Urology Flashcards
postobstructive diuresis mgmt
fluid resuscitation with one-half normal saline is a good starting point, aiming for approximately a 2:1 ratio of volume of urine output to fluid replacement.
testicular ca chemo
Bleomycin, etoposide, and cisplatin
dx of testicular ca
start with US. CT CAP for mets. LDH follows BULK. AFP and BHCG.
germ cell = seminoma (BHCG) or nonseminoma (AFP+BHCG)
20-35YO
seminoma
MC testicular tumor
10% have B-HCG elevation
NO AFP ELEVATION
ORCHIECTOMY +++ very sensitive to XRT
chemo if bulky bets
nonseminomatous ca
types: embryonal, teratoma, chorio, yolk sac
mgmt seminoma
orchiectomy and RP XRT (chemo if metastatic or bulky RP disease cisplatin, bleomycin, etoposide with surgery afterwards)
mgmt nonseminoma
orchietomy and RP DISSECITIO (no XRT)
chemo (cisplatin, bleo, etoposide) for stage II+ = beyond the testis with residual resection after
spread of nonseminoma
lymphatics EXCEPT choriocarcinoma which spreads HEME (like to lungs)
testicular ca resection
orchiectomy through INGUINAL incision (disrupts lymphatics with transscrotal incision)
use INGUINAL incision to avoid disrupting lymphatics via scrotal
mgmt ruptured testicle
debridement of the seminiferous tubules and closure of the tunica albuginea with absorbable suture
renal hilum order
vein
artery
pelvis
cord structures
testicular artery
pampiniform plexus
vas deferens (medial)
cremasterics
ilioinguinal nerve
genital branch of genitofemoral nerve
calcium oxalate stones on XR
radiopaque, MC
struvite stones
Mg Ammonium phosphate; radiopaque
Proteus, urease producing
staghorn calculi
uric acid stones
radioLUCENT (think lots of cells dying or whatever, and also ileostomy from loss of bicarb)
cysteine stones
radioLUCENT; cystinuria
mgmt: tiopronin
size not likely to pass (stone)
6mm
MC site of prostate ca
POSTERIOR lobe
MC met from prostate
bone (osteoblastic)
if PSA+ after 3 wks, need bone scan to see if metastasized alreADY
dx prostate ca
transrectal Bx, CT CAP, PSA, Alk phos
mgmt prostate ca if no capsular spread
radiation or radical prosatectomy + PLND
mgmt prostate ca if capsular spread or metastatic
XRT adn androgen ablation (leuprodie GnRH agonist, flutamide testosterone-R blockade, or b/l orchiectomy)
PSA after prostatectomy
0 at 3 weeks (otherwise get bone scan for mets)
prostate ca screening
black men or men wth fam hx: PSA q1-2 years starting 40-45 YO
normal risk: 40 YO PSA q1-2 yrs, go to Urology if PSA>7
normal PSA
<4
renal cell carcinoma dx
CT scan CAP (1/3 have mets at dx)
met from renal
LUNG (isolated lung or coon mets = wedge it out)
mgmt renal ca
radical nephrectomy (kidney, adrenal, fat, Gerota’s, regional nodes), pull any tumor out of IVC; ten chemoXRT