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Urology Topics > Topic List 1 > Flashcards

Topic List 1 Flashcards

1
Q

Surgical procedures - Kidney

A
  1. Nephrectomy (simple, radical, partial, laparoscopic, retroperitoneoscopic)
  2. Percutaneous nephrolithotomy
  3. Extracorporeal Shock Wave Lithotripsy (ESWL)
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2
Q

Surgical procedures - Ureters

A
  1. Nephroureterectomy
  2. Pyeloplasty (open, laparoscopic)
  3. Ureteroureterostomy
  4. Ureterocystoneostomy
  5. Megaureter operations
  6. Ureteroscopy
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3
Q

Surgical procedures - Bladder

A
  1. Tension free vaginal tape (TVT)
  2. Cystoscopy
  3. Transurethral resection of the bladder (TURB)
  4. Cystectomy (open, laparaoscopic)
  5. Conduit formation (ileum/colon)
  6. Ileum neobladder (studer/hautmann)
  7. Urostoma (Mainz-Pouch 1)
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4
Q

Surgical procedures - Prostate

A
  1. Biopsy
  2. Transurethral resection of the prostate (TURP)
  3. Laser treatment of BPH
  4. Prostatectomy (suprapubic, retropubic, simple, radical, laparoscopic)
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5
Q

Surgical procedures - Penis

A
  1. Circumcision
  2. Frenuloplasty
  3. Internal urethrotomy
  4. Urethral reconstruction
  5. Hypospadia repair (MAGPI, Tubularized incised plate urethroplasty (TIP), Mathiey, Duckett, Two-stage)
  6. Penectomy
  7. Inguinal lymphadenectomy
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6
Q

Surgical procedures - Testis

A
  1. Orchidopexy (shoemaker’s technique)
  2. Orchiectomy (scrotal, radical)
  3. Retroperitoneal lymphadenectomy
  4. Hydrocelectomy
  5. Spermatocelectomy
  6. Vasectomy
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7
Q

Developmental disorders - Kidneys

A
  1. Simple cyst
  2. PCKD
  3. Multicystic kidney
  4. Medullary sponge kidney
  5. Renal agenesis
  6. Duplex kidney
  7. Renal ectopia
  8. Horseshoe kidney
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8
Q

Developmental disorders - Ureter

A
  1. Ectopic
  2. Uretocele
  3. Uretopelvic junction (UPJ) obstruction
  4. Ureteral duplication
  5. Vesicoureteral reflux
  6. Megaureter
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9
Q

Developmental disorders - Bladder

A
  1. Periureteral diverticulum
  2. Bladder exstrophy (classical, cloacal)
  3. Patent urachus
  4. Posterior urethral valve
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10
Q

Developmental disorders - Urethra/Male Genitalia

A
  1. Hypospadia
  2. Phimosis
  3. Failure of testicular development
  4. Cryptorchidism
  5. Hydrocele - processus vaginalis fails to close
  6. Varicocele
  7. Epispadia
  8. Micropenis
  9. Urethra duplex
  10. Megalourethra
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11
Q

Injuries to - Kidney

A
  1. Blunt renal injuries (laceration)
  2. Penetrating renal injuries (gunshot/stab wounds)
  3. Minor renal trauma (84%)
  4. Major renal trauma (15%)
  5. Vascular injury (1%)
    The injuries are graded 1-5
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12
Q

Indications for surgery after kidney trauma

A

Absolute:
1. Persistent bleeding
2. Expanding/pulsatile hematoma
3. Arterial injury
Relative:
1. Major urine extravasation
2. Penetrating injury

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13
Q

Injuries to - Ureter

A
  1. Iatrogenic factors
  2. Blunt trauma
  3. Penetrating trauma
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14
Q

Treatment after ureter trauma

A
  1. Ureteric stents + nephrostomy in minor trauma
  2. Debridement, mobilization, and spatulation of ureter
  3. Ureteroureterostomy
  4. Pyeloplasty
  5. Ureter-neoimplantation
  6. Bladder tube flap (Boari-Mezo)
  7. Psoas hitch
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15
Q

Injuries to - Bladder

A
  1. Iatrogenic
    Blunt:
  2. Contusion
  3. Extraperitoneal rupture - Pelvic fractures
  4. Intraperitoneal rupture - Full bladder and increased pressure
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16
Q

Lesions of the urethra

A

Female is rare normally iatrogenic
Male:
1. Anterior - Iatrogenic, Straddle injuries (bulbar urethra)
2. Posterior - Pelvic fractures

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17
Q

Lesions of the penis

A
  1. Penile fracture (distal to suspensory ligament)
  2. Penetrating penile injury (bites)
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18
Q

Lesions of the scrotum and testes

A
  1. Blunt trauma
  2. Penetrating injury
  3. Necrotizing fasciitis
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19
Q

Stenosis of urinary tract - causes

A
  1. Trauma (saddle injury)
  2. Infection
  3. Congenital anomaly
  4. Iatrogenic
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20
Q

Stenosis of urinary tract - treatment

A
  1. Dilatation
  2. Urethrotomy
  3. Anastomotic repair
  4. Reconstruction
  5. Catheterization
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21
Q

Fistulas of urinary tract - types

A
  1. Vesicovaginal
  2. Enterovesical
  3. Vesicouterine
  4. Uterovaginal
  5. Colovesical
  6. Rectovaginal
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22
Q

Urological causes of Acute Abdomen

A
  1. Ureteral stone
  2. Pyelonephritis
  3. Renal abscess
  4. Retroperitoneal bleeding or hematoma
  5. Kidney infarction
  6. Renal vein thrombosis
  7. Urinary retention
  8. Acute prostatitis
  9. Testicular torsion
  10. Congenital disorders
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23
Q

Urological emergencies

A
  1. Oliguria, anuria
  2. Acute renal failure
  3. Acute urinary retention
  4. Hematuria
  5. Kidney colic, pyonephrosis
  6. Testicular torsion
  7. Paraphimosis (foreskin doesn’t go back to normal)
  8. Priapism
  9. Necrotizing fasciitis
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24
Q

Oliguria

A

Reduced urine volume (<500ml/day)

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25
Q

Anuria

A

urine volume <100ml/day

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26
Q

Intrarenal causes of acute renal failure

A
  1. Glomerulonephritis
  2. Interstitial nephritis
  3. Hemolytic uremic syndrome
  4. Acute tubular necrosis
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27
Q

Causes of kidney colic/pyonephrosis

A
  1. Ureteral stone
  2. Ureteral stricture
  3. Ureteral tumor
  4. Extraureteral compressions
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28
Q

Pathophysiology of Priapism

A
  1. High flow: Non-ischemic/arterial priapism. Injury to central penile arteries cause loss of regulation. Painless. (secondary to perineal trauma)
  2. Low flow: (95%) Ischemic. Obstruction of the venous drainage. Deoxygenated blood in corpora cavernosa. Painful.
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29
Q

Treatment of Necrotizing Fasciitis

A

Triple Drug Antibiotics:
1. Metronidazole, ampicillin, gentamycin
Surgery:
1. Debridement
2. Leave open with Dakin’s solution

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30
Q

Urine leaks (incontinence)

A
  1. Stress (mechanical problem)
  2. Urge (bladder problem)
  3. Mixed
  4. Overflow (bladder outlet obstruction)
  5. Overactive (increased frequency and urgency)
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31
Q

Urodynamics

A

Assesses how the bladder and urethra are performing.
1. Post-void residual volume
2. Uroflowmetry (Free=time till empty bladder; pressure=rate)
3. Multichannel cystometry: measures pressure in bladder and rectum
4. Urethral pressure profilometry: strength of sphincter contraction
5. Electromyography (EMG)
6. Pressure flow study: detrusor function

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32
Q

Pressure flow study results

A

Normal = high flow, low pressure
Obstruction = low flow, high pressure
Detrusor weakness = low flow, low pressure
High-flow obstruction = high flow, high pressure

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33
Q

Treatments for urge incontinence

A

Anticholinergics:
1. Oxybutynin (SE: xerostomia, constipation, headache)
2. Tolterodine
3. Solifenacin

B3 Agonist:
4. Mirabegron (SE: increased blood pressure, palpitations)

Randoms:
5. Botox
6. Sacral neuromodulation
7. Bladder augmentation

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34
Q

Treatments for stress incontinence

A
  1. Duloxetine (SNRI) off label DO NOT PRESCRIBE
  2. Kegel exercise
  3. TVT
  4. Artificial urinary sphincter
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35
Q

Dysuria etiologies

A
  1. Infectious: Cystitis, Urethritis, Pyelonephritis, STDs, Prostatitis, Epididymitis-Orchitis (Just name all the inflammations you dumbass)
  2. Foreign body/stone
  3. Anatomical: Stricture, BPH, Phimosis
  4. Neoplastic: Bladder, Renal, Prostate, Penile cc
  5. Iatrogenic: Surgery/Catheter, Post-irradiation
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36
Q

Acute kidney injury symptoms

A
  1. Azotemia
  2. Anorexia
  3. Nausea/Vomiting
  4. Seizures and coma
  5. Fluid, electrolyte, and acid-base disorders
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37
Q

Acute kidney injury etiologies

A

Pre-renal (60%)
1. Hypovolemia
2. Hypotension
3. Sepsis
4. Cardiogenic shock/heart failure

Renal (35%)
1. Acute tubular necrosis
2. Acute glomerulonephritis

Post-renal (5%)
1. Obstruction
2. Neurogenic bladder
3. Congenital malformations

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38
Q

Acute kidney injury stages

A

Stage 1: Creatinine 1.5-1.9 times baseline; Urine output is <0.5mL/kg/hr
Stage 2: Creatinine 2-2.9 times baseline; Urine output is <0.5mL/kg/hr
Stage 3: Creatinine >3 times baseline; Urine output is <0.3mL/kg/hr

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39
Q

Chronic kidney disease etiologies

A
  1. Diabetes
  2. Hypertension
  3. Glomerular disease
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40
Q

Stages CKD based on GFR:

A

Stage 1 with normal or high GFR (GFR > 90 mL/min)
Stage 2 Mild CKD (GFR = 60-89 mL/min)
Stage 3A Moderate CKD (GFR = 45-59 mL/min)
Stage 3B Moderate CKD (GFR = 30-44 mL/min)
Stage 4 Severe CKD (GFR = 15-29 mL/min)
Stage 5 End Stage CKD (GFR <15 mL/min)

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41
Q

Effects of CKD include:

A
  1. Hypocalcemia
  2. Hyperphosphatemia
  3. Metabolic acidosis
  4. Anemia
  5. Secondary hyperparathyroidism
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42
Q

What US signs are indicative of diminished kidney function?

A
  1. Thin parenchyma
  2. Shrinkage
  3. Congenital renal hypoplasia
43
Q

What part of the urogenital tract CANNOT be visualized by US?

44
Q

Urological X-ray examinations

A
  1. IV pyelogram (contrast enhanced X-ray)
  2. Retrograde pyelography (catheter through cystoscope to fill ureter with contrast material) Contraindicated: UTIs and Pregnancy
  3. Anterograde pyelography (percutaneous nephrostomy + contrast) Contraindicated: coagulopathies
45
Q

Isotope scintigraphy

A

Tc99-MAG3 (mercapto-acetyl-triglycine)
Used in prostate>bladder>kidney cancers to see if bone metastases
Dynamic kidney scan that allows us to assess function of each kidney

46
Q

Bladder imaging techniques

A
  1. US: full bladder; can’t see cystitis or small tumors
  2. X-ray: Cystography (contrast-enhanced); Contraindicated: pregnancy, UTI, bladder surgery, strictures
  3. Endoscopy: Cystourethroscopy
47
Q

Prostate imaging techniques

A
  1. US: Supravesical or transrectal (Normal size 20-25mL)
  2. MRI
48
Q

Seminal Vesicles imaging techniques

A

Transrectal US

49
Q

Testes imaging techniques

50
Q

Non-specific infections of the kidney parenchyma and capsules

A
  1. Acute uncomplicated pyelonephritis (ascending infection)
  2. Acute complicated pyelonephritis (urological disease; may cause abscesses)
  3. Chronic pyelonephritis
  4. Xanthogranulomatous pyelonephritis
  5. Papillary necrosis
  6. Emphysematous pyelonephritis
  7. Pyonephrosis
51
Q

Acute uncomplicated pyelonephritis treatment

A

Augmentin (amoxicillin + clavalunate)
3rd generation cephalosporins (Cefexime, Cefotaxime)

52
Q

Chronic pyelonephritis pathogenesis

A

Infection or incompletely treated acute pyelonephritis leads to scarring and atrophy; SMALL scarred kidney

53
Q

Xanthogranulomatous pyelonephritis definition

A

Rare, severe, chronic, diffuse destructive parenchymal inflammation normally with retroperitoneal involvement
LOOK FOR ENLARGED NON-FUNCTIONING KIDNEY WITH OBSTRUCTION

54
Q

Factors needed for xanthogranulomatous pyelonephritis

A
  1. Obstruction
  2. Infection
  3. Tissue destruction and collection of lipids by histiocytes
55
Q

Papillary necrosis definition

A

Coagulative necrosis of the renal medullary pyramids and papillae

56
Q

Emphysematous pyelonephritis definition

A

Life-threatening, fulminant, necrotizing upper UTI associated with gas within the kidney and perinephric space;
Bactiuria/positive urine culture is necessary for diagnosis

57
Q

Emphysematous pyelonephritis pathogenesis

A

Acute/Chronic pyelonephritis with multiple renal abscesses leads to mixed acid fermentation of glucose by enterobacteriaceae and then septic shock/crepitant mass can occur

58
Q

Pyonephrosis definition

A

Infected purulent urine in obstructed collecting system
Can quickly go from asymptomatic to septic

59
Q

Pyonephrosis diagnosis

A

Renal US:
1. Persistent echoes from the inf. portion of collecting system
2. Fluid-debris level with dependent echoes that shift when patient changes position
3. Strong echoes with acoustic shadowing
4. Weak echoes throughout dilated collecting system

60
Q

Cystitis types

A
  1. Acute uncomplicated cystitis
  2. Recurrent uncomplicated cystitis (3 episodes in 12 months)
  3. Complicated cystitis
61
Q

Treatment for acute uncomplicated cystitis

A
  1. Fosfomycin
  2. Nitrofurantoin
  3. Fluroquinolones
  4. Ampicillin + Gentamycin
62
Q

Treatment of complicated cystitis

A
  1. Cephalosporins
  2. Broad-spectrum β lactams
  3. Fluroquinolones
63
Q

Urethritis etiologies

A

Primary: STDs (N. gonorrhea, Ureaplasma, Trichomonas v., Candida)
Secondary: After cystoscopy (E. Coli, Pseudomonas)

64
Q

Prostatitis classifications

A
  1. Acute bacterial
  2. Chronic bacterial
  3. Chronic abacterial / chronic pelvic syndrome
    3a. Inflammatory chronic pelvic - inflammatory cells in semen
    3b. Non-inflammatory chronic pelvic
  4. Asymptomatic inflammatory prostatitis
65
Q

LUTS meaning

A

Lower urinary tract symptoms:
weak stream, difficult urination, frequency

66
Q

Inflammation of the male genitals

A

Common sense: Prostatitis, Epididymitis, Orchitis (can be caused by mumps), Balanitis

67
Q

Pharmacological treatments of epididymitis and orchitis

A
  1. Fluoroquinolones
  2. Ceftriaxone
  3. Aminopenicillin
  4. Aminoglycosides
68
Q

Penis inflammation types

A

Penis:
Balanitis = inflammation of glans penis
Balanoposthitis = inflammation of foreskin and glans
Balanitis erosive circinate = recurrent necrotic
Balanitis ulcerans/gangrenosa = fever, ulcers, lymph node enlargement

69
Q

Urolithiasis: etiology endogenic factors

A
  1. Hyperparathyroidism
  2. Idiopathic hypercalciuria
  3. Cystinuria
  4. Primary hyperoxaluria
  5. Familial renal tubular acidosis
70
Q

Theories of urolithiasis

A
  1. Nucleation: urine is supersaturated and stone is formed around crystal or foreign body
  2. Organic matrix: serum and urinary proteins provide a framework for deposits
  3. Inhibitor of crystallization: absence of inhibitors (Mg, citrate, mucoproteins)
71
Q

Process of urolithiasis

A
  1. Supersaturation
  2. Crystallization
  3. Stone retention
  4. Growing
72
Q

Types of urolithiasis

A
  1. Calcium oxalate (monohydrate and dihydrate)
  2. Calcium phosphate
  3. Uric acid
  4. Cystine
  5. Struvite
73
Q

Radiolucent kidney stone

74
Q

Radiopaque kidney stones

A
  1. Calcium oxalate
  2. Calcium phosphate
  3. Cystine
  4. Struvite
75
Q

General kidney stone prevention

A
  1. Good fluid intake (>2L/day)
  2. Salt intake (5g/day)
  3. Protein intake (1g/kg/day)
  4. Less fat and carbs, more fiber
  5. Thiazide diuretics
  6. Restrict oxalates: teas, spinach, and chocolate
  7. Restrict calcium: dairy
76
Q

Struvite stone prevention

A

1.Treat proteus and pseudomonas properly
2. Urease inhibitors - Acetohydroxamic acid
3. Acidify urine pH

77
Q

Uric acid stone prevention

A
  1. Urine alkalization
  2. Restrict red meat
  3. Allopurinol
78
Q

Cystine stone prevention

A
  1. Excessive fluid intake (3-4L/day)
  2. Low protein intake
  3. Increase citrates
  4. Captopril (no idea why)
  5. D-penicillamine (no idea why)
79
Q

Diagnosis of urinary stones

A
  1. US
  2. X-ray: Intravenous pyelogram
  3. Non-contrast Low Dose CT is GOLD STANDARD
  4. Contrast-enhanced CT
80
Q

Treatment of urinary stones

A
  1. Conservative therapy (max: 5mm stone)
  2. ESWL (max: 2cm-kidney; max: 1cm-ureter)
    Endourology (stone surgery)
  3. Ureteroscopy
  4. Percutaneous nephrolithotripsy
  5. Flexible ureterscopy
  6. Open/laparoscopic stone surgery
81
Q

What is special about uric acid stone treatment?

A

They can be chemolysed with medications (citrates and bicarbonates)

82
Q

Treatments of prostatitis

A

Antibiotics
1. Aminoglycoside + cephalosporin or fluroquinolones
2. Alpha blockers to relax smooth muscle (Tamsulosin)
3. Surgery (Suprapubic catheter)

83
Q

Symptoms fo BPH

A

Obstructive:
1. Decreased/intermittent flow
2. Dribbling
3. Hesitancy
4. Residual volume

Irritative:
1. Nocturia
2. Pollakisuria
3. Urgency
4. Dysuria

84
Q

BPH Diagnostic steps

A
  1. Symptoms
  2. DRE
  3. Labs: PSA <4ng/mL
  4. Questionnaires: International Prostate Symptom Score, Freq. Volume charts, Bladder diaries (NOT REALLY USED ANYMORE)
  5. Uroflowmetry
  6. US
85
Q

Differential diagnosis of BPH

A
  1. Prostate cancer
  2. Urethral stricture
  3. Bladder stone
  4. Chronic prostatitis
  5. Bladder cancer
  6. Bladder atonia
  7. Phimosis
  8. Bladder diverticulum
  9. Cardial decompensation
  10. Diuretics
  11. Neurogenic dysfunction
  12. Parkinsonism
86
Q

Conservative/Pharmacological treatment of BPH

A
  1. Phytotherapy
  2. Alpha-blockers (Tamsulosin) - treats symptoms
  3. 5-α reductase inhibitors (Finasteride): takes 5 to 6 months to be effective. Decreases testosterone and PSA
87
Q

Indications for Surgical treatment of BPH

A
  1. Urine retention
  2. Stone or diverticuli
  3. Hydronephrosis
  4. Renal failure
  5. UTI
  6. Macroscopic hematuria
88
Q

Surgical treatment of BPH

A

Transurethral resection of prostate (Gold)
Open adenomectomy (removes inner part of prostate)
Laser

89
Q

Complications of TURP

A

Post-op bleeding, infection, stricture of urethra, incontinence, retrograde ejaculation
TURP syndrome - fluid used to wash bladder is absorped

90
Q

Things to look at in male infertility

A
  1. History
  2. Physical exam
  3. Sperm analysis (count, concentration, motility, morphology)
  4. Infections
  5. Biochemical and immunological markers
  6. Hormones
  7. Imaging
  8. Genetics
91
Q

Treatment of primary hypogonadism

A

Testosterone substitution

92
Q

Treatment of secondary hypogonadism

A

Androgen replacement alone. Stimulation of sperm production by hCG and recombinant FSH.

93
Q

Surgical treatment for male infertility

A

If the patient has azoospermia:
Obstructive we collect it from epididymis
Non-obstructive we look for residual or focal spermatogenesis

94
Q

Male sexual dysfunctions

A
  1. Premature ejaculation 1/4 males
  2. Erectile dysfunction
  3. Priapism
95
Q

What is the average intravaginal ejaculation latency time and how is premature ejactulation defined?

A

Average intravaginal ejaculation latency time = 4.5 minutes
Premature ejaculation = less than 1 minute

96
Q

Premature ejaculation treatment

A

Dapoxetin 30/60mg (SSRI)
Psychosexual counseling and education

97
Q

Erectile dysfunction definition

A

Persistent inability to attain and maintain an erection sufficient to permit satisfactory sexual performance.

98
Q

Erectile dysfunction pathophysiology

A
  1. Vasculogenic (smoking, no exercise, obesity, CVD, diabetes)
  2. Neurogenic (stroke, parkinsons, tumors, diabetes)
  3. Anatomical/structural (micropenis, phimosis, penile cancer)
  4. Hormonal (hyperprolactinemia, hypogonadism)
  5. Mixed
  6. Drug-induced (antihypertensives, antidepressives, antipsychotics, recreational)
  7. Psychogenic
  8. Trauma
99
Q

Erectile dysfunction treatment

A

1st line: PDE5 inhibitors (Sildenafil), vacuum device, extracorporeal shockwave therapy
2nd line: Intracavernosal injection of PGE-1
3rd line: Penile prosthesis

100
Q

Main pediatric urological diseases

A

Obstructive uropathies
1. Ureteropelvic junction obstruction
2. Obstructive megaureter (primary/congenital and secondary)
3. Ureterocele
4. Intravesical obstruction

Vesicoureteral reflux!!!! 5 grades

Tumors:
1. Wilms
2. Rhabdomyosarcoma
3. Testicular tumors

101
Q

Causes of vesicoureteral reflux

A
  1. Anatomical deficiency
  2. Increased bladder pressure
102
Q

Vesicoureteral reflux diagnosis

A
  1. Contrast voiding cystourethrogram (VCUG)
  2. Isotope renography and US
103
Q

Treatment of Vesicoureteral reflux

A
  1. Endoscopic surgical repair to augment and elongate the intramural ureter preventing reflux.
  2. ABX prophylactic
104
Q

Symptoms of urological disease in childhood

A
  1. Abdominal pain
  2. Abdominal distension, loss of app., vomiting, anemia, failure to thrive
  3. Pyuria
  4. Hematuria
  5. Dysfunctional voiding
  6. Abdominal mass

Urology Topics (2 decks)

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