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Urology Flashcards

1
Q

Right renal artery

A

Crosses posterior to IVC

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2
Q

Left renal vein

A

The left gonadal vein drains into the left renal vein; the left renal vein crosses anterior to the aorta and receives branches from: left adrenal, left gonadal, left lumbar

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3
Q

Ureters

A

Pass over iliac vessels

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4
Q

Calcium oxalate stones

A

Most common stones, radiopaque

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5
Q

Magnesium ammonium phosphate stones

A

Struvite stones, associated with infections, urea splitting, proteus. Staghorn calculi. Radiopaque

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6
Q

Uric acid stones

A

Radiolucent. Risk factors include ileostomy, gout, short gut.

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7
Q

Cysteine stones

A

Radiolucent. Prevent with tiopronin

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8
Q

Stone size for spontaneous passage

A

> 6 mm stone will not pass spontaneously

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9
Q

Testicular cancer

A

1 male killer 25-35

Majority of testicular masses = malignant
Any mass in testicle = orchiectomy through inguinal incision
More common on right, so is cryptochordism

Avoid scrotal approach and open testicular biopsy: can cause metastatic spread to both retroperitoneal and inguinal node

Primary metatstatic site:
-Left: para-aortic nodes
-Right: interaortocaval nodes

-Lymphoma involving both testis is more common cause of bilateral testicular masses in men over 50

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10
Q

Testicular mass in congenital adrenal hyperplasia

A

Is a hyperplastic nodule, treatment is glucocorticoid

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11
Q

Diagnosis of testicular cancer

A

Need US first

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12
Q

Staging for testicular cancer

A

CT abdomen/chest to look for retroperitoneum and chest metastasis

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13
Q

Labs needed before orchiectomy

A

LDH, B-HCG, AFP

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14
Q

Percentage of germ cell tumors

A

90% are Germ cell - Seminoma or non-seminoma

Seminoma most common histology in primary testis tumors

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15
Q

Undescended testes

A

Increased risk of seminoma; if corrected, increased risk of non-seminoma

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16
Q

MC seminoma characteristics

A

10% have B-HCG elevation, NEVER has AFP elevation. If AFP high = non-seminoma

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17
Q

Seminoma treatment

A

-Extremely sensitive to XRT. Spread to retroperitoneum.
- Tx:
o Start radical inguinal orchiectomy
o Stage I – no tumor outside of testicle  Close follow up
o Stage II spread to retroperitoneum lymph nodes
o If LN involved now need chemo vs XRT
o If LN < 2 cm  XRT
o If LN > 2 cm, any mets or if BGCG elevated: chemo
- Chemo (cisplatin, bleomycin, etoposide)
- Then need surgical resection of any residual disease after above

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18
Q

Non-seminoma types

A

Embryonal, teratoma, choriocarcinoma, yolk sac.

Spreads to retroperitoneum and hematogenously to lungs.

High AFP and BHCG

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19
Q

Non-seminoma treatment

A

o Start radical inguinal orchiectomy
o Stage I – no tumor outside of testicle  Close follow up
o Stage II spread to retroperitoneum lymph nodes
o If LN involved now need chemo vs retroperitoneum lymph node dissection
o If LN < 2 cm  retroperitoneum lymph node dissection
o If LN > 2 cm, any mets  chemo
- Tx: all stages get radical inguinal orchiectomy and retroperitoneal LN dissection
- Stage II or greater (beyond testicle) – also get chemo (cisplatin, bleomycin, etoposide)
- Surgical resection for residual disease after above

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20
Q

5-year survival for seminoma

A

90%, better than non-seminoma

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21
Q

MC location for primary germ cell tumor

A

Mediastinum

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22
Q

Prostate cancer concern

A

If alk phos high, worry about metastasis

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23
Q

Diagnosis of prostate cancer

A

TRUS biopsy. Most common in posterior lobe

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24
Q

Stage I prostate cancer

A

Found on TURP; do nothing

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25
Q

Stage I or stage II, intracapsular T1 or T2 with no metastatic disease options:

A
  1. XRT
  2. Radical prostatectomy + pelvic LN dissection (if life span > 10 years)
  3. Nothing (age > 75, short life expectancy)
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26
Q

Extracapsular (Stage III or IV) prostate cancer

A

Extends through capsule or metastatic disease.

-Tx: XRT and androgen ablation -> (leuprolide (GnRH analogue, decreases FSH and LH), flutamide (testosterone receptor blocker) or bilateral orchiectomy)

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27
Q

MC kidney tumor

A

Metastasis from breast cancer

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28
Q

Renal cell carcinoma diagnosis

A

CT scan is sufficient for diagnosis. Never biopsy kidney lesions.

-All kidney tumors need some sort of resection for official diagnosis

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29
Q

MC subtype of renal cell carcinoma

A

Clear cell carcinoma

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30
Q

MC site of metastasis for renal cell carcinoma

A

Lung

31
Q

Paraneoplastic syndrome associated with renal cell carcinoma

A

Stauffer syndrome - increased LFT, improved with resection

32
Q

Renal cell carcinoma treatment

A

Radical nephrectomy (don’t take adrenal unless involved) with regional nodes, followed by postoperative chemo-radiation

33
Q

Renal artery ligation during nephrectomy

A

Vital to ligate the renal artery before the renal vein to prevent congestion of the kidney

34
Q

Partial nephrectomy indication

A

Only if resection would lead to dialysis, BL renal lesion or mass <4 cm and Cr >2.5

35
Q

Transitional cell carcinoma of renal pelvis

A

Requires radical nephroureterectomy

36
Q

Metastatic renal cell carcinoma treatment

A

Non-curable; treatment is immunotherapy with sunitinib or pazopanib (tyrosine kinase inhibitors)

37
Q

Bladder cancer treatment for T1a and T1b

A

T1a (mucosa) T1b (submucosa) (no muscle involvement) do trans-urethral resection and a single dose of Intravesical mitomycin or BCG

38
Q

Muscle wall invasion in bladder cancer (T2 or higher)

A

Need cystectomy with ileal conduit, BL pelvic node dissection, then chemo-XRT (MVAC- Methotrexate, vinblastine, Adriamycin, cisplatin)

Men include prostatectomy
Women include TAH-BSO and anterior vaginal wall

39
Q

Testicular torsion most accurate sign

A

Loss of cremasteric reflex (rubbing inner thigh does not elevate scrotum)

40
Q

Testicular torsion presentation

A

High riding testicle, testicle lies horizontally

41
Q

Torsion direction

A

Usually towards midline (like closing a book)

42
Q

Prehn sign in testicular torsion

A

Negative; elevating the scrotum does not alleviate pain. Found in epididymitis

43
Q

Diagnosis of testicular torsion

A

Clinically diagnosed; no imaging needed if highly suspected

44
Q

Testicular torsion treatment

A

All need bilateral orchidopexy +/- orchiectomy

45
Q

Priapism cause

A

Caused by decreased venous outflow from corpora cavernosa

corpora cavernosa involved, not corpus spongiosum

46
Q

Priapism treatment

A

Tx: 1st corporal cavernosa aspiration and irrigation with epinephrine, can try injecting phenylephrine into corpora too

2nd cavernoglandular shunt procedure

47
Q

BPH treatment

A

– transitional zone.
-Finasteride
-TURP only for recurrent UTI, gross hematuria, stones, renal damage, failure of medical management.

48
Q

TURP side effects

A

Retrograde ejaculation

49
Q

Varicocele location

A

Most common on left, on posterior surface of testicle

Exam: “bag of worms”
Treatment: Most do not require treatment. But if symptomatic, causing infertility  ligate spermatic vein

50
Q

New onset left varicocele in adult

A

Means IVC obstruction; MCC renal cancer, get CT abdomen

51
Q

Varicocele effects on fertility

A

Causes reduced fertility; improve fertility with high spermatic vein ligation

52
Q

Nutcracker syndrome

A

Compression of left renal vein between aorta and SMA

Left gonadal vein empties in left renal: can cause testicular pain and VARICOCELES

53
Q

Nutcracker syndrome symptoms

A

Left flank pain, abdominal pain, and hematuria

54
Q

Spermatocele

A

MC cystic structure of scrotum. cyst superior and separate from testis along epididymis. Tx: Leave alone if asymptomatic. surgical removal if symptoms.
Spermatocele and hydrocele do not affect fertility

55
Q

Hydrocele in pediatrics

A

Hydrocele: - most disappear by 1 year in pediatrics. Formed by tunica vaginalis.

Can have connection to peritoneum  processus vaginalis, communicating hydrocele or non-communicating

56
Q

Adult hydrocele acute onset

A

If acute and new onset, rule out cancer

57
Q

Hydrocele diagnosis

A

Will transilluminate

58
Q

Hydrocele treatment indication

A

Only indicated if symptomatic; otherwise leave alone

59
Q

Hydrocele treatment if symptomatic

A

Excision of hydrocele sac; don’t aspirate

In adult males these are all non-communicating!!!! They don’t connect to peritoneal cavity
- Lump that goes into the internal ring = hernia – differentiates from hydrocele
- Non-Communicating will resolve
- Failure to resolve indicates persistent processus vaginalis = communicating hydrocele
- CAN BE IN INGUINAL CANAL OR SCROTUM
- Dx: US will transilluminate if in scrotum
- If < 1 year old and non-communicating. Wait until 1 year old and resect if still there
- If thought to be communicating (size waxes and wanes), then resect hydrocele even if < 1 year old
- Resect hydrocele and ligate processus vaginalis inguinal approach

60
Q

Ureteropelvic junction obstruction treatment

A

Pyeloplasty

61
Q

Ureteral duplication

A

Most common urinary tract abnormality. Treatment: reimplantation if obstruction occurs

62
Q

Ureterocele location

A

Most common at junction of ureter and bladder. Symptoms: UTI, retention. Resect and reimplant if symptomatic

63
Q

Patent urachus

A

Connection between bladder and umbilicus (wet umbilicus). Diagnosis: voiding cystourethrogram. Treatment: resect cyst and close bladder

64
Q

Epididymitis cause

A

Most common cause of scrotal pain in adults. Need to rule out torsion with US: shows increased blood flow to epididymis. Most common cause is chlamydia

65
Q

Neurogenic bladder

A

Neurogenic bladder = SPASTIC bladder
Most commonly 2/2 to spinal injury
Patient urinates all the time
Nerve injury above T12
Tx: surgery to improve bladder resistance

66
Q

Neurogenic obstructive uropathy

A

Incomplete emptying
Nerve injury below T12, can occur with APR
Tx: Intermittent cath

67
Q

Stress incontinence

A

Stress incontinence (cough sneeze)
Due to Pelvic floor weakness Causes hypermobile urethra or loss of sphincter mechanism
MC Women
Tx: Kegel exercises, alpha agonist, surgery for urethral suspension or pubovaginal sling (Best)

68
Q

Overflow incontinence

A

Incomplete emptying of enlarged bladder
MC men
BPH leads to this
Tx: Flomax, TURP

69
Q

Urge incontinence treatment

A

Antimuscarinics, oxybutynin, tolterodine

70
Q

Peyronie’s disease

A

Thick plaque in tunica albuginea. Treatment: conservative management for 1 year (colchicine, vitamin E). If that fails, need Nesbit operation (tissue on opposite side of plaque is shortened). PLAQUE IS NOT EXCISED

71
Q

Infundibular ligament

A

Carries ovarian vessels

72
Q

Broad ligament

A

Carries uterine vessels. Medial to this is the ureter

73
Q

Cardinal ligament

A

At the base of broad ligament contains uterine vessels

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