Urology Flashcards
ED summary
Def: failure to achieve or maintain a penile erection suitable for sexual intercourse
Txt: Non Pharm: Lifestyle changes psychotherapy Vacuum erection device Surgical
Pharm:
Phophodiesterase Type 5 Inhibitors
- Avanafil (Stendra) 100 mg po 30 min prior sex
- Sildenafil (Viagra) 50 mg po 60 min prior sex
- Vardenafil (Levitra) 10 mg po 60 min prior sex
- Tadalafil (Cilalis) 10 mg po 30 min prior sex
Alprostadil
Testosterone
BPH (Benign Prostatic Hyperplasia) summary
Def: nonmalignant enlargement prostate
SS:
Difficulty voiding
Eval: Mild - asymptomatic - urinary flow rate 25 - 50 mL - BUN and SCr increased Moderate - Mild symptoms and obstructive/irritative voiding symptoms Severe - Moderate symptoms and complications of BPH
Txt: Mild - watchful waiting Moderate - Pharm - alpha1 blockers (terazosin) - alpha1a blockers - 5 alpha-reductase inhibitor (finasteride) - PDE5 inhibitor - Herbals Severe - Surgery
Urinary Incontinence Summary
Def: Involuntary loss of urine
SS:
Urge Incontinence (bladder overactive)
stress incontinence (urethral underactive)
overflow incontinence (urge or stress)
functional incontinence (not bladder or urethral related)
Mixed
Txt: NonPharm - bladder training (Urge) - result in higher improvemtn rate than the the use of anticholinergic medications - bladder control strategies - pelvic muscle training (stress); Kegel exercises work best in mild cases of stress inconctinence - fluid management -surgery (stress)
Pharm: Urge - anticholinergic - oxybuynin - TCA - topical estrogen - Beta-3 agonist Stress - Duloxetine - alpha-adrenergic agonist - Topical estrogen - Imipramine Overflow - cholinomimetics
Urinary Tract Infection Summary
Def: infection/inflammation of lower urinary tract
Cause: Serratia E coli (MC) Enterobacter Klebsiella Proteus Pseudomonas
SS: Frequency Urgency Dysuria suprapubic pain Hematuria Odiferous urine
Eval: History Urinanalysis Preg test Xrays - usually not done
Txt: antibiotics - uncomplicated TMP/SMX 1 DS po bid x 3 days or ciproflaxin 250 mg bid - comp/preg TMP/SMX 1 DS po bid x 7 days - STD Azithromycin 1 gm po x 1 and Doxycycline 100 mg po bid x 7 days - male TMP/SMX 1 DS po bid 10-14 days OTC Fluids
urethritis summary
Def: sexually transmitted infection in men
Cause: Gonorrhea Chlamydia (MC) Trichomonas HSV
SS:
dysuria
discharge
Eval:
Urethral swab
first void urine
Txt:
abx
partner txt
hydrocele
def: fluid filled sac surrounding a testicle that results in swelling of the scrotum
S/s:
painless
cremasteric reflex intact
tx:
observation
surgical
varicocele
def: abnormal dilation of a vein within the spermatic cord “bag of worms”
s/s:
painless
tx:
surgery to relieve sx
epididymitis
def: inflamm of the epididymis
s/s: painful palpation of the epididymis swelling positive Prehn sign (pain is relieved with elevation) cremasteric reflex intact
Eval:
radionuclide scan is most accurate imaging study for dgx
Tx:
TMP/SMX
ciprofloxacin
Orchitis
def: acute inflamm of the the testes and is uncommon
s/s:
inflamm
may have systemic infection (mumps is MC)
local extension of epididymitis
Tx: elevation support hot/cold packs abx anti-inflamm
crytochordism
S/s: undescended testes
tx:
surgically corrected > one year of age
prostatitis
inflamm of the prostate
tx:
abx (250 mg IM x 1)
alpha-blockers
balanitis
inflamm of the glans penis
s/s:
inflam
smegma
angioedema
tx:
circumcision prevents recurrances
acid base balance
PCO2:
- Less than 40 mmHg = RESP ALKALOSIS (hyperventilating)
- Greater than 44 mmHg = RESP ACIDOSIS (not breathing enough)
Look at bicarbonate
- greater than 25 mEq = MET ALKALOSIS
- less than 25 mEq = MET ACIDOSIS
What acid base combination is never possible
Resp acidosis and resp alkalosis
What are urine culture recommendations
complicated cystitis or pyelonephritis - before abx - +/- 2 weeks after tx finished cystitis clinical failure - 2 weeks after retxt finished cystitis preg - before abx - 1-2 weeks after
