Urology Flashcards
T/F: Fever and pyuria are seen in testicular torsion.
False! But it is seen in epididymitis
T/F: Unlike in testicular torsion, the cord is tender in epididymitis
True
How is epididymitis treated?
Antibiotics; possibly a sonogram to rule out testicular torsion
Patient allowed to pass a stone spontaneously suddenly develops chills, fever spike to 104/105, and flank pain:
Next step?
Ureteral obstruction!
Treat with IV antibiotics and immediate decompresion of the urinary tract (with ureteral stent or percutaneous nephrostomy)
IVP is contraindicated with patients who have Cr of
> 2
Only __________ can look at hte bladder mucosa in detail and aid in detecting early bladder cancers
cystography
What imaging modality is used to look for dilation of ureters or kidneys?
ultrasound
What imaging modality is good for looking at renal tumors?
CT
Old man with chills, fever, dysuria, urinary frequency, diffuse low back pain, and an exquisitely tender prostate on rectal exam:
acute bacterial prostatitis. Treat with IV abx and don’t repeat any more rectal exams (could lead to septic shock)
What is the most common reason a newborn boy is not urinating during his first day of life? How do you assess?
Posterior urethral valves (meatal stenosis should also be looked for)
Catheterization should be done, as well as voiding cystourethrogram for diagnosis and endoscopic fulguration (electrical dissection) or resection will get rid of them
Why should circumcision not be performed on a child with hypospadias?
Precupice will be needed for plastic reconstruction that will eventually be done
T/F: UTI in children should always lead to urologic work up
True.. (?); VUR may be reason or another congenital anomaly
T/F: IF vesicoureteral reflex is found following IVP and voiding cystogram, child should be kept on IV abx until they “grow out of the problem”
True
Little girl who voids normally at appropriate intervals but is also wet with urine all the time:
Low implantation of a ureter (other ureter deposits urine into bladder normally). Physical exam may reveal, or IVP may be needed. Corrective surgery is needed
Adolescent who goes on beer-drinking binge for first time in life and has colicky flank pain:
ureteropelvic junction obstruction (anomaly at UPJ allows normal urinary output to flow without difficulty, but a large diuresis cannot be accomodated)
What is the workup of hematuria?
CT (kidney cancer) and cystoscopy (bladder cancer)
What are the 3 cardinal signs of renal cell carcinoma?
1) Flank pain
2) Hematuria
3) Flank mass
What are lab abnormalities caused by renal cell carcinoma?
Hypercalcemia, erythrocytosis, and elevated liver enzymes
What does renal cell carcinoma look like on CT?
Solid homogenous mass (may be growing into IVC or renal vein)
T/F: Transitional cell cancer of the bladder has a stronger association with smoking than lung cancer.
True
T/F: Lifelong follow-up is a necessity for bladder cancer.
True, though surgery and intravesical chemo (BCG) have therapeutic roles, bladder cancer has a high rate of local recurrence
WIdespread bone metastases from prostatic cancer respond to what?
Androgen ablation, either surgical (orchiectomy) or medical (LH releasing-hormone agonists, like leuprolide, or anti-androgens like flutamide (note: anti-androgens may be given in the beginning with LHRH agonists to prevent flare))
Even with all of its contingencies, what is considered a normal PSA?
4 mg/dL or below
Because benign testicular tumors are virtually nonexistent, the presence of a testicular mass will always require a radical orchiectomy by the _________ route.
Inguinal
Why is urinary retention in men with BPH often precipitated during a cold?
1) use of antihistamines and nasal drops
2) abundant fluid intake
What are choices for long-term therapy for BPH?
1) alpha blockers
2) 5-Alpha-reductase inhibitors (finasteride) are used for very large glands (over 40g). FInasteride is also used for androgenic hair loss
This drug prevents conversion of testosterone into the more potent DHT.
finasteride (or other 5-alpha reductase inhibitors)
Kidney stones greater than ______ require intervention since they do not likely pass spontaneously.
5mm
In which patients can ESWL (extracorporeal shock-wave lithotripsy) not be performed?
Pregnant women
Bleeding diathesis
stones that are several cm large
Pneumaturia is almost always caused by
fistulization between the bladder and the GI tract, most commonly the sigmoid colon
Fistulization between the bladder and the GI tract (most commonly the sigmoid colon) is most commonly caused by
diverticulitis
second possibility is cancer of the sigmoid and cancer of the bladder is a “very distant third”
What is the workup of pneumaturia?
1) CT to look for inflammatory diverticular mass
2) sigmoidoscopy to rule out cancer
surgical therapy is required
Characterize psychogenic impotence. What is the treatment?
Sudden onset, is partner- or situation-specific, does not interfere with nocturanl erections, and is effectively treated with only psychotherapy if done promptly
T/F: Organic impotence can also be sudden-onset.
True! If it is caused by trauma (such as after pelvic surgery, because of nerve damage, or after trauma to the perineum, which involves arterial disruption)
Organic impotence because of chronic diseases (like ________) has very gradual onset, going from erections not lasting long enough, to being of poor quality, to not happening at all.
diabetes, arteriosclerosis
What are the different therapeutic options for incontinence?
1) sildenafil, tadalafil, vardenafil (cGMP PDE5 inhibitors)
2) vascular surgery (for those with arterial injury)
3) suction devices (everybody)
* *not really 4) prosthetic implants (irreversible and fraught with complications)
