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
