Urology 2 Flashcards
MC type of bladder CA
urothelial (transitional cell) carcinoma
risks bladder CA
smoking MC
caucasion
cyclophosphamide
dyes, leather, rubber
sx bladder CA
hematuria MC, painless, present throughout micturition
may have dysuria, urgency, frequency
dx bladder CA
UA w microscopy and cultures to rule out benign causes
workup for bladder CA - cystoscopy, renal function testing, upper urinary tract imaging (CT urography)
cystoscopy w biopsy - standard for dx and staging; can be curative
tx bladder CA
localized - transurethral resection of bladder tumor (electrocautery)
muscle invasive - radical cystectomy w urinary diversion
metastatic - platinum based chemo
benign prostatic hyperplasia
hyperplasia of periurethral or transitional one –> prostatic obstruction or bladder outlet obstruction
sx BPH
irritative sx - urinary frequency, urgency, nocturia, incontinence
obstructive - hesitancy, weak, slow, splitting, intermittent stream force, incomplete emptying
PE BPH
DRE - uniformly enlarged, smooth, firm, contender, rubbery prostate
dx BPH
no eval if no significant sx or not impacting health
UA - look for hematuria
PVR if retention
urine cytology if concerned for CA
tx BPH
observation if asx - mild; lifestyle - avoid fluids prior to bed, decreased consumption of diuretics (alcohol, caffeine), double void to empty bladder completely
alpha 1 blockers - best initial for rapid relief; do not change size of prostate; tamsulosin
- PDE 5 if both BPH and ED
5 alpha reductase inhibitors - reduces size of pastorate over 6-12 months (finasteride or dutasteride)
transurethral resection of prostate - can cause sexual dysfunction or incontinence
MC type of prostate CA
adenocarcinoma - 95%
risks prostate CA
increasing age > 40 (strongest)
genetics
black race
sx prostate CA
most asx
back or bone pain - METs
urinary frequency, urgency, retention, decreased stream
PE prostate CA
DRE - hard, indurated, nodular, enlarged, asymmetrical prostate
dx prostate CA
PSA - > 4 ng/mL
Transrectal US guided needle biopsy - most accurate
bone scan if PSA > 10
Gleason grading system determines aggressiveness
tx prostate CA
observation
external beam radiation
radical prostatectomy –> can cause incontinence and ED
hormonal therapy - androgen deprivation therapy - GnRH agonist (Leuprolide, Goserelin) or GnRH antagonist (Degarelix, Relugolix)
4 types of kidney stones
calcium - calcium oxalate MC
uric acid
struvite - composed of magnesium ammonium phosphate; stag horn calcite - usually due to proteus
cystine - rare; usually due to congenital defect
sx nephrolithiasis
renal colic - sudden, constant upper lateral back or flank pain
or
painless gross hematuria without pain (less common)
may have groin pain
PE nephrolithiasis
CVA tenderness
usually afebrile
dx nephrolithiasis
UA - initial - microscopic or gross hematuria; nitrites if infectious; acidic urine pH < 5; may have alkaline urine ph > 7.2 if struvite stones
non contrast CT abdomen and pelvis - test of choice
KUB radiographs - only calcium and struvite stones are radiopaque - visible on radiographs
tx nephrolithiasis
stones < 5 mm diameter - IV or oral fluids and analgesics - NSAIDs, ketorolac, ibuprofen
stones > 5 - < 10 mm diameter - alpha blockers - tamsulosin, extracorporeal shock wave lithotripsy, ureteroscopy with or without stent - provides immediate relief
percutaneous nephrolithotomy most invasive and used for large stones > 10 mm or struvite or other methods fail
what is the narrowest point of urinary tract
ureterovesiscular junction
dietary factors associated w lower risk for nephrolithasis
calcium
potassium
phytake intake
increased fluid
causes of erectile dysfunction ED
vascular - MC - atherosclerosis, dm, psychogenic, prolactinoma
meds - BB, thiazides, spironolactone, CCB, SSRI, TCA
