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EOR Exam 1 > Renal and Genitourinary System > Flashcards

Renal and Genitourinary System Flashcards

1
Q

What is the clinical presentation of BPH?

A
  • Weak urinary stream
  • Urinary hesitancy
  • Stream intermittency
  • Post void dribbling
  • Nocturia
  • Urinary retention
  • Recurrent urinary tract infections
  • Hx of cystolithiasis, other urolithiasis
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2
Q

Tests that can be done to evaluate BPH?

A
  • U/A
  • PSA
  • Uroflow study (Voided volume, Peak flow in mL/sec, Mean flow in mL/sec)—low flow rate
  • Post void residual (in mL)— high residual
  • Cystoscopy—trabeculation, obstructive prostate encroaching into urinary outlet lumen, “kissing lobes”
  • Urodynamic study (UDS) may be indicated—low flow, elevated intravesical pressures
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3
Q

Tx for BPH?

A
  1. Watchful waiting: monitor sx and recheck labs
  2. Lifestyle modification:
    - Avoid fluid intake and diuretics in evening to decrease nocturia
    - If leg edema, elevate legs in evening to mobilize and eliminate fluid before hs
    - Avoid drinks/food that exacerbate sx (caffeine, EtOH, acidic or spicy foods)
    - Double void to completely empty bladder
    - Avoid pseudoephedrine/ alpha agonists
    - Caution with anticholinergics: can cause retention
  3. Medications
    - Phytotherapy: saw palmetto
    - PDE5-I
    - Alpha blockers: relaxes smooth muscle and allows for freer passage of urine. Alpha 1- terazosin and doxazosin, alpha 1A- tamsulosin, silodosin, alfuzosin
    - 5 alpha reductase inhibitors: finasteride and dutasteride
  4. Surgery
    - 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)
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4
Q

Side effects of alpha blockers for BPH?

A
  • Dizziness
  • Asthenia
  • Nasal congestion
  • Orthostatic hypotension/syncope (rare)
  • Retrograde ejaculation
  • Intra-operative floppy iris syndrome (IFIS)—don’t start pt on alpha-blockers if he has cataract surgery coming up. Pt needs to inform cataract surgeon in advance if he is taking alpha-blocker.
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5
Q

What is the gold standard surgical tx for BPH?

A

TURP

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6
Q

What are the complications with TURP?

A

-Retrograde ejaculation
-TURP Syndrome: Hyponatremia, Mental confusion, Hypertension,
Visual changes
-Hematuria

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7
Q

Which BPH medication class causes a decrease in PSA readings of 50%

A

5 alpha reductase inhibitors

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8
Q

What are the side effects of 5 alpha reductase inhibitors?

A
  • Impotence <5%
  • Decreased libido <4%
  • Lower ejaculatory volume <3%
  • Gynecomastia <1%
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9
Q

Which medication is useful in patients with both BPH and ED?

A

Tadalifil

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10
Q

What is the function of 5 alpha reductase inhibitors? Characteristics?

A
  • Block conversion of testosterone to DHT
  • Lower DHT levels
  • Decrease prostatic glandular volume
  • Increase max urinary flow rates
  • Improve AUA sx scores
  • Decrease risk of BPH progression
  • Can take 6 months to see effect (as opposed to weeks for alpha-blockers)
  • Decreases PSA readings by 50%
  • May stop chronic hematuria 2ndary to prostatic varices
  • Most beneficial in larger volume prostates >40 cc and PSAs greater than 1.4
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11
Q

What is a phimosis?

A

Prepuce stuck distal to glans

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12
Q

What causes phimosis?

A
  • Hygiene

- Balanitis

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13
Q

How is phimosis treated?

A

Circumcision

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14
Q

What is a paraphimosis?

A

Prepuce stuck proximal to glans, unable to be reduced

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15
Q

What is a complication of untreated paraphimosis?

A
  • Penile necrosis

- In immunocompromised: Fournier’s gangrene

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16
Q

How is paraphimosis treated?

A
  • Manual push/pull

- If manual reduction not successful, dorsal slit or circumcision

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17
Q

Risk factors for testicular torsion?

A
  • Undescended testis

- Bell clapper deformity

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18
Q

Clinical presentation for testicular torsion?

A
  • Age: 12-18 yr old male (most common)
  • Onset: acute
  • Intensity: severe
  • Swelling: absent
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19
Q

Physical exam findings for testicular torsion?

A
  • Tender, firm testis
  • High riding testis
  • Horizontal lie
  • Absent cremasteric reflex
  • No pain relief with elevation
  • Thick/knotted sperm cord
  • Epididymis not posterior to testis
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20
Q

Tx for testicular torsion?

A
  • Manual detorsion: “Open the book”
  • Detorse surgically: testis viable then orchiopexy both sides, non-viable testis then orchiectomy and orchiopexy of contralateral side.
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21
Q

Was is the time frame for a viable testis in a testicular torsion?

A

< 6 hrs

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22
Q

How is testicular torsion diagnosed?

A
  • Physical exam and clinical suspicion
  • Doppler ultrasound
  • Nuclear testicular scan
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23
Q

What is a varicocele?

A

Dilated veins of the pampiniform plexus

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24
Q

Clinical presentation of varicocele?

A
  • Pain
  • Testis damage—fibrosis and decreased spermatogenesis
  • Testis atrophy
  • Infertility: Stress pattern on semen analysis (Decreased sperm count, decreased sperm motility, increased abnormal sperm)
25
Q

Physical exam finding for varicocele?

A

Bag of worms feeling

26
Q

Where is a varicocele MC located?

A

Left side

27
Q

How is a varicocele treated?

A

-Surveillance:
-Palpable varicocele
with normal semen analysis in young men: Semen
analysis q 1-2 yr
-Varicocele with normal testis size in children and
pre-sexual adolescents: Measurement of testicular
size annually to detect size decrease

-Surgery: embolization or vein ligation

28
Q

When is surgery indicated for a varicocele?

A
  • Symptomatic
  • Palpable varicocele with abnormal semen analysis in evaluation of infertile couple (if female nl or correctable)
  • Varicocele with small testis—repair can reverse atrophy
29
Q

What is a hydrocele?

A

Collection of fluid around the testicle, forming between the parietal tunica vaginalis and the visceral tunica vaginalis

30
Q

Causes of hydrocele?

A

-Majority are idiopathic
-Associated with inflammatory conditions:
Epididymitis, torsed appendix testis

Resolves with resolution of underlying condition

31
Q

Clinical presentation of hydrocele?

A
  • Unilateral scrotal enlargement MC
  • Asx
  • Sx such as pain
32
Q

How is hydrocele diagnosed?

A
  • Palpation
  • Transillumination
  • Scrotal US –gold standard
33
Q

Hydrocele is treated if?

A

-Bothersome or sx

34
Q

How are hydroceles treated?

A
  • Needle aspiration, with injection of sclerosing agent

- Hydrocelectomy

35
Q

What is the disadvantage of needle aspiration?

A

May recur

36
Q

Complications of needle aspiration?

A
  • Possible infection
  • Bleeding (hematoma)
  • Pain
37
Q

What is the advantage of hydrocelectomy?

A

Not likely to recur

38
Q

Complications of hydrocelectomy?

A
  • Possible infection
  • Bleeding (hematoma)
  • Pain
  • Poss loss of testis
39
Q

What are the risk factors for cystitis?

A

Immunocompromised:

  • DM
  • HIV
  • Malignancy
  • Steroids
  • Chemotherapy
  • Malnutrition

Urinary stasis/obstruction:

  • Urinary retention
  • Ureteral obstruction
  • Vesicoureteral reflux
  • Bladder diverticulum
  • Congenital GU abn
  • Sexual activity
  • Spermicide use
  • Diaphragm use
  • Urinary incontinence
  • Cystocele or pelvic prolapse
40
Q

What things won’t lead to cystitis?

A
  • Voiding after intercourse
  • Wiping from front to back
  • Tight clothing
  • Voiding as soon feel urge to void
  • Hot tubs
  • Douches
  • Tampons
41
Q

What is the clinical presentation of cystitis?

A
  • Irritative voiding symptoms: dysuria, urgency, frequency
  • Suprapubic discomfort
  • Cloudy, malodorous urine
  • Fever
  • Mental status change
  • SCI: Autonomic dysreflexia, incr muscle spasticity
42
Q

How is cystitis diagnosed?

A

Urinalysis:

  • Leukocyte esterase positive (WBC enzyme)
  • Nitrite positive (reductase enzymes convert nitrate to nitrite. Most do. Strep does not)
  • Pyuria > 5 WBC/hpf
  • Bacteria

Urine culture: > 100,000 organisms, monoculture

43
Q

What is the MC cause of cystitis? Other organisms that cause cystitis?

A
  • MC cause: E.coli
  • Other common pathogens: Klebsiella, Enterobacter, Proteus, Pseudomonas, Staphylococcus saprophyticus, Enterococcus, Candida
44
Q

How is cystitis treated?

A
  • Trimethoprim/Sulfamethoxazole (TMP/SMZ, Bactrim, Septra) DS bid x 3 day treatment course
  • Nitrofurantoin (Macrodantin, Macrobid)
  • Ampicillin and amoxicillin effective against enterococcus
  • Beta lactamase inhibitor for beta-lactam resistant bacteria
  • Fluoroquinolones
  • Fosfomycin 3 gm po single dose (though not if pyelo suspected) (Monurol)
  • Cefdinir (Omnicef)
  • Amoxicillin-clavulanic acid (????)
  • Cefaclor (Ceclor)
  • Cefpodoxime proxetil (Vantin)
45
Q

T/F: Bacteruria equals infection

A

False

46
Q

Complicated cystitis occurs in….

A
  • Immunosuppression
  • Pregnancy
  • Male
  • Pediatric
  • Indwelling urinary catheter, stent, drain
  • Anatomic abnormality (e.g. vesicoureteral reflux, calyceal diverticulum, ureteropelvic junction obstruction)
  • Urinary obstruction
  • Urolithiasis
  • Renal insufficiency
47
Q

What is the hallmark symptom of prostatitis?

A

Prostatic pain

48
Q

What are the types of prostatitis?

A
  • Acute Bacterial Prostatitis
  • Chronic Bacterial Prostatitis
  • Inflammatory Chronic Pelvic Pain Syndrome (Non-bacterial Prostatitis)
  • Non-inflammatory Chronic Pelvic Pain (Prostatodynia)
49
Q

What is the clinical presentation of acute bacterial prostatitis?

A
  • Fever
  • Irritative poss obstructive voiding sx
  • Warm boggy tender prostate.
50
Q

Acute Bacterial Prostatitis occurs commonly in what age group?

A

Young men

51
Q

MC organism causing acute bacterial prostatitis?

A

E. coli

52
Q

How to test for acute bacterial prostatitis?

A
  • H+P

- Urine culture

53
Q

Tx for acute bacterial prostatitis?

A

Abx

54
Q

What is the cliical presentation for chronic bacterial prostatitis?

A
  • Recurrent prostatic infections
  • Pain in genitals, urinary tract, perineum, low back
  • Irritative urinary symptoms (dysuria, urgency, frequency)
  • Pain w/ejaculation
55
Q

What age group is chronic bacterial prostatitis common in?

A

Older men

56
Q

MC organism causing chronic bacterial prostatitis? Other organisms that cause this?

A
  • MC: E. coli
  • Klebsiella
  • Pseudomonas
  • Proteus
  • Enterococcus
  • Staphylococcus saprophyticus
  • Chlamydia trachomatis
  • Ureaplasma urealyticum
  • Mycoplasma hominis
57
Q

How is chronic bacterial prostatitis diagnosed?

A

-H+P
-History of recurrent UTIs
-Physical Exam: tender boggy prostate
-Expressed prostatic secretion (EPS)
-Post prostate massage urine culture
-Meares Stamey 4 glass test (Initial, Midstream,
EPS, Post prostatic massage)

58
Q

How is chronic bacterial prostatitis treated?

A
  • Fluoroquinolones -Sulfamethoxazole/ Trimethoprim
  • NSAIDs
  • Alpha blockers
  • Anticholinergics/antimuscarinics
  • Phytotherapy (Saw palmetto)
  • Zinc
  • Diet
  • Stress management
  • Prostate massage, ejaculation
  • Sitz baths

EOR Exam 1 (3 decks)

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