Urology Flashcards
A PVR greater than __________ is concerning.
100 mL
What five drugs are first line for uncomplicated cystitis?
Amoxcillin
Bactrim
Nitrofurantoin
Fosfomycin
Cephalexin
What four drugs treat complicated cystitis?
Ciprofloxacin
Levofloxacin
Bactrim
Cefpodoxime
What three drugs treat cystitis in a pregnant woman?
Augmentin/amoxicillin
Nitrofurantoin
Cefpodoxime
Review the common causes of urinary retention in women.
Postpartum inflammation
HSV inflammation
Bartholin gland cysts/abscesses
Pelvic masses
Neurogenic bladder
Vaginitis
Malignancy typically presents as __________ hematuria.
painless
In women, _________ abscess can cause urinary retention.
Bartholin’s
There are four categories of causes of urinary retention. Review them and list some examples in each.
Obstructive:
- Stone
- Cancer
- Stricture
- Phimosis
- BPH
Infection:
- UTI
- Urethritis
- Vulvovaginitis
- HSV
Neurologic:
- Spinal cord compression/infarction/trauma
- Tabes dorsalis
- MS
- Diabetes
Pharmacologic:
- Anticholinergic
- Antihistamine
- Anti-adrenergic
- Anti-spasmodic
What is Prehn sign?
Relief of testicular pain in epididymitis with elevation of the testicle
Which direction should you try first in manual detorsion of a testicle?
Medial to lateral (“open the book”)
What agents are acceptable first-line agents for empiric prostatitis?
Ciprofloxacin or Bactrim
If a backpacker has red urine but no RBCs on UA, what should you think of?
Iodine
Iodinated water tablets can cause red urine.
“Thickened bladder wall” on a prenatal ultrasound is suggestive of _____________.
posterior urethral valve
What is the pathophysiology of posterior urethral valve?
Abnormal insertion of the Wolffian ducts into the bladder which leads to excess tissue that obstructs the urethra
What feature of a VCUG suggests posterior urethral valve?
Dilated proximal urethra on the removal of the catheter
PUV presents with tissue in the proximal part of the urethra. The tissue is usually not at the absolute beginning of the urethra and so the most proximal part of the urethra gets dilated. This will show up with contrast collection on VCUG.
Review the management of priapism.
Priapism is worrying if it persists for more than 4 hours.
First, use cold compresses and encourage the patient to urinate to relieve the erection.
If cold compresses and urination fail to relieve it, then aspirate the corpus cavernosa and infuse cold saline.
If the aspiration and saline don’t work, then inject intracavernosal phenylephrine.
The corpus cavernosa is _________ to the corpus spongiosum.
posterior
The corpus spongiosum is the part of the penis that is immediately around the urethra and is contiguous with the glans. The corpus cavernosa is the “back” part of the penis that is doral to the spongiosum; the cavernosa are two bodies.
Review the two options for bacterial prostatitis.
- Ciprofloxacin 6 weeks
- Bactrim 6 weeks
Stress incontinence presents with what?
Leakage of urine with anything that increases the intraabdominal pressure: Valsalva, coughing, vomiting.
You need to rule out UTI with a UA. You should also look for hematuria on UA which would warrant a malignancy evaluation.
Beyond the above rule-outs, you can treat with pelvic floor PT, pessary, lifestyle modification, and sling surgery.
How do you differentiate the two types of priapism?
Obtain a cavernosal blood gas.
The two kinds of priapism are ischemic and non-ischemic. Ischemic priapism is caused by mechanisms that limit flow. Non-ischemic priapism is caused by increased flow.
On a blood gas, ischemic priapism will have acidosis and with a low O2
What is the movement of detorsing a testicle?
Rotate laterally (“open the book”)