Urologic disorders 2

Question 1

Phimosis

Answer 1

inability to retract the foreskin over the glans penis, congenital or acquired, may complain of obstructive voiding, hematuria, or pain

Question 2

Phimosis treatment

Answer 2

no tx in asymptomatic, if symptomatic, refer for cicumcision, treat w/ BS abx, steroidal/nonsteroidal creams, check for diabetes

Question 3

Paraphimosis

Answer 3

entrapment of the foreskin behind the glans, can be caused bu frequent catherization w/out reducing the foreskin, or by forcibly retracting a phimosis, also by vigorous sexual activity

Question 4

Paraphimosis treatment

Answer 4

initially try manual reduction, surgery, urologic referral, circumcision highly recommended

Question 5

Erectile dysfunction

Answer 5

consistent inability to maintain an erection with sufficient rigidity for sex, many causes, age related

Question 6

normal erection requires

Answer 6

intact parasympathetic and somatic nerve supply, unobstructed arterial flow, adequate venous constriction, hormonal stimulation, and psychological desire

Question 7

Determining the cause of ED

Answer 7

past med hx, meds, sex hx: timing and frequency, ejaculation and ability to masterbate, IIEF questionnaire, physical exam: look for deformities, atrophy, HTN, peripheral neuropathy

Question 8

ED testing

Answer 8

CBC, UA, lipid profile, TSH, FT4, testosterone, glucose, prolactin, if abnormal check FSH and LH, also check nocturnal penile tumescence

Question 9

ED treatment

Answer 9

psychogenic causes treat w/ behaviorally oriented sex therapy, PDE-5 I, sildenafil, vardenafil, tadalafil; avoid in pts taking nitrates

Question 10

Hydrocele

Answer 10

mass of fluid filled congenital remnants of the tunica vaginalis, results from a patent processus vaginalis

Question 11

Spermatocele treatment

Answer 11

usually not required, but large ones can be surgically removed or sclerosed

Question 12

Hydrocele symptoms

Answer 12

soft, nontender fullness of hemiscrotum, mass transilluminates, mass may wax and wane, indirect hernia may be present

Question 13

Spermatocele symptoms

Answer 13

painless, possible tenderness, less than 1 cm size, palpable, firm round cystic mass with distinct borders, free floatin above testicle, transilluminates

Question 14

Testicular torsion

Answer 14

caused by testis being abnormally twisted on its spermatic cord, resulting in arterial supply and venous drainage being compromised, can lead to ischemia, most common in 12-18 yom, esp w/ hx of cryptorchidism

Question 15

Testicular torsion sx

Answer 15

sudden onset of severe unilateral pain and scrotal swelling, testis painful to palpation, swollen testicle and scrotum, negative phrehn’s sign; doppler U/s shows dec blood flow to affected spermatic cord, radioisotope dec uptake

Question 16

Testicular torsion tx

Answer 16

surgical emergency, if corrected within 6 hours full recovery

Question 17

Varicocele

Answer 17

formation of venous varicosity w/in the spermatic vein, inc incidence more common w/ left spermatic vein “bag of worms”, chronic non tender, no transillumination

Question 18

Varicocele dx and tx

Answer 18

clinical dx, but if inconclusive, doppler u/s method of choice; surgical repair if painful or cause of infertility

Question 19

Benign prostatic hyperplasia

Answer 19

fibrostromal tissue of prostate is abnormally proliferated leading to prostatic urethra compression, urine obstruction, onset 60-65 yo, use AUA sx indec to assess sx severity

Question 20

BPH sx

Answer 20

dec force of stream, sensation of incomplete emptying, postvoid dribbling, irritive sx, recurrent UTI, urinary retention, enlarged prostate on rectal exam

Question 21

BPH labs and tx

Answer 21

PSA usually inc, R/O kidney, infection, ca; use a adrenergic agonists and 5 alpha reductase inhibitors, relieve obstruction, balloon dilation, microwave irradiation, stent placement, transurethral resection or incision of prostate

Question 22

Prostate ca

Answer 22

disease of aging, rarely seen in men

Question 23

Risk of prostate CA

Answer 23

genetic predisposition, hormonal influence, dietary and environmental factors, infectious agents

Question 24

prostate CA sx

Answer 24

vary depending on severity, may have irritative voiding, but may have bone pain, back pain etc, usually nodular, enlarged and asymmetric, 10% with hyperplasia have malignancy

Question 25

Prostate CA diagnosis

Answer 25

PSA inc, tissue biopsy confirms, gleason grading 2-10, higher score, worse prognosis, transrectal u/s, hypoechoic lesions in prostate

Question 26

Prostate CA tx

Answer 26

determine stage w/ CT/MRI and perform pelvic lymphadenectomy and bone scan to look for mets, Stage A/B: radical retropubic prostatectomy, brachytherapy, external beam radiation, Stage C: less effective w/ above, stage D: chemo use limited, palliative

Question 27

Testicular CA

Answer 27

most common malignancy in young men, history of cryptorchidism

Question 28

Testicular CA sx

Answer 28

> 90% painless, solid, testicular swelling or heaviness, paraaortic lymph node involvement, urethral obstruction, abdominal complaints or pulmonary symptoms

Question 29

Testicular CA dx

Answer 29

scrotal us: intratesticular echogenic focus, CT of chest, abdomen and pelvis, elevated HCG or alpha fetoprotein in nonseminomatous germ cell tumors, staging determined by degree of lymph node spread by orchiectomy

Question 30

Classification of testicular CA

Answer 30

Seminomatous: radiosensitive, Stage 1: radiation, stage IIa/b: inc radiation to affected lymph nodes, stage IIc/III: chemotherapy; Nonseminomatous (65%): radioresistant, stage 1: nerve-sparing retroperitoneal lymph node dissection, stage II: surgery or chemo, stage III: surgery and chemo