Urology Flashcards
Urge vs overflow vs stress incontinence
Urge is suddenly getting intense urge due to detrusor muscle overactivity and individual cannot make it to bathroom in time a lot of time, treated with bladder training primarily or antimuscarinics as first line medical therapy like tolterodine or oxybutynin
Overflow incontinence is due to bladder detrusor muscle underactivity or urinary outlet obstruction and might be seen with neurologic autonomic dysfunction such as DM or spinal injuries also common in BPH will see loss of urine with no warning or dribbling, diagnosed clinically but with a post void residual >200mL and treated with intermittent or indwelling catheter primarily and sometimes cholinergics like bethanechol
Stress incontinence is involuntary leakage of urine that occurs with increased abdominal pressure and can be seen after childbirth or after surgery, treated with pelvic floor muscle exercises primarily but can also use a pessary
Peyronie’s disease management of mild <30 degrees vs severe >30 degrees or associated with sexual dysfunction or pain
Mild - observation and urologist referral
Severe - Intralesional injections
Imaging test to diagnose vesicoureteral reflux
Voiding cystourethrogram
Management of mild vesicoureteral reflux vs severe
Mild is observation with antibiotic prophylaxis to prevent recurrent UTI’s, severe is surgery
2nd most common causative agent of acute cystits
Staph saprophyticus
Diagnosis of acute cystitis
Urinaylsis demonstrating pyuria >10wbc/hpf initial, urine culture is definitive diagnosis from a clean catch specimen
Management of uncomplicated acute cystitis (4)
Nitrofurantoin
Bactrim
Amoxicillin or augmentin during pregnancy
Fluroquinolones second line
Adjunctive therapy for acute cystitis symptoms
Phenazopyridine (bladder analgesic) that turns urine orange color, not to be used more than 48 hours
Interstitial cystitis definition
Chronic condition resulting in painful inflamed bladder despite absence of infection
Signs and symptoms of pyelonephritis
Fever, chills, flank or back pain, nausea, vomiting, dysuria, urgency, frequency, costovertebral angle tenderness, tachycardia, WBC casts hallmark
Outpatient vs inpatient vs pregnant management of pyelonephritis
- Fluoroquinolones first line (if no resistance) outpatient
- 3rd or 4th gen cephalosporins, fluroquinolones, aminoglycosides inpatient
- IV ceftriaxone first line
Most common bacterial STI in the US
Chlamydia
Most specific test for GC chlamydia
NAAT (nucleic acid amplification)
If test results not available, what is treatment of possible GC/chlamydia vs tested confirmed n. gonorroeae vs tested confirmed chlamydia alone
- Ceftriaxone 250 mg IM x1 plus azithromycin 1g x 1 dose
- Same
- Azithromycin 1g oral OR doxycycline 100 mg orally bid x 10 days
Most common cause of acute prostatitis in patients >35 years vs below, what is the most common cause of chronic prostatits
E coli vs chlamydia and gonorrhea, e coli is most common cause of chronic
Difference between acute and chronic prostatitis and BPH and prostate cancer on physical exam
Acute will be exquisitely tender, while chronic is usually nontender but both are boggy, BPH is symmetric enlarged firm nontender prostate, prostate cancer is a rock hard prostate that is asymmetric
Prostatitis diagnosis
Urinalysis and culture, transrectal ultrasound or CT if concern for abscess
Medications used to manage prostatitis in >35 years vs younger
Fluoroquinolones or bactrim outpatient vs ceftriaxone plus doxycycline
Most common cause of epididymitis in patients >35 vs younger
E coli vs chlamydia and neisseria gonorrhoeae
Manifestations of epididymitis
- Gradual onset localized testicular pain and swelling, groin pain, flank or abdominal pain, may have fever, chills, or urinary irritative symptoms
- Scrotal swelling, epididymal tenderness and induration
- Positive prehn sign - relief of pain with scrotal elevation (classic but not reliable)
- Normal cremasteric reflex
Epididymitis best initial imaging test
Scrotal ultrasound, can be done to rule out torsion (testicular doppler ultrasound)
Epididymitis treatment in >35 year old patients
Fluorquinolones
Physical exam signs in testicular torsion
Negative prehn sign, absent (negative) cremasteric reflex on affected side
Definitive diagnosis and preferred over others in testicular torsion
Emergency surgical exploration within 6 hours of pain onset
Torsion of appendix testes definition
Abrupt testicular pain with blue dot sign (discoloration directly over the appendage), diagnosed clinically or with a doppler ultrasound, managed with ice and nsaids or surgical excision if persistent pain despite management
Cryptorchidism diagnostic criteria
Testicle that has not descended by 4 months of age, will need orchiopexy if undescended after this point
Most common type of testicular cancer, what is the most common manifestation?
Germinal cell tumor, testicular painless mass most common and physical exam will show it does NOT transilluminate
Diagnosis of testicular cancer
Scrotal ultrasound, alpha fetoprotein tumor marker
Most common cause of painless scrotal swelling
Hydrocele
What two testicular conditions see transillumination?
Hydrocele and spermatocele (benign epididymal cyst that contains sperm)
Most common surgically correctable cause of male infertility
Varicocele
Unilateral right sided varicoceles are concerning for ____, sudden onset left side in an older man may raise concern for ____
abdominal malignancy, renal cell carcinoma
Most common type of bladder cancer
Urothelial (transitiona cell) carcinoma
Risk factors for bladder cancer
- smoking number 1
- Occupational exposure to dyes, leather, rubber
Gold standard diagnostic and therapeutic for bladder carcinoma
Cystoscopy with biopsy
Paraphimosis vs phimosis urologic emergency
Paraphymosis is a urological emergency as it can lead to constriction of penile tissues leading to gangrene, phimosis is not a urological emergency
Paraphimosis management most common vs definitive management
Manual reduction is mainstay
Definitive treatment is incision (dorsal slit) or circumcision
Phimosis management msot common vs definitive management
Stretching exercises and topical corticosteroids
Definitive is circumcision
BPH management options
Observation in mild symptoms, alpha blockers best initial symptomatic therapy (tamsulosin, doxazosin) but these doo not impact prostate size, 5 alpha reductase inhibitors reduce size of prostate over time (finasteride), surgical management like TURP option in persistent progressive or refractory
Most common cause of microscopic hematuria in men
BPH
CVA tenderness indicates these 2 pathologies
Pyelonoephritis
Nephrolithiasis
Imaging test of choice for nephrolithiasis
Noncontrast CT abdomen and pelvis
Management of stones <5mm in diameter vs 5-10 mm diameter
Supportive care, spontaneous passage
Extracorporeal shock wave lithotripsy, ureteroscopy with or without stent, percutaneous nephrolithotomy (for vey large stones or if other methods fail)
4 types of kidney stones
- Calcium oxylate (most common) decreased fluid intake most common risk factor
- Uric acid due to high protein foods or gout
- Struvite staghorn calculi may be complication of uti with certain organisms
- Cystine congenital defect
1st and 2nd most common congenital defects in males
Cryptorchidism, hypospadias
Hypospadias maangement
AVOID circumcision, elective surgical correction
Trazodone side effect
Priapism
Management of priapism
Phenylephrine first line medication, needle aspiration
First line therapy vs most effective long term therapy vs pharmacologic therapy for enuresis
Behavioral management, enuresis alarm, desmopressin (DDAVP)
