SASP 2014 Flashcards
when to use estrogen in exposed asymptomatic vaginal mesh
postmenopausal women only. no effect in premenopausal
complete bulbar disruption from straddle injury - mgmt
sp tube placement with delayed reconstruction
trans-scrotal orchiectomy for seminoma
XRT to include retroperitoneum, groin, and hemiscrotum
significance of scrotal violation for testicular ca
3% local recurrence vs 0.4%
finasteride blocks which 5 alpha reductase
type 2
what type of 5-alpha reductase is in the prostate
type 2
serum and prostatic testosterone with finasteride
decreased DHT causes reduced negative feedback, increased LH, and increased testosterone in serum and prostate
chance of viable disease, teratoma, necrosis in post chemo NSGCT mass
50%, 40%, 10%
most important factor in preserving upper tract renal function in urinary diversion
use of ileum over colon
why is ileum preferred for neobladder
less high pressure contractions noted on UDS vs colon
how much does capacity increase with ileal neobladder over 1 yr
7x
bacteria associated with renal deterioration in urinary diversion - 2
proteus, pseudomonas - these should be treated
nl intraop neobladder capacity
200 ml
what area of kidney is injured first during prolonged ischemia
medullary thick ascending loop of henle
why is ascending loop of henle more prone ton injury
rich in na-k-atpase
AUA BPS - what is low risk DVT patient
minor surg in pt < 40 yo w/o risk factors
AUA BPS - what is moderate risk DVT patient
- minor surg in pt w additional RF, 2. surg in 40-60 yo w/o additl RF
AUA BPS - what is high risk DVT patient
- surg in pt > 60 yo, 2. surg in pt 40-60 yo w additl RF (prior VTE, ca, hypercoagulable state)
AUA BPS - what is highest risk DVT patient
multiple RF (>40 yo, ca, prior VTE)
AUA BPS - what is a minor procedure
“short” procedure where pt ambulates early
female pelvic reconstructive surgery is considered x risk for DVT/VTE
anti-incontinence and pelvic reconstructive surgery is high risk if not cysto or sling
AUA BPS - DVT prophylaxis - moderate risk
heparin 5000 q 12 hrs or lovenox 40 daily or SCD if high bleeding risk
AUA BPS - DVT prophylaxis - high risk
heparin 5000 q 8 hrs or lovenox 40 daily or SCD if high bleeding risk
AUA BPS - DVT prophylaxis - highest risk
heparin 5000 q 8 hrs or lovenox 40 daily AND SCD
second treatment option for recurrent UTI after intercourse if failed nitrofurantoin
3 day course of bactrim b/c nitro is concentrated in urine and she prob has uropathogenic bacteria hiding in vag
mgmt of urethral perf with malleable vs inflatable penile prosthesis
malleable - can leave one cylinder in if its on uninvolved side and no spetal perf present. ipp - remove the entire thing
acute adrenal insufficiency sx - 3
n/v, abd pain, hypovolemia unresponsive to fluids
tx of acute adrenal insufficiency
hydrocortisone - dont delay for lab test
what would lab test be for acute adrenal insufficiiency - 2
morning serum cortisol, acth
what % of men havesuccessful erection with MUSE
40% (not very good)
7 motzer criteria
- karnoksky performance status < 80%, 2. LDH > 1.5 x nl, 3. hgb < lower limit of nl, 4. high corrected calcium > 10, 5. ABSENCE of prior nx, 6. presence of liver mets, 7. increased alk phos
low risk motzer - def and sig
0 RF, median survival 30 months
intermediate risk motzer - def and sig
1-2 risk factors, median survival 14 months
poor risk motzer - def and sig
> 3 RF, median survival 5 mo
imaging modality with highest sens/spec for prostate ca mets
18F - PET (superior to classic bone scan)
ddx of acidic azoospermic semen - 2
b/d EDO, CABVD
b/l EDO findings on TRUS - 3
midline urethral cysts, bilateral SV cysts, or a combination of these
% with CBAVD who have no CF mutation
30%
cause of CBAVD if no genetic abnormality found
mesonephric ductal-ureteral bud abnormality
assd finding in CBAVD pts with negative genetic testing and mgmt
5% w renal agenesis - do us
inverted papilloma - 2 types
type 1 - benign, type 2 - may have malignant behavior. histologically identical
inverted papilloma mgmt
have to do bladder and upper tract surveillance for 2 yrs
when doing captopril renography for RAS - mgmt of home medications - 2
have to be stopped for 2 weeks. if on ACE inhibitor - will significantly affect test result.
steroids for ureteral swelling
not used
what medication causes intraoperative floppy iris syndrome
flomax
ESRD and RCC screening- time frame
wait until 3 yrs on dialysis
medication for people with stent pain
flomax, (no benefit with anticholinergic, pyridium, toradol)
interstim infection mgmt
remove IPG and lead, dont reimplant at the same time due to risk of infection
incidence of malignancy in adrenal mass < 4 cm
almost all benign if no hx ca, 50% malig if hx ca
2 CT findings that suggest benign adrenal adenoma
< 10 HU and < 4 cm = 98% specificity of benign
when to resect adrenal masses - 2
> 4 cm or metabilically active
biochemical workup of adrenal mass < 4cm
cortisol and catecholamines, include aldosterone if hx HTN
coagulation of semen is dependent on
semenogelin
semenogelin aka
seminal vesicle specific antigen
what is benign urethrorrhagia
terminal gross heaturia and nl PE casued by transient inflammation of bulbar urethral epithelium. observe
first test in young male with low ejaculate volume and nl exam/labs
post ejaculate urine volume - least invasive and easy to fix
is locally advanced disease a contraindication to orthotopic neobladder?
no]
ipp pain with inflation - how to evaluate w/ imaging
MRI with IPP inflated will allow you to see if cylinders are buckling
what is SST deformity
floppy glans
how to fix SST deformity
move glans onto the distal portion of the cylinders with glansplasty
what is glansplasty
dorsal plication of glans back onto shaft of penis
prostatic utricle is analagous to what in female
distal 1/3 vagina.
embryologic origin of prostatic utricle
UG sinus
significance of leukocytes in semen of infertil male
indicate functional damage from DNA fragmentation due to sperm membrane lipid peroxidation from reactive oxygen species released from leukocytes. leukocytes dont = infection
best test to eval pseudoaneurism after kidney surgery
doppler - less radiation and gives same info
what space does TOT pass through
ischiorectal fossa, not obturator canal
outside-in course of tocar in TOT - 6
gracilis, adductor longus and brevis, obturator externus muscle, obturator membrane, obturator internus muscle.
when to get imaging in uncomplicated pyelo - 5
fever > 72 hrs, or hints of complicated UTI: DM, immunosupression, hx stones, sx obstruction.
clavien grade 1 complication
any deviation from nl postop course without need for pharmacoloic tx or other intervention
clavien grade 2 complication
with need for pharmacoligic intervention (including TPN, blood transfusion)
clavien 4 complication
life threatening complication
clavien 4a vs 4b
a - single organ dysfunction, b - multi organ dysfunction
pop Q “c” point value
0= at hymen, aka bad prolapse
microscopic finding in bacterial vaginosis
“clue cells”
findings in BV
vag discharge, vag pH>4.5, malodorous fishy vag discharge
RF for BV - 4
multiple sexual partners, new sex partner, use of IUD, douching
tx for BV
flagyl - treating pt is the same as tx partner. 1/3 recur
distal ureteral stone in prepubertal child - cant pass scope
ureteral dilation with urs is safe in prepubertal children. avoids need for stent and second anesthesia.
mgmt of ED in pt with early peyrones disease
pde5-i may reverse endothelial impairment. ICI may be associated with penile plaques.
C-arm position that minimizes radiation scatter
x ray tube below patient and as far from pt as possible.
location of PCNL puncture in horseshoe kidney itself
posterior and superior calyx
location of PCNL puncture needle passage in horseshoe kidney
more emdial, just lateral to paraspinus muscles
floppy glans in ipp due to 3
inadequate dilation, too short cylinder, or variation in corporal anatomy where corpora dont reach to glans
2 options for mgmt of poorly supported glans in ipp
remove current ipp and perforate corpora then reinsert ipp with rear tip extender or larger ipp.
chemo induced RTA type 1 looks like
acidosis, hypokalemia w no signs of dehydration of abnormal renal function
mgmt of RTA type 1 - chemo induced or otherwise
k citrate
next step in ECF mgmt if persistently high output continues after TPN/NPO started
agents to decrease bowel motility - loperamide, atropine
chronic anabolic steroid induced hypogonadism mgmt (nl FSH, low T) - 2
HCG replacement if 1 yr of exogenous steroid has not worked. clomiphine will also work but is less effective
why not give testoserone in chronic anabolic steroid induced hypogonadism mgmt (nl FSH, low T)
exogenous T will further supress central axis (FSH/LH)
initial mgmt of renal ein thrombosis due to prolonged delivery/prematurity
iv hydration to tx dehydration
success rate of cystoscopic fulguration of VVF
66% for fistula < 7 mm in size when used as primary or secondary tx
success of fibrin glue in VVF and caveat
75% success in fistula < 15mm in size but tend to break down at 1 yr
mgmt of testicular fracture
immediate surgical exploration - dont delay for us
imaging required after reimplant for VUR in kid
renal us to r/o hydronephrosis, VUG is optional
what does hydro look like at 2 and 3 months postop
if preop hydro is SFU grade 2 or higher, 60% resolve by 3 mo, 30% improve, and reminder are unchanged or worse
what to do if hydro is unchaged or worse at 3 mo
mag 3 and VCUG
postop mgmt of bulking agent injection - 2
VCUG and renal us
mgmt of traumatic injury to bladder neck, vag, and rectum
if stable - immediate repair of injuries and diverting colostomy, if unstable - nephrostomies or diverting ureteral stents
problem with delayed mgmt of bladder neck, vaginal rectal injury
high risk of fistula, abscess, osteomyelitis, and persistent bladder neck incontinence.
def of dysfunctional voiding
involuntary contraction of pelvic floor during voiding in a neurologically intact person
primary function of PTH
blocks calcium reabsorbtion in PCT and promote calcium reabsorbtion in ascending loop, DCT, and collectig duct.
enzyme converting vit D in kidney
1-hydroxylase
location of 1-hydroxylase
proximal tubule
precourser to Vit D production in skin
7-dehydroxycholesterol
where does vit D activation happen - both parts
25 hydroxylation in liver, 1-hydroxylation in kidney
primary action of 1,25 vit d3
promote gut absorbtion of ca by stimulating formatoin of ca-binding protein within intestinal epithelium
urinary urgency behavioral mgmt
rapid,short pelvic contractions (quick flicks) decrease DO/urgency and tell pt to delay voiding in response to urge to void (not to pee just in case or when the urge hits)
alpha-mercaptopropionylglycine
oral agent for cystine stones that participates in thiol-disulfide exchange with cystine - increasing solubility
newborn circumcisoin with re-approximation of foreskin edges mgmt
topical steroid for 6 weeks, if fails consider abx +/- dorsal slit. dont do revision circumcison in acute setting b/x poor result due to inflamed foreskin
urethral hypermobility on PE suggests what finding
intrinsic sphincter deficiency
persistent ISD after mid urethral sling - mgmt
pubovaginal sling is more durable than submucosal injection
what kind of abscess is hydradenitis suppurativa
sterile
nerve most likely injured during psoas hitch
femoral - tracks through psoas and exits under lateral aspect of the psoas under ilioinguinal ligament
where does botox work in nerve pathway
postsynaptic parasympathetic efferent nerves to detrussor
secondary effect of botox in bladder
decrease in afferent sensation (urgency) due to localized inhibition of detrussor muscle ATP, substance P, and reduction in afferent axonal capsasin and purinergic receptors
tx for chancroid
azithromycin 1 gm po x 1
alternative tx for chancroid - 2
erythromycin 500 mg po qid x 7d or ceftriaxone 250mg im x 1
bacteria that causes chancroid
haemophilus ducreyi
bp and autonomic dysreflexia
nl sc injury bp is low (approx 100 sbp), elevation of 20 mmhg suggests AD, and if > 120mmhg and pt is symtomatic consider as having AD
how to use nitropaste in Autonomic dysreflexia
apply above level of lesion (vasoconstriction happens below). paste can be wiped off if rebound hypotension occurs
second line agent for autonomic dysreflexia
sublingual nitroglycerine
problem with nifedipine in autonomic dysreflexia
can cause severe rebound hypotension resulting in stroke or MI and not recommended any more
posthypotensive episode mgmt in AD
monitor BP for 2 hrs to make sure they dont get rebound hypertension
recommended methods to prevent AD - 5
terazosin 5 mg, prazosin mg, or tamsulosin 0.8mg the night before the exam, or nitropaste 2% 0.5 inch or captopril sublingual10-15 mins prior to exam
nitropaste/nitroglycerine caveat
make sure they havent used PDE5 in last 24 hrs
best way to deflate foley balloon that will not deflate with syringe, and what not to do
cut off valve and pass a wire. try not to pop the balloon as it will leave a fragment that has to be removed with cysto
obtundation in kid with urinary stasis problem (prune belly) and e coli UTI
caused by hyperammonemia as urea splitting organisms generate alot of ammonia in the urine.
T, LH, and FSH levels in androgen insensitivity
high T and LH (pituitary doesnt recognize T), nl FSH
T, LH, and FSH levels in puberty
normal
T, LH, and FSH levels in kleinfelters
high FSH and LH, low T
T, LH, and FSH levels in sertoli only
high FSH and LH, low T
how many patients will have residual ca after chemo for stage 2 testicular ca
20%
what nodes drain right kidney
interaortocaval
what is serenoa repens
saw palmetto
effect of serenoa repens
no change in prostate size, AUA SI, flow rate, or change in rate of AUR
initial mgmt of small cell of the prostate
chemo
most concerning part of large ureterocele in kid with bilateral hydro
bladder outlet obstruction
when to intervene in duplicated system with nonfunctioning upper pole
breakthrough febrile uti while on prophylactic abx
initial mgmt for reflux in duplicated system
prophylactic abx
tadalafil brand name
cialis
how long to wait for nitrates with sildenafil, tadalafil, vardenafil
S,V - 24 hrs, T - 48 hrs
ureteral injury at the time of pubovaginal sling - mgmt steps - 4
cysto/stent –> antegrade NU –> open repair only if previous 2 cannot be placed –> reimplant if significant devitalization of ureter
how to increase glandular engorgement with ipp
PDE5
partial nx in the setting of tumor thrombus
higher risk of recurrence and poor prognosis
candida UTI in neonate mgmt
have to treat agressively due to risk of candidemia (upto 80%)
tx of choice for candida uti in neonate
fluconazole
first signal in T cell activation
APC presents antigen via MHC on APC
second signal in T cell activation
stabilization and co stimulation btw APC and T cell via CD40/CD80
third signal in T cell activation
interleukin stimulation
additional mgmt for ileal conduit in pregnant female
none. same routine obstetric care.
undescended testicle - distance of testicle form internal ring for 2 stage fowler stevens
> 2 cm with no vascular redundancy and you have to clip spermatic vessels.
concern with acute hCG stimulation in one yr old
damage to seminerifous tubules
what is the trial of mid urethral slings
showed equivelant efficacy (80% vs 77%) and greater risk of postop voiding dysfunction for retropubic (2.7%) vs trans obturator slings (0%)
residual lung nodule in post chemo testis cancer mgmt
do wedge resection for tissue dx to determine if more tx is needed. needle biopsy is insufficient
nl position of conus medularis
L2
30 gm benign prostate and dutasteride
not considered a “large” prostate
location of chromosomal mutation in Clear cell RCC
short arm of chr 3
papillary type 1 mutation location
chromosome 7
papillary type 1 mutation gene
c-met
papillary type 2 mutation location
chromosome 1
papillary type 2 mutation gene
fumarate hydratase
oncocytoma mutation location
short arm of chr 17
oncocytoma mutation gene
BHD1
distal prostatic ducts are lined by what epithelium
pseudostratified
lining of urethra - epithelium - male
proximal 2/3 = transtional, distal 1/3 = stratified squamous
maturation arrest on testicular biopsy fertility mgmt
can do testicular sperm extration with more extensive biopsy
mgmt of incontinence combined with high arch foot - initial mgmt
r/o tethered cord with MRI
what is tethered cord
stretch induced functional disorder of SC with most caudal part of cord anchored by an inelastic structure.
suspected chronic prostatitis in pt with bactiuria
get initial midstream cultures then treat bactiuria first with nitrofurantoin (dosnt effect prostate bacteria), then do localization cultures -
mgmt of e coli chronic prostatitis
4-6 wks of FQ
mgmt of failure of initial round with FQ in chronic prostatitis
second cycle with an alternative FQ
alternative initial treatment to FQ in e coli chronic bacterial prostatitis
bactrim x 3 months
ileal conduit in spinal cord injury patinet - where to place conduit
RUQ so they can reach it
most sensitive test for confirming pheochromocytomy
PLASMA free metanephrines. metanehrine metabolism is uninterrupted
new onset hydronephrosis after sphincter/sling in pt with neurogenic bladder caused by - 2
detrussor decompensation aka detrussor noncompliance not identified preop or patinet noncompliance with CIC/ timed voiding intervals
target of abiraterone - 3
irreversibly inhibits products of CYP17 gene including 17,20-lyase and 17-alpha hydroxylase
non-testosterone effect of abiraterone
decrease in cortisol and rise in ACTH due to blocing 17-alpha-hydroxylase resulting in increased mineralocorticoid effect (aldosterone)
clinical manifestation of 17-alpha-hydroxylase blockage in abiraterone
hyper-aldosteronism aka HTN, hypokalemia, fluid retention
hyperaldosteronism in abiraterone
give with cortisol to attenuate aldosterone effects
ideal method to repair congenital penile curvature in teens
plication
why is re-biopsy after ASAP necessary
this is a small foci of glands that exhibits features of adenocarcinoma due to insufficient biopsy material to make the diagnosis of prostate cancer and repeat biopsy is recommended.
seizure after prolonged ileus and ngt suction due to
hypomagnesemia
other causes of hypomagnesemia - 4
diuretics, DKA, alcoholism, prolonge NGT
soda and stone risk
stopping soda over 3 yr period results in 35% decreased stone risk if acidified by phosphoric acid. not the same for those acidified by citric acid.
independent factor with poor prognosis in pts with local recurence of RCC following radical nx
local recurrence + synchronous mets.
best mgmt for local recurrence in RCC
surgical resection
pts getting d penicillamine should get supplemental
vit b6
side effects of d-penicillamine - 8
fever, rash, GI side effects, arthralgia, leukopenia, thrombocytopenia, proteinuria w/ nephrotic syndrome, polymyositis
risk of recurrence with T1, T2, T3 RCC
7, 25, 40% ESPECIALLY during the 1st 3 yrs
AUA guidelines for T1 RCC lesion followup
CXR, labs x 3 yrs. not routine CT
AUA guidelines for T2-3 RCC lesion followup
cxr, labs, ct q 6 mo x 3 yrs then yearly to yr 5
3 types of bladder dysfunction in PUV patinets
detrussor overactivity, decreased compliance, myogenic failure
3 types of bladder dysfunction in PUV patinets and ages
detrussor overactivity (older child), decreased compliance (infant), myogenic failure (adolescnt)
role of acetohydroxamic acid
decreases growth of residual struvite stone fragments, but doesnt stone recurrence in patients made stone free at the time of surgery
acetohydroxamic acid and alcohol
nonpuritic macular rash of the face and upper extremeties that disappears 30-60 mins after starting
when should intravesical chemo be administered post turbt
within 24 hrs
effect of post turbt mitomycin
reduces SHORT term recurrence (<2yrs)
DSD can be predicted by what finding in lumbosacral myelomeningocele
an intact sacral arc
how to determine if someone has intact sacral arc - 3
most reliable is intact bulbocavernosal reflex. others include: LE movement, spontaneous voiding, nl anal sphincter tone
burn to penile shaft characteristic
usually full thickenss
first step in penile shaft burn
place sp tube. debriedment isnt necessary in the first few hrs after the injury
urethra and penile shaft burn
dont instrument it or do any studies to avoid further damage
PSA and finasteride/ dutasteride - timing
doubling psa in 1st yr OVERestimates PSA and can lead to an increased likelyhood of biopsy, after 2 yrs doubling can lead to UNDERestimating and less biopsies
psa interpretation and finasteride/dutasteride
using a 0.3 ng/dl increase from nadir as a trigger for biopsy maintains sensitivity and specificity similar to an absolute value of 4 ng/dl
abdominal mass and racoon eyes = ?
neuroblastoma
what are racoon eyes
periorbital metastasis causing edema, proptosis, ecchymosis
what condition leads to facial adenoma sebaceum
tuberous sclerosis
how does hodgkins lymphoma present
fever, nightsweats, fatigue
facial angiofibromata aka
facial adenoma sebaceum
what do facial angiofibromas look like
firm, discrete, red/brown telangectic papules in nasolabial folds, chin, cheeks
treatment for topical candida
clotrimazole
treatment for scabies
premethrin
partial nx is most appropriate for what kind of pediatric tumor
stage V wilms
most common way to measure free testosterone
immunoassay
problem with free testosterone immunoassay and alternative
not accurate, bioavailable T measures T with ultracentrifugation or dialysis
if total T is low, whats the next step
check LH and prolactin to r/o central process
problem with aromatase inhibitors for low T in obese pts with elevated estrogen
off label use that can result in elevated LFT and affect bone health
if only total testosterone is available - how to calculate free T
calculate with total T, SHBG +/- albumin level
selenium/vit E in prostate ca
no effect on outcome
site of origin with WORST prognosis in pediatric RMS
prostate
site of orgin/histology with BEST prognosis in pediatric RMS
vaginal origin or embryonal histology
rationale for post urs imaging to confirm stone passage even if no endoscopic evidence of stones
documentation of: 1. clearance of stone fragments, 2. resolution of preop obstructive hydronephrosis, 3. r/o obstruction from ureteral stricture
AUA guideline recommendation for post-URS radio-opaque vs radiolucent stone
radio-opaque, get kub and renal us, lucent get renal us alone ONLY if pt is asymptomatic. if symptomatic OR hydronehrosis is found - high likely hood of obstruction and need CT. alternatively, hydro pts can be observed
most common paratesticular tumor
adenomatoid tumors
where are paratesticular tumors located - 3
epididymis, testicular tunica, rarely spermaticord
significance of adenomatoid tumors
considered benign, 20’s-30’s, < 4 cm, usu in epididymis
what method prevents bladder prolapse at the time of vesicostomy
exteriorize the dome by placing vesicostomy cephelad to the urachus - immobilizes peritonealized portion of bladder.
what is blocksom technique
exteriorizing dome of bladder
testicular pain/swelling in teen - when to tx for std - 3
urethral discharge, + UA, admission of sexual activity
hormone deprivation effect on gleason score
results in inaccurate score - artifically higher
renal cystic condition that arises prior to formation of nephron
MCDK
specifics of MCDK origin
results from abnormal differentiation of metanephric parenchyma early in development of the kidney
ARPKD gene
PKHD1 gene
ARPKD protein
membrane associated receptor like protein, fibrocystin
outcome of abnormal fibrocystin secretion in ARPKD - 2
causes abnormal ductal development, stimulates fibrous connective tissue resulting in congenital hepatic fibrosis
ADPKD genes - 2
PKD 1 an PKD 2
ADPKD proteins - 2
polycystin-1 and 2
polycystin protein function (or lack of) in PCKD
normally functions within calcium channels and disruption leads to cyst formation, fibrotic renal stroma that manifests in 2nd-3rd decade
what is juvenile nephronophthisis
rare, most common genetic cause of childhood kidney failure characterized by fibrosis and cystic dysplasia of renal tubules
mgmt of lichen sclerosus/BXO of meatus
distal urethroplasty w buccal mucosa
why is buccal mucosa best in LS/BXO
field change to genital skin
most common sites of origin of extragonadal germ cell tumors in decreasing order - 4
mediastinum, retroperitoneum, sacrococcygeal, pineal gland
gross hematuria after vigorous exercise in teen, mgmt
can be normal in people free of congenital GU problems. mgmt is to repeat UA in 48-72 hrs as it will normalize
difference btw benign hemoglobinuria in teen and myoglobinuria
no RBC’s in myoglobinuria
failure to improve on PO vanc in c diff, mgmt
surg consult for colectomy improves survival
current virulent c diff strain name
NAP 1 - thought to be due to use of FQ’s
role of prophylactic lymphadnectomy in penile cancer without palpable nodes
improved survival if prophylactic vs at time of palpable nodes. not enough evidence currently for sentinel LN bx
how to best dx renal pseudotumor
nuclear scan with cortical scanning agent (like DMSA, not MAG3) demonstrates activity in area in question. CT can also answer this but are more expensive/invasive
candiduria and GU procedure
treat as UTI due to risk of fungemia. antifungal at time of procedure is not sufficient
pathologic classificaiton of RCC with positive margin at resection
R1 - this doesnt affect T stage
T3a v T3b vs T3c in RCC
T3a - isolated renal vein involvement. T3b - renal vein with infradiaphragmatic , T3c - supradiaphragmatic
what condition is assd w testicles in hernia sac in girls
androgen insensitivity
45XO/46XY and gonads
streak gonads
who gets workup after pyelo
older M with peylo. younger sexually active male with CYSTITIS can be observed
mgmt of resolved pyelo in 65 yo 1 month later - 2
do CT urogram and cysto to r/o GU pathology
when is carbazitaxel used
docetaxel failure (progression while on)
carbazitaxel MOA
tubulin-binding taxane drug
carbazitaxel benefit
3 month survival benefit
renal ablation followup
CT at 3 and 6 months, then yearly upto 5 yrs. CXR yearly
definition of low risk RCC in followup AUA guidelines
T1N0 or NX regardless of furhman grade
AUA followup of LOW risk after partal vs radical nx
partial - labs, CXR yearly to 3 yrs, abd CT/MRI within 3-12 months then yearly (f/u can be renal us) to yr 3, radical nx - CXR yearly, abd US**/ct/mri at 3-12 months then at discretion of clinician
AUA followup of mod/high risk after surgery
labs, baseline abd imaging (CT or MRI only) at 3-6 mo then Q 6 months (can include US) for 3 yrs then q yr to 5 yrs. baseline CT chest at 3-6 mo then q 6 mo (can be CXR) x 3 yr then yearly to 5 yrs
