
99
painless scrotal swelling often increases during the day
hydrocele
100
hydrocele PE
translucency (transilluminates), fluids located anterior and lateral to the testes, swelling worse w/ valsalva if it is the communicating type
101
Diagnosis of hydrocele
testicular sono
102
hydrocele management
Usually no treatment is needed because often resolves spontaneously
Surgical excision may be needed if persists after 1 year old (often occur at birth but resolve within 12 months) or in adults with communicating types to reduce the risk of a hernia.
103
cystic testicular mass of varicose veins
varicocele
104
asymptomatic varicoceles usually painless by may cause dull ache or heavy sensation
varicocele
105
On left, scrotal mass with bag of worms of spaghetti in bag superior to testicle, dilation worsens when pt is upright or with valsalva, less apparent when the pt is supine or with testicular elevation
varicocele
106
varicocele management
Surgery in some cases for pain, infertility or impaired testicular growth
107
r sided varicocele due to
abd malignancy
108
left side varicocele
renal cell carcinoma
109
gradual onset of localized testicular pain and swelling usually unilateral may be associated with fevers, chills, dysuria, urgency & frequency, no n/v.
epididymitis
110
MCC in male 14-35 of epididymitis
chlamydia or gonorheaa
111
MCC in males of epididymitis
e. coli
112
Positive Prehn sign and + cremasteric reflex
epididymitis
113
diagnosis of epididymitis
Scrotal sono = best initial test; will show enlarged epididymis, increased testicular blood flow (can also rule out torsion)
Urinalysis = check for infection
CT/GC testing
114
epididymitis
Scrotal elevation, NSAIDS, cool compresses
If under 35 y/o, treat with….ceftriaxone and azithromycin
If over 35 y/o, treat empirically with Fluoroquinolones
115
painless, cystic testicular mass
spermatocele (more than 2 cm) /epididymal cyst (less than 2 cm)
116
soft round mass at head of epididymis, seperate from testicles freely movable transilluminates
spermatocele/epididymal cyst
117
scrotal pain, swelling and tenderness
orchitis
118
scrotal erythema and tenderness
orchitis
119
orchitis treatment
Symptomatic - NSAIDS, bed rest, scrotal support/elevation, cool pack
120
orchitis MCC
mumps
121
abrupt onset of scrotal, inguinal, lower abd pain, n/v
testicular torsion
122
swollen, tender, retracted (high) testicle, may lie horizontally, negative preen sign, negative cremasteric reflex
testicular torsion
123
testicular torsion diagnosis
Clinical diagnosis -> immediate surgery!
Testicular doppler sono - most commonly used
Emergency surgical exploration (definitive) - preferred over sono if highly suspected!
124
testicular torsion management
Urgent detorsion & orchiopexy within 6 hours of pain onset.
Irreversible damage likely if > 12 hours.
Manual detorsion should be done if surgical intervention not available
Orchiectomy if not salvageable
125
MC age for testicular cancer
15-25 y/o (avg32)
126
Risk factor for testicular cancer
undescended testicle, white, Klinefelter syndrome, hypospadias
127
Seminomas
Simple (no alpha-fetaprotein)
Sensitive to radiation
Slower growing
Stepwise spread
128
Nonseminomas
Associated with increased serum alpha-fetoprotein & beta-hCG and resistant to radiation.
Yolk sac (MC in boys 10 y/o and younger)
Choriocarcinoma (worst prognosis)
129
Gonadoblastoma
testicular lymphom
130
painless testicular mass may have dull pain or testicular tenderness
testicular cancer
131
firm hard fixed mass that does no transilluminate
testicular cancer
132
testicular ca diagnosis
Sonogram - initial test of choice
Tumor markers (what are tumor markers?)
If nonseminoma, increased serum alpha-fetoprotein & beta-hCG a
133
Seminoma, Stage I
| management
Radical orchiectomy & possible radiation
134
Seminoma, Stage 2
| management
Debulking chemo followed by orchiectomy & radiation
135
Nonseminoma, Stage I management
radial orchiectomy
136
increased frequency, urgency, nocturia, hesitancy, weak or int stream, incomplete emptying & dribbling,
BPH
137
diagnosis of bph
Digital Rectal Exam (DRE): uniformly enlarged, firm, nontender, rubbery prostate
Prostate Specific Antigen (PSA): correlated with risk of symptom progression. (Normal < 4 ng/mL)
U/A to look for hematuria (or other cause of symptoms)
Urine cytology if at risk of bladder cancer (Smoker)
138
BPH management
sxs relief: 1st line- Alpha 1 blockers (Tamsulosin, Terazosin, Doxazosin)
2nd line- 5 alpha reductase inhibitors (finasteride & dutasteride)
139
Alpha-1 blockers: Tamsulosin, Terazosin, Doxazosin
| MOA and SE
Smooth muscle relaxation of prostate & bladder neck leading to decreased urethral resistance, obstruction relief and increased urinary outflow.
SE = dizziness & orthostatic hypotension
140
5-alpha reductase inhibitors: Finasteride & Dutasteride
| MOA and SE
inhibits conversion of testosterone to dihydrotestosterone which suppresses prostate growth which decreases size of prostate and decreases need for surgery
SE = sexual dysfunction, decreased libido, breast tenderness & enlargement
141
BPH Surgery
If persistent, progressive or refectory despite medical therapy for 12-24 months
Transurethral resection of prostate (TURP) removes excess prostate tissue
Risks = sexual dysfunction, urinary incontinence
142
Men < 35 MCC of acute prostatitis
Chlamydia and gonorrhea
143
men > 35 MCC of acute prostatitis
e.coli
144
children acute prostatitis
mumps
145
fever, chills, perineal pain, lower back or abd pain, increased frequency, urgency, nocturia, hesitancy weak or int stream =, incomplete emptying and dribbling
acute prostatitis
146
tender, got boggy prostate
acute prostatitis
147
Diagnosis of acute prostatitis
Urinalysis & culture = WBC increased, bacteria
| Avoid prostatic massage (may cause bacteremia)
148
acute prostatitis management
Acute < 35 y/o = Treatment for CT & GC.
Acute > 35 y/o = Fluoroquinolones or Bactrim x 4-6 WEEKS (outpatient); IV fluoroquinolones with or without Aminoglycoside)
149
chronic prostatitis MCC
e coli
150
recurrent Otis or int dysfunction, malaise, arthralgia, increased frequency, urgency, nocturia, hesitancy, weak or intermittent stream, incomplete emptying & dribbling
chronic prostatitis
151
non tender boggy prostate
chronic prostatitis
152
diagnosis chronic prostatitis
Urinalysis & culture often normal, so prostatic massage often done (IF and only if you know it is chronic) to increase bacterial yield
153
management of chronic prostatitis
Fluoroquinolones or Bactrim x 6-12 WEEKS
If refractory, TURP
Alpha-1 blockers can help with chronic pain
154
2nd mc ca in men
prostate cancer
155
MC type prostate cancer
adenocarcinoma
156
prostate cancer
slow growing tumor of prostate
157
risk factors of prostate cancer
Age (>40) & genetics
Black men have higher incidence
Diet (high in animal fat)
158
Most pts are asymptomatic and are dx either abnormal DRE or via workup after abnormal PSA or after invasion of bladder, urethral obstruction or bone involvement
Back or bone pain with METS to bone, weight loss
prostate cancer
159
diagnosis of prostate cancer
```
DRE = hard, indurated, nodular, enlarged, ASYMMETICAL prostate
PSA = above 4 ng/mL (but elevated PSA can be seen with other disorders)
```
If either of these are “positive,” then a biopsy is typically done:
Transrectal ultrasound-guided needle biopsy = most accurate test
If the PSA is over 10, a bone scan is usually also done, because the most common site of METS is the bone
Gleason grading system is used to determine aggressiveness or malignant potential (higher grade = more benefit from surgical removal of prostate)
160
management of local prostate cancer
Observation/surveillance if low risk, clinically localized or life expectancy < 10 years
VS
Definitive treatment with external beam radiation, brachytherapy or radical prostatectomy
Risks of prostatectomy = incontinence and erectile dysfunction
161
management of advanced prostate cancer
External beam radiation
Hormonal therapy = androgen deprivation (meds) and/or orchiectomy
Chemotherapy if hormonal therapy is ineffective
