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Nephro/Uro > Topics in urology > Flashcards

Topics in urology Flashcards

1
Q

hydrocele definition

A

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

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2
Q

non-communicating hydrocele

A

closed off from abdominal cavity (fluid collection)

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3
Q

communicating hydrocele

A

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

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4
Q

diagnosis of hydrocele

A

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

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5
Q

treatment of hydrocele

A
  • observation, especially in infants
  • surgical for symptomatic lesions
  • aspiration not appropriate by itself; occasionally done followed by a sclerosing agent.
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6
Q

spermatocele defintion

A

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

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7
Q

spermatocele treatment

A

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

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8
Q

varicocele

A

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

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9
Q

epididymitis

A

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

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10
Q

diagnosis of epididymitis

A

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

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11
Q

most accurate imaging study for diagnosis of epididymitis?

A

radionuclide scan

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12
Q

treatment of epididymitis

A

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

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13
Q

orchitis definition

A

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

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14
Q

treatment of orchitis

A

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

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15
Q

cryptorchidism

A

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

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16
Q

testicular torsion

A

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”

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17
Q

testicular torsion symptoms

A

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

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18
Q

evaluation of testicular torsion

A

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

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19
Q

treatment of testicular torsion

A

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

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20
Q

cell necrosis time

A

360 degree rotation- 12-24 hours

1080 degree rotation-2 hours

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21
Q

appendix testes torsion

A

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

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22
Q

testicular malignancy epidemiology

A

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

23
Q

carcinoma arises:

A

from epithelial cells which cover the body or line organs

24
Q

sarcoma arises:

A

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

25
Q

testicular malignancy imaging

A

abdominal and pelvic ct to evaluate retroperitoneal lymph nodes

26
Q

treatment of testicular malignancy

A

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

27
Q

prostatitis

A

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

28
Q

acute bacterial prostatitis

A

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

29
Q

chronic bacterial prostatitis

A

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)

30
Q

nonbacterial prostatitis

A

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

31
Q

prostadynia

A

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

32
Q

benign prostatic hyperplasia (BPH)

A

hyperplasia of the prostatic epithelium; it is defined histologically.

33
Q

Symptoms of BPH

A

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

34
Q

what to check to dx BPH

A

PSA elevated

DRE may show an enlarged gland

35
Q

treatment of BPH

A 
5 a-reductase inhibitors (finasteride)
alpha blockers
saw palmetto
transurethral microwave thermotherapy
transurethral resection
36
Q

prostate cancer

A 
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
37
Q

urethritis

A
  • gonococcal and non gonococcal
  • NGU think chlamydia
  • caffeine
  • spermatocides, lotions, soaps, condoms
38
Q

non-gonococcal urethritis (NGU) defined by:

A

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

39
Q

symptoms of NGU

A

mucoid or watery discharge common
dysuria common
42% asymptomatic

40
Q

urethritis treatment

A

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

41
Q

balanitis

A

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

42
Q

symptoms of balanitis

A

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

43
Q

phimosis

A

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

44
Q

paraphimosis

A

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

45
Q

penile cancer

A

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

46
Q

types of ED

A

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

47
Q

vasculogenic ED

A

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

48
Q

neurogenic ED

A

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

49
Q

endocrinologic ED

A 
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)
50
Q

diabetic ED

A

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

51
Q

psychogenic ED

A

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

52
Q

medication related ED

A 
diuretics
antihtn
hormones
antidepressants
H2 blockers
ETOH, cocaine, THC
others
53
Q

ED evaluation

A

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

Nephro/Uro (14 decks)

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