Urology Flashcards
1
Q
What is a cystogram?
A
Contrast study of the bladder
2
Q
What are ureteral stents?
A
Plastic tubes placed via cystoscope into the ureters for stenting, identification, etc.
3
Q
What is a cystoscope?
A
Scope placed into the urethra and into the bladder to visualize the bladder
4
Q
What is a perc nephrostomy?
A
Catheter placed through the skin into the kidney pelvis to drain urine with distal obstruction
5
Q
What is a retrograde pyelogram?
A
Dye injected into the ureter up into the kidney, and films taken
6
Q
What is a RUG?
A
Retrograde UrethroGram
Dye injected into the urethra and films taken.
Rules out urethral injury, usually in trauma patients.
7
Q
What is a Gomco clamp?
A
Clamp used for circumcision.
Protects penis glans.
8
Q
What is a Bell clapper’s deformity?
A
Condition of congenital absence of gubernaculum attachment to scrotum
9
Q
What is Fournier’s gangrene?
A
Extensive tissue necrosis/infection of the perineum in patients with diabetes
10
Q
What is a Foley catheter?
A
Straight bladder catheter placed through the urethra
11
Q
What is a Coude catheter?
A
Basically, a Foley catheter with hook on the end to get around a large prostate
12
Q
What is a suprapubic catheter?
A
Bladder catheter place through the skin above the pubic symphasis into the bladder
13
Q
What is posthitis?
A
Foreskin infection
14
Q
What is a hydrocele?
A
Clear fluid in the processus vaginalis membrane
15
Q
What is a communicating hydrocele?
A
Hydrocele that communicates with peritoneal cavity and, thus, gets smaller and larger as fluid drains and then reaccumulates
16
Q
What is a non-communicating hydrocele?
A
Hydrocele that does not communicate with the peritoneal cavity.
Remains the same size.
17
Q
What is a varicocele?
A
Abnormal dilation of the pampiniform plexus to the spermatic vein in the spermatic cord.
Described as a “bag of worms”.
18
Q
What is a spermatocele?
A
Dilatation of epididymis or vas deferens
19
Q
What is epididymitis?
A
Infection of the epididymis
20
Q
What is Prehn’s sign?
A
Elevation of the painful testicle that reduces the pain of epididymitis
21
Q
What is a TRUS?
A
TransRectal UltraSound
22
Q
What is a DRE?
A
Digital Rectal Examination
23
Q
What is orchitis?
A
Inflammation/infection of the testicle
24
Q
What is pseudohermaphroditism?
A
Genetically one sex, partial or complete opposite-sex genitalia
25
What is urgency?
Overwhelming sensation to void immediately
26
What is dysuria?
Painful urination (usually burning sensation)
27
What is frequency?
Urination more frequently than usual
28
What is polyuria?
Urination in larger amounts than usual
29
What is nocturia?
Awakening to urinate
30
What is hesitancy?
Delay in urination
31
What is pneumaturia?
Air passed with urine via the urethra
32
What is pyuria?
WBCs in urine (UTI: > 10 WBCs/HPF)
33
What is cryptorchidism?
Undescended testicle
34
What is an IVP?
IntraVenous Pyelogram:
| Dye is injected into the vein, collects in the renal collecting system, and an x-ray is taken
35
What is hematuria?
RBCs in urine
36
What is the space of Retzius?
Anatomic extraperitoneal space in front of the bladder
37
What is enuresis?
Involuntary urination while asleep
38
What is incontinence?
Involuntary urination
39
What is a TURP?
TransUrethral Resection of the Prostate
40
What is PVR?
PostVoid Residual
41
What is priapism?
Prolonged, painful erection
42
What is paraphimosis?
Foreskin held (stuck) in the retracted position
43
What is phimosis?
Inability to retract the foreskin
44
What is balanitis?
Inflammation/infection of the glans penis
45
What is balanoposthitis?
Inflammation/infection of the glans and prepuce of the penis
46
What is a UTI?
Urinary Tract Infection
47
What is Peyronie's disease?
Abnormal fibrosis of the penis shaft, resulting in a bend upon erection
48
What is BPH?
Benign Prostatic Hyperplasia
49
What is epispadias?
Abnormal urethral opening on the dorsal surface of the penis
50
What is hypospadias?
Abnormal urethral opening on the ventral surface of the penis.
May occur in anterior, middle or posterior of penis.
51
What is erectile dysfunction?
Inability to achieve an erection
52
What is sterility?
Inability to reproduce
53
What is an appendix testis?
Common redundant testicular tissue
54
What is VUR?
VesicoUreteral Reflux
55
What are the layers of the scrotum?
(1) Skin, (2) Dartos fascia, (3) External spermatic fascia, (4) Cremaster muscle, (5) Internal spermatic fascia, (6) Parietal and Visceral layers of tunica vaginalis, (7) Tunica albuginea
56
What is the differential diagnosis of scrotal mass?
Cancer, torsion, epididymitis, hydrocele, spermatocele, varicocele, inguinal hernia, testicular appendage, swollen testicle after trauma, non-testicular tumor (e.g. rhabdomyosarcoma, leiomyosarcoma, liposarcoma)
57
What are the causes of hematuria?
Bladder cancer, trauma, UTI, cystitis from chemotherapy or radiation, stones, kidney lesion, BPH
58
What is the most common cause of severe gross hematuria without trauma, chemotherapy, or radiation?
Bladder cancer
59
What is the differential diagnosis for bladder outlet obstruction?
BPH, stone, foreign body, urethral stricture, urethral valve
60
What is the differential diagnosis for ureteral obstruction?
Stone, tumor, iatrogenic (suture), stricture, gravid uterus, radiation injury, retroperitoneal fibrosis
61
What is the differential diagnosis for kidney tumor?
Renal cell carcinoma, sarcoma, adenoma, angiomyolipoma, hemangiopericytoma, oncocytoma
62
What is renal cell carcinoma?
Most common solid renal tumor (90%).
| Originates from proximal renal tubular epithelium.
63
What is the epidemiology of renal cell carcinoma?
Primarily a tumor of adults 40-60 years with 3:1 M:F ratio.
64
What percentage of renal cell tumors are bilateral?
1%
65
What are the risk factors for renal cell carcinoma?
Male, smoking, von Hippel-Lindau syndrome, polycystic kidney
66
What are the symptoms of renal cell carcinoma?
Pain, hematuria, weight loss, flank mass, HTN
67
What is the classic triad of renal cell carcinoma?
1. Flank pain
2. Hematuria
3. Palpable mass
68
How are most cases of renal cell carcinoma diagnosed?
Found incidentally on an imaging study
69
What radiologic test are performed for renal cell carcinoma?
IVP, Abdominal CT with contrast
70
What is stage I renal cell carcinoma?
Tumor < 2.5 cm no nodes, no metastases
71
What is stage II renal cell carcinoma?
Tumor > 2.5 cm limited to kidney, no nodes no metastases
72
What is stage III renal cell carcinoma?
Tumor extends into IVC or main renal vein.
| Positive regional lymph nodes but < 2 cm in diameter and no metastases.
73
What is stage IV renal cell carcinoma?
Distant metastasis or positive lymph node > 2 cm in diameter, or tumor extends past Gerota's fascia
74
What is the metastatic workup for renal cell carcinoma?
CXR, IVP, CT, LFTs, calcium
75
What are the sites of metastases for renal cell carcinoma?
Lung, liver, brain, bone.
| Tumor thrombus entering renal vein or IVC is not uncommon.
76
What is the unique route of spread with renal cell carcinoma?
Tumor thrombus in IVC lumen
77
What is the treatment of renal cell carcinoma?
Radical nephrectomy (excision of the kidney, adrenal gland, including Gerota's fascia) for stages I-IV
78
What gland is removed with a radical nephrectomy?
Adrenal gland
79
What is the unique treatment of metastatic spread of renal cell carcinoma?
1. alpha-interferon
| 2. LAK cells (lymphokine-activated killer) and IL-2
80
What is a syndrome of renal cell carcinoma and liver disease?
Stauffer's syndrome
81
What is the concern in an adult with new onset left varicocele?
Left renal cell carcinoma (the left gonadal vein drains into the left renal vein)
82
What is the most common histology in bladder cancer?
Transitional cell carcinoma (90%).
| Remaining cases are squamous or adenocarcinomas.
83
What are the risk factors for bladder cancer?
Smoking, industrial carcinogens (aromatic amines), schistosomiasis, truck drivers, petroleum workers, cyclophosphamide
84
What are the symptoms of bladder cancer?
Hematuria +/- irritative symptoms, frequency
85
What is the classic presentation of bladder cancer?
Painless hematuria
86
What tests are included in the workup for bladder cancer?
Urinanalysis and culture, IVP, cystoscopy with cytology and biopsy
87
What is stage 0 bladder cancer?
Superficial, carcinoma in situ
88
What is stage I bladder cancer?
Invades subepithelial connective tissue, no positive nodes, no metastases
89
What is stage II bladder cancer?
Invades superficial or deep muscularis propria, no positive nodes, no metastases
90
What is stage III bladder cancer?
Invades perivesical tissues, no positive nodes, no metastases
91
What is stage IV bladder cancer?
Positive nodal spread with distant metastases and/or invades abdominal pelvic wall
92
What is the treatment of stage 0 bladder cancer?
TURB and intravesical chemotherapy
93
What is the treatment of stage I bladder cancer?
TURB
94
What is the treatment of stage II and III bladder cancer?
Radical cystectomy, lymph node dissection, removal of prostate/uterus/ovaries/anterior vaginal wall, and urinary diversion (e.g. ileal conduit) +/- chemotherapy
95
What is the treatment of stage IV bladder cancer?
+/- cystectomy and systemic chemotherapy
96
What are the indications for partial cystectomy?
Superficial, isolated tumor, apical with 3-cm margin from any orifices
97
What is TURB?
TransUrethral Resection of the Bladder
98
If after a TURB the tumor occurs, then what?
Repeat TURB and intravesical chemotherapy (mitomycin C) or bacillus Calmette-Guerin
99
What is and how does bacillus Calmette-Guerin work?
Attenuated TB vaccine.
| Thought to work by immune response.
100
What is the incidence of prostate cancer?
Most common GU cancer.
| Most common carcinoma in men in the US.
101
What is the epidemiology of prostate cancer?
Present in 33% of men 70-79 years and 66% of men 80-89 years; more common in African Americans
102
What is the histology of prostate cancer?
Adenocarcinoma (95%)
103
What are the symptoms of prostate cancer?
Often asymptomatic.
Nodule found on routine DRE.
Usually begins in the periphery of the gland and moves centrally, thus obstructive symptoms occur late.
104
What percentage of patients have metastasis of prostate cancer at diagnosis?
40%
105
What are the common sites of metastasis of prostate cancer?
Osteoblastic bony lesions, lung, liver, adrenal glands
106
What provides lymphatic drainage of prostate?
Obturator and hypogastric nodes
107
What is the significance of Batson's plexus?
Spinal cord venous plexus.
| Route of isolated skull/brain metastasis.
108
What are the steps in early detection of prostate cancer?
1. Prostate-specific antigen (most sensitive and specific marker)
2. DRE
109
When should men get a PSA-level check?
Controversial:
1. All men > 50 years
2. > 40 years if first-degree family history or African American
110
What percentage of patients with prostate cancer will have an elevated PSA?
60%
111
What is the imaging test for prostate cancer?
TRUS
112
How is the diagnosis of prostate cancer made?
Transrectal biopsy
113
What is the Gleason score?
Histologic grades 2-10:
Low score: well-differentiated
High score: poorly-differentiated
114
What are the indications for transrectal biopsy with normal DRE?
PSA > 10 or abnormal TRUS
115
What is stage I prostate cancer?
Tumor involves < 50% of 1 lobe, no nodes, no metastases, PSA < 10, Gleason < 7
116
What is stage II prostate cancer?
Tumor within prostate, lobe < 50% but PSA > 10, or Gleason > 6, or > 50% of 1 lobe, no nodes, no metastases
117
What is stage III prostate cancer?
Tumor through prostate capsule or into seminal vesicles, no nodes, no metastases
118
What is stage IV prostate cancer?
Tumor extends into adjacent structures (other than seminal vesicles) or positive nodes or positive metastases
119
What does radical prostatectomy remove?
1. Prostate gland
2. Seminal vesicles
3. Ampullae of the vasa deferentia
120
What is androgen ablation therapy?
1. Bilateral ochiectomy or
| 2. LHRH agonists
121
How do LHRH agonists work?
Decrease LH release from pituitary, which then decreases testosterone production in the testes
122
What is the treatment for stage I prostate cancer?
Radical prostatectomy
123
What is the treatment for stage II prostate cancer?
Radical prostatectomy +/- lymph node dissection
124
What is the treatment for stage III prostate cancer?
Radiation therapy +/- androgen ablation
125
What is the treatment for stage IV prostate cancer?
Androgen ablation, radiation therapy
126
What is the medical treatment for systemic metastatic disease from prostate cancer?
Androgen ablation
127
What is the option for treatment in the early stage prostate cancer patient > 70 years with comorbidity?
Radiation therapy
128
What is benign prostatic hyperplasia?
Disease of elderly men in which the prostate gradually enlarges, creating symptoms of urinary outflow obstruction
129
What is the size of a normal prostate?
20-25 g
130
Where does BPH occur?
Periurethrally
131
What are the symptoms of BPH?
Obstructive-type symptoms (e.g. hesitancy, weak stream, nocturia, intermittency, UTI, urinary retention)
132
How is the diagnosis of BPH made?
History, DRE, elevated PVR, UA, cystoscopy, U/S
133
What lab tests should be performed for BPH?
UA, PSA, BUN, Cr
134
What is the differential diagnosis of BPH?
Prostate cancer (biopsy); neurogenic bladder (history of neurologic disease); acute prostatitis (hot, tender gland); urethral stricture (RUG, history of STD); stone; UTI
135
What are the treatment options for BPH?
alpha-1 blockade, antiandrogens, TURP, TUIP, open prostate resection, transurethral balloon dilation
136
Why do alpha-adrenergic blockers work for BPH?
Relaxes sphincter and prostate capsule
137
What is finasteride (Proscar)?
5-alpha-reductase inhibitor.
Blocks transformation of testosterone to DHT.
May shrink and slow progression of BPH.
138
What is terazosin (Hytrin)?
alpha-blocker.
| May increase urine outflow by relaxing prostatic smooth muscles
139
What are the indications for surgery in BPH?
Urinary retention, hydronephrosis, UTIs, severe symptoms
140
What is TUIP?
TransUrethral Incision of Prostate
141
What percentage of tissue removed for BPH will have malignant tissue on histology?
Up to 10%
142
What are the possible complications of TURP?
Failure to void, bleeding, clot retention, UTI, incontinence
143
What is the incidence of testicular cancer?
Rare; 2-3/100,000 men per year
144
What is the most common solid tumor of men 20-40 years?
Testicular cancer
145
What are the risk factors for testicular cancer?
Cryptorchidism
146
Does orchiopexy as an adult remove the risk of testicular cancer?
No
147
What are the symptoms of testicular cancer?
Painless mass, swelling, firmness of testicle
148
What percentage of patients with testicular cancer present with an acute hydrocele?
10%
149
What percentage of patients with testicular cancer present with symptoms of metastatic disease (e.g. back pain, anorexia)?
10%
150
What are the classifications of testicular cancer?
Germ cell tumors (seminomatous, non-seminomatous, teratoma, mixed, choriocarcinoma); Non-germinal (Leydig cell, Sertoli cell, gonadoblastoma)
151
What is the major classification of testicular cancer based on therapy?
Seminomatous and non-seminomatous
152
What are the tumor markers for testicular tumors?
1. B-HCG
| 2. AFP
153
What are the tumor markers by tumor type?
B-HCG: choriocarcinoma, embryonal carcinoma, seminomatous carcinoma
AFT: embryonal carcinoma, yolk sac tumors, non-seminomatous carcinoma
154
What is the difference between seminomatous and non-seminomatous germ cell testicular tumor markers?
Non-seminomatous: 90% have positive AFP and/or B-HCG.
| Seminomatous: 10% are AFP positive.
155
Which testicular tumors almost never have an elevated AFP?
Choriocarcinoma and seminoma
156
In which testicular tumor is B-HCG almost always found elevated?
Choriocarcinoma
157
How often is B-HCG elevated in patients with pure seminoma?
10%
158
How often is B-HCG elevated with nonseminoma?
65%
159
What other testicular tumor markers may be elevated and useful for recurrence surveillance?
LDH, CEA, HCS, GGT, PLAP
160
What are the steps in workup for testicular cancer?
PE, scrotal U/S, check tumor markers, CXR, CT
161
What is stage I testicular cancer?
Any tumor size, no nodes, no metastases
162
What is stage II testicular cancer?
Positive nodes, no metastases, any tumor
163
What is stage III testicular cancer?
Distant metastases
164
What is the initial treatment for all testicular tumors?
Inguinal orchiectomy (removal of testicle through a groin incision)
165
What is the treatment of stage I and II seminoma?
Inguinal orchiectomy and radiation to retroperitoneal nodal basins
166
What is the treatment of stage III seminoma?
Orchiectomy and chemotherapy
167
What is the treatment of stage I and II nonseminoma?
Orchiectomy and retroperitoneal lymph node dissection vs. close followup for retroperitoneal nodal involvement
168
What is the treatment of stage III nonseminoma?
Orchiectomy and chemotherapy
169
What percentage of stage I seminomas are cured after treatment?
95%
170
Which type of testicular cancer is most radiosensitive?
Seminoma
171
Why not remove testis with cancer through a scrotal incision?
Could result in tumor seeding of the scrotum
172
What is the major side effect of retroperitoneal lymph node dissection?
Erectile dysfunction
173
What is testicular torsion?
Twisting of the spermatic cord, resulting in venous outflow obstruction, and subsequent arterial occlusion, leading to infarction of the testicle
174
What is the classic history of testicular torsion?
Acute onset of scrotal pain usually after vigorous activity or minor trauma
175
What is a bell-clapper deformity?
Bilateral non-attachment of the testicles by the gubernaculum to the scrotum
176
What are the symptoms of testicular torsion?
Pain in the scrotum, suprapubic pain
177
What are the signs of testicular torsion?
Very tender, swollen, elevated testicle, non-illumination, absence of cremasteric reflex
178
What is the differential diagnosis of testicular torsion?
Testicular trauma, inguinal hernia, epididymitis, appendage torsion
179
How is the diagnosis of testicular torsion made?
Surgical exploration, U/S (solid mass) and Doppler flow study, cold Tc-99m scan
180
What is the treatment for testicular torsion?
Surgical detorsion and bilateral orchiopexy to the scrotum
181
How much time is available from the onset of symptoms to detorse the testicle?
< 6 hours will bring about the best results
182
What are the chances of testicle salvage after 24 hours of torsion?
< 10%
183
What are the signs and symptoms of epididymitis?
Swollen, tender testicle, dysuria, scrotal pain, fever, chills, scrotal mass
184
What is the cause of epididymitis?
Bacteria from the urethra
185
What are the common pathogens of epididymitis in elderly patients and children?
E. coli
186
What are the common pathogens of epididymitis in young men?
Gonorrhea, chlamydia
187
What is the major differential diagnosis for epididymitis?
Testicular torsion
188
What is the workup for epididymitis?
U/A, urine culture, swab if STD suspected, +/- U/S with Doppler or nuclear study to rule out torsion
189
What is the treatment for epididymitis?
Antibiotics
190
What are the causes of priapism?
```
Low flow (e.g. leukemia, drugs, sickle-cell disease, erectile dysfunction treatment gone wrong)
High flow (e.g. pudendal artery fistula, usually from trauma)
```
191
What is the first-line treatment for priapism?
1. Aspiration of blood from corporus cavernosum
| 2. alpha-adrenergic agent
192
What are the 6 major causes of erectile dysfunction?
1. Vascular (decreased blood flow or lead of blood from the corpus cavernosus)
2. Endocrine (low T)
3. Anatomic (structural abnormality of the erectile apparatus, e.g. Peyronie's disease)
4. Neurologic (damage to nerves, e.g. post-operative, IDDM)
5. Medications (clonidine)
6. Psychologic (performance anxiety)
193
What lab tests should be performed for erectile dysfunction?
Fasting glucose (rule out diabetic neuropathy); serum testosterone; serum prolactin
194
What is the incidence of calculus disease?
10%
195
What are the risk factors for calculus disease?
Poor fluid intake, IBD, hypercalcemia, renal tubular acidosis, small bowel bypass
196
What are the 4 types of stones?
1. Calcium oxalate/phosphate (secondary to hypercalcemia)
2. Struvite, MgAmPh (infection stones; seen in UTI with urea-splitting bacteria; may cause staghorn calculi; high urine pH)
3. Uric acid (stones are radiolucent, seen in gout, Lesch-Nyhan, chronic diarrhea, cancer, low urine pH)
4. Cystine (genetic predisposition)
197
What type of stones are not seen on AXR?
Uric acid
198
What stone is associated with UTIs?
Struvite
199
What stones are seen in IBD and bowel bypass?
Calcium oxalate
200
What are the symptoms of calculus disease?
Severe pain (patient cannot sit still); renal colic (typically pain in the kidney/ureter that radiates to the testis or penis); hematuria
201
What are the classic findings with calculus disease?
Flank pain, stone on AXR, hematuria
202
How is the diagnosis of calculus disease made?
KUB, IVP, U/A and culture, BUN/Cr, CBC
203
What is the significance of hematuria and pyuria?
Stone with concomitant infection
204
What is the treatment for calculus disease?
Narcotics for pain, vigorous hydration, observation.
Further options: ESWL (lithotripsy), ureteroscopy, percutaneous lithotripsy, open surgery, metabolic workup for recurrence
205
What are the indications for intervention in calculus disease?
Urinary tract obstruction, persistant infection, impaired renal function
206
What are the contraindications of outpatient treatment of calculus disease?
Pregnancy, diabetes, obstruction, severe dehydration, severe pain, urosepsis/fever, pyelonephritis, previous urologic surgery, only one functioning kidney
207
What are the 3 common sites of obstruction in calculus disease?
1. UPJ (UreteroPelvic Junction)
2. UVJ (UreteroVesicular Junction)
3. Intersection of the ureter and the iliac vessels
208
What are the common types of incontinence?
Stress, overflow, urge
209
What is stress incontinence?
Loss of urine associated with coughing, lifting, exercise, etc.
Seen most often in women, secondary to relaxation of pelvic floor following multiple deliveries.
210
What is overflow incontinence?
Failure of the bladder to empty properly.
| May be caused by bladder outlet obstruction (BPH or stricture) or detrusor hypotonicity.
211
What is urge incontinence?
Loss of urine secondary to detrusor instability in patients with stroke, dementia, Parkinson's disease, etc.
212
What is mixed incontinence?
Stress and urge incontinence combined
213
How is the diagnosis of incontinence made?
H&P, U/A, PVR, urodynamics, cystoscopy or VCUG may be necessary
214
What is the Marshall test?
Women with stress incontinence placed in the lithotomy position with a full bladder leaks urine when asked to cough
215
What is the treatment for stress incontinence?
Bladder neck suspension
216
What is the treatment for urge incontinence?
Anticholinergics, alpha-agonists
217
What is the treatment for overflow incontinence?
Self-catheterization, surgical relief of obstruction, alpha-blockers
218
What is the etiology of UTI?
Ascending infection, instrumentation, coitus in females
219
What are the 3 common pathogens in UTI?
1. E. coli
2. Proteus
3. Klebsiella, Pseudomonas
220
What are the predisposing factors for UTI?
Stones, obstruction, reflux, diabetes, pregnancy, indwelling catheter or stent
221
What are the symptoms of UTI?
Lower UTI: frequency, urgency, dysuria, nocturia
| Upper UTI: back or flank pain, fever, chills
222
How is the diagnosis of UTI made?
Symptoms, U/A (> 10 WBCs/HPF)
223
When should workup be performed for UTI?
After first infection in male patients (unless Foley in place).
After first pyelonephritis in prepubescent females.
224
What is the treatment for UTI?
Lower: 1-4 days of oral antibiotics
Upper: 3-7 days of IV antibiotics
225
Why should orchiopexy be performed?
Decrease the susceptibility to blunt trauma; increase the ease of followup exams
226
What type of bony lesions is seen in metastatic prostate cancer?
Osteoblastic (radiopaque)
227
What percentage of renal cell carcinoma show evidence of metastatic disease at presentation?
33%
228
What is the most common site of distant metastasis in renal cell carcinoma?
Lung
229
What is the most common solid renal tumor in children?
Wilms' tumor
230
What are posterior urethral valves?
Most common obstructive urethral lesion in infants and newborns.
Occurs only in males, found at the distal prostatic urethra.
231
What is the most common intraoperative bladder tumor?
Foley catheter
232
What provides drainage of the left gonadal vein?
Left renal vein
233
What provides drainage of the right gonadal vein?
IVC
234
What are the signs of urethral injury in the trauma patient?
High-riding, ballottable prostate, blood at the urethral meatus, severe pelvic fracture, ecchymosis of scrotum
235
What is the evaluation for urethral injury in the trauma patient?
RUG
236
What is the evaluation for a transected ureter intraoperatively?
IV indigo carmine and then look for leak of blue urine in the operative field
237
What aid is used to help identify the ureters in a previously radiated retroperitoneum?
Ureteral stents
238
How can a small traumatic extraperitoneal bladder rupture be treated?
Foley catheter
239
How should a traumatic intraperitoneal bladder rupture be treated?
Operative repair
240
What percentage of patients with an injured ureter will have no blood on U/A?
33%
241
What is the classic history of papillary necrosis?
Patient with diabetes taking NSAIDs or patient with sickle cell trait
242
What unique bleeding problem can be seen with prostate surgery?
Release of TPA and urokinase (treat with e-aminocaproic acid)
243
What is the scrotal blue dot sign?
Torsed appendix testis
244
What is Peyronie's disease?
Curved penile orientation with erection due to fibrosis of corpora cavernosa
245
What is a ureterocele?
Dilation of the ureter (treat with endoscopic incision or operative excision)
246
What is "three-way" irrigating Foley catheter?
Foley catheter that irrigates and then drains
