Urology Flashcards
pain, redness, and a foul-smelling discharge from under the foreskin of penis
Balanitis
Tx of balanitis
Topical antifungal agents: clotrimazole 1% or miconazole 2%, each applied twice daily for one to three weeks
For suspected anaerobic infection: metronidazole 0.75% applied twice daily for seven days
In extreme cases, the foreskin may need to be removed (circumcision)
In BPH which area is affected the most
Enlargement of transitional zone;PSA often elevated > 4
Tx options of BPH
Relax the bladder/urethra: α-1 blockers - tamsulosin (Flomax)
Decrease prostate size (shrink prostate): 5 alpha-reductase inhibitors (finasteride) and (dutasteride
Tx of chlamydia
-
CDC recommended treatment for chlamydia is doxycycline 100 mg PO BID × 7 days
- Alternative regimens include: Azithromycin 1 g orally in a single dose OR Levofloxacin 500 mg orally once daily for 7 days
Determine cystitis from pylenephritis
- Absence of fever, chills, or flank pain. Change in urine color/odor
Cystitis tx
Nitrofurantoin (not over age 65), Bactrim, Fosfomycin
- Ciprofloxacin - reserved for complicated cases
- Postcoital UTI: single-dose TMP-SMX or cephalexin may reduce the frequency of UTI in sexually active women
a 25-year-old male with a dull, achy scrotal pain that has been gradually increasing over the last several days. He also reports pain with urination. Physical exam reveals a swollen right testicle with substantial induration. Urinalysis reveals positive leukocyte esterase and 20 WBC/HPF
Epididymitis
Epididymitis pathogens based on age (over 35 and under 35)
The pathogen is based on the patient’s age and risk factors:
- men < 35 chlamydia and gonorrhea
- men > 35 E.coli
dysuria, unilateral dull aching scrotal pain that can radiate up the ipsilateral flank
Epididymitis
Tx of epididymitis in men over 35
- Levofloxacin (Levaquin) 500 mg/day PO for 10 days (21-30 days if associated prostatitis)
- For patients who are unable to take fluoroquinolones, trimethoprim-sulfamethoxazole (one double-strength tablet twice a day for 10 days) is a good alternative
Tx of epididymitis under 35
- Doxycycline 100 mg PO BID for 10 days PLUS ceftriaxone 500 mg IM × 1 (or 1 g if the patient weighs 150 kg or greater)
- Refer sexual partner(s) for evaluation and treatment if contact within 60 days of the onset of symptoms
inflammation of glomeruli causing protein and RBC leakage into the urine, typically caused by an immune response
Acute glomerulonephritis
edema + HTN + hematuria + RBC Casts/dysmorphic RBCs + proteinuria 1-3.5 g/day + azotemia
Nephritic syndrome
Urinary excretion of > 3 g of protein in a 24-hour urine sample due to a glomerular disorder plus edema and hypoalbuminemia
Nephrotic syndrome
- HTN, azotemia, oliguria (<400 ml urine/day), hematuria (RBC casts) hallmark, edema is not as much as nephrotic syndrome
- Urinalysis: proteinuria < 3.5 grams per day, hematuria, RBC casts
Nephritic syndrome
a child with idiopathic nephrotic syndrome improves after treatment with corticosteroids.
Minimal change disease
obese patients, heroin, and HIV+ black males.
Focal segmental glomerulosclerosis (FSGS)
Passage of intestine through the internal inguinal ring down the inguinal canal, may pass into the scrotum
Indirect inguinal hernia
Passage of intestine through the external inguinal ring at Hesselbach triangle, rarely enters the scrotum
Direct inguinal hernia
right flank pain radiating into the scrotum, gross hematuria, right-sided hydronephrosis, and normal abdominal x-ray
Nephrolithiasis
Nephrolithiasis diagnostic study
- CT scan (spiral CT) without contrast of the abdomen and pelvis is the gold standard for diagnosis
- Urinalysis will often show microscopic hematuria
- BUN and Cr levels (for evaluation of renal function) and also calcium, uric acid, and phosphate levels
Four types nephrolithiasis
- Calcium oxalate (80%): Most common, excess oxalate, hyperparathyroidism, radiopaque - avoid grapefruit juice (makes calcium oxalate stones worse)
- Struvite (10%): Associated with chronic UTI with Klebsiella and Proteus species, radiopaque
- Uric Acid (7%): Form in individuals with persistently acidic urine - Excess meat/alcohol, gout, radiolucent
- Cystine (1%): Rare genetic, radiolucent (young boy with kidney stones)
Tx for nephrolithiasis
- Analgesia: IV morphine, parenteral NSAIDs (ketorolac)
- Vigorous fluid hydration—beneficial in all forms of nephrolithiasis
- Antibiotics—if UTI is present
- Alpha-blocker therapy (Flomax) for patients with symptomatic ureteral stones >5 mm and ≤10 mm to facilitate ureteral stone passage (usually given to most patients independent of size)
unilateral scrotal swelling with pain radiating to the ipsilateral groin. Examination reveals a tender swollen testicle, scrotal edema with erythema and shininess of the overlying skin.
Orchitis
inflammation of the testicles. It can be caused by either bacteria or a virus
Orchitis
MCC of orchitis
- scending bacterial infection from urinary tract
- Occurs in 25% of postpubertal males with MUMPS
- Unilateral swollen testicle/tenderness with erythema and shininess of the overlying skin, fever/tachycardia
- Orchitis is rarely seen without epididymitis unless the patient has mumps
Tx of orchitis
If mumps is the cause, treat mumps (+ ice/analgesia)
If bacteria is the cause, treat it like epididymitis
-
Age <35 or sexually active postpubertal males (cover for GC/Chlamydia)
- Ceftriaxone 500 mg IM once PLUS doxycycline 100 mg PO BID for 10 days
- Azithromycin 2 g PO once PLUS doxycycline 100 mg BID if severe PCN allergy
- Age >35 (STI not suspected) - Levofloxacin 500 mg/d PO once daily for 10 days (21 days if associated prostatitis)
Ascending infection of gram-negative rods into prostatic ducts
Prostatitis
Acute and chronic symptoms of prostatitis
- Acute: sudden onset of fever, chills, and low back pain combined with urinary frequency, urgency, and dysuria
- Chronic: variable – asymptomatic ⇒ acute symptomatology
Prostatitis diagnostics
Urinalysis will reveal pyuria and hematuria
-
Prostatic fluid = leukocytosis, culture typically positive for E.coli in acute infections
- chronic usually have enterococcus
- If you suspect acute prostatitis DO NOT massage the prostate this can lead to sepsis!
Tx of orchitis
- Men < 35: Chlamydia and Gonorrhea - ceftriaxone and doxycycline
- E coli and pseudomonas in men > 35 - treat with fluoroquinolones or Bactrim for 4-6 weeks to ensure eradication of the infection – culture urine 1 week after the conclusion of therapy
Pyelonephritis
Pyelonephritis
MCC bug in pyelonephritis
Organism: E. coli
- Urinalysis: Bacteria and WBC casts
Tx of pyelonephritis inpt vs outpt
- Outpatient: FQ (Cipro/Levaquin)/Bactrim for 1-2 weeks (longer if immunocompromised)
- Inpatient: IV FQ, 3rd/4th gen cephalosporins, extended-spectrum penicillins, gentamicin
22-year-old male who develops a firm, painless, non-tender testicular mass with elevated serum β-HCG
Testicular cancer
firm, painless, non-tender testicular mass and a feeling of heaviness in the scrotum
Testicular cancer sx
MC type and RF for testicular cancer
- Seminoma is the most common type (60%)
- Risk factors include a history of cryptorchidism
Tumor marker of testicular cancer
AFP, βHCG
Dx of urethritis
First-void or first-catch urine and sometimes urine culture
- Positive leukocyte esterase on urine dipstick or having ≥ 10 WBC/HPF on microscopy is suggestive of urethritis
- Diagnosis by culture is not always necessary. If done, diagnosis by culture requires demonstration of significant bacteriuria in properly collected urine
- Nucleic acid amplification test allows for the specific identification of N. gonorrhoeae, C. trachomatis, M genitalium
