Urology Flashcards
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?
testicular torsion
tx. of testicular torsion
emergency surgery followed by bilateral orchiopexy
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?
acute epididymitis
management of acute epididymitis
do USG to r/o torsion (to be safe)
antibiotic therapy
pt is being observed for a ureteral stone expected to pass; he develops chills, a very high fever and flank pain - dx?
infection + obstruction = urologic emergency!
tx. of urinary obstruction + infection
massive IV antibiotic therapy
stone extraction - if pt is septic, decompression w/ ureteral stent or percutaneous nephrostomy
you have a man, child or febrile patient suspected of having a UTI - what do you do?
start work-up with USG
- these groups dont usually get UTIs
62 yo man presents with chills, fever, dysuria, urinary frequency, diffuse low back pain and exquisitely tender prostate on rectal exam - dx?
acute bacterial prostatitis
management of acute bacterial prostatitis
IV antibiotics
do not do any more DREs or vigorous prostate massage - can lead to septic shock
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?
likely due to obstruction
- first check meatus; if not, posterior urethral valves
- drain bladder with catheter
how do you diagnose and tx posterior urethral valves?
dx. voiding cystourethrogram
tx. endoscopic fulguration or resection for tx
newborn with urethral opening in ventral side of penis - management?
hypospadias
- do not do circumscision!
- surgical reconstruction eventually
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?
low implantation of one ureter - into vagina
- symptoms only in girls
dx. with IVP and tx. with surgery
pt goes on a beer drinking binge for first time ever and shortly after develops colicky flank pain
ureteropelvic junction obstruction
- allows normal urine output w/o difficulty but if large diuresis, narrow opening cannot handle it
where is the source with total hematuria?
kidney, ureter or bladder
where is the source with initial or terminal hematuria?
bladder, prostate or urethra
what are you concerned about with total hematuria in an older pt?
cancer - do CT scan and cystoscopy to R/o
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?
dx. renal cell carcinoma
test - do a CT scan
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?
bladder cancer
dx of bladder cancer
CT scan first, then cystoscopy
tx of bladder cancer
surgery
intravesical BCG
- very high rate of local recurrence
dx. of prostate cancer
transrectal biopsy
CT scan to assess extent of spread/mets
tx. of bone mets from prostate cancer
androgen ablation
- surgical (orchiectomy)
- LHRH agonists
- anti-androgens
when is surveillance for prostate cancer usually stopped?
> age 75; however, if man is in good general health, may consider testing
management approach to testicular cancer
USG confirms testicular mass
serum markers - AFP, bHCG (dont change next step)
radical inguinal orchiectomy
platinum-based chemotherapy
tx. of acute urinary retention due to underlying BPH
indwelling bladder catheter for atleast 3 days
tx. of renal colic due to 3 mm stone
watch and wait - will likely pass on its own
- pain meds, plenty of fluids
tx. of large renal stones
shock wave lithotripsy
contra-indications for shock wave lithotripsy
pregnancy
bleeding diathesis
stones that are several cm big
pt presents bc he noticed bubbles of air coming out along with urine as he urinates; has has symptoms of mild cystitis - dx?
pneumaturia
- fistula between bowel and bladder
- MC from sigmoid colon to dome of bladder due to diverticulitis
dx. study of choice in pneumaturia
CT scan
impotence due to a crush injury of perineum
vascular injury
- vascular reconstruction may help
impotence due to abdominoperineal resection of rectal cancer
nerve injury
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
organic impotence
- tx. sildenafi
