penile & urethral disorders Flashcards
what is the conditon? tx if mild vs severe?
- mostly d/t e. coli & mostly ascending
- PE: fever CVAT, +/- N/V, LUTS
- pyuria, leukocytosis
pyelonephritis
- CT imaging?- dilation, delayed nephrogram, fat stranding, renal abscess ephysematous pyelo
- if mild then 14 d course of fluoroquinolone (add IV/IM ceftriaxone if over 10% resistance)
- if severe– admit w/ extended abx
bladder infection likely d/t ecoli. how is uncomplicated vs complicated treated in terms of duration?
- cystitis
- uncomplicated 3-5d course
- complicated 7-10 d
when is cystitis considered ‘Complicated’?
a bunch of scenarios but rememer Males, PREGNANT, PEDS, obstruction, h.o MDR organisms
condition? 3 labs to get?
- most common presentation of STI in sexually active males
- onset related to sexual activity time line!
- PE: urethral discharge? epidiymitis? penile or scrotal lesions/ulcers? inguinal LAD, urethral erythema
- DRE to r/o coexisting prostatits or bimanual exam in female to r/o PID/cervicitis
urethritis
swab has over 2 WC/hpf
over 10 WBC/hpf on 1st void urine microscopy– send for NAAT
test for gc/chlamydia +/- other STIs if sign is present
if someone has urethritis + purulent discharge, what is the likely etiology?
neisseria gonorrhea
- swab gram stain shows gram neg diplococci
if suspecting mycoplasma/ureaplasma as cause of urethritis, what are 3 ways to treat it?
doxycyline PO ID x 14 days
azithromycin 1g PO x 1
FQ
4 complications of urethritis
infertility
pain
PID
strictures
condition? 4 diagnostic tests? way to risk stratify via UA?
- most common GU cancer, more in males w/ avg age of 65
- mostly classified via urothelial histological type
- painless intermittent gross hematuria vs asymptomatic microscopic hematuria (3+ RBC/hpf on 1 UA + negative culture)
- pain from obstruction; renal insufficiency from upper obstruction
bladder carcinoma
dx: upper tract imaging (RBUS, CTU/MRU), cystoscopy, culture, cytology
over 10 RBC/hpf is “intermediate risk” while over 25 RBC/hpf is high risk
what is this?
- rupture of tunica albuginea of an erect penis, when engorged penile corpora forced to buckle & “pop” under pressure during intercourse or masturbation
- bruising “eggplant deformity”, pain, no blood at meatus, clear urine w/o difficulty
penile fracture
tx: emergent referral, observation, surgery (best w/in 24-48 hrs)
condition? imaging? tx?
- straddle injury or pelvic fracture causing dysuria/urgency, retention/pain, edema
- blood at meatus, +/- penile pain
urethral injury
get RUG (retrograde urethrogram) & urgent urology referral
DO NOT CATHETERIZE
- persistent penile erection for hours beyond OR unrelated to sexual stimulation & lasts over 4 h
- urologic emergency!!!
- most important to determine the type
Priapism
what is this? how is it treated?
- persistent erection w/ little or no cavernous blood flow that leads to fibrosis & ED (esp w/ longer time to detumescence)
- corpora cavernosa are rigid & tender
- etiology: sickle cell trait & dz, leukemia, meds (PDEF,testosterone, trazodone, cocaine, anti-psychotics)
- cavernous PO2 is under 30
ischemic (low flow) priapism
EMERGENCY– corporal aspiration & irrigation > phenylephrine (if first one fails), shunt; if sickle cell– also hydration, O2 +/- pRBC
what condition is this? how is it tx (2)?
- recurrent form of ischemic priapism where unwanted painful erections occur repeatedly w/ intervening periods of detumescence
- most commonly d/t sickle cell dz (present before 20 typically)
stuttering priapism
tx aimed at prevention– Low dose PDE5i (reset circuit), hydroxyurea, prevent dehydration, infxn in sickle cell
- nonsexual, peristent erection caused by unregulated cavernous arterial inflow; not hypoxic or acidotic
- partially erect, nontender
- etio: antecedent trauma is most common; also SCI or needle injury
- cavernousal PO2 is over 90mmHg
nonischemic (high flow) priapism– less common
tx: observe > arterial embolization if unresolved
over 60% are self-limiting– does not need emergent tx
conditon? treatment (3)?
- foreskin cannot retract (normal in under 5 yo)
- acquired > congenital
- histology: chronic inflammation, fibrosis, edema, vascular congestion
phimosis
circumcision/dorsal slit
topical steroids, manual stretching
