Urology Flashcards
story: blunt trauma to kidney
see flank bruising + UA w/ hematuria. Get mechanism of injury, ABCDEs, CT to stage. Stage 1 = contusion/hematoma, Stage 5= shattered kidney with urinary extravasation. may be outpt or need angiography + embolization
bladder trauma
can be blunt or penetrating injury, person complains of tenderness and inability to pee. Issue is pelvic fracture = blood loss = hypotensive. Secure ABCS. UA shows blood, CT to assess urine estravasation. If contusion only - foley until hematuria gone. If worse, surgery.
Urethral injury
They need RUG ( retrograde urethrogram), always ?bladder rupture when urethra injured. Hx: shearing force = posterior urethra, Saddle injury = anterior urethra. ps: blood at urethral meatus. IX: RUG. Tx urethra rest - use foley or suprapubic tube.
phimosis
cant retract foreskin, mostly because the balantis is infected. Tx proper hygiene, dorsal slit, circumcision. complications = penile cancer ( its not good to have genitals inflamed all the time)
paraphimosis
EMERGENCY- skin stuck behind glans, can lead to ischemia. tx: with anasthesia, squeeze out the edema with manual pressure. PLace the skin back in position. Circumsize to prevent recurence.
priapism
4hrs + painful erection because corpus cavernosa filled with blood and squishing off venous outflow, but corpus spongiosum has no blood = ischemia! Defined as low flow ( ishemic) or high flow ( no ischemia). Tx of low flow is blood aspiration out of cavernosa, phenylephrine ( epi squeezes, gets blood flowing = no ischemia), or shunt ( poor sexual outcomes tho). :(
peyronie’s
penile shaft is best from dorsal fibrotic area giving painful erections/ penile shortening. 50% spontaneously resolve, can also give verapamil, surgery if significant deformity
DDX scrotal mass
varicocele ( bag of worms,ache by end of day)
Hydrocele- trasilluminates, not separable from testis, spermatocele ( illuminates, testis Seperatable in Spermatocele),
Orchitis/ Epididymitis- cremaster, positive Prehns sign
TORSION- absent cremasteric reflex, prehns
hernia- buldge that disappears when lying down, pain with straining
Types of hematuria ( pseudo, pre-renal, renal, post renal)
pseudo- vaginal bleeding, beets
prerenal - blood problems : sickle, coagulation defects, leukemia
Renal- Obstruction (stone, trauma, RCC), exercise induced, infex (pyelo, glomerulo)
post renal- obstruction ( stone, cancer, stricture), infxn (bladder/ urethra)
gross painless hematuria is?
Bladder cancer unless proven otherwise
common causes of hematuria: TICS
T- trauma, tumor
I- infxn
C- calculi/ cysts
S- surgery/ sickle ( blood things)
hematuria’s story
someone has blood in the beginning, middle, or end of their stream ( gross hematuria). You get CBC ( r/o blood things), BUN, Cr, Lytes, UA with C+S,/R+M. Get CT with contrast. in meantime clean out that bladder - foley + irrigation +/-embolize +/- 1% alum
high risk pt for hematuria?
male, smoker, occupational chemical exposure/ pelvic radiation , Hx of recurrent UTI
hydronephrosis story
this person, either from congential/ acquired or neurologic problems has urine going up to their kidneys and you can see the kidneys enlarged on ultrasound. ask about flank pain.
Dysuria
mostly UTI/ infectious, could also be stone ( kidney, ureteral or bladder), tumor ( renal cell, bladder, prostate,), BPH, trauma after cath. Make sure its not reactive arthritis ( arthritis, uveitis, urethritis) by asking about joint pain/ conjunctivitis. Check urine ( UA),give Abx (septra), image tract if needed ( upper = U/s), Lower = cystoscopy
