Urology Flashcards
What is the name of the fascia that surrounds the kidney?
Gerota’s fascia
What is the relationship of the renal vessels from anterior to posterior?
From anterior to posterior, renal vein, renal artery, and renal pelvis
What is the relationship of the right renal artery to the IVC?
The right renal artery crosses posterior to IVC
What is the relationship of the left renal vein to the aorta?
The left renal vein is anterior to the aorta
What is the relationship of the ureters to the iliac vessels?
The ureters cross over the iliac vessels
Which renal vein can be ligated and why?
The left renal vein because it has increased collaterals (left adrenal vein, left gonadal vein, and left ascending lumbar vein)
What are the spermatic cord structures?
Testicular artery, pampiniform plexus, vas deferens , cremasteric muscle, genital branch of the genitofemoral nerve
What is the most common cause of acute renal insufficiency following surgery?
Hypotension
What are the symptoms of kidney stones?
Severe colicky pain, restlessness, hematuria
What scan should you get if you suspect kidney stones?
CT scan—can demonstrate stones and associated hydronephrosis
What are the most common kidney stones?
Calcium oxalate stones (75%)
What patients are prone to calcium oxalate kidney stones?
Patients with terminal ileum resection due to increase oxalate absorption in the colon
What are struvite stones and what causes them?
Made of magnesium ammonium phosphate. Occurs with infections that are urease producing (Proteus)
What type of kidney stones are radiopaque?
Calcium oxalate and struvite stones
What patients are at risk for Uric acid stones?
Patients with ileostomies, gout, and myeloproliferative disorders
What type of kidney stones are radiolucent?
Uric acid stones and cysteine stones
What patients are at risk for cysteine stones?
Associated with congenital disorders in the reabsorption of cysteine (cystinuria)
How can you prevent cysteine stones?
Give tiopronin
What are the surgical indications for kidney stones?
Intractable pain or infection
Progressive obstruction
Progressive renal damage
Solitary kidney
What percentage of kidney stones are opaque?
90%
At what kidney stone size is it unlikely to pass?
> 6 mm
What are the treatment options for kidney stones?
Extra-corporeal shock wave lithotripsy, ureteroscopy with stone extraction or placement of stent past obstruction, percutaneous nephrostomy tube, open nephrolithotomy
What is the number 1 cancer killer in men 25-35?
Testicular cancer
What symptoms are present in testicular cancer?
Painless hard mass
Are most testicular masses are malignant or benign?
Malignant
What lab marker correlates with tumor bulk?
LDH
90% of all testicular cancers are of what type?
Seminoma or nonseminoma
What increases the risk of testicular cancer?
Cryptorchidism (undescended testes)
What is the number one testicular tumor?
Seminoma
What other lab values should you check in patients with suspected or confirmed testicular cancer?
B-hCG and AFP
What lab values are increased in seminomatous tumors?
B-hCG
NOT AFP. If AFP is elevated, must treat like non-seminomatous
What is the treatment for seminomatous testicular cancer?
Orchiectomy and retroperitoneal radiation
Complete surgical resection of residual disease after radiation and chemo
When is chemo used in testicular cancer?
For metastatic disease and bulky retroperitoneal disease
What types of non-seminomatous testicular CA are there?
Embryonal, teratoma, choriocarcinoma, yolk sac
What lab results are often increased in non-seminomatous testicular cancer?
Alpha fetoprotein and beta-hCG
What kind of tumors are more likely to metastasize to the retroperitoneum?
Tumors with increased teratoma components
What is the treatment for nonseminomatous testicular cancer?
All stages get orchiectomy and retroperitoneal node dissection. If stage II or greater, give chemo. Surgical resection fo residual disease after above.
What is the most common site of prostate cancer?
Posterior lobe
What is the most common site of metastasis in prostate cancer?
Bone
What kind of bone metastasis is often seen in prostate cancer? What is often seen on imaging?
Osteoblasts. Seen as hyper dense areas on x-rays
What are some complications of surgery for prostate cancer?
Patients can become impotent, incontinent, and can develop urethral strictures
How is the diagnosis of prostate cancer made?
By trasrectal biopsy, chest/abdomen, pelvis CT, PSA, alkaline phosphatase, and possible bone scan
