Urology

Question 1

adolescent boy complains of very severe pain of sudden onset in right testicle; the testes is swollen, very painful, high riding and has a horizontal lie; the cord is not tender - dx?

Answer 1

testicular torsion

Question 2

tx. of testicular torsion

Answer 2

emergency surgery followed by bilateral orchiopexy

Question 3

young, sexually active man presents with severe pain of recent onset in right scrotal contents; he has a high fever and pyuria. His testes are no normal position, but they are swollen and painful, the cord is also tender - dx?

Answer 3

acute epididymitis

Question 4

management of acute epididymitis

Answer 4

do USG to r/o torsion (to be safe)

antibiotic therapy

Question 5

pt is being observed for a ureteral stone expected to pass; he develops chills, a very high fever and flank pain - dx?

Answer 5

infection + obstruction = urologic emergency!

Question 6

tx. of urinary obstruction + infection

Answer 6

massive IV antibiotic therapy

stone extraction - if pt is septic, decompression w/ ureteral stent or percutaneous nephrostomy

Question 7

you have a man, child or febrile patient suspected of having a UTI - what do you do?

Answer 7

start work-up with USG

- these groups dont usually get UTIs

Question 8

62 yo man presents with chills, fever, dysuria, urinary frequency, diffuse low back pain and exquisitely tender prostate on rectal exam - dx?

Answer 8

acute bacterial prostatitis

Question 9

management of acute bacterial prostatitis

Answer 9

IV antibiotics

do not do any more DREs or vigorous prostate massage - can lead to septic shock

Question 10

otherwise healthy newborn boy has not urinated in first 24 hours of life; on exam he has a big, distended urinary bladder - what do you do?

Answer 10

likely due to obstruction

• first check meatus; if not, posterior urethral valves
• drain bladder with catheter

Question 11

how do you diagnose and tx posterior urethral valves?

Answer 11

dx. voiding cystourethrogram

tx. endoscopic fulguration or resection for tx

Question 12

newborn with urethral opening in ventral side of penis - management?

Answer 12

hypospadias

• do not do circumscision!
• surgical reconstruction eventually

Question 13

little girl is brought in because she perceives the sensations of having to void and voids normally but happens to be wet with urine all the time - dx and management?

Answer 13

low implantation of one ureter - into vagina

• symptoms only in girls
  dx. with IVP and tx. with surgery

Question 14

pt goes on a beer drinking binge for first time ever and shortly after develops colicky flank pain

Answer 14

ureteropelvic junction obstruction

- allows normal urine output w/o difficulty but if large diuresis, narrow opening cannot handle it

Question 15

where is the source with total hematuria?

Answer 15

kidney, ureter or bladder

Question 16

where is the source with initial or terminal hematuria?

Answer 16

bladder, prostate or urethra

Question 17

what are you concerned about with total hematuria in an older pt?

Answer 17

cancer - do CT scan and cystoscopy to R/o

Question 18

75 yo pt is referred for evaluation of hematuria, flank pain and a flank mass; he has hypercalcemia, erythrocytosis and elevated liver enzymes - dx? test?

Answer 18

dx. renal cell carcinoma

test - do a CT scan

Question 19

55 yo chronic smoker reports 3 instances of painless, gross total hematuria in part 2 months; he previously had irritative voiding symptoms and tx. for UTI. He is not febrile and urinary cultures are negative - dx?

Answer 19

bladder cancer

Question 20

dx of bladder cancer

Answer 20

CT scan first, then cystoscopy

Question 21

tx of bladder cancer

Answer 21

surgery
intravesical BCG
- very high rate of local recurrence

Question 22

dx. of prostate cancer

Answer 22

transrectal biopsy

CT scan to assess extent of spread/mets

Question 23

tx. of bone mets from prostate cancer

Answer 23

androgen ablation

• surgical (orchiectomy)
• LHRH agonists
• anti-androgens

Question 24

when is surveillance for prostate cancer usually stopped?

Answer 24

> age 75; however, if man is in good general health, may consider testing

Question 25

management approach to testicular cancer

Answer 25

USG confirms testicular mass
serum markers - AFP, bHCG (dont change next step)
radical inguinal orchiectomy
platinum-based chemotherapy

Question 26

tx. of acute urinary retention due to underlying BPH

Answer 26

indwelling bladder catheter for atleast 3 days

Question 27

tx. of renal colic due to 3 mm stone

Answer 27

watch and wait - will likely pass on its own

- pain meds, plenty of fluids

Question 28

tx. of large renal stones

Answer 28

shock wave lithotripsy

Question 29

contra-indications for shock wave lithotripsy

Answer 29

pregnancy
bleeding diathesis
stones that are several cm big

Question 30

pt presents bc he noticed bubbles of air coming out along with urine as he urinates; has has symptoms of mild cystitis - dx?

Answer 30

pneumaturia

• fistula between bowel and bladder
• MC from sigmoid colon to dome of bladder due to diverticulitis

Question 31

dx. study of choice in pneumaturia

Answer 31

CT scan

Question 32

impotence due to a crush injury of perineum

Answer 32

vascular injury

- vascular reconstruction may help

Question 33

impotence due to abdominoperineal resection of rectal cancer

Answer 33

nerve injury

Question 34

diabetic man with generalized arteriosclerotic occlusive disease notices gradual loss of erectile function; first they didnt last as long, then the quality was poor and now he is completely impotent

Answer 34

organic impotence

- tx. sildenafi