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PHA 522 > Men's Health/Urology > Flashcards

Men's Health/Urology Flashcards

1
Q

Hydrocele: what is it

A

collection of fluid around the testicle

forms between the parietal and visceral tunica vaginalis

benign

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2
Q

Hydrocele: etiology

A

idiopathic
OR
reactive (assc w/ inflammatory process)

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3
Q

Hydrocele: presentation

A

unilateral scrotal enlargement

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4
Q

Hydrocele: evaluation/diagnostics

A

palpation
transillumination
scrotal US

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5
Q

Hydrocele: treatment

A

asymptomatic:
- reassurance, monitoring

bothersome:
- needle aspiration w/ sclerosing agent
- hydrocelectomy

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6
Q

Hydrocele: Which treatment option has an increased risk of recurrence?

A

needle aspiration w/ sclerosing agent

hydrolcelectomy: not likely to recur

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7
Q

Varicocele: what is it

A

dilated veins of the pampiniform plexus

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8
Q

Varicocele: effects (can lead to…)

A

pain
testis damage (fibrosis, dec spermatogenesis)
testis atrophy
infertility (dec sperm count, dec sperm motility, inc abnormal sperm)

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9
Q

Varicocele: physical exam

  • which positions to we exam the patient in
  • what is the hallmark finding
A

supine, standing, valsalva w/ standing

feels like a BAG OF WORMS

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10
Q

Varicocele: Grade I

A

small size
not grossly visible
only palpable w/ valsalva

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11
Q

Varicocele: Grade II

A

med size
not grossly visible
palpable w/ standing

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12
Q

Varicocele: Grade III

A

large size

grossly visible

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13
Q

What is the MC location for a varicocele?

A

typically on the left

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14
Q

What is the potential significance of a right sided, rapid onset varicocele?

A

can signal renal malignancy

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15
Q

Varicocele: treatment

A

surveillance (semen analysis, measure testicular size)

surgery (ligation of vein to redirect venous outflow, percutaneous embolization)

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16
Q

Varicocele: indications for surgery

A

symptomatic

palpable w/ abnormal semen analysis

w/ small testis

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17
Q

Phimosis: what is it

A

prepuce stuck distal to glans

“muzzle”

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18
Q

Phimosis: presentation

A

difficulty voiding

balanitis

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19
Q

Phimosis: treatment

A

circumcision

hygiene

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20
Q

Paraphimosis: what is it

A

prepuce stuck proximal to the glans – unable to be reduced

emergency!

preventable!

constriction of venous outflow, normal arterial flow –> swelling –> prepuce gets tighter (positive feedback loop)

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21
Q

Paraphimosis: treatment

A

reduction (prepuce pulled back over glans)

if manual reduction not successful:

  • dorsal slit
  • circumcision
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22
Q

Paraphimosis: complications

A

Fournier’s gangrene in IM

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23
Q

Testicular Torsion: risk factors

A

undescended testis (cryptorchidism)

bell clapper deformity

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24
Q

Testicular Torsion: presentation, MC age group

A

acute onset
severe intensity
absent swelling

tender, firm testis
high riding testis
horizontal lie
ABSENT CREMASTERIC REFLEX
no relief w/ elevation
thick/knotted sperm cord
misplaced epididymis (not posterior)

MC age group: 12-18yo

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25
Q

Testicular Torsion: diagnosis

A

clinical
doppler US (minimal blood flow)
nuclear testicular scan (dec radiotracer activity)

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26
Q

Testicular Torsion: treatment

A

manual detorsion

if viable: B orchiopexy

if not viable: orchiectomy + orchiopexy of contralateral testis

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27
Q

What is the timeline for viability with testicular torsion?

A

detorsion <6hrs: most viable

detorsion >24hrs most non-viable

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28
Q

Cystitis: what is it

A

urinary infection involving the bladder

aka bladder infx, lower UTI

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29
Q

Cystitis: risk factors

A 
immunocompromised 
urinary stasis/obstruction
congenital abn
sexual activity
spermicide use
diaphragm use
urinary incontinence
cystocele, pelvic prolapse
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30
Q

Cystitis: presentation

A 
dysuria, urgency, frequency
suprapubic discomfort
cloudy malodorous urine
fever
mental status change 
SCI
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31
Q

Cystitis: diagnosis

A

urinalysis:

  • leukocyte esterase positive
  • nitrite positive
  • pyuria >5
  • bacteria

urine culture:

  • > 100,000
  • monoculture
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32
Q

What is the MC pathogen for cystitis?

A

E coli

Other common: Klebsiella, Enterobacter, Proteus, Pseudomonas, Staphylococcus saprophyticus, Enterococcus, Candida

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33
Q

Cystitis: treatment

A

antibiotics

  • TMP/SMZ DS bid x 3d
  • nitrofurantoin 100mg bid x 5-7d
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34
Q

Cystitis: persistent symptoms post treatment: prevent re-infection

A

avoid spermicides/diaphragm
topical vaginal estrogen
prophylactic abx
self start abx therapy

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35
Q

Cystitis in the presence of a chronic indwelling catheter: what do you do

A

remove catheter
replace catheter and obtain urine culture
abx

**colonization does NOT equal infection!

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36
Q

Urethritis: what is it

A

inflammation of the urethra

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37
Q

Urethritis: causes (infectious and non infectious)

A

non infectious:

  • trauma
  • reiter’s
  • urethral stricture
  • urethral stone
  • urethral lesions

infectious:

  • gonorrhea
  • chlamydia, mycoplasma, etc
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38
Q

Urethritis: presentation

A 
dysuria
urethral pruritis 
urethral discharge
-gonorrhea: profuse, purulent
-chlamydia: clear/purulent/absent
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39
Q

Urethritis: labs

A

first void urinalysis

  • leukocyte esterase positive
  • > 10 wbc

gram stain
- >5 wbc

culture/NAAT for gonorrhea/chlamydia

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40
Q

Urethritis: treatment

A

gonorrhea: ceftriaxone 250mg IM x 1
chlamydia: azithromycin 1g PO x 1 OR doxycycline 100mg PO bid x 7d

abstain from sex until 7d after tx initiated

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41
Q

Urethritis: follow up

A

gonorrhea: test of cure in 3mo (1wk if alt tx)
chlamydia: if pregnant – test of cure in 3-4wks

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42
Q

Epididymitis: causes

A 
behcet's disease 
accumulation of amiodarone in epididymis
testis/epididymal tumor 
acute bacterial infx
viral 
granulomatous (TB)
fungus, ureaplasma, trichomonas
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43
Q

Epididymitis: What are the MC pathogens for which age groups?

A

< 35yo: neisseria gonorrhoeae, chlamydia trachomatous

> 35yo: E coli

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44
Q

Epididymitis: presentation

A

testicular pain
edematous tender testicle, epididymis, spermatic cord

fever
hydrocele

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45
Q

Epididymitis: diagnosis

A

clinical
urine culture
STD test (if suspected)
scrotal US w/ doppler

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46
Q

Epididymitis: treatment

A

scrotal support
analgesia
cold
antibiotics (levofloxacin)

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47
Q

Chronic Epididymitis: what is it

A

epididymitis for 3+ months

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48
Q

Chronic Epididymitis: diagnosis

A

clinical
UA, urine C&S, other cultures
scrotal US w/ doppler
CT

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49
Q

Chronic Epididymitis: treatment

A 
analgesics
pain clinic
scrotal support
activity modification
moist heat
spermatic cord block
antibiotics
testicular denervation
removal of granuloma
vasovasostomy/epididymectomy
orchiopexy
inguinal orchiectomy
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50
Q

Prostatitis: what is the hallmark

A

prostatic pain

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51
Q

Acute Bacterial Prostatitis: presentation

A

fever
irritative, poss obstructive voiding sx
warm, boggy, tender prostate

“they look septic”

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52
Q

Acute Bacterial Prostatitis:
MC population
MC pathogen

A

young men

E coli

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53
Q

Acute Bacterial Prostatitis: diagnosis

A

clinical (NO vigous prostate exam)

urine culture (NO post prostate massage)

CBC, blood cultures

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54
Q

Acute Bacterial Prostatitis: treatment

A

may need to admit for IV abx

PO abx x 4-6wks

*if persistently febrile: CT pelvis (r/o abscess)

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55
Q

Chronic Bacterial Prostatitis: presentation

A 
recurrent prostatic infx
pain in genitals, urinary tract, perineum, low back
dysuria, urgency, frequency
pain w/ ejaculation
tender, boggy prostate
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56
Q

Chronic Bacterial Prostatitis:
MC population
MC pathogen

A

older men
E coli

other organisms: Klebsiella, Pseudomonas, Proteus, Enterococcus, Staphylococcus saprophyticus, Chlamydia trachomatis, Ureaplasma urealyticum, Mycoplasma hominis

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57
Q

Chronic Bacterial Prostatitis: diagnosis

A

clinical

labs:

  • expressed prostatic secretion
  • post prostate massage urine culture
  • meares stamey 4 glass test
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58
Q

Chronic Bacterial Prostatitis: treatment

A

antibiotics (TMP/SMZ) x 8-16wks
NSAIDs
alpha blockers
anticholinergics/antimuscarinics

phytotherapy
zinc
diet
stress management
prostate massage, ejaculation
sitz baths
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59
Q

Inflammatory Chronic Pelvic Pain Syndrome: what is it

A

nonbacterial prostatitis

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60
Q

Inflammatory Chronic Pelvic Pain Syndrome: presentation

A 
recurrent prostatic infx
pain in genitals, urinary tract, perineum, low back
dysuria, urgency, frequency
pain w/ ejaculation
tender prostate
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61
Q

Inflammatory Chronic Pelvic Pain Syndrome: diagnosis

A

clinical

labs:

  • prostatic fluid w/ leukocytes
  • no bacteria on culture
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62
Q

Inflammatory Chronic Pelvic Pain Syndrome: treatment

A

FQ or SMX-TMP x 6-8wks (not responsive: doxycycline 4-6wks)

mycoplasma genitalium (NAAT test)

palliative measures

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63
Q

Noninflammatory Chronic Pelvic Pain Syndrome: presentation

A 
recurrent prostatic infx
pain in genitals, urinary tract, perineum, low back
dysuria, urgency, frequency
pain w/ ejaculation
tender prostate
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64
Q

Noninflammatory Chronic Pelvic Pain Syndrome: diagnosis

A

clinical

labs:

  • no bacteria on culture
  • no leukocytes in prostatic fluid
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65
Q

Noninflammatory Chronic Pelvic Pain Syndrome: treatment

A

palliative measures

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66
Q

What are the palliative measures in the treatment of prostatitis?

A

NSAIDs
Anticholinergics for urinary urgency
Alpha blockers
Sitz baths
Stress reduction, biofeedback, counselling
Can try zinc, nickel, saw palmetto, quercitin
Prostate massage
Dietary (caffeine, alcohol, spicy acidic food)
Benzodiazepine
Tricyclic antidepressant
Analgesics, Pain specialist consult

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67
Q

Pyelonephritis: what is it

A

upper tract urinary infx involving kidney’s renal parenchyma

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68
Q

Pyelonephritis: presentation

A 
fevers
chills
flank pain 
abdominal pain
N/V
ascending infx:
dysuria
frequency
urgency 
hematuria
hematogenous spread (IVDA, cutaneous infx)
no urinary sx
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69
Q

Pyelonephritis: diagnosis

A

UA: WBC, WBC casts
urine culture
CBC: leukocytosis w/ L shift

CT urogram:

  • perinephric stranding
  • kidney enlargement
  • dec nephrogram
  • dilated renal collecting system

Renal US:

  • kidney enlargement
  • abn echogenicity
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70
Q

Pyelonephritis: indications for imaging

A 
very ill
unstable
septic
DM
IM
structural abnormality
obstruction
stones
unresponsive to abx
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71
Q

Pyelonephritis: treatment: mild illness

A

FQ PO x 7d

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72
Q

Pyelonephritis: treatment: mod-sev illness

A

(high fever, high wbc, vomiting, dehydration, sepsis)

admit:

  • cultures
  • IV abx
  • imaging
  • f/u C&S after tx
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73
Q

What GU infections is part of a spectrum?

What else does the spectrum include?

A

pyelonephritis

acute bacterial nephritis and renal abscess

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74
Q

Acute Bacterial Nephritis: what is it

A

bacterial interstitial nephritis of the renal cortex

causes renal mass but NO liquefaction

aka acute lobar nephronia

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75
Q

Renal Abscess:
what is it
MC population
MC pathogen

A

purulent fluid collection of kidney

DM, IM

gram negatives
(hematogenous route: gram positives)

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76
Q

Renal Abscess: treatment

A

IV abx
percutaneous drainage
surgical drainage

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77
Q

Chronic Pyelonephritis: what is it

A

scarred atrophic poorly functioning kidney

result of prior infx

low flow, high renin

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78
Q

Chronic Pyelonephritis: presentation

A 
HTN
anemia
proteinuria
renal insufficiency
recurrent UTIs
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79
Q

Chronic Pyelonephritis: diagnosis

A

radiography: caliceal blunting

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80
Q

Chronic Pyelonephritis: treatment

A

manage UTI risk factors
control HTN
nephrectomy

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81
Q

Benign Prostatic Hyperplasia: what is it

A

enlarged prostate in the absence of malignancy

impedes urine leaving bladder by:

  • growth of prostatic glandular tissue
  • inc smooth muscle of prostatic stroma
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82
Q

BPH: presentation

A 
(LUTS)
weak urinary stream
urinary hesitancy
stream intermittency
post void dribbling
nocturia

urinary retention
recurrent UTIs
hx of cystolithiasis, urolithiasis

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83
Q

What is the questionnaire used to assess patients with BPH?

A

AUA symptom score
7 questions

score:
0-7: mild sx
8-19: moderate sx
20-35: severe sx

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84
Q

BPH: diagnosis

A

GU exam w/ DRE
(note size, consistency, tenderness)

UA
PSA if indicated

uroflow study (low flow rate)
PVR (high residual)
cytoscopy (trabeculation, obstructive prostate, kissing lobes)
urodynamic study (low flow, elevated intravesical pressures)
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85
Q

BPH: treatment

A

watchful waiting
lifestyle modification
medication
surgery

86
Q

BPH: treatment: lifestyle modifications

A 
avoid fluid intake and diuretics in evening
elevate legs in evening (if edema)
avoid food/drinks that exacerbate sx
double void
avoid pseudoephedrine/alpha agonists
caution w/ anticholinergics
87
Q

BPH: treatment: medication

A

phytotherapy (saw palmetto)

alpha blockers (1: terazosin, doxazosin)(1A: tamsulosin, silodosin, alfuzosin)

5 alpha reductase inhibitors (finasteride, dutasteride)

PDE 5 inhibitors (tadalafil)

88
Q

BPH: treatment: alpha blockers

  • action
  • 1A vs 1
  • ADEs
A

relax smooth muscle –> freer urine passage

1A: more specific, less ADEs than 1

ADEs: dizziness, asthenia, nasal congestion, orthostatic hypotension/syncope, retrograde ejaculation, IFIS (no cataract surgery)

89
Q

BPH: treatment: 5 alpha reductase inhibitors

  • action
  • time to effect
  • indication
  • ADEs
A 
dec glandular vol
inc flow rates
improve sx score
dec risk of progression 
dec PSA readings by 50%

can take 6 mo to see effect

most beneficial in large prostates (>40cc, PSA > 1.4)

ADEs: impotence, dec libido, lower ejaculatory vol, gynecomastia

90
Q

BPH: treatment: medication plan

A

combination alpha blocker + 5 ARI

alpha blocker: early response until 5 ARI takes effect

91
Q

BPH: treatment: PDE5-I

-indication

A

patients w/ BPH + ED

92
Q

BPH: treatment: surgery

A

Transurethral Microwave Thermotherapy (TUMT)
Transurethral Incision of Prostate (TUIP)
Urolift
Transurethral Resection of Prostate (TURP)
Photoselective Vaporization of Prostate (PVP)
Open simple prostatectomy
Holmium Laser Enucleation of Prostate (HoLEP)

93
Q

BPH: when is TUIP indicated?

A

smaller collar type prostates

94
Q

BPH: treatment: urolift

-what is it

A

permanent implant into prostate

compresses prostatic tissue –> widened urethral lumen

95
Q

What is the gold standard surgical treatment for BPH?

A

Transurethral Resection of Prostate (TURP)

96
Q

BPH: treatment: TURP: complications

A 
retrograde ejaculation
hematuria
TUR syndrome
-hyponatremia
-mental confusion
-HTN
-visual changes
97
Q

BPH: what is an advantage of PVP treatment?

A

can be done on an anticoagulated pt

98
Q

BPH: when is open simple prostatectomy indicated?

A

very large prostate >80cc

99
Q

BPH: when is HoLEP indicated?

A

For large prostates (>80g, >100g, >200g…)

100
Q

Urinary Incontinence: what is it, classification

A

involuntary loss of urine

classified based on:

  • symptoms (stress, urge)
  • underlying pathology (sphincter def, detrusor overactivity, urinary retention)
101
Q

Urinary Incontinence: Transient Causes

A 
DIAPPERS
delirium
infection
atrophic vaginitis
pharmaceuticals/polypharmacy
psychological
excessive urine production
restricted mobility
stool impaction/constipation
102
Q

Urinary Incontinence: precipitating factors

A 
cough/laugh/strain
movement
EtOH, caffeine
constipation
immobility
103
Q

Urinary Incontinence: treatment (DIAPPERS)

A 
D: treat underlying cause
I: abx
A: topical vaginal estrogens
P: elimination/adjustments
P: psych referral
E: treat cause, alter timing of fluid intake/diuretics, elevate LE
R: bedside commode
S: bowel management
104
Q

Urinary Incontinent: treatment (urinary retention)

A

avoid certain meds
catheterization
BPH meds, surgery

105
Q

Urinary Incontinence: treatment (continuous incontinence/fistula)

A

surgery

106
Q

Urinary Incontinence: Female SUI Treatment (noninvasive)

A

behavioral therapy
medication
continence devices

107
Q

Urinary Incontinence: Female SUI Treatment (minimally invasive)

A

bulking agents (collagen, graphite, calcium hydroxyapatite, silicone)

108
Q

Urinary Incontinence: Female SUI Treatment (surgical)

A

anterior repair
suspension
artificial urinary sphincter
sling

109
Q

Urinary Incontinence: Female SUI Treatment: behavioral therapy

A 
Activity modification
Voiding diary
Timed voiding
Bladder training
Pelvic floor muscle training (PFMT)
Fluid intake modification
Dietary modification
Weight loss
Avoidance of constipation
Elevation of edematous lower extremities
110
Q

Urinary Incontinence: Female SUI Treatment: medications

A

alpha agonists

duloxetine

111
Q

Urinary Incontinence: Female SUI Treatment: continence devices

A

pessary
indwelling urinary catheter
urethral occlusive device

112
Q

Urinary Incontinence: Artificial Urinary Sphincter: complications

A

infection

  • pain, edema, erythema, leukocytosis, fever
  • tx: explantation, abx

erosion

  • dysuria, hematuria, recurrent infx
  • tx: explantation, re-implant 3 months later
  • prevention: avoid harsh perineal pressure
113
Q

Urinary Incontinence: Urge Incontinence: what is it

A

episodic involuntary loss of urine

immediately preceded by/associated w/ urgency

114
Q

Urinary Incontinence: Overactive Bladder: what is it

A

urinary urgency

usually associated w/ frequency

115
Q

Urinary Incontinence: Urge Incontinence and Overactive Bladder: treatment (non invasive)

A

behavioral therapy

estrogen (postmenopausal females)

anticholinergic meds (oxybutynin, tolterodine, fesoterodine, darifenacin, solifenacin, trospium)

bet adrenergic medication (mirabegron)

116
Q

Urinary Incontinence: Urge Incontinence and Overactive Bladder: treatment (min invasive)

A

neuromodulation (sacral, posterior tibialis)

botulinum

117
Q

Urinary Incontinence: Urge Incontinence and Overactive Bladder: treatment (surgical)

A

augmentation enterocystoplasty
autoaugmentation
urinary diversion

118
Q

When treating patients with Mirabegron, what do you need to monitor for?

A

increased blood pressure

119
Q

Prostate Cancer: risk factors

A

FAMILY HISTORY

possible:

  • environmental
  • diet (mediterranean = protective)
  • high serum T
120
Q

What is the relationship between prostate cancer and castrated men?

A

castrated before puberty –> do NOT develop prostate cancer

prostate cancer responds to hormonal deprivation

121
Q

Prostate Cancer: early signs and symptoms

A

none

122
Q

Prostate Cancer: late signs and symptoms

A

obstructive sx

123
Q

Prostate Cancer: later signs and symptoms

A

metastatic sx

124
Q

Prostate Cancer: DRE general principles

A

any hard nodule needs to be biopsied

any questionable nodule needs to be correlated with PSA

125
Q

What are the indications for checking PSA when screening for prostate cancer?

A

positive FH
African American
symptomatic

126
Q

Is it appropriate to check PSA after a DRE?

A

yes

inc in serum PSA after DRE is clinically insignificant

127
Q

PSA velocity: definition, usefulness

A

change in PSA concentration over a period of time

may detect early prostate cancer

128
Q

PSA density: definition, usefulness

A

serum PSA concentration divided by prostate volume

significant >0.15

helps differentiate prostate cancer from BPH

129
Q

Is PSA specific to prostate cancer?

A

NO

can also be elevated by:
-acute urinary retention
-BPH
-prostatitis
-prostatic infarction
-prostatic intraepithelial neoplasia
instrumentation/catheterization
130
Q

Aside from PSA and DRE, what are other tools used in diagnosis of prostate cancer?

A

genomic testing (PCA 3, 4K score)

multiparametric MRI (PI RADS score)

targeted fusion biopsy

transrectal US/biopsy

131
Q

What is the Gleason score?

A

histologic grading of prostate cancer

132
Q

Prostate Cancer: symptoms of metastasis

A 
bone pain
weight loss
anemia
azotemia
fatigue
dyspnea
lymphedema
ureteral obstruction
133
Q

Prostate Cancer: metastatic evaluation

A

nuclear medicine bone scan
CT abdomen and pelvis

PET

134
Q

Prostate Cancer: treatment

A 
surgical (radical prostatectomy)
radiation (external beam, seed implantation)
hormonal manipulation
observation/active surveillance
new options
135
Q

Prostate Cancer: indication for radical prostatectomy

A

lesions clinically confined to prostate

136
Q

Prostate Cancer: radical prostatectomy complications

A

IMPOTENCE
bladder neck contracture
incontinence

137
Q

Prostate Cancer: what is the result of hormonal manipulation treatment?

A

tumor regression

138
Q

Prostate Cancer: hormonal manipulation

A

B orchiectomy
LH RH analogs (leuprolide, goserelin)
anti androgens

139
Q

Prostate Cancer: common ADEs of LH RH analogs

A 
diarrhea
N/V
peripheral edema
gynecomastia
HOT FLASHES
140
Q

Prostate Cancer: castrate resistant treatments

A 
Abiraterone (Zytiga)
Enzalutamide (Xtandi)
Sipuleucel-T (Provenge)
Docetaxel (Taxotere)
Cabazitaxel (Jevtana)
Radium-223
141
Q

Most Common causes of cancer death in US males

A
  1. lung
  2. prostate
  3. colorectal
  4. bladder
142
Q

MC type of bladder cancer

A

urothelial carcinoma

143
Q

MC etiology of urothelial carcinoma

A

smoking

144
Q

MC population for bladder cancer

Race with the lowest rate of bladder cancer

A

caucasian males

asian

145
Q

Bladder Cancer: treatment

A

transurethral resection of bladder tumor (TURBT)
cystoscopy, biopsy, fulguration (CBF)
intravesicle therapy (BCG, mitomycin, thiotepa, valrubicin)
cystectomy (robot assist, open)

146
Q

Bladder Cancer: when is a cystectomy indicated?

A

if the tumor is muscle invasive

**SF vs muscle invasive

147
Q

Bladder Cancer: urine pathway

A

ileal conduit
neobladder
mainz II
catheterizable pouch

148
Q

Noncancerous reasons to do a cystectomy

A

urinary incontinence

interstitial cystitis

149
Q

Bladder cancer is a disease of the …

A

urothelium

150
Q

What is the MC type of testicular tumor?

A

germ cell tumors (seminoma and non seminomas)

**5-10%: stromal tumors (leydig cell, sertoli cell, granulosa cell)

151
Q

Testicular Tumor: risk factors

A

cryptorchidism
FH
personal hx
HIV infx

152
Q

Testicular Tumor: presentation

A

PAINLESS mass/swelling
R>L
back pain, abdominal mass

153
Q

Testicular Tumor: locations of metastasis

A

contralateral testis
retroperitoneal LN
lung, liver, brain, bone, kidney, adrenal, GI, spleen

154
Q

Testicular Tumor: diagnostics

A 
H&amp;P
US
tumor markers (alpha fetoprotein, beta HCG, lactate dehydrogenase)
LFTs, CBC, creatinine
CXR
155
Q

Testicular Tumor: treatment

A

refer to oncology (lymphoma)

radical inguinal orchiectomy

156
Q

Testicular Tumor: post orchiectomy evaluation

A

wait 5 half lives to assess tumor markers

  • AFP: 5wks
  • B HCG: 1-2wks
  • LDH: 3wks

CT chest/abd/pelvis

157
Q

Testicular Tumors: staging is based on…

A

tumor
lymph nodes
distant metastasis
serum tumor markers

158
Q

Testicular Tumor: post orchiectomy management

A

surveillance
chemotherapy
radiation
retroperitoneal LN dissection (RPLND)

159
Q

Testicular Tumor: post orchiectomy: surveillance

A

H&P, tumor markers

  • q3-4mo x 2yr
  • q6-12mo x 2 yr
  • annually

CT abd/pelvis

  • q6mo x 2yr
  • q6-12mo x 1yr
  • annually

CXR PRN

160
Q

Testicular Tumor: post orchiectomy: chemotherapy (agents, ADEs)

A

carboplatin, bleomycin, etoposide, cisplatin

ADEs:

  • myelosuppression
  • nausea
  • fatigue
  • infertility
161
Q

Testicular Tumor: post orchiectomy: radiation (side effects)

A

Acute:

  • nausea
  • vomiting, fatigue, myelosuppresion

Later:

  • PUD, gastritis
  • inc risk of CV death
  • inc risk of secondary cancer
162
Q

Testicular Tumor: follow up

A

tumor markers
physical exam
imaging

lifelong

163
Q

What is the most common stone composition in urolithiasis? (features, MCC)

A

calcium oxalate

  • radio opaque
  • resistant to dissolution
  • MCC: dehyrdation
164
Q

Urolithiasis: other stone compositions

A

uric acid (radiolucent, dissolves in alkaline urine)

magnesium ammonium phosphate (MCC: uti, dissolved in acidic urine, staghorn)

cystine (genetic defect, MCC: cystinuria, dissolves in alkaline)

matrix (proteus uti, radiolucent)

ammonium acid urate (uti/laxative abuse, radiolucent)

proteus inhibitor stone (drug/indinavir, radiolucent, not visible on stone protocol CT)

165
Q

Urolithiasis: etiology

A

anatomy (obstruction, stasis)
urine characteristics (pH, citrate, urea)
volume status (vol depletion, low UO, supersaturation)
diet
metabolic (hypercalciuria, hypocitraturia, hyperoxaluria, hyperuricosuria)
disease state
UTI
medication

166
Q

Urolithiasis: etiology: disease states

A 
obesity
metabolic acidosis
renal tubular acidosis 
sarcoidosis
chronic diarrhea (--> vol dep)
cystinuria
inflammatory bowel disease
hyperparathyroidism
medullary sponge kidney
adult polycystic kidney disease
167
Q

Urolithiasis: etiology: medications

A 
vitamin C
vitamin D
triamterene precipitation
protease inhibitors (indinavir)
furosemide
acetazolamide
uricosuric agents (probenecid, salicyclates)
168
Q

Urolithiasis: presentation

A

pain (flank, radiating, colic)
N/V
hematuria
hyperkinetic

fever –> emergency
CVA tenderness

169
Q

Urolithiasis: is it worse when you drink?

A

yes

making more urine –> pressing against stone –> worse pain

170
Q

Urolithiasis: is it worse with twisting/bending?

A

no

yes would be more indicative of MSK issue

171
Q

Urolithiasis: diagnostics

A

UA
CBC
creatinine, BUN, electrolytes

KUB
US
IV urogram
**CT STONE PROTOCOL
CT urogram
172
Q

Urolithiasis: indications for acute intervention

A 
complete/high grade obs
bilateral obs
obs w/ infx
obs in solitary kidney
obs w/ rising creatinine
sev N/V
sev pain
173
Q

Urolithiasis: acute treatment

A

antibiotics

ureteral stent/nephrostomy tube

174
Q

Urolithiasis: lower tract stone treatment

A

cystourethroscopy,cystolitholapaxy
extracorporeal shock wave lithotripsy (ESWL)
open stone removal
dissolution

175
Q

Urolithiasis: upper tract stone treatment

A 
trial of passage
dissolution
extracorporeal shock wave lithotripsy (ESWL)
ureteroscopy w/ stone manipulation
percutaneous nephrolithotomy (PCNL)
open/laparoscopic surgery
176
Q

Urolithiasis: candidates for trial of passage

A 
renal function
pain control
PO intake
no infx
stone size (5mm or less)
177
Q

Urolithiasis: which stones are dissolved in alkaline urine?

A

uric acid

cystine

178
Q

Urolithiasis: which stones are dissolved in acidic solution?

A

struvite

calcium phosphate

179
Q

Urolithiasis: ESWL contraindications

A

pregnancy
coagulopathy
UTI
renal artery aneurysm, AAA

relative:

  • cystine stone, matrix stone
  • pancreatitis
  • distal obs
180
Q

Urolithiasis: what are the requirements for ESWL?

A

stone <2cm

visible on fluoroscopy

181
Q

Urolithiasis: ESWL complications

A 
renal/retroperitoneal hematoma
ecchymosis
UTI, sepsis
steinstrasse
ureteral stricture
pain
182
Q

Urolithiasis: ureteroscopy w/ manipulation complications

A 
ureteral avulsion
ureteral perforation
submucosal tunneling
ureteral stricture
extrusion of stone outside ureter
UTI
bleeding
pain
183
Q

Urolithiasis: PCNL indications

A

large stone burden (>2cm)

staghorn calculus

184
Q

Urolithiasis: PCNL: contraindications

A

UTI
coagulopathy
no percutaneous renal access

185
Q

Urolithiasis: PCNL: complications

A

bleeding
sepsis
renal pelvis perforation
pneumothorax/hydrothorax

186
Q

Urolithiasis: high risk for recurrent stones

A 
Pediatric stone formers
Solitary kidney
Staghorn/multiple stones
Cystine, uric acid, struvite stones
Nephrocalcinosis
Gout
Chronic UTI
FH Stones
GI diseases w/ higher incidences of stones (Crohn’s)
Bone diseases (path fx, osteoporosis)
Professions where stone pain can endanger others
187
Q

Urolithiasis: prevention of future stones

A 
inc fluid intake (esp w/ citrate, no soda)
low Na
low animal protein
low oxalate
mod Ca 
avoid high dose vitamin C and D
reduce PRAL
medications
188
Q

Urolithiasis: prevention of future stones: medications

A 
potassium citrate
thiazide
allopurinol
pyridoxine (B6)
cholestyramine
thiols
189
Q

What are the 6 things to not miss in urology?

A 
obstructive stone w/ fever
testicular torsion
fournier's gangrene
acute urinary retention
priapism
paraphimosis
190
Q

Obstructive Stone w/ Fever: what is it

A

infected urine upstream of obstruction

unable to drain infx

abscess

191
Q

Obstructive Stone w/ Fever: treatment

A

drainage (nephrostomy tube, ureteral stent)

IV abx

192
Q

Fournier’s Gangrene: what is it

A

necrotizing fasciitis of male genitalia and perineum

infx advances RAPIDLY, over minutes

193
Q

Fournier’s Gangrene: risk factors

A

diabetes
alcohol abuse
IM

194
Q

Fournier’s Gangrene: presentation

A 
painful swelling/induration of penis, scrotum, perineum
cellulitis
eschar
necrosis
ecchymosis
crepitus
cutaneous anesthesia
foul odor
fever
195
Q

Fournier’s Gangrene: finding on imaging

A

gas in subcutaneous tissues

196
Q

Fournier’s Gangrene: treatment

A 
IV abx
surgical debridement
wet to dry dressings
whirlpool therapy
HBO
197
Q

Acute Urinary Retention: etiology

A

BPH

anticholinergic meds

198
Q

Acute Urinary Retention: diagnosis, treatment

A 
Normal bladder capacity
Bladder scan (Ultrasound)
Lidocaine gel/ Lubrication
Foley catheter
Coude catheter
Suprapubic tube
199
Q

Priapism: what is it

A

Persistent penile erection that continues hours beyond, or is unrelated to sexual strimulation and lasts greater than 4 hours duration

200
Q

Priapism: etiology

A

sickle cell
trazodone
cocaine
ED treatments

201
Q

Priapism: sequelae

A

ischemia/hypoxia
progressive cavernosal fibrosis
ED

202
Q

Priapism: treatment

A

aspiration
instillation of phenylephrine

shunts

203
Q

Erectile Dysfunction: definition

A

inability to attain/maintain penile erection sufficient for satisfactory sexual performance

204
Q

Erectile Dysfunction: etiology

A

vasculogenic

neurogenic (prostatectomy)

psychogenic (depression, stress, anxiety, psych d/o)

endocrine (hyperPRL, thyroid d/o, SHBG, hypogonadism)

medication induced (antihypertensives - beta blockers, antidepressants, antipsychotics, etc)(alcohol, smoking)

disease states (renal/hepatic disease, DM, atheroscelrotic, neurologic, endocrine disease, surgery, pelvic/penile fx)

205
Q

Erectile Dysfunction: diagnostics

A

if indicated: T, PRL
nocturnal penile tumescence
penile duplex doppler sonography (arterial insufficiency)
cavernosometry/cavernosography (venous leak)

206
Q

Erectile Dysfunction: treatment

A

PDE 5 I
yohimbine

vacuum erection device (VED)
medicated urethral system for erection (MUSE)
penile injection
constriction ring
penile spint
penile prosthesis
penile revascularization
207
Q

Erectile Dysfunction: when are PDE 5 inhibitors contraindicated?

A

with nitrate use

208
Q

Erectile Dysfunction: PDE 5 I: ADEs

A 
nasal congestions
facial flushing
headache
dyspepsia
back pain/myalgia
visual changes (blue halo/NAION)
priapism
209
Q

Erectile Dysfunction: PDE 5 I: instructions for use

A

30-60min before sex
avoid taking after meal (not tadalafil)

PHYSICAL STIMULATION NEEDED

tadalafil stays in system for 36hrs (more likely to have back pain)

210
Q

Erectile Dysfunction: penile injection: risks

A 
pain
infx
bleeding
fibrosis (curvature)
priapism
211
Q

Erectile Dysfunction: penile revascularization surgery: indication, grafted artery

A

focal arterial occlusion of cavernosal artery

inferior epigastric

PHA 522 (2 decks)

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