Topics in urology

Question 1

hydrocele definition

Answer 1

a fluid filled sac surrounding a testicle that results in swelling of the scrotum PAINLESS-covers the anterior aspect of the testes

Question 2

non-communicating hydrocele

Answer 2

closed off from abdominal cavity (fluid collection)

Question 3

communicating hydrocele

Answer 3

communicates with the peritoneal cavity and has an associated indirect inguinal hernia.

Question 4

diagnosis of hydrocele

Answer 4

history, nontender, fluid filled sac, transilumination, cremasteric reflex intact, US for large ones to rule out tumor

Question 5

treatment of hydrocele

Answer 5

• observation, especially in infants
• surgical for symptomatic lesions
• aspiration not appropriate by itself; occasionally done followed by a sclerosing agent.

Question 6

spermatocele defintion

Answer 6

diverticulum of the epididymis
cystic dilation of the efferent ducts of the epididymis
can be separated from the testes
cremasteric reflex intact

Question 7

spermatocele treatment

Answer 7

can be surgically removed if they are painful or are large enough to cause significant discomfort. neither hydroceles or spermatoceles cause infertility.

Question 8

varicocele

Answer 8

dilations of the papiniform plexus.
papiniform plexus on the right drains into the internal spermatic vein and then into the IVC; on the left it drains into the renal vein and has a more acute angle. therefore the left is affected 100% of the time and right sided should be further investigated
-may affect fertility

Question 9

epididymitis

Answer 9

inflammation of the epididymis may be caused by chemical irritation (reflux of urine into epididymis)

Question 10

diagnosis of epididymitis

Answer 10

history: recent UTI? sexual practices? urethral discharge? pain (usually acute)
exam: painful palpation of the epididymis; swelling of the epididymis, prehn sign (pain relieved by elevation of the affected testes/epididymis); cremasteric reflex intact
Lab: ua/uc; aspiration may be necessary for definitive diagnosis/tx

Question 11

most accurate imaging study for diagnosis of epididymitis?

Answer 11

radionuclide scan

Question 12

treatment of epididymitis

Answer 12

appropriate abx, consider anti-inflammatory medications, scrotal elevation and support to facilitate venous and lymphatic drainage, ice, may cause infertility (scarring)

Question 13

orchitis definition

Answer 13

acute inflammation of testes and is uncommon, typically with the mumps virus

Question 14

treatment of orchitis

Answer 14

scrotal support and elevation, hot or cold packs, abx if appropriate, anti-inflam meds including possibly prednisone, may cause infertility or sterility

Question 15

cryptorchidism

Answer 15

condition of testicular maldescent. should be followed carefully and surgical correction is indicated if not resolved by one year of age.

Question 16

testicular torsion

Answer 16

twisting of the testis and its spermatic cord resulting in acute ischemia, impeded venous and lymphatic drainage. surgical emergency. occurs at 12-18 y.o. lack of normal attachments to scrotum “bell clapper deformity”

Question 17

testicular torsion symptoms

Answer 17

acute scrotal pain, n/v and anorexia frequently present, may have a history of milder self reducing episodes, trauma may contribute.

Question 18

evaluation of testicular torsion

Answer 18

testis “riding high”, abnormal orientation, swelling, extreme tenderness, firmness, absent cremasteric reflex, elevation of the testis doesn’t relieve pain, US with doppler to eval blood flow, radionuclide scan, emergent urology consult

Question 19

treatment of testicular torsion

Answer 19

manual: untwist right clockwise and left counterclockwise; orchidoplexy must follow (twist toward middle)

Question 20

cell necrosis time

Answer 20

360 degree rotation- 12-24 hours

1080 degree rotation-2 hours

Question 21

appendix testes torsion

Answer 21

acute pain, normal testicular orientation, pain over the upper pole of the the testis, blue appearing lesion over the upper pole of the testis when the skin is stretched over it, analgesics

Question 22

testicular malignancy epidemiology

Answer 22

peak incidence between 20-40 yrs
accompanying epididymitis may delay dx
solid tumors don’t transiluminate
most commonly germ cell tumors

Question 23

carcinoma arises:

Answer 23

from epithelial cells which cover the body or line organs

Question 24

sarcoma arises:

Answer 24

from connective tissues and are often named for the specific type of tissue

Question 25

testicular malignancy imaging

Answer 25

abdominal and pelvic ct to evaluate retroperitoneal lymph nodes

Question 26

treatment of testicular malignancy

Answer 26

external beam radiation, surgery: radical orchiectomy; lymphatics drain into the inguinal nodes [stage dependent]

Question 27

prostatitis

Answer 27

inflammation of the prostate; classified as acute bacterial prostatitis, chronic bacterial prostatitis, non-bacterial prostatitis (inflammatory), prostadynia.

Question 28

acute bacterial prostatitis

Answer 28

recovery of bacteria from prostatic fluid, purulence of fluid, and systemic signs of infection

Question 29

chronic bacterial prostatitis

Answer 29

recovery of bacteria in significant numbers from prostatic fluid in the absence of concomitant urinary infection or significant systemic signs (as in acute bacterial prostatitis)

Question 30

nonbacterial prostatitis

Answer 30

no recovery of significant numbers of bacteria from prostatic fluid, but the fluid consistently reveals microscopic purulence

Question 31

prostadynia

Answer 31

no recovery of significant bacteria or purulence in prostatic fluid, but patients have persistent urinary urgency, dysuria, poor urinary flow, and prostatic discomfort

Question 32

benign prostatic hyperplasia (BPH)

Answer 32

hyperplasia of the prostatic epithelium; it is defined histologically.

Question 33

Symptoms of BPH

Answer 33

irritative voiding symptoms (dysuria, nocturia, urgency, frequency) and symptoms of bladder outlet obstruction (intermittency, weak stream, post-void dribbling) may lead to acute urinary retention

Question 34

what to check to dx BPH

Answer 34

PSA elevated | DRE may show an enlarged gland

Question 35

treatment of BPH

Answer 35

``` 5 a-reductase inhibitors (finasteride) alpha blockers saw palmetto transurethral microwave thermotherapy transurethral resection ```

Question 36

prostate cancer

Answer 36

``` rare before age 50 dre recommended annually after age 40 PSA after age 50? -95% are adenocarcinomas -most common mets are to the pelvic lymph nodes and skeleton; visceral mets occur late and are less common ```

Question 37

urethritis

Answer 37

- gonococcal and non gonococcal - NGU think chlamydia - caffeine - spermatocides, lotions, soaps, condoms

Question 38

non-gonococcal urethritis (NGU) defined by:

Answer 38

urethral discharge or dysuria and urethral inflammation documented by mucopurulent discharge or leukocytes on gram stain

Question 39

symptoms of NGU

Answer 39

mucoid or watery discharge common dysuria common 42% asymptomatic

Question 40

urethritis treatment

Answer 40

appropriate eval and antibiotic treatment (azithro or doxy) consider trial of metronidazole if symptoms persist (trichamonas) decrease caffeine avoid irritants

Question 41

balanitis

Answer 41

inflammation of the glans penis. usually occurs in conjunction with posthitis (inflammation of the prepuce) and can be associated with poor hygeine

Question 42

symptoms of balanitis

Answer 42

smegma (glandular secretions), sloughed cells, and mycobacterium smegmatis may collect under the foreskin and cause direct irritation or infection

Question 43

phimosis

Answer 43

too tight foreskin to retract; hygeine issues; sexual function issues

Question 44

paraphimosis

Answer 44

too tight to get back to starting point (foreskin) may need emergent circumcision if tourniquet effect cannot be reversed manually

Question 45

penile cancer

Answer 45

risk factors: hpv infection, smoking, treatment of penile psoriatic lesions with psoralen and uv exposure usually squamous cell carcinoma often presents with leukoplakia often have a significant morbidity and mortality

Question 46

types of ED

Answer 46

failure to initiate (endocrin, psychogenic, neurogenic) failure to fill (arteriogenic) failure to store (venoocclusive dysfunction) DM atherosclerosis, drugs are about 80% of ED

Question 47

vasculogenic ED

Answer 47

unrestricted outflow may occur with increased adrenergic activity or decreased parasympathetic tone to the affected area. decreased compressability of the tunical veins

Question 48

neurogenic ED

Answer 48

spinal cord lesions (lower cord lesions produce higher degree of dysfunction) multiple sclerosis peripheral neuropathy pelvic surgery

Question 49

endocrinologic ED

Answer 49

``` testosterone levels are probably a factor (augmentation is not helpful if levels are normal) prolactin excess can depress libido and testosterone estrogen excess (excess fat) ```

Question 50

diabetic ED

Answer 50

primarily secondary to vascular and neurologic complications of DM. decreased levels of nitric oxide sythase in neural and endothelial tissues

Question 51

psychogenic ED

Answer 51

performance anxiety, loss of attraction, relationship conflict, depression, sexual inhibition, fear of STD, pregnancy, commitment. Excess sympathetic tone; blocking of sacral cord reflexogenic activation of the vascular changes in the penis necessary for erection

Question 52

medication related ED

Answer 52

``` diuretics antihtn hormones antidepressants H2 blockers ETOH, cocaine, THC others ```

Question 53

ED evaluation

Answer 53

history, evidence of vascular disease, evidence of hypogonadism, penile palpation (plaques in corpora), lab exam: prolactin, testosterone, complete metabolic profile, CBC, lipids