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Urology > Other facts > Flashcards

Other facts Flashcards

1
Q

potential medical advantages to circumcision (5)

A
  1. prevent phimosis
  2. prevent balanoposthitis (superficial infection of glans and foreskin)
  3. eliminate risk of penile cancer
  4. decreased risk STI, HIV, and cervical cancer
  5. Decreased UTI in newborns
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2
Q

when do 90% of boys have completely retractable foreskin?

A

by 3 years

-at 6 months, only 20% do

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3
Q

phimosis

A

narrowing of the opening of the prepuce, preventing it from being drawn back over the glans

TX: trial of topical betamethasone 0.05% ointment for 6-8 weeks

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4
Q

four major techniques of circumcision

A
  1. Dorsal Slit
  2. Shield technique (Mogen clamp)
  3. Gomco clamp or plastibell clamp
  4. Freehand surgical excision
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5
Q

common complications from circumcision

A
  1. bleeding
  2. adhesions of mucosal skin to the glans penis (prevented at 1 wk visit to push skin at head of penis back so the groove of the glans is visible)
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6
Q

hypospadius

A

congenital defect of the penis

  • results in incomplete development of the anterior urethra, corpora cavernosa, and prepuce
  • due to incomplete development of the glandular urethra which does not allow for preputial folds to fuse –> foreskin absent on ventrum, excessive on dorsum

-can be associated with abnormal penile curvature

NOT associated with increased risk of UTI

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7
Q

Classification of hypospadius

A

based on where meatus is after penile straightening

  1. anterior hypospadius (meatus on glans or subcoronal) (50%)
  2. penile shaft meatus (20%)
  3. meatus between perineum and penoscrotal junction (30%)
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8
Q

is hypospadius associated with other anomalies?

A

nope

not associated with other abrnomalities because external genitalia are formed much later than the kidneys, ureter, and bladder

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9
Q

timing of hypospadius correction

A

best performed between 6-18 months before toilet training

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10
Q

Ectopic ureteral orifices

A

ectopic ureter = a ureter that does not insert into the trigone

  • usually presents with UTI
  • more common in girls than boys
  • Girls –> can have incontinence if insertion is distal to urinary sphincter, associated with a DUPLICATED SYSTEM
  • Boys –> no incontinence (usually inserts into bladder neck or proximal urethra), NOT associated with a duplicated system
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11
Q

complete duplication of the collecting system - ureter arising from lateral orifice

A

can have a ureter arising from the lateral orifice –> drains lower pole, causes reflux, can get UPJ obstruction

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12
Q

complete duplication of the collecting system - ureter arising from medial orifice

A

–> drains upper pole of kidney
associated with an ectopic ureterocele
-commonly obstructed, more likely to be ectopic

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13
Q

ureterocele

A

caused by incomplete or delayed dissolution of CHWALLA’S MEMBRANE (separates ureteral bud from urogenital sinus)

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14
Q

complete ureteral duplication

A

caused by the presence of 2 ureteric buds on the Wolffian duct (mesonephros)

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15
Q

Meyer-Weigert law

A

complete ureteral duplication

idea that a LOWER ureteric bud merges with the urogenital sinus, migrates LATERAL on the trigone and becomes the lower pole ureter…

UPPER ureteric bud merges with urogenital sinus and does no migrate as fare lateral –> upper pole is more medial

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16
Q

incomplete ureteral duplication or bifid renal pelvis caused by…

A

a single ureteric bud that bifurcates prematurely

17
Q

UPJ obstruction is caused by…

A

a later atresia of the ureter after ureteric ingrowth into the metanephros

18
Q

Multicystic dysplastic kidney caused by…

A

early atresia of the ureter after ureteric ingrowth into the metanephros (kidney)

19
Q

horseshoe kidney caused by…

A

fusion of the lower poles of both metanephros –> abnormal ascendence (caught on IMA) and abnormal rotation

20
Q

Thoracic kidney

A

due to incomplete closure of posterior diaphragm, kidney is in the chest

21
Q

Bochdalek hernia

A

herniation of the kidney and other abdominal contents through an opening in the diaphragm (Bochdalek’s foramen)

22
Q

pathophys behind VUR

A

ureterovesical junction competence depends on trigone tone
-if the trigone is week, then the ureteral orifice migrates towards the ureteral hiatus where ureter penetrates bladder –> shorter submucosal tunnel –> VUR

23
Q

what are the mechanisms that prevent reflux

A
  1. trigone contraction - move ureteral orifice away from the ureteral hiatus and lengthens the submucosal tunnl
  2. filling of the bladder - stretches trigone and increases length of the submucosal tunner
  3. submucosal ureteral tunnel of adequate length.
24
Q

Bowel-Bladder Dysfunction

A

any abnormal pattern of urination and defecation
-constipation, dysuria, incontinence, and abnormal voiding interval

-increased risk of damage from VUR and UTI

25
Q

Grade of VUR

A

Grade 1 - reflux into ureter - no dilation - no tortuous ureter
Grade 2 - reflux into ureter and pelvis - no dilation, no tortuous ureter
Grade 3 - reflux into ureter, pelvis, infundibulum - MILD dilation of affected structures, no tortuous ureter
Grade 4 - reflux into ureter, pelvis, infundibulum, and calyces - MODERATE dilation of affected structures, MILD tortuous ureter
Grade 5 - SEVERE dilation of ureter, pelvis, infundibulum, and calyces, SEVERE tortuous ureter

26
Q

Complications of VUR

A
  1. UTI (pyelo) - MOST COMMON
  2. Hydroureteronephrosis
  3. Renal scarring (from infection) –> HTN later on
  4. Reflux nephropathy –> HTN later on
27
Q

Where does renal scarring most often occur?

A

more likely at poles of the kidney because these areas have more confluent papillae that allow intra-renal reflux

28
Q

VUR presentation

A
  1. most present with UTI
  2. Age - 3-6 yrs
  3. 85% of VUR are females
29
Q

VUR in girls vs. boys

A

boys –> younger age presentation, higher grade VUR, less associated with voiding dysfunction

30
Q

goal of treating VUR

A

prevent recurrent febrile UTIs and prevent renal scarring

31
Q

VUR surgical treatment - Ureteroneocystomy (ureteral reimplant)

A
  1. Resect lower 2-3 cm of ureter because its muscle is underdeveloped.
  2. put intravesical portion of ureter into a submucosal tunnel
  3. submucosal tunnel should be 3x as long as ureter diameter
  4. tension free anastomosis between bladder and ureter
  5. taper mega-ureters before reimplantation
32
Q

Complications of ureteral reimplant surgery for VUR

A
  1. Ureteral obstruction (1-2 wks postop, abd pain, nausea, vomiting) –> ureteral edema if perioperative, ischemic stricture if later
  2. persistent reflux –> 2/2 voiding dysfunction, contralateral VUR
33
Q

f/u after surgery for ureteral re-implant for VUR

A
  1. ppx abx continued
  2. renal and bladder US 4-6 wks post op to look for ureteral obstruction
  3. VCUG 3 months post-op to check for resolution of VUR
  4. stop ppx abx if VCUG and US are normal
34
Q

Contents of spermatic cord (7)

A
  1. testiscular artery
  2. cremasteric artery
  3. genital branch of the genitofemoral nerve (cremaster muscle)
  4. testicular verves
  5. Vas deferens
  6. pampiniform plexus
  7. Lymphatic vessels

**ilioinguinal nerve runs along the spermatic cord

35
Q

An undescended testicle can be…

A

absent, undescended, retractile, or ectopic

Urology (3 decks)

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