Surgery 3B - Urology Flashcards
Renal fxns
FIltration
Reabsorption
Secretion
x phagocytosis
Ureteral blood supply
Abdominal aorta
Renal artery
Illiac artery
x thoracic artery
Endocrine organs
Kidneys
Testes
x ureters
x bladder
Male urethra
Prostatic
Bulbous
Penile
x vas deferens
Areas of narrowing in ureter
Uretrovesical jxn
Area crossing iliac vessels
Uretero pelvic jxn
x Fossa navicularis
Contained w/in gerota’s gascia
Adrenal glands
Kidney
Perinephric fat
x Psoas muscle
Renal lymphatic drainage
Perihilar nodes
Interaortocaval nodes
Paraaortic nodes
x internal iliac nodes
Urinary bladder structures
Detrussor m
Trigone
Transitional cell epithelium
x seminal vesicles
Prostate gland consists of
Sm muscle
Glandular structures
Fibrous tissue
x Seminiferous tubues
Penile structures
Corpora cavernosa
Urethra
Corpora Spongiosa
x Epididymis
Obstructive urinary tract symptoms
Dec of uninary caliber
Terminal dribbling
Urinary retention
x dysuria
Irritative urinary symptoms
Dysuria
x Hesitancy
x Terminal dribbling
x Urinary retention
Bloody urine
Hematuria
x Chyluria, pneumaturia, dysuria
Blood in semen
Hematospermia
x Hematuria, pneumaturia, chyluria
Exam urilized for renal dse
Palpation
Kidney Punch
x vaginal exam, rectal exam
UA components
Pus cells
RBC
pH
x Creatinine
UTI
WBC: 20-30/hpf
>100k colonies of E. coli
x pH 6, SG 1.010
Imaging studies for renal stones
UTZ
CT
XRay
x Angiography
Evaluate renal fxn
Renal scan
Acute prostatitis
Enlarged tender prostate
Dysuria
Fever
x hard nodular prostate
Kidney produces
Renin
Angiotensin
Erythropoietin
1’ physical characteristic of high osmolar contrast agents is that responsible for their toxicity
Hyper-tonicity
Contrast agent-induced reactions including urtricaria, edema, hypotension, are thought to be
Anaphylactoid
Agent of choice for renal cortical imaging
Tc99m DMSA
WAGR syndrome most freq associated w/
deletion of chromosome 11
Risk factors associated w/nephrotoxicity in patients receiving high osmolar contrast media include ff except
renal insufficiency diabetic nephropathy multiple administrations w/short interval hyperuricemia x hypoalbuminemia
MC non invasive dx workup used for urological pt
UTZ
MC dx GU carcinoma in males
prostate CA
Tx for prostate CA
Ext beam radiation
Radical prostatectomy
Brachytherapy
Chemotherapy
Radical nephrectomy includes
Kidney
Gerota’s fascia
Hilar LN
Contralateral adrenal glands
Straddle injury includes
Corpus spongiosum
Bulbous urethra
x prostatic urethra, bladder
Radical cystectomy in men includes
Perivesical fat
Complications of ureterolithiasis
Hydronephrosis
Pyonephrosis
Pyelonephritis
x UB diverticulum
Radioluscent stones
Uric acid
Cystine
x Struvite Ca phosphate
Hematogenous route of infection
Tuberculous orchitis
Tuberculous nephritis
x pyelonephritis epididymitis
Asc route of infection
Pyelonephritis
Cystitis
x Tuberculous orchitis, Diverticulitis
Multiple scrotal sinuses
Actinomycosis
Tuberculosis (testicular)
x prostatitis, cystitis
Struvite stones/Staghorn calculi
Mg
NH4
PO4
x cystine
Tx for renal calculi
ESWL
Open nephrolithotomy
Percutaneous nephrolithotomy
Medical therapy
Major renal injury
Contusion
1cm parachymal laceration
x urinary extravasetion, renal artery avulsion
Posterior urethral injury
Floating prostate
Blood per urethral meatus
Bladder distension
Pelvic fracture
Ant urethral injury
Straddle injury
Bulbous urethra
x pelvic fracture, prostatic urethra
Distal third urethral injury
Ureteroscopic injury
Pelvic Sx
x Deceleration injury, Blunt injury
Stage B UB tumor includes
Mucosa
Muscularis
x Illiac LN, Adventia
Stage A prostatic CA involves
Peripheral zone of prostate
x illiac LN, seminal vesicles, bladder neck
REnal cell CA metastasizes to
Lung
Liver
Bones
LN
Radical nephrectomy includes
Gerota’s fascia
Perinephric fat
Kidneys
Adrenal glands
Radical cystectomy for males includes
Prostate
Seminal vesicles
U bladder
Distal part of vas deferens
Radical prostatectomy
Prostate
Seminal vesicle
Distal part of vas deferens
Illian LN
Treatment for acute prostatitis
Antimicrobials
Alpha blocker
Anti inflammatory
x finasteride
Tx for symptomatic BPH
5 alpha reductase inh
Alpha blocker
TURP
Open prostatectomy
Tx for organ confied prostatic CA
Low dose rate brachytherapy
Radical prostatectomy
High dose rate bradytherapy
Ext beam radiation
Immediate tx/mgt for urethral injury
Cystostomy
x primary anastomosis, urethral catherization, observation
Tx modalities for RCC
Radical nephrectomy
Biologic response modifiers
x simple nephrectomy, chemotherapy
Tx modalities for bladder malignancies
Radical cystectomy
Intra-vesical chemo
Radiation
Bladder replacement
Where are renal pyramids
Inner medulla
Apices of renal pyramids project into
renal sinus
Urine in the renal papillae drain into
minor calices
Where are pacemaker muscle cells of kidney that initiate and exert peristalic activite
minor calices
Which part of kidney is not covered by renal fascia
hilum ?
R internal spermatic v drains
IVC
L gonadal vein drains
L Renal vein
Area of prostate traversed by ejaculatory ducts is known as the
central zone
Lower UT symptoms in BPH
Urgency
Frequency
Nocturia
What causes the pain assoc w/stone in the ureter
Obstruction of urine flow w/distension of renal capsule
Site where BPH arises
transitional zone
Colic caused by ureteral stone and RLQ pain in appendicitis
referred pain
MCC pain w/gross hematuria
ureteral obstruction d/t blood clots
MCC continuous incontinence
Vesiculovaginal fistula
Info from pelvic bimanual exam not obtained in radiologic eval
mobility/fixation of pelvic organs
MCC cloudy urine
alkaline
Hematuria distinguished from hemoglobinuria or myoglobinuria by
microscopic presence of RBC
Chronic scrotal pain most often d/t
hydrocoele
Terminal hematuria is usually seen in
prostatic inflammation
Enuresis is physiologic until
1-3
Measurement for catheters
French
1 mm in diameter = __ French
3 French
What is unique of obstructive nephropathy compared to hydronephrosis
Renal fxn impairment
Chance of renal recovery after ureteral obstruction most influenced by
early relief of obstruction
Characteristic of hydronephrosis of pregnancy
R side more affected
Male urethra corresponds to posterior urethra
Prostatic urethra
What part of the male urethra is longest
spongy penile urethra
Bilateral obstruction of UT what is noticed
max fxns excerted by both kidneys
Normal excusion of kidneys during respiration
4cm
Abnormal loc of kidneys are noted in
nephroptosis
Stress incontinence is common seen in
laxed pelciv floor musculature
CVA tenderness is elicited in
Pyelonephritis
Presence of gas (pneumaaturia) in UT is seen in
Sigmoid CA
Initial hematuria seen in ff
Meatal stricture
Condition assoc w/exstrophy of the bladder
epispadias
Oliguria =
< 400cc/day
Imaging of choice in scrotal pathology
UTZ
Calculi composed of what are not seen on plain radiographs
Uric acid
Absolute indication for open repair of blunt bladder rupture injury
sig intraperitoneal bladder rupture
Blunt trauma pt w/pelvic fracture was seen at the ER. No urine output, hypogastric area distended. Blood coming out of meatus. Dx choice?
Retrograde urethrography
Which environmental factor is most generally accepted as a risk factor for RCC
tobacco
Suppressor gene for Wilm’s tumor
11p13
Voiding cystourethropgraphy shows reflux of contrast to upper tract, dilation of calyceal system, marked tortuosity of ureter. What grade
Grade V
Histologic type of bladder CA from remnant of urachus
adenocarcinoma
Incidence of prostatic CA strongly assoc w/
family history
what structure w/in renal hilum divides renal artery into ant and post
renal pelvis
Best renal imaging protocol for living renal donor to define renal anatomy and vasculature and to rule out renal stone
helical CT w/out and w/ IV contrast and a KUB radiograph
Risk of hyperacute rejection after kidney transplant is high when which of the ff crossmatch is (+)
B cell micro-lymphocyto-toxicity
Total hematuria is noted in
passage of ureteral stone
Assoc w/ extrophy of the bladder
Epispadias