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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
Anuria
urine volume <100ml/day
26
Intrarenal causes of acute renal failure
1. Glomerulonephritis 2. Interstitial nephritis 3. Hemolytic uremic syndrome 4. Acute tubular necrosis
27
Causes of kidney colic/pyonephrosis
1. Ureteral stone 2. Ureteral stricture 3. Ureteral tumor 4. Extraureteral compressions
28
Pathophysiology of Priapism
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.
29
Treatment of Necrotizing Fasciitis
Triple Drug Antibiotics: 1. Metronidazole, ampicillin, gentamycin Surgery: 1. Debridement 2. Leave open with Dakin's solution
30
Urine leaks (incontinence)
1. Stress (mechanical problem) 2. Urge (bladder problem) 3. Mixed 4. Overflow (bladder outlet obstruction) 5. Overactive (increased frequency and urgency)
31
Urodynamics
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
32
Pressure flow study results
Normal = high flow, low pressure Obstruction = low flow, high pressure Detrusor weakness = low flow, low pressure High-flow obstruction = high flow, high pressure
33
Treatments for urge incontinence
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
34
Treatments for stress incontinence
1. Duloxetine (SNRI) off label DO NOT PRESCRIBE 2. Kegel exercise 3. TVT 4. Artificial urinary sphincter
35
Dysuria etiologies
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
36
Acute kidney injury symptoms
1. Azotemia 2. Anorexia 3. Nausea/Vomiting 4. Seizures and coma 5. Fluid, electrolyte, and acid-base disorders
37
Acute kidney injury etiologies
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
38
Acute kidney injury stages
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
39
Chronic kidney disease etiologies
1. Diabetes 2. Hypertension 3. Glomerular disease
40
Stages CKD based on GFR:
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)
41
Effects of CKD include:
1. Hypocalcemia 2. Hyperphosphatemia 3. Metabolic acidosis 4. Anemia 5. Secondary hyperparathyroidism
42
What US signs are indicative of diminished kidney function?
1. Thin parenchyma 2. Shrinkage 3. Congenital renal hypoplasia
43
What part of the urogenital tract CANNOT be visualized by US?
Ureters
44
Urological X-ray examinations
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
Isotope scintigraphy
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
Bladder imaging techniques
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
Prostate imaging techniques
1. US: Supravesical or transrectal (Normal size 20-25mL) 2. MRI
48
Seminal Vesicles imaging techniques
Transrectal US
49
Testes imaging techniques
1. US 2. CT
50
Non-specific infections of the kidney parenchyma and capsules
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
Acute uncomplicated pyelonephritis treatment
Augmentin (amoxicillin + clavalunate) 3rd generation cephalosporins (Cefexime, Cefotaxime)
52
Chronic pyelonephritis pathogenesis
Infection or incompletely treated acute pyelonephritis leads to scarring and atrophy; SMALL scarred kidney
53
Xanthogranulomatous pyelonephritis definition
Rare, severe, chronic, diffuse destructive parenchymal inflammation normally with retroperitoneal involvement LOOK FOR ENLARGED NON-FUNCTIONING KIDNEY WITH OBSTRUCTION
54
Factors needed for xanthogranulomatous pyelonephritis
1. Obstruction 2. Infection 3. Tissue destruction and collection of lipids by histiocytes
55
Papillary necrosis definition
Coagulative necrosis of the renal medullary pyramids and papillae
56
Emphysematous pyelonephritis definition
Life-threatening, fulminant, necrotizing upper UTI associated with gas within the kidney and perinephric space; Bactiuria/positive urine culture is necessary for diagnosis
57
Emphysematous pyelonephritis pathogenesis
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
Pyonephrosis definition
Infected purulent urine in obstructed collecting system Can quickly go from asymptomatic to septic
59
Pyonephrosis diagnosis
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
Cystitis types
1. Acute uncomplicated cystitis 2. Recurrent uncomplicated cystitis (3 episodes in 12 months) 3. Complicated cystitis
61
Treatment for acute uncomplicated cystitis
1. Fosfomycin 2. Nitrofurantoin 3. Fluroquinolones 4. Ampicillin + Gentamycin
62
Treatment of complicated cystitis
1. Cephalosporins 2. Broad-spectrum β lactams 3. Fluroquinolones
63
Urethritis etiologies
Primary: STDs (N. gonorrhea, Ureaplasma, Trichomonas v., Candida) Secondary: After cystoscopy (E. Coli, Pseudomonas)
64
Prostatitis classifications
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
LUTS meaning
Lower urinary tract symptoms: weak stream, difficult urination, frequency
66
Inflammation of the male genitals
Common sense: Prostatitis, Epididymitis, Orchitis (can be caused by mumps), Balanitis
67
Pharmacological treatments of epididymitis and orchitis
1. Fluoroquinolones 2. Ceftriaxone 3. Aminopenicillin 4. Aminoglycosides
68
Penis inflammation types
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
Urolithiasis: etiology endogenic factors
1. Hyperparathyroidism 2. Idiopathic hypercalciuria 3. Cystinuria 4. Primary hyperoxaluria 5. Familial renal tubular acidosis
70
Theories of urolithiasis
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
Process of urolithiasis
1. Supersaturation 2. Crystallization 3. Stone retention 4. Growing
72
Types of urolithiasis
1. Calcium oxalate (monohydrate and dihydrate) 2. Calcium phosphate 3. Uric acid 4. Cystine 5. Struvite
73
Radiolucent kidney stone
Uric acid
74
Radiopaque kidney stones
1. Calcium oxalate 2. Calcium phosphate 3. Cystine 4. Struvite
75
General kidney stone prevention
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
Struvite stone prevention
1.Treat proteus and pseudomonas properly 2. Urease inhibitors - Acetohydroxamic acid 3. Acidify urine pH
77
Uric acid stone prevention
1. Urine alkalization 2. Restrict red meat 3. Allopurinol
78
Cystine stone prevention
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
Diagnosis of urinary stones
1. US 2. X-ray: Intravenous pyelogram 3. Non-contrast Low Dose CT is GOLD STANDARD 4. Contrast-enhanced CT
80
Treatment of urinary stones
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
What is special about uric acid stone treatment?
They can be chemolysed with medications (citrates and bicarbonates)
82
Treatments of prostatitis
Antibiotics 1. Aminoglycoside + cephalosporin or fluroquinolones 2. Alpha blockers to relax smooth muscle (Tamsulosin) 3. Surgery (Suprapubic catheter)
83
Symptoms fo BPH
Obstructive: 1. Decreased/intermittent flow 2. Dribbling 3. Hesitancy 4. Residual volume Irritative: 1. Nocturia 2. Pollakisuria 3. Urgency 4. Dysuria
84
BPH Diagnostic steps
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
Differential diagnosis of BPH
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
Conservative/Pharmacological treatment of BPH
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
Indications for Surgical treatment of BPH
1. Urine retention 2. Stone or diverticuli 3. Hydronephrosis 4. Renal failure 5. UTI 6. Macroscopic hematuria
88
Surgical treatment of BPH
Transurethral resection of prostate (Gold) Open adenomectomy (removes inner part of prostate) Laser
89
Complications of TURP
Post-op bleeding, infection, stricture of urethra, incontinence, retrograde ejaculation TURP syndrome - fluid used to wash bladder is absorped
90
Things to look at in male infertility
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
Treatment of primary hypogonadism
Testosterone substitution
92
Treatment of secondary hypogonadism
Androgen replacement alone. Stimulation of sperm production by hCG and recombinant FSH.
93
Surgical treatment for male infertility
If the patient has azoospermia: Obstructive we collect it from epididymis Non-obstructive we look for residual or focal spermatogenesis
94
Male sexual dysfunctions
1. Premature ejaculation 1/4 males 2. Erectile dysfunction 3. Priapism
95
What is the average intravaginal ejaculation latency time and how is premature ejactulation defined?
Average intravaginal ejaculation latency time = 4.5 minutes Premature ejaculation = less than 1 minute
96
Premature ejaculation treatment
Dapoxetin 30/60mg (SSRI) Psychosexual counseling and education
97
Erectile dysfunction definition
Persistent inability to attain and maintain an erection sufficient to permit satisfactory sexual performance.
98
Erectile dysfunction pathophysiology
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
Erectile dysfunction treatment
1st line: PDE5 inhibitors (Sildenafil), vacuum device, extracorporeal shockwave therapy 2nd line: Intracavernosal injection of PGE-1 3rd line: Penile prosthesis
100
Main pediatric urological diseases
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
Causes of vesicoureteral reflux
1. Anatomical deficiency 2. Increased bladder pressure
102
Vesicoureteral reflux diagnosis
1. Contrast voiding cystourethrogram (VCUG) 2. Isotope renography and US
103
Treatment of Vesicoureteral reflux
1. Endoscopic surgical repair to augment and elongate the intramural ureter preventing reflux. 2. ABX prophylactic
104
Symptoms of urological disease in childhood
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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