Renal. Hydronephrosis+ BPH+ED (08-02) (1) Flashcards
FA. Hydronephrosis. definition? and mechanism?
dilation of the urinary tract.
Dilation is secondary to downstream obstruction of urinary tract.
FA. Hydronephrosis. causes in children 3
obstruction at the ureteropelvic junction
may also be at ureterovesicular junction
or at bladder outlet (eg from posterior urethral valves)
FA. Hydronephrosis. causes in adults?
BPH
aortic aneurysm
FA. Hydronephrosis. causes in both children and adult? 3
neurogenic bladder (spinal cord injuries), tumors, renal calculi.
FA. Hydronephrosis.
Apart from obstruction can be caused by excessively high out-put urinary flow and vesicoureteral reflux.
.
FA. Hydronephrosis.
Symptoms? 3
may be asymptomatic
may present with flank/back pain, abdominal pain, UTI
FA. Hydronephrosis.
Diagnosis? 2
UG or CT
seen dilation of renal pelvis, calyces, and/or ureter
FA. Hydronephrosis. treatment.
pediatric - some resolve spontaneusly
.
FA. Hydronephrosis. treatment. usual method?
surgically treated to correct anatomic obstruction or reflux
FA. Hydronephrosis. treatment for neurologic bladder?
can start a clean intermitent cath regimen for bladder emptying.
FA. Hydronephrosis. 2 surgical methods?
stent
percutaneous nephrostomy
FA. Hydronephrosis. when need catheter? 2 methods
Foley
or
suprapubic cath. may be required for lower urinary tract obstruction (eg BPH)
FA. BPH.
in what proc of male seen?
seen in > 80 proc by age of 80.
It is normal part of aging
FA. BPH. in what age most commonly occur?
> 50 y/o
FA. BPH. does it cause cancer?
NO
but can coexists together
FA. BPH.
what are obstructive symptoms?
hesitancy, weak stream, intermittent stream, incomplete emptying, urinary retention, bladder fullness, acute urinary retention following surgery
FA. BPH.
Irritative symptoms?
nocturia, daytime frequency, urge incontinence, opening hematuria
FA. BPH. DRE?
uniformly enlarged with rubbery texture.
Suspect cancer if hard or irregular lesions.
FA. BPH. DRE. Why may not be detected?
BPH occurs in central zone (periurethral)
FA. BPH. what labs?
Urine culture and Urinalysis to rule out infection and hematuria.
PSA - would be increased, but the need contraversial.
Further workup needed if inc. BPH correlates with findings suggesting cancer.
Creatinine - to evaluate renal insuf. or obstructive uropathy.
+ do electrolytes if tubular dysfunction due to obstruction.
FA. table.
BPH risk factor?
age > 50
FA. table.
prostate cancer risk factor?
age > 40, family history
FA. table.
BPH zone affected?
central
FA. table.
prostate cancer affected?
lateral lobe
FA. table.
BPH zone DRE examination?
smooth symetrically enlarged
FA. table.
Prostate cancer examination?
firms with nodules and asimmetrically enlarged
FA. ED. what prevalence?
10-25 proc. in middle age men.
FA. ED. classification?
failure to initiate
failure to fill
failure to store
FA. ED.
failure to initiate - causes? 3
psychologic, endocrinologic, neurologic
FA. ED. failure to fill cause 1?
arteriogenic
FA. ED. failure to store cause?1
veno-occlusive dysfunction
FA. ED. risk factors?
DM, atherosclerosis, drugs- BAB, SSRI, TCA, diuretics, hypertension, heart disease, surgery or radiation for prostate cancer, spinal cord injury.
FA. ED.
initially - ask about risk factors, medications, psycho stressors.
.
FA. ED.
distinction between psychologic vs oranic ED?
it is based on
Situational dependence (eg occurs with only one partner) and the presence of nocturnal or early mornin erections with penile tumescence testing (if presents, it is non organic)
FA. ED. diagnosis?1
CLINICAL
FA. ED. what evaluate initially? 2
neurologic dysfunction and for hypogonadism
neuro - anal tone, lower extremity sensations
hypog - small testes, loss of secondary sexual characteristics.
FA. ED. neurologic evaluation?
anal tone, lower extremity sensations
FA. ED. hypogonadism evaluation?
small testes, loss of secondary sexual characteristics
FA. ED. other workup? 5
screening for DM and cardiovascular disease, measurement of TSH and testosterone
prolacting - elevated can resul in decr. androgen activity.
FA. ED. key fact. innervation. erection?
PNS
FA. ED. key fact. innervation. ejaculation?
SNS
FA. ED. best initial treatment?
Psychologic cause - psychotherapy involving discussion and exercise with partner.
FA. ED. drugs?
p/os
sildenafil, vardenafil, tadalafil
FA. ED. drugs what group and mechanism?
PDE-5 inhibitors, that prolong action of cGMP-mediated smooth muscle relaxation and inc. blood flow to corpora cavernosa.
FA. ED. drugs contraindicated with what?
nitrates
FA. ED. in what case give testosterone?
useful if hypogonadism of testicular or pituitary origin
dont use if normal testosterone levels
FA. ED. what treatment if PDE5 fails or contraindicated? many methods
vacuum pumps, intracavernosal injections of prostaglandins, surgical implantation of semirigid or inflatable penil prostheses.
FA. BPH. treatment.
INITIAL medical?
a-blockers (tamsulosin, terazosin) -relax smooth muscles in prostate and bladder neck
FA. BPH. treatment.
SECONDARY medical?
5alfa reductase inhibitors (finasteride) - inhibits production of dihydrotestosterone
FA. BPH. treatment. surgical?
for what patients
TURP, open, laparoscopic, robotic ,,simple prostatectomy”
moderate to severe symptoms/complications (renal insuf, recurent UTI, bladder stones)
FA. BPH. treatment. in case of bladder obstruction?
urgent catheterization while waiting more definitive management.
