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Urologic Flashcards

1
Q

Neurological causes for urinary incontinence:
____
Spinal injury
Normal-pressure hydrocephalus

A

Multiple sclerosis

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2
Q

Potentially reversible causes for urinary incontinence:

diuretics
UTIs
____

A

Stool impaction

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3
Q

__ incontinence 2/2
urethral hyper-mobility
increased intra abd pressure

A

Stress

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4
Q

__ incontinence 2/2

autonomous contractions of the detrusor muscle

A

Urge

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5
Q

Treatment for urge incontinence

A

Anticholinergic (M3) medication (oxybutynin*)
Sympathomimetics (mirabegron**)
—————————————————-

*M3 antagonist causes antispasmodic effect on bladder smooth muscle

**Beta 3 agonist relaxes detrusor smooth muscle which increases the bladder’s storage capacity

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6
Q 
\_\_ incontinence 2/2
Loss of or weak detrusor contractility due to: 
Neurogenic bladder (multiple sclerosis)
Neuropathy (diabetes mellitus)
Spinal cord injuries
BPH
A

Overflow

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7
Q

Overflow incontinence 2/2
Absence of an urge to urinate/Incomplete bladder emptying → bladder overfilling → chronically distended bladder with ↑ bladder pressure → dribbling of urine (leak) when ___ pressure > sphincter outlet pressure

A

intravesical

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8
Q

Post void residual volume >50 ml in
Overflow incontinence treatment

Acute settings: ____
Long term: ___

A

intermittent catheterization

Scheduled voiding daily

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9
Q

Type of incontinence seen in multiple sclerosis or spinal cord injury
____ → simultaneous contractions of the detrusor muscle + urethral sphincter contraction → urine leaks

A

Detrusor sphincter dyssynergia

urinary retention and leaking without an associated urge to void

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10
Q

Work up for incontinence:

1st test → ____

If negative get:
→ ____
→ ____

A
  1. UA & urine culture (r/o UTI)
  2. Post void residual volume
  3. Renal ultrasound
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11
Q

1st line treatment for stress incontinence

A

Weight loss
decrease consumption of alcohol, caffeine
Kegel’s

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12
Q

1st line treatment for urge incontinence

A

Bladder training:

  • scheduled voiding
  • holding for as long as possible
  • relaxation/distraction techniques

*If that fails or sxs affect ADLs give oxybutynin or mirabegron

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13
Q

Stress incontinence treatment if refractory to 1st line or affecting quality of life

A

mid urethral urinary sling

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14
Q

The most common (∼ 95%) type of cancer of the bladder, ureter, renal pelvis, and proximal urethra in males

A

Transitional cell (urothelial) carcinoma

*Present from proximal urethra to renal pelvis

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15
Q

Urinary tract cancer risk factors:

___ use

Prolonged (occupational) exposure to ____

_____ ( Africa and the Middle East)

cyclophosphamide

A

Tobacco

Carcinogens (dyes, heavy metals, plastics, aromatic amines like benzidine)

Schistosomiasis

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16
Q

Painless gross hematuria throughout micturition (most commonly)
&
Irritative voiding symptoms (dysuria, urinary frequency, urgency)

associated with ___ carcinoma

A

Bladder

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17
Q

Diagnostics for suspected Urinary tract cancer:

  1. ___ indicated in all patients with hematuria
  2. _____ Imaging modality of choice to examine the entire urinary tract.
  3. ___ & biopsy direct visualization of urethral and bladder mucosa
A

Urinalysis

CT urography

Cystoscopy

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18
Q

Treatment for bladder cancer:
____
+/-
chemotherapy or chemoradiation

A

Radical cystectomy

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19
Q

Painless gross hematuria at the beginning of micturition

Bladder outlet obstruction
Irritative voiding symptoms

associated with ___ carcinoma

A

Urethral

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20
Q

Painless gross hematuria throughout micturition
Flank pain
associated with Carcinoma of ____ & ____

A

Renal pelvis (Kidney)
&
Ureters

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21
Q 
Upper urinary tract obstruction causes:
\_\_\_
Renal pelvis carcinoma
Ureteropelvic junction obstruction
\_\_\_\_
Ureteral carcinoma
A

Nephrolithiasis
Ureteral stricture

(Stones, Strictures, Tumors
cause Upper urinary tract obstructions)

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22
Q

Lower urinary tract obstruction (bladder outlet obstruction) causes:

Bladder carcinoma
Neurogenic bladder
BPH/ prostate cancer 
\_\_\_\_\_ (Congenital) 
urethral stricture
\_\_\_\_ (Mechanical)
A

posterior urethral valves

kinked/plugged catheter

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23
Q

Urinary retention
Suprapubic pain and mild distention
Palpable bladder
symptoms of what?

A

Lower urinary tract obstruction

bladder outlet obstruction

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24
Q

Labs in urinary tract obstruction

(↑/↓) BUN & Cr
(hyper/hypo)-kalemia

A

↑ BUN & Cr

hyperkalemia

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25
Imaging modalities for diagnosing urinary tract obstruction: Best initial test: ___ Best initial imaging study in cases of suspected nephrolithiasis: ____
Renal/Abd Ultrasound CT abdomen/pelvis
26
First-line imaging study to diagnose patients with suspected vesicoureteral reflux (VUR).
Contrast Voiding Cystourethrography
27
Best workup for patients with suspected neurogenic bladder
Urodynamic studies ``` –Cystometry –Electromyelogram (EMG) –Pressure-flow study –Leak point pressure –Postvoid residual volume ```
28
Nephrolithiasis: conservative treatment: –Nsaids – Explusion Therapy drug (1) ``` Urological interventions (2) for: –Stones > __ mm –ANURIA, intolerable pain, PO intolerance –Renal failure or Sepsis –Retained stone after ___ weeks ```
Tamsulosin (Alpha Antagonist); Nifedipine (CCB) Lithotripsy Extracorporal shock wave (ESWL) Uretero-renoscopy 10mm 4-6 weeks
29
2 kidney stones causing | ↑ Urine pH (alkalic)
Calcium phosphate stone Struvite stone (STUpid PHads are basic)
30
3 kidney stones causing | ↓ Urine pH (acidic)
Uric acid stones Calcium oxalate stones Cystine stones
31
Hyperparathyroidism is associated with what type of kidney stones?
Calcium phosphate stone | makes sense since calcium & phosphate levels are affected by parathyroid hormone PTH
32
Gout, leukemia, & chemotherapy are associated with what type of kidney stones?
Uric acid stones
33
Hypocitraturia, Ethylene glycol (antifreeze), and IBD are associated with what type of kidney stones?
Calcium oxalate stones *also with Vitamin C/ Hyperoxaluria
34
2 Diagnostics for kidney stones
Urine microscopy X-ray (or CT): radiopaque (except uric- radiolucent)
35
Nephrolithiasis | Biconcave dumbbells or bipyramidal envelopes
Calcium oxalate stones | dumb Ox carrying envelopes to pyramids & caves
36
Nephrolithiasis | Rounded rhomboids, rosettes, or needle-shaped
Uric acid stones
37
``` Nephrolithiasis Rectangular prisms (coffin lid-appearance) ```
Struvite stones | In a rectangular coffin when you Stru-bite the dust
38
Nephrolithiasis | Wedge-shaped prisms
Calcium phosphate stones
39
``` Nephrolithiasis presents with Severe unilateral and ____ pain Radiates to lower abdomen or groin Nausea, vomiting Dysuria [__-uria] ```
colicky flank (renal colic) Hematuria
40
__ & __ are the preferred diagnostic imaging for nephrolithiasis.
NC-CT of abdomen & pelvis (1st line) | U/S of abdomen & pelvis
41
``` Consult urology urgently for interventional treatment in Large stones (> __ mm) ```
> 10 mm
42
Conservative tx indicated for kidney stones < 10 mm - Hydration - Analgesia - 1st line medical expulsive therapy (MET): ___ *Treat concomitant UTI, if present.
tamsulosin (alpha 1 Antagonist) * Nifedipine (CCB) not 1st line
43
Consult urology for Nephrolithiasis interventional tx if: ``` Uncontrolled ____ Large stones (> 10 mm) Urosepsis Acute renal failure Solitary kidney complete obstruction If conservative mngmt is unsuccessful after __ weeks. ```
pain 4–6 weeks
44
Consult urology for Nephrolithiasis interventional tx if: ``` Uncontrolled pain Large stones (> 10 mm) Urosepsis Acute renal failure __ kidney ___ obstruction If conservative mngmt is unsuccessful after 4-6 weeks. ```
Solitary Complete
45
2 non-surgical interventional procedures for ureteral stones
Uretero-renoscopy (URS) extracorporeal shockwave lithotripsy (ESWL) - acoustic pulse
46
non-surgical interventional procedures for: Renal stones >20 mm → lower renal pole stones >10 mm →
percutaneous nephrolithotomy (PCNL)
47
non-surgical interventional procedures for: Lower renal pole stones 10mm or LESS→ Renal stones 20mm or LESS→
Lithotripsy extracorporeal shockwave (ESWL) Uretero-renoscopy (URS)
48
Low calcium diets increase the risk of calcium-containing stone formation because they increase __ reabsorption.
oxalate | also IBD and CF b/c of poor calcium absorption in tract
49
Nephrolithiasis risk increases with pregnancy | bc urinary stasis s/t increased ___ levels
progesterone Diagnostics → Renal U/S
50
BPH management: Small prostate (< 40 mL) or PSA < 1.5 → Large prostate (> 40 mL) or PSA > 1.5 →
Tamsulosin (Alpha blocker) Finasteride (5-alpha reductase inhibitor) *Inadequate response to monotherapy → Combination of both meds above.
51
___ ejaculation is a common complication of prostate surgery.
Retrograde
52
Features of metastatic prostate cancer: 1. 2. Lymphedema
Bone pain | mets to spine
53
The classical triad of renal cell carcinoma consists of
hematuria flank pain palpable flank mass
54
Paraneoplastic syndromes of RCC (4)
EPO (Polycythemia) Renin (HTN) PTHrP (Hypercalcemia) ACTH (hypercortisolism-cushing's) *25% present with symptoms related to paraneoplastic syndromes or bone pain/fx & hemoptysis
55
Indicated in children with febrile UTI
Renal Ultrasound (If they have another episode then get a contrast voiding urethrogram)
56
initial imagine if there is a concern for hydronephrosis and dilated ureter
Renal Ultrasound
57
Imaging indicated if: Child with 2+ episodes of febrile UTI A renal anomaly detected on ultrasound
Contrast voiding cystourethrogram | micturating cystourethrogram
58
Imaging performed if urethral injury suspected in penile fractures
Retrograde urethrogram
59
Causes of Low-flow priapism (ischemic priapism) Drugs: - - Hypercoagulable states: -
Viagra (Sildenafil– PDE inhibitor) TrazoBone Sickle cell disease
60
Diagnostic for suspected testicular torsion
Duplex ultrasound of the scrotum
61
___ is contraindicated in boys with hypospadias (ventral/bottom of penis) that includes the foreskin.
Circumcision *Foreskin may be needed for a skin flap when performing urethroplasty.
62
Epispadias: urethra on the dorsal (top) penis. | Can present with urinary ____.
incontinence

Surgery (36 decks)

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