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Surgery: Pestana's > Urology > Flashcards

Urology Flashcards

1
Q

Severe, sudden testicular pain w/o fever, pyuria or hx of recent mumps

A

-Testicular torsion

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2
Q

What are the characteristics of testicular torsion?

A
  • Swollen testis, exquisitely tender
  • “High riding” and with “horizontal lie”
  • Cord is not tender
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3
Q

How is testicular torsion treated?

A
  • Urological emergency
  • Immediate surgical intervention
  • Orchiopexy done after the testis is untwisted
  • Some surgeons fix both testicles
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4
Q

What condition is commonly confused with testicular torsion?

A

-Acute epididymitis

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5
Q

How does Acute epididymitis present?

A

-In young men old enough to be sexually active
-Severe, sudden testicular pain
-Has fever and pyuria
-Testis is swollen and tender, but in the right position
-Cord is very tender
-

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6
Q

How is Acute epididymitis treated?

A
  • r/o testicular torsion

- antibiotics

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7
Q

What are the two main urologic emergency?

A
  • Testicular torsion

- Combination of obstruction and infection of the urinary tract

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8
Q

What is the most dire consequence of having both obstruction and infection of the urinary tract?

A

-Destruction of the kidney within hours and potential death from sepsis

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9
Q

How is the Combination of obstruction and infection of the urinary tract managed?

A
  • IV antibiotics

- Immediate decompression of urinary tract above the obstruction using the quickest and simplest means

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10
Q

Urinary frequency, painful urination with small volumes of cloudy and malodorous urine:

A

Urinary tract infection (UTI; cystitis)

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11
Q

In which patient are UTI’s most common?

A
  • Women of reproductive age

- Does not require elaborate workup

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12
Q

How are UTI’s managed?

A

-empiric antimicrobial therapy

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13
Q

What does an urologic workup consist of?

A
  • Sonogram to look for dilation/obstruction
  • CT used for renal tumors
  • Cystoscopy is the only way to look at the bladder mucosa in detail (to detect early cancers)
  • Intravenous Pyelogram (IVP) which is the gold standard, but only used when safer, cheaper tests have been done
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14
Q

What is an IVP? What is it good for? What are its limitations?

A
  • Intravenous Pyelogram
  • Good to view the kidney, collecting ducts, ureters and some of the bladder (does not detect early bladder cancer)
  • Provides good idea of function of the kidney, ureters and bladder
  • Limited by potential dye allergy, contraindications in patients with limited renal function (Cr>2)
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15
Q

A patients with chills, high fever, nausea and vomiting, and flank pain, most likely has:

A

-Pyelonephritis

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16
Q

How is pyelonephritis treated?

A
  • Hospitalization
  • IV antibiotics guided by cultures
  • Urologic workup
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17
Q

An elder male patient with chills, fever, dysuria, urinary frequency, diffused low back pain, and exquisitely tender prostate on rectal exam, most like has:

A

-Acute bacterial prostatitis

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18
Q

How is acute bacterial prostatitis treated?

A
  • IV antibiotics

- NO more rectal exams bc continuous prostatic massage can lead to septic shock

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19
Q

What is the most common reason for a new-born boy to NOT urinate during the first day of life?

A

-Posterior urethral valves (congenital)

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20
Q

How are posterior urethral valves managed?

A
  • r/o meatal stenosis
  • Catheterization to empty the bladder
  • Dx w voiding cystourethrogram
  • Tx w endoscopic fulguration/resection
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21
Q

In what patients should circumcision never be done? Why?

A
  • Patients with hypospadias (congenital)
  • Urethral opening in on dorsal side of the penis, between the tip and the base of the shaft.
  • The skin of the prepuce will be needed for the plastic reconstruction that will eventually be done
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22
Q

When should urologic workup always be done?

A

-In the case of UTIs in children since they may be caused by vesicouretereal reflux, or another congenital abnormality

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23
Q

A child having burning with urination, urinary frequency, low abdominal and perineal pain, flank pain, and fever and chills, most like has:

A

-Vesicoureteral reflux and infection

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24
Q

How is a vesicoureteral reflux and infection in a child managed?

A
  • Tx infection with antibiotics (empiric, then culture guided)
  • Do IVP and voiding cystogram to look for reflux
  • Long term abx are used until the child “grows out of the problem”
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25
Q

How does low implantation of the ureter present in little boys? Little girls?

A
  • It is usually asymptomatic in little boys
  • In little girls there is normal void at appropriate intervals, but the girls is wet with urine all the time bc of urine that drips into the vagina
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26
Q

How is a low implanted ureter managed in a little girl?

A
  • IVP is used for dx

- Corrective surgery is done

27
Q

An adolescent that goes on a beer-drinking binge for the first time and develops colicky flank pain, most likely las?

A

-Ureteropelvic junction (UPJ) obstruction

28
Q

What is the cause of the sx in a UPJ obstruction?

A

-The UPJ allows normal urine output to flow without difficulty, but when a larger diuresis occurs, the narrow area cannot handle it and causes backup

29
Q

What is the most common cause of hematuria?

A

-Most cases are caused by benign disease

30
Q

What is the most common presentation for cancers of the kidney , ureter, or bladder?

A
  • Hematuria

- although mostly benign, all patients with hematuria (excepts after urologic trauma) need to have cancer workup

31
Q

What si the workup for hematuria?

A
  • CT scan first

- Cystoscopy (only reliable way to r/o bladder cancer)

32
Q

A patients that presents with hematuria, flank pain, and flank mass, most likely has:

A

-Renal cell carcinoma

33
Q

What other sx can be seen in Renal Cell Carcinoma?

A

-Hypercalcemia, erythrocytosis, elevated liver enzymes

34
Q

What is the best imaging method for Renal Cell carcinoma? How does it look like?

A
  • CT scan

- Heterogenic solid tumor (w potential growth into the renal vein and vena cava

35
Q

What is the treatment of Renal Cell carcinoma?

A

-Surgery is the only effective therapy

36
Q

Which is the most common type of bladder cancer?

A

-Transitional cell cancer

37
Q

What is the usual presentation of bladder cancer?

A
  • Hematuria

- Sometimes w irritative void sx that may lead to tx w antibiotic for a UTI (despite negative cultures and no fever)

38
Q

Which is the best way to diagnose bladder cancer?

A

-Cystoscopy (But CT should be done first)

39
Q

How is bladder cancer treated?

A
  • Surgery
  • Intravesical Bacillus Calmette-Guerin (BCG) therapy
  • Close f/u d/t high rate of recurrence
40
Q

What are the sx of prostate cancer?

A

-Mostly asymptomatic

41
Q

What is the relationship between prostate cancer and age?

A

-Incidence increases with age

42
Q

How is prostate cancer diagnosed?

A
  • Rectal exam showing a rock-hard discrete nodule
  • Elevated prostatic specific antigen (PSA) for age group
  • Transrectal needle biopsy
  • CT helps assess extent and choose therapy
43
Q

How is prostate cancer treated?

A
  • Surgery and/or radiation
  • Widespread bone metastasis responds to androgen ablation (orchiectomy, LH-releasing hormone agonist or antiandrogens like flutamide)
44
Q

How does testicular cancer present?

A

-Painless testicular mass in young men

45
Q

How is testicular cancer managed?

A
  • Bc testicular tumors are most likely malignant a biopsy is done w a radical orchiectomy by the inguinal route
  • Pre-op and post-op levels of AFP and bHCG are used for f/u
  • Further lymph node dissection may be done int he future
46
Q

How is advanced, metastatic testicular cancer managed?

A

–Platinum-based chemotherapy may be used since most testicular cancers are very sensitive to radiation and chemo

47
Q

Which urologic cancer is most strongly associated with smoking?

A

-Bladder cancer (even more so than lung cancer)

48
Q

In which patients is acute urinary retention most commonly seen?

A
  • Men with significant symptoms of BPH

- Often precipitated during a cold by the use of antihistamines and nasal drops and abundant intake of fluids

49
Q

What are the sx of acute urinary retention?

A

-Patients wants to void but can’t and the huge distended bladder is palpable

50
Q

How is acute urinary retention managed?

A
  • Indwelling bladder catheter placed and left for at least 3 days
  • Long temp tx w alpha-blockers
  • 5-alpha-reductase inhibitors are used for very large glands (>40g)
  • Transurethral resection of the prostate (TURP) is rarely done
51
Q

What is post-op urinary retention? How is it managed?

A
  • Very common
  • masquerades as incontinence
  • Patient does not feel the need to void bc of post-op pain, medication, etc.
  • There are involuntary release of small amounts of urine from time to time
  • A huge distended bladder is palpable (overflow incontinence from retention)
  • An indwelling bladder catheter is needed
52
Q

In which patients is stress incontinence most commonly seen

A

-Middle-age women who have had many pregnancies and vaginal deliveries

53
Q

How does stress incontinence present?

A
  • Leakage of small amounts of urine after increases in intraabdominal pressure such as sneezing, laughing, standing up, lifting or coughing
  • No incontinence during the night
  • Weak pelvic floor with prolapsed bladder neck outside the “high pressure” abdominal area
54
Q

-How is stress incontinence managed?

A
  • Surgical repair of pelvic floor in cases with large cystoceles
  • Pelvic floor exercises may be sufficient for early cases
55
Q

What causes colicky flank pain w irradiation to the inner thigh and labia/scrotum, sometimes accompanied by nausea and vomiting?

A

-Passage of ureteral stones

56
Q

Most stones are visible in which type of imaging?

A

-CT

57
Q

How are small (<3mm) stones at ureterovesical junction managed?

A
  • 70% chances of passing spontaneously

- Analgesics, fluids and watchful waiting

58
Q

How are large (>7mm) stone at the ureteropelvic junction managed?

A
  • 5% chances of passing spontaneously
  • Extracorporeal shock-wave lithotripsy (ESWL)
  • Basket extraction, sonic proves, laser beams and open surgery may be done in patients in which ESWL is contraindicated (pregnant, bleeding diathesis, stones several centimeters large)
59
Q

What are the most common causes of pneumaturia?

A
  1. Most commonly d/t fistula between bladder and GI tract, especially the sigmoid colon d/t diverticulitis
  2. Cancer of the sigmoid colon
  3. Cancer of the bladder (distant 3rd)
60
Q

What is the workup for pneumaturia? How is it managed?

A
  • CT first to look for diverticulitis
  • Sigmoidoscopy to r/o cancer
  • Surgical therapy is required
61
Q

What are the 2 types of impotence?

A
  • Organic

- Psychogenic

62
Q

What are the characteristic of psychogenic impotence?

A
  • Sudden onset
  • Partner/situation specific
  • Does not interfere with nocturnal erections
  • Effectively tx with psychotherapy only if done promptly
63
Q

What are the characteristic of organic impotence?

A
  • Sudden onset if caused by trauma (pelvic surgery, arterial disruption)
  • Gradual onset if caused by chronic disease (atherosclerosis, diabetes): from erection not lasting long enough to being poor quality, to not happening at all
  • Includes absence of nocturnal erections
  • First choices for tx are Sildenafil, tadalafil, vardenafil
  • Vascular surgery, suction devices and prosthetic implants are also available as therapy
64
Q

What is a varicocele? What causes it?…physical exam maneuver to make it bigger?

A

Tortuous dilation of pampinifotm plexus of veins surrounding spermatic cord and testis in scrotum…caused by incompetent valves of testicular veins….valsalva makes it bigger

Surgery: Pestana's (13 decks)

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