Pretest_10_Urology Flashcards
____________ results from incomplete development of the anterior urethra
Hypospadias
What is chordee?
When the head of the penis curves downward or upward at the junction of the head and shaft of the penis
While most hypospadias occurs in the corona, hypospadias in this location is associatd with bilateral undescended testes and infertilty and must be differentiated from pseudohermaphroditism and adrenogenital syndrome:
scrotal area
T/F: Smoking is a risk factor for bladder cancers
True
90% of bladder cancers are of __________ cell origin
transitional
When transitional cell bladder cancer is superficial, what is the treatment?
transurethral resection of visible lesions and intravesicular chemo (more radical resection for more advanced stages)
T/F: Transitional cell cancer of the bladder is usually solitary and deep.
False!! Usually MULTIFOCAL and SUPERFICIAL
What sized kidney stones usually pass spontaneously?
Below 0.5 cm
Why might a large kidney stone not be associated with microhematuria?
If it is so big it is occluding the ureter
Why won’t BUN and Cr increase if there is a large kidney stone obstructing a ureter?
the other kidney is still functioning!!
What is the treatment for undescended testicle?
HCg (causes testes to release testosterone and to descend), but surgery by the first year of life
What is the most common type of testicular cancer? How does it present?
Seminoma: nonpainful lump that does not transluminate. Slow growth and radiosensitivty
Which lymph nodes do seminomas metastasize to? Which are sampled for therapy?
iliac, aortic, and renal. Sample the external iliac
What is the underlying pathology in testicular torsion?
Abnormally narrowed testicular mesntery with tunica vaginalis surrounding the testis and epididymis in a bell clapper deformity
Failure of normal posterior anchoring of the gubernaculum, epididymis and testis is called a bell clapper deformity because it leaves the testis free to swing and rotate within the tunica vaginalis
To save the torsed testicle, surgery must be performed within the first ______ hours of symptoms
4-6 hours
T/F: In the operative procedure for testicular torsion, BOTH the affected and unaffected testes undergo orchiopexy
true
How do you use Doppler ultrasound to distinguish between epidydmitis and testicular torsion?
Epididymitis = increased blood flow to testicle Torsion = NO blood flow
For renal cell cancers less than __ cm, a partial nephrectomy can be performed. If any larger, a radical nephrectomy (kidney, ipsilateral adrenal gland, and perirenal fat) is indicated.
4 cm
A tumor made up of an epithelial cell from the intercalated cells of hte collecting duct, characterized by an excessive amount of mitochondria, resulting in an abundant acidophilic, granular cytoplasm:
oncocytoma! round and mahogany with central scar on gross
Prostate cancer (adenocarcinoma) arises in the (central/peripheral) part of the gland
peripheral
Initial treatment of BPH is
an alpha-1 blockade: (doxazosin, tamsulosin)
What is the sympathetic innervation of the bladder?
Of internal urethral sphincter
What is the parasympathetic innervation of the bladder?
detrusor muscle
What is the innervation of the external urethral sphincter?
somatic (pudendal)
Persistent obstruction and overdistention of the bladder leads to (high/low) bladder pressures and (high/low) flow rates
low bladder pressures and low flow rates
THere are is a lot of hypotonic fluid used for irrigation in transurethral resection of the prostate (TURP), which can lead to (hypo/hyper)natremia
hyponatremia and hemodilution
How do you treat rupture of the urethra with pelvic fracture?
Placement of a suprapubic catheter with delayed repair (for up to 4-6 months). At this time, the hematoma will have resolved and the prostate will have descended into the proximity of the urogenital diaphragm
What is the treatment of priapism 2/2 SCD?
IV hydration, alkalinization with bicarb in IV fluids, analgesia, adn supplemental oxygen (ultimately blood transfusion too to get HbS <30%)
What is the treatment of priapism 2/2 pharmacologic agents?
Intracorporal alpha-adrenergic agonist injections (phenylephrine). If that fails, surgical procedures with shunts (corporosaphenous, corporoglandular, or corporospongiosal) are needed to diverthe occluded corporal blood
T/F: Simple renal cysts should be followed up.
False! But multiple septations and calcifications increase suspicion for malignancy
How should a single focus of prostate adenocarcinoma be treated?
This is stage 1. In patients > 65, expectant management. Otherwise radiation or radical prostatectomy (removes the prostate gland and attached seminal vesicles. Lymph nodes near the prostate can be removed at the same time. )
What is the treatment of prostatitis?
IV abx until patient afebrile and hemodynamically normal. Then 3 weeks of oral abx.
Which kidney stones are seen coexisting with urease producing organisms like Proteus or Kelbsiella?
Calcium struvite (made of magnesium ammonium phosphate) Infection causes alkalization of the urine and an environment in which the struvite crystals precipitate
Percutaneous nephrolithotomy is first line
What stones precipitate in alkaline urein?
Calcium struvie (magnesium ammonium phosphate, Klebisella and Proteus infxn) Calcium phosphate (RTA)
What stones form in acidic urine?
Uric acid stones
Note: alkalinization of the urine can help dissolve these stones
Patients complaining of suprapubic pain, increased frequency, normal biopsy and cystoscopy, coexisting with depression, anxiety, IBS, fibromyalgia, and Sjogren syndrome:
interstitial cystitis
What are Hunner ulcers?
Seen in ulcerative interstitial cystitis. Characterized on cystoscopy as reddened mucosal areas with small vessels radiating toward a central scar accompanied by fibrin deposition, rupture, and/or oozing
What is the treatment of metastatic prostate cancer?
Surgical orchiectomy or medical orchiectomy (androgen deprivation via GnRH agonists)
What is the workup for acute bacterial prostatitis?
midstream urinalysis and gram stain
What is the treatment of Peyronie disease?
Pentoxifyline (thought to prevent collagen deposition). Other medical options include vit E, potassium paraaminobenzoate, colchicine, verapamil. Surgery is reserved for those with ED or severe/progressive disease refractory to medical treatment)
What is the treatment of urothelial CIS?
Intravesical BCG
For Ta and T1 disease, it’s transurethral resection of bladder tumors followed by intravesical BCG (Oftentimes a single dose of intravesical dose of mytomycin beforehand)
CTX regimens for advanced TCC include:
GC or MVAC
When is radical cystectomy used for TCC bladder cancer?
T2-T4a
T2 = into muscularis propria
What are contraindications to intravesical BCG therapy?
risks for BCG sepsis: gross hematuria (not microscopic hematura), within 2 weeks of transurethral resection of bladder tumor, active UTIs, high fever, immunosupressed states, previous BCG sepsis
Gross exam of testicular tumor = yellow uniform and well-circumscribed bulging mass. Histo reveals sheets of uniform large cells with abundant cytoplasm and minimal mitotic figures. Diagnosis?
Seminoma
Virilizing symptoms, testicular tumor, sheets of round/polygonal cells with eosinophilic cytoplasm on histo. Occasionallly have “reinke” crystals (rod shaped crystal like structures staining with lipofuscin):
Leydig tumors; tumors of gonadal interstitium
Testicular tumor well-circumscribed, yellow, white, or gray; solid tubules containing Sertoli cells in cords, nests, or sheets; masculinization in females:
Sertoli cell tumor
What is the treatment of viral orchitis?
Orchitis caused by Neisseria gonorrhea?
viral: usually self-limited. bed rest, hot/cold packs, scrotal elevation
N. gonorrhea: ceftriaxone or doxycycline
Bladder extrosphy may be associated with what other congenital defect?
Short phallus with urethral meatus located on the dorsal penile shaft (EPISPADIAS)
Both are caused by failure of the mesenchyme to migrate between the ectodermal and endodermal layers of the lower abdominal wall –> cloacal membrane instability
What characteristic of E coli contributes to its capacity for repeated infections?
P fimbriae, an adherence factor
What characteristic of E coli contributes to its bacterial resistance?
hemolysin and colicin V
