Male Urology Flashcards
1
Q
What type of tissue comprises 30% of the prostate?
What comprises the other 70%?
A
30%: Glandular tissue
70%: Stroma
2
Q
What is the smallest structural component of glandular prostate?
A
Acini
3
Q
T/F: Proliferation of the acini results in BPH
A
True
4
Q
Proliferation of the ________ (Acini/Basement Membrane) of the prostate leads to prostate cancer
A
Basement Membrane
5
Q
What are the three zones of the prostate?
A
Central Zone
Transitional Zone
Peripheral Zone
6
Q
Which zone of the prostate contains mucosal and submucosal glands?
Changes in this zone often lead to urethral pressure.
A
Periurethral Zone
7
Q
Which zone of the prostate contains the majority of prostatic glandular tissue and is the origin site for most adenocarcinomas of the prostate?
A
Peripheral Zone
8
Q
Which zone of the prostate is often described of as the “cone shaped” portion of the prostate?
A
Central Zone
9
Q
T/F: The transitional zone of the prostate does NOT surround the urethra
A
False
It does surround the urethra
10
Q
What percentage of men have BPH by the age of 60?
80?
A
60: 50%
80: 90%
11
Q
What is the mechanism for BPH development?
A
Testosterone is broken down by 5alpha-reductase to form DHT
DHT then binds to nuclear receptors in the prostate leading to BPH
12
Q
What receptors in the prostate (near the bladder neck) result in smooth muscle contraction leading to LUTS associated with BPH?
A
A1-Adrenergic Receptors
13
Q
What are examples of obstructive LUTS?
A
Weal Stream
Hesitancy
Incomplete Emptying
Double voiding
14
Q
What are examples of irritative LUTS?
A
Urgency
Frequency
Nocturia
15
Q
What are FOUR key components to a BPH work-up?
A
DRE
UA
BMP
Baseline PSA
16
Q
What ‘imaging’ study can be obtained to see if a patient is retaining urine?
A
PVR (Post-Void Residual)
17
Q
What is the name of the ‘imaging study’ used to measure how strong a patient’s urine stream is?
A
Uroflow
18
Q
What is the name of the procedure used to visual the inside of the bladder?
A
Cystoscopy
19
Q
What may the appearance of the bladder be described as if it has been squeezing hard against the prostate?
A
Trabeculated
20
Q
What medications used in BPH management “open up” the prostate through smooth muscle relaxation?
A
Alpha Blockers…..
Non-Selective: Terazosin (Hytrin), Doxazosin
Selective: Tamsulosin (Flomax), Silodosin (Rapaflo)
21
Q
What medications used in BPH management “shrink” the prostatic glands?
A
%-alpha reductase inhibitors…..
Finasteride
Dutasteride
22
Q
What is an antimuscarinic used in BPH management?
A
Oxybutynin
23
Q
What are examples of surgical procedures used to manage BPH?
A
TURP
TUNA
TUMT
PVP
24
Q
T/F: Recurrent UTIs attributable to BPH is NOT an indication for surgical management
A
False
It is an indication
25
T/F: Prostate CA is the 2nd leading cause of cancer death in US men
True
26
What are two crucial screening tools for prostate cancer?
PSA
| DRE
27
What is the normal PSA range?
0.0 - 4.0
28
What are three examples of things that lead to a benign elevation in PSA?
Trauma
Instrumentation
Ejaculation
29
T/F: You should always trend PSA values prior to jumping to conclusions or management decisions (ie: Biopsy)
True
30
A 75 y.o. male presents for annual screening. He denied any urinary symptoms but has been noticing himself get sweaty at night. His exam is unremarkable other than an enlarged nodular prostate on DRE. Upon review of his annual labs you notice that his PSA is trending up and most recently is at 8.9.
What is your most concerning diagnosis and how is this diagnosed?
Prostate Cancer
Diagnosed through a prostate biopsy with transrectal US guidance
31
How many samples of prostate tissue are taken during a prostate biopsy?
12
32
What is the name of the 'grading score' used in staging prostate cancer?
Gleason Score
33
Where are the first two places prostate cancer is likely to metastasize?
Lymph Nodes
| Bones
34
What is the name of the surgical procedure used in prostate cancer treatment?
What is the most common and concerning 'side effect' of this procedure?
Radical Prostatectomy
Most Common Complication is ED and Impotence
35
_________ is the name of the prostate cancer therapy in which radioactive seeds are implanted in the prostate....this works best for localized contained prostate cancers.
Brachytherapy
36
_________ is pain or burning with urination
Dysuria
37
What is hematuria?
Blood in the urine
38
________ is the a sudden, strong urge to pass urine
Urgency
39
What is urinary frequency?
Voiding too often
40
A ______ UTI occurs frequently with different or similar organisms for each infection
Recurrent UTI
41
How is a persistent UTI described?
Same organism never clears often with the same susceptibility profile
42
A _______ UTI results from inadequate treatment
Unresolved
43
A _________ UTI may occur in the presence of features that may result in therapy failure
Complicated UTI
44
What is Asymptomatic bacteriuria?
Bacteria present in the urine without host response of symptoms
45
What is the most common pathogen associated with an acute UTI?
E coli (80%)
*Staph, Klebsiella, Proteus are also common
46
A 39 y.o male presents with complaints of burning with urination, feeling like he has to pee all the time, and a cloudy appearance to his urine over the last two days. He denied any fever or fatigue. This has happened to him as a child she remembers and he was diagnosed with a bladder infection.
What is you most likely diagnosis at this time?
Acute UTI
47
A 39 y.o male presents with complaints of burning with urination, feeling like he has to pee all the time, and a cloudy appearance to his urine over the last two days. He is febrile and appears very fatigued in the examination room. He also describes a vague back pain over the last 24 hours, but is unable to localize it.
What would be the most concerning at this time?
What physical examination finding may support this diagnosis?
Pyelonephritis
+ CVA Tenderness
48
How should a urine sample be collected when working up a UTI?
It need to be a "Clean Catch"
49
Positive nitrites in a urine sample would indicate what?
Infection
50
WBC Casts on a microscopic urinalysis would indicate what?
Pyleonephritis
| Glomerulonephritis
51
T/F: Urine samples don't need to be cultured
False
They do!
52
T/F: All urine samples from men dont need cultured
False
All urine samples from men should be cultured!
53
What is the cheapest and most effective ABx in UTI management?
TMP/SMX (Bactrim)
54
Why arent fluoroquinoones used as much in UTI management?
Resistance
Renal Dosing
Avoid with Warfarin
55
What is a drawback to using nitrofurantonin (Macrobid) in UTI treatment?
```
Longer Course (~7 days)
GI Upset
```
56
How long do patients take ABx if they're on them for UTI prophylaxis?
6 Months!
Examples:
TMP/SMX 100 mg
TMP 100 mg
NItrofurantonin 100 mg
57
What is an example of a common hospital procedure/treatment that is associated with a high UTI rate?
Urinary Catheters
58
Catheterization longer than __ days greatly increases a patients risk for catheter associated UTIs
6 Days
59
What is the most common pathogen associated with pyelonephritis?
E Coli
*Proteus, Pseudomonas, and Klebsiella are also common
60
T/F: A patient with a renal calculi is at a higher risk of developing pyelonephritis
True
61
A patient with suspected pyelonephritis and a history of renal stones should get what imaging study and why?
Renal US
To exclude obstructing stone and hydronephrosis
62
How is pyelonephritis managed?
IV Abx
IVF
Glucose control
63
What procedure can be to relieve pressure on the kidneys if the urinary outflow tract is obstructed?
Percutaneous Nephrostomy Tube Placement
64
What are the most common types of urinary lithiasis?
Ca-Containing Stones (Calcium-Oxalate, Calcium-Phosphate)
65
What is another name for a struvite stone?
Infectious Stone
66
A 25 y.o. male presents to the ED with right flank pain. He notes that yesterday he had this waxing and waning pain in his lower back, but this morning it became a harp stabbing pain. He is visibly uncomfortable in the exam room and moves around throughout. He denied any fever or chills, but he has noticed some difficulty and discomfort with urination. He denied any gross hematuria.
What is the most likely Dx at this time?
Urinary Lithiasis
67
A 25 y.o. male presents to the ED with right flank pain. He notes that yesterday he had this waxing and waning pain in his lower back, but this morning it became a harp stabbing pain. He is visibly uncomfortable in the exam room and moves around throughout. He denied any fever or chills, but he has noticed some difficulty and discomfort with urination. He denied any gross hematuria
You decide to start his work up with a CBC with is unremarkable, CMP that shows slightly elevated BUN and sCr from the patients normal, and a UA that has microscopic hematuria.
Does this support the diagnosis of Urinary lithaisis? What diagnosis might these labs rule out?
The labs support the diagnosis of urinary lithiasis and make pyelonephritis less likely at this time.
68
A 25 y.o. male presents to the ED with right flank pain. He notes that yesterday he had this waxing and waning pain in his lower back, but this morning it became a harp stabbing pain. He is visibly uncomfortable in the exam room and moves around throughout. He denied any fever or chills, but he has noticed some difficulty and discomfort with urination. He denied any gross hematuria
What imaging study is 100% sensitive in diagnosing your most likely diagnosis?
CT Abdomen/Pelvis w/o contrast
69
Where are the THREE most common places for stones to "get stuck" or become symptomatic?
UPJ
Illiac Vessels/Pelvic Brim
UVj
70
____% of stones in the distal ureter that are less than 4 mm will pass spontaneously
90%
71
What alpha-blocker is often given to stone patients to help stones pass easier?
Tamsulosin (Flomax)
72
What are examples of surgical procedures used in urinary lithiasis management?
Shock-Wave Lithotripsy (ESWL)
Ureteroscopy + Laser Lithrotripsy
Percutaneous Nephrolithotripsy
73
What work up do patients with recurrent stones need?
Meatbolic Work-Up to include......
Serum Uric Acid, Calcium, Magnesium, Phosphate, PTH, and 24-Hour urine collection
74
What medication is indicated in a recurrent stone patient with hypercalciuria?
HCTZ
75
What medication can be given to a recurrent stone patient with uric acid stones?
Allopurinol
76
____________ is described as inflammation of the glans penis or foreskin.
Symptoms include....
Glossy flat lesions on the penis or foreskin with blotchy erythema, smega, and possibly phimosis
Balantitis (Glans)
| Posthitis (Foreskin)
77
What medication is used to treat balantitis/posthitis?
Clotrimazole (Lotrimin)
78
What is phimosis?
The inability to retract the foreskin
79
T/F: Yeast are a common cause of phimosis or posthitis in patients especially with poorly controlled DM
True
80
How can phimosis be managed pharmacologically?
Nystatin +/- Topical Steroid
81
If phimosis is refractory to pharmacological or conservative management.....
What would be recommended?
Circumcision
82
__________ is described as the foreskin being stuck in a retracted position and cannot be reduced
Paraphimosis
83
What are two ways paraphimosis is managed?
Manual Compression/Reduction
| Dorsal Silt
84
_____ is described as inflammation of the urethra commonly associated with STIs.
Sx include.....
Diffuse purulent discharge with dysuria
Urethritis
85
How is Urethritis treated?
| remember it is usually due to a STI
Ceftriaxone + Azithromycin
86
________ ________ is the inability to obtain or maintain an erection
Erectile Dysfunction
87
What are two classes of medications that are associated with erectile dysfunction?
Pyschotropics
| Anti-Hypertensives
88
What are co-morbid conditions associated with ED?
```
DM
HTN
CAD
HLD
Smoking
```
89
T/F: A radical prostatectomy is associated with ED
True
90
Up to ___% of patients with undiagnosed vascular disease will present with ED
20%
91
What labs should be obtained when working up erectile dysfunction?
Total and free testosterone
| Lipid Panel
92
What medication class is indicated for ED treatment?
PDE-5 Inhibitors
| Sildenafil - Viagra
93
What are penile condylomas?
Genital Warts
94
What pathogen is typically the cause of genital warts?
HPV
95
If there are warts on the penis where else should be inspected for warts?
The Anus
96
T/F: Penile Condylomas are a clinical diagnosis
True
97
Is there a cure for penile condylomas?
No, this is a chronic disease
98
What 'strains' of HPV are associated with penile cancer?
16
18
31
33
99
How is penile cancer managed?
Surgery
100
What is a good preventative measure to take for penile cancer prevention?
HPV Vaccine
101
What medication classes are associated with priapism?
Psychotropics (Trazadone)
| PDE5-Inhibitors
102
What systemic diseases are associated with priapism?
Sickle Cell
| Disseminated CA
103
_________ _______ results in plaque deposits in the tunica albugenia eventually resulting in penile fibrosis
Peyronies Disease
104
Are there proven therapies for peyronies disease?
No, there has not been proven therapies for this disease. There are surgical options but not proven effective long term.
105
___________ is low testosterone levels that presents with symptoms of fatigue, ED, decrease ejaculatory force, and decreased libido.
Hypogonadism
106
A primary cause of hypogonadism is testicular failure.....
What is a common cause of this?
Mumps Orchitis
107
How is hypogonadism treated?
Androgen (Testosterone) Supplementation
108
After initiating androgen supplementation for hypogonadism.....
What should you monitor and for how long?
Monitor PSA, H&H, Testosterone, DRE
Evaluate at 3, 6, and 12 months and then annually
109
What is the name of the questionnaire used to assess men for hypogonadism?
ADAM Questionnaire
110
What is cryptorchidism?
Failure of the testis to descend into the scrotum
111
How is is cryptorchidism treated?
Hormonal Manipulation (GnRH Injections)
Orchidopexy
112
If cryptorchidism is present......
Most testis descend by what age?
3 months
If they are still undescended by 6 months old then descent is unlikely
113
T/F: Being a twin increases the risk for cryptorchidism
True
114
What are three common sequelea/consequences of cryptorchidism?
1. Increased CA Risk
2. Decreased Fertility
3. Torsion
115
A ________ is a benign accumulation of serous fluid between layers of tunica vaginalis
Hydrocele
116
What is the most common cause of a hydrocele in infants?
Patent process vaginalis
117
What are common causes of a hydrocele in adults?
Idiopathic
Post-Traumatic
Post-Infectious
118
If conservative management of a hydrocele (ie; aspiration) fails what can be done?
Scrotal excision (Hydrocelectomy)
119
A ________ results from congestion in the veins around the testis due to a valvular anomaly
Does this condition typically occur in patient older than 40 y.o.?
Varicocele
No, these occurtypically in patients 15 - 30 years old
120
Is a varicocele more common in the right of left testis?
Left
121
What physical examination finding would help clinically diagnose a varicocele?
"Bag of worms" presentation to the veins in the pampiniform plexus
122
T/F: Imaging is required to work up a varicocele
False
123
How are varicoceles managed?
Varicocelectomy
| Embolization
124
T/F: Infertility is associated with varicoceles
True
This typically improves with surgical treatment
125
A 21 y.o. male presents to the ED with complaints of sudden right testicular pain that began about 1 hour ago. He denied any traumatic injury prior to the onset of the pain.
What is the most concerning diagnosis?
What physical examination findings are consistent with this diagnosis?
Testicular Torsion
Physical Examination....
Negative ipsilateral cremasteric reflex
Scrotal Edema
Negative Phren;s Sign
126
A 21 y.o. male presents to the ED with complaints of sudden right testicular pain that began about 1 hour ago. He denied any traumatic injury prior to the onset of the pain. On examination, he is afebrile, there is no cremasteric reflex on the right, and his pain is not relieved with scrotal elevation.
What is the most diagnostic imaging study?
How should this condition be managed?
Scrotal US
Surgery ASAP!
127
What 'deformity' is commonly associated with an increased risk of testicular torsion?
Bell-Clapper Deformity
128
_______ is the inflammation or infection of the epididymis
Epididymitis
129
What are the common pathogens in epipidymitis in patients.....
<35 y.o.?
>35 y.o.?
<35: C. Trachomatis, N. gonorrhoeae
>35: E Coli
130
If a patient has scrotal pain relieved with elevation, what diagnosis would this be consistent with?
What is the name of the physical examination sign described above?
Epididymitis
Phrens Sign
131
How is epididymitis treated?
ABx (Doxycycline or Ciprofloxacin)
132
___________ is an acute inflammatory reaction of the testis secondary to an infection
Orchitis
133
What is the most common etiology of orchitis?
Mumps Orchitis
134
T/F: Bacterial Orchitis is most common associated with epididymitis in sexually active males and men >50 with BPH
True
135
Is testicular cancer highly curable?
Yes
136
What is the most common type of testicular cancer?
95% are Germ Cell
| Seminoma, Non-seminoma, Mixed
137
How would testicular CA present?
Painless Testicular Mass Incidentally Found
138
What tumor markers are typically present in testicular cancer?
AFP
Beta-HCG
LDH
139
in a Bell'Clapper's Deformity there is an absence or weakness in the ______ ligament, which is a remnant of the gubernaculum
Scrotal ligament
140
80% of people with testicular cancer have an extra copy of a portion of chromosome ___
Chromosome 12
141
T/F: Most testicular cancers are triploid or tetraploid
True
142
Why are varicoceles more common on the left rather than on the right?
The left drains to the renal vein instead of the IVC
143
Patients with a patent funicular process may increase the risk for what?
Indirect Hernia
144
What intra-abdominal disease processes could cause this person to have scrotal swelling?
Intraperitoneal Bleeding
Ascites
Abdominal CA
145
A __________ (Non-Communicating/Communicating) hydrocele occurs when the process vaginalis has closed.
What are two ways this can occur?
Non-communicating
1. Fluid accumulates in the tunica vaginalis before birth, and just doesn’t get reabsorbed.
2. A process inside the scrotum (infection, cancer, or fluid production by the tunica itself) causes fluid to build up there.
146
What is the name of the plexus that supplies the prostate and bladder?
Pelvic (Hypogastric) Plexus
147
T/F: DHT can activate proto-oncogenes in the prostate
True
148
Which zone is the most common site of prostate cancer?
A. Transitional Zone
B. Peripheral Zone
C. Central Zone
B. Peripheral Zone
149
T/F: Many prostate cancers are known to increase production of transcription factors that eliminate apoptosis
True
150
Prostate cancer is also associated with androgens that _______ (increase/decrease) cell turnover
Increase
151
Physiologic phimosis typically resolves by what age?
7 y.o.
152
What are THREE risk factors that increase the risk of developing Peyronie's Disease?
Diabetes
Tobacco Use
Pelvic Trauma
153
Erections are mediated by NO and ___________ (paracrine/endocrine) signaling
Paracrine
154
What are the TWO types of priapism?
High-Flow (non-ischemic): Abundance of arterial flow
Low-Flow (ischemic): Decreased venous drainage, vaso-occlusion
155
The average temperature of the penis is __ degrees lower than the body
4 degrees
