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
when to consider partial nephrectomy in renal cell ca
if needs HD after nephrectomy (tumor < 4 cm, Cr > 2.5)
renal cell carcinoma paraneoplastic synd
epo, renin, PTHrP, ACTH, insulin
transitional cell ca of renal pelvis mgmt
radical nephroureterectomy
von hippel lindau
mutlifocal/recurrent RCC
renal cysts
pheos
CNS tumors
MC tumor in kidney
met from BREAST
renal cell pain vs painless
painful (flank)
transitional cell pain vs painless
painless hematuria
risk factor bladder ca
smoking
aniline dyes
arsenic
radiation
cyclophosphamide
mgmt bladder ca
intravesical BCG or transurethral resection if T1
if muscle wall invaed (T2+), cystectomy with ileal conduit, chemo, and XRT
metastatic: chemo alone
chemo for bladder ca
methotrexate, vinblastine, adriamycin (doxo), and cisplatin = MVAC
squamous cell ca of bladder caused by
schistosomiasis infection
torsion direction typically
TOWARD midline
mgmt torsion
detorsion and b/l orchiopexy
orchiectomy if not viable
mgmt BPH
alpha blocker (terazosin, doxazosin) to relax smooth muscle
5a reductase inhibitor (finasteride) to inhibit T to DHT and inhibit prostate hypertrophy
TURP if medical fails (renal insuff, stones, hematuria, UTIs, sx)st
post TURP syndrome
hyponatremia 2/2 irrigation with water; can precipitate sz (cerebral edema)
mgmt: carefully correct with diuresis
retrograde ejaculations
after TURP; common
neurogenic bladder effect
neurogenic bladder above T12 = always pee
neurogenic obstructive uropathy below T12 = always retain
ureteral duplication
usually with ectopic implantation into urethra vs vagina
mgmt: reimplant if sx
ureterocele mgmt
resect and reimplant ureter if sx
posterior urethral valaves
MC lack of urination in boy
mgmt: foley, DX with VCUG, then resect the valves
vesicoureteral reflux w/u
many UTI’s; give ppx abx and then get VCUG
mgmt: reimplant with long bladder portion
epispadia
dorsal urethral opening
mgmt: reconstruct
hypospadia
ventral urethral opening
gmt: repair 6 mons with foreskin (KEEP IT)
failed urachal closure
peeing thru umbilicus
mgmt: resect sinus and close bladder; relieve bladder outlet obstruction
interstitialnephritis sx
eosinophilia, arthralgia, fever, rash
priapism
> 4 hours
jaboulay repair for hydrocele
most standard repair
complication: scrotal hematoma or recurrence
functional kidney remnant necessary (otherwise just do a nephrectomy)
15-20%
concern for clots in bladder (what kind of irrigation)
MANUAL irrigation
bladder spasm tx
anticholinergics
what fluid to treat severe post-obstructive diuresis?
D5 1/2NS at 50% UOP
CI to ESWEL extra corporeal shock wave lithotripsy
pregnancy
disposition to easily bleed or stones that are several cm in size
varicocele typically what side
mostly L because R drains directly into IVC
isolated right varicocele concern
for a retroperitoneal process
hydrocele location
between parietal and visceral layers of tunica vaginalis (mostly from patent processus vaginalis)
spermatocele vs hydrocele difference on physical exam
palpable SPERMATOCELE.. not hydrocele
scrotal vs inguinal approach to hydrocele operation
scrotal: for ADULT repair
inguinal: for PEDIATRIC
mc MET FROM KIDNEY RCC
LUNG
RCC paraneoplastic
renin
epo
PTHrP
ACTH
insulin
transitional ca in RENAL PELVIS
radical nephroureterectomy
oncocytoma in kidney
benign
angiomyolipomas in kidney
benign hamartoma…. look for tuberous sclerosis though
