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My Surgical Recall > Urology > Flashcards

Urology Flashcards

1
Q

Perc nephrostomy

A

catheter placed through skin into kidney pelvis to drain urine with distal obstruction, etc.

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2
Q

RUG

A

retrograde UrethroGram (dye injected into the urethra and films taken; rules out urethral injury, usually in trauma patients)

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3
Q

Gomco Clamp

A

clamp used for circumcision; protects penis glans

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4
Q

Bell clapper’s deformity

A

condition of congenital absence of gubernaculum attachment to scrotum

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5
Q

Fournier’s gangrene

A

Extensive tissue necrosis/infection of the perineum in patients with diabetes

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6
Q

Coude catheter

A

Basically a foley catheter with hook on the end to get around a large prostate

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7
Q

Posthitis

A

foreskin infection

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8
Q

hydrocele

A

clear fluid in the processus vaginalis

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9
Q

communicating hydrocele

A

hydrocele that communicates with peritoneal cavity and, thus, gets smaller and larger as fluid drains and then reaccumulates

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10
Q

Noncommunicating hydrocele

A

hydrocele that does not communicate with the peritoneal cavity; hydrocele remains the same size

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11
Q

varicocele

A

abnomal dilation of the pampiniform plexus to the spermatic vein in the spermatic cord; described as a bag of worms

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12
Q

spermatocele

A

dilation of epidiymis or vas deferens

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13
Q

Prehn’s sign

A

elevation of the painful testicle that reduces the pain of epididymitis

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14
Q

TRUS

A

TransRectal UltraSound

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15
Q

Orchitis

A

inflammation of the testicle

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16
Q

Crytorchidism

A

Undescended testicle

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17
Q

IVP

A

intraVenous Pyelogram (dye injected into the vein, collects in the renal collecting system, and an xray is taken

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18
Q

Space of Retzius

A

Anatomic extraperitoneal space in front of the bladder

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19
Q

TURP

A

TransUrethral Resection of the Prostate

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20
Q

PVR

A

Post Void Residual

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21
Q

Paraphimosis

A

foreskin held (stuck) in the retracted position

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22
Q

phimosis

A

inability to retract the foreskin

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23
Q

Balanitis

A

inflammation/infection of the glans penis

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24
Q

Balanoposthitis

A

inflammation/infection of the glans and prepuce of the penis

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25
Q

Peyronie’s disease

A

Abnormal fibrosis of the penis shaft, resulting in a bend upon erection

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26
Q

`Appendix testis

A

common redundant testicular tissue

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27
Q

VUR

A

VesicoUrethral Reflux

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28
Q

Layers of the scrotum

A

Skin, Dartos, External spermatic fascia, Cremaster muscle, internal spermatic fascia, parietal and visceral layers of the tunica vaginalis, tunica albuginea (Some Damn Englishmen Call It The Testes)

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29
Q

DDx for scrotal mass

A

Cancer, torsion, epididymitis, hydrocele, spermatocele, varicocele, inguinal hernia, testicular appendage, swollen testes, nontesticular tumor (paratesticular tumor: rhabdomyosarcoma, leiomyosarcoma, liposarcoma)

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30
Q

causes of hematuria

A

bladder cancer, trauma, uti, cystitis from chemotherapy or radiotherapy, stones, kidney lesion, BPH

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31
Q

Most common cause of severe gross hematuria without trauma or chemotherapy/radiotherapy

A

Bladder CA

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32
Q

DDX for bladder outlet obstruction

A

BPH, foreign body, urethral stricture, urethral valve

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33
Q

DDX for ureteral obstruction

A

stone, tumor, iatrogenic (suture), stricture, gravid uterus, radiation injury, retroperitoneal fibrosis

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34
Q

DDX for kidney tumor

A

renal cell carcinoma, sarcoma, adenoma, angiomyolipoma, hemangiopericytoma, oncocytoma

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35
Q

What is Renal Cell Carcinoma?

A

Most common solid renal tumor (90%); originates from proximal renal tubular epithelium

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36
Q

what is the epidemiology of RCC?

A

Primarily a turmo of adults 40-60yrs with 3:1 male:female ratio; 5% of cancers overall in adults

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37
Q

what percentage of the RCC tumors are bilateral?

A

1%

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38
Q

what are the risk factors to RCC?

A

Male, tobacco, von-Hippel-Lindau syndrome, polycystic kidney

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39
Q

What are the symptoms of RCC?

A

Pain (40%), hematuria (35%), weight loss (35%), flank mass (25%), HTN (20%)

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40
Q

What is the classic TRIAD of renal cell carcinoma?

A
  1. flank pain
  2. hematuria
  3. palpable mass (triad occurs in only 10-15% of patients)
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41
Q

how are most cases of RCC diagnosed?

A

Found incidentally on imaging (CT, MRI, U/S)

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42
Q

what radiological tests are performed for RCC?

A
  1. IVP

2. Abdominal CT scan with contrast

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43
Q 
What are the stages of RCC per the AJCC?
Stage 1
Stage 2
Stage 3
Stage 4
A

Stage 1 - tumor <2.5 cm, no nodes, no metastases
Stage 2-Tumor >2.5 cm limited to kidney, no nodes, no metastases
Stage 3- Tumor extends into IVC or main renal vein; positive regional lymph nodes but <2cm in diameter, no metastasis
Stage 4 - distant metastasis or positive lymph nodes>2cm in diameter, or tumor extends past gerota’s fasci

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44
Q

What is the metastatic workup for RCC?

A

CXR, IVP, CT scan, LFTs, calcium

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45
Q

what are the sites of RCC metastasis

A

lung, liver, brain, bone; tumor thrombus entering renal vein or IVC is not uncommon

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46
Q

what is the unique route of spread of RCC?

A

tumor thrombus into the IVC

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47
Q

what is the treatment of RCC?

A

radical nephrectomy (excision of the kidney and adrenal, including gerota’s fascia) for stages 1 - 4

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48
Q

what gland is removed with a radical nephrectomy

A

adrenal

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49
Q

what is the unique treatment for metastatic spread?

A
  1. alpha-interferon

2. LAK cells lymphokin acativated killer) and IL-2 (interleukin 2)

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50
Q

what is the syndrome of RCC and liver disease?

A

Stauffer’s sydnrome

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51
Q

what is the concern in an adult with new onset L varicocele?

A

L RCC - the left gonadal vein drains into the L renal vein

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52
Q

what is the incidence of bladder cancer?

A

second most common urologic malignancy. Male to female ratio 3:1. AA are most commonly affected

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53
Q

what is the most common histology of bladder cancer?

A

Transitional Cell Carcinoma (TCC) - 90%, remaining cases are squamous cell or adenocarcinomas

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54
Q

what are the risk factors for bladder cancer?

A

SMOKING, industrial carcinogens (aromatic amines), schistosomiasis, truck drivers, petroleum workers, cyclophosphamide

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55
Q

how do you work up bladder cancer?

A

urinalysis and culture, IVP, cystoscopy with cytology and biopsy

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56
Q

define the AJCC transitional cell bladder cancer stages?

Stage 0-IV

A

Stage 0- superficial, carcinoma in situ
Stage I - invades subepithelial CT, no positive nodes, no mets
Stage 2- Invades superficial or deep muscularis propria, no positive nodes, no mets
Stage 3 - invades perivesical tissues, no positive nodes, no mets
Stage 4- Positive nodal spread with distant mets, and/or invades the abdominal/pelvic wall

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57
Q

what are the indications of partial cystoscopy in bladder cancer?

A

superficial, isolated tumor, apical with 3cm margin from any orifices

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58
Q

what is the treatment for bladder cancer?

stage 0-IV

A

0- TURB and intravesical chemotherapy
1-TURB
2 and 3 - Radical cystectomy, lymph node dissection, removal of prostate/uterus/ovaries/anterior vaginal wall, and urinary diversion (eg. ileal conduit) +/- chemo

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59
Q

What is TURB?

A

transurethral resection of the bladder

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60
Q

after TURB the tumor recurs, then what?

A

repeat TURB and intravesical chemotherapy (mitomycin C) or bacillus Calmette-Guerin

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61
Q

What is and how does bacillus Calmette-Guerin work?

A

Attenuated TB vaccine- thought to work by immune response

62
Q

What is the incidence of Prostate CA?

A

Most common GU cancer (>100,000 new cases per year), most common carcinoma in men, second most common cause of death

63
Q

what is the epidemiology of prostate CA

A

“disease of elderly men” present in 33% of men 70-79, and 66% of men 80-89%, AA have a 50% higher chance of getting it

64
Q

what are the common sites of metatasis of prostate CA?

A

osteoblastic bony lesions, lung, liver, adrenal

65
Q

what provides lymphatic drainage of the prostate?

A

obturator and hypogastric nodes

66
Q

what is the significance of Batson’s plexus

A

spinal cord venous plexus, route of isolated skull/brain mets

67
Q

how do you detect prostate CA?

A

PSA and DRE

68
Q

when should men get a PSA check?

A

men >50 or >40yrs if first degree family history or AA

69
Q

what percentage of patients with prostate CA will have an elevated PSA?

70
Q

what is the imaging test for prostate CA

A

TransRectal UltraSound (TRUS)

71
Q

how do you diagnose prostate cancer?

A

transrectal biopsy

72
Q

what is the Gleason Score?

A

Histologic grades 2-10: Low score=well differentiated, High score=poorly differentiated

73
Q

what are the indications for transrectal biopsy with normal rectal examination

A

PSA>10 or abnormal TRUS

74
Q

how do you stage prostate CA (AJCC)

StageI-IV

A

1- tumor involves <50% of 1 lobe, no nodes, no mets, PSA<10, Gleason <6
2-Tumor within prostate; lobe<50% but PSA>10, or Gleason>6 or >50% of 1 lobe, no nodes no mets
3-Tumor thorugh the prostate capsule or into the seminal vesicles, no nodes no mets
4-tumor extends into adjacent structures (other than seminal vesicles) or +nodes or +mets

75
Q

what does a radical prostatectomy remove?

A
  1. prostate glands 2. seminal vesicles 3. ampullae of the vas deferens
76
Q

what is “androgen ablation” therapy?

A
  1. bilateral orchiectomy or 2. Luteinizing Hormone Releasing Hormone agonist (LHRH)
77
Q

how do LHRH work?

A

decrease LH release from pituitary, which then decreases testosterone production in the testes

78
Q

what are the generalized treatment options of prostate cancer according to stage I-IV

A

stage 1-radical prostatectomy
stage 2- radical prostatectomy +/-lymph dissection
stage3- radiation therapy +/- androgen ablation
stage 4- androgen ablation, radiation therapy

79
Q

what is the medial treatment for systemic metastatic disease?

A

Androgen ablation

80
Q

What is the option for treatment in early stage prostate CA patient >70yo with comorbidity?

81
Q

What is the normal size of the prostate?

82
Q

where does BPH occur?

A

periurethrally (prostate CA occurs in the periphery)

83
Q

what are the symptoms of BPH

A

Obstructive type symptoms; hesitancy, weak stream, nocturia, intermittency, UTI, urinary retention

84
Q

how is the diagnosis made? labs?

A

history, DRE, elevated PostVoid Residual (PVR), urinalysis, cystoscopy, U/S
labs- UA, PSA, BUN, CR

85
Q

What is the ddx for BPH?

A

Prostate CA (nodular)- biopsy
Neurogenic bladder - history of neurologic disease
Acute prostatitis - hot, tender, gland
Uretral stricture - RUG, history of STD, UTI

86
Q

how do you treat BPH

A

pharmacologic - a-1 antagonist
hormonal - antiandrogen
surgical - TURP, TUIP, open prostate resection
Transurethral balloon dilation

87
Q

why do a1 antagonists work for BPH?

A

relax the sphincter relax prostate capsule

88
Q

what is Proscar?

A

Finasteride: 5a-reductase inhibitor, blocks transformation of testosterone to dihydrotestosterone, may shrink and slow progression of BPH

89
Q

what is Hytrin?

A

Terazosin: a1 antagonist, may inhibit urine outflow by relaxing the prostatic smooth mm

90
Q

what aer the indications for BPH surgery

A

Due to obstruction: urinary retention, hydronephrosis, UTI, Severe symptoms

91
Q

What is TUIP?

A

TransURethral Incision of Prostate

92
Q

what percentage of tissue removed for BPH will have malignant tissue on histology?

93
Q

what are the possible complications of TURP?

A

Immediate: failure to void, bleeding, clot retention, UTI, Incontinance

94
Q

what is the incidence of testicular cancer?

A

rare, 2-3 new cases per 100,000 per year in the US

95
Q

who is most likely affected by testicular cancer

A

most common solid tumor of 20-40yos

96
Q

what are the risk factors of testicular cancer?

A

crytpochidism (6% of testicular tumors)

97
Q

does orchiopexy as an adult remove the risk of testicular cancer?

98
Q

what are the symptoms of testicular cancer?

A

painless lump, swelling, or firmness of the testicle; they usually notice after incidental trauma to the groin

99
Q

what percentage of patients with testicular cancer present with an acute hydrocele?

100
Q

what percentage of patients with testicular cancers present with symptoms of metastatic disease (back pain, anorexia)?

101
Q

what are the classification of testicular cancers?

A

Germ cell tumors (95%)

Nongerminal (5%)

102
Q

what are the germ cell cell tumors?

A

Seminomatous (~35%), nonseminomatous (~65%), Embryonal cell carcincoma (teratoma, mixed, choriocarcinoma)

103
Q

what are the Nongerminal cell tumors?

A

Leydig, Sertoli, Gonadoblastoma

104
Q

what is the major classification of testicular cancer based on therapy?

A

seminomatous and nonseminomatous

105
Q

what are the major tumor markers for testicular tumors?

A
  1. Beta-human chorionic gonadotropin (B-HCG)

2. Alpha-fetoprotein (AFP)

106
Q

what er the tumor markers by tumor type?

A

B-HCG - inc in choriocarcinoma (100%), embryonal carcinoma (50%) and rarely in pure seminomas (10%), nonseminomatous tumors (50%)
AFP - inc in embryonal carcinoma and yolk sac tumors; nonseminomatous tumors (50%)

107
Q

Define the difference between seminomatous and NONseminomatous germ cell testicular tumor markers

A

NONseminomatous common = 90% have a +AFP and/or B-HCG

Seminomatous -rare = only 15% are AFP+

108
Q

Which tumors almost NEVER have an elevated AFP?

A

Choriocarcinoma and Seminoma

109
Q

In which tumor is B-HCG almost always found elevated

A

Choriocarcinoma

110
Q

How often is B-HCG elevated in patients with pure seminoma?

A

Only about 10% of the time!

111
Q

How often is B-HCG elevated with nonseminoma?

112
Q

What other tumor markers may be elevated and useful for recurrence surveillance?

A

LDH, CEA, Human Chorionic Sematomammotropic (HCS), Gamma-Glutamyl Transpeptidase (GGT), PLacental Alkaline Phosphate (PLAP)

113
Q

What are the steps to diagnosing Testicular Cancer?

A

PE, Scrotal U/S, check tumor markers, CXR, CT (Chest, pelvis, Abdomen)

114
Q

Define the stages according to Testicular Cancer staging I-III

A

I- any tumor size, no nodes, no mets
II-+nodes, no mets, any tumor
III-distant Mets (any nodal status, any size tumor)

115
Q

What is the treatment of seminoma at the various stages? I-III

A

Stage I and II- Inguinal orchiectomy and radiation to retroperitoneal nodal basins
stage III-orchiectomy and chemotherapy

116
Q

What is the treatment of NONseminomatous disease at various stages? I-III

A

Stages I and II - Orchiectomy and retroperitoneal lymph node dissection versus close follow-ups for retroperitoneal nodal involvment
Stage III-Orchiectomy and chemotherapy

117
Q

What percentage of stage I seminomas are cured after treatment?

118
Q

which type of testicular type cancer is the most radiosensitive?

A

Seminoma (think Seminoma = Sensitive to radiation

119
Q

why not remove testis with cancer through a scrotal incision?

A

it could result in tumor seeding of the scrotum

120
Q

What is the major side effect of retroperitoneal lymph node dissection?

A

Erectile dysfunction

121
Q

What is testicular torsion?

A

twist of the spermatic cord resulting in venous outflow obstruction and subsequent arterial occlusion and testicular infarction

122
Q

what is a “bell clapper” deformity?

A

Bilateral nonattachment of the testicles by the gubernaculum to the scrotum (free like the clappers of bells

123
Q

what are the signs of testicular torsion?

A

very tender, swollen elevated testicle; nonillumination; absence of cremasteric reflex

124
Q

How is the diagnosis made?

A

Surgical exploration, U/S (solid mass) and doppler flow, cold Tc-99 scan (nuclear study)

125
Q

what is the treatment of testicular torsion?

A

Surgical detorsion and bilateral orchiopexy to the scrotum

126
Q

How much time is available from the onset of symptoms to detorse the testicle?

A

<6hours will bering the best results >90% salvage rate

127
Q

What are the chances of testicle salvage after 24 hours?

128
Q

What are the common bugs involved with epididymitis?

  1. elderly/children
  2. adults
A
  1. e. coli

2. STD bacteria: gonorrhea, chlamydia

129
Q

What is the work up for epididymitis?

A

U/A, Urine culture, STD swab +/- U/S with doppler or nuclear study to r/o torsion

130
Q

what are some causes of priapism

A

Low flow: leukemia, drugs (eg. prazosin), sickle cell, ED treatment gone wrong.
High flow: pudendal artery fistula, usually from trauma

131
Q

what is the treatment to priapism?

A
  1. aspiration of blood from corporus cavernosum

2. a-adrenergic agent

132
Q

What are the 6 MAJOR causes of ED?

A
  1. Vascular - not enough flow
  2. Endocrine - Low T
  3. Anatomic - structural abnormality (peyronie’s)
  4. Neurologic
  5. Meds
  6. Psychologic
133
Q

what lab tests should be performed?

A

Fasting Glu (r/o DM), Serum T, Serum Prolactin

134
Q

what are the 4 types of kidney stones?

A
  1. Calcium oxalate/Calcium phosphate (75%)- secondary to hypercalcuria (inc intestinal absorption, dec renal reabsorption, inc bone reabsorption)
  2. Struvite (MgAmPh) (15%) - infection stones, seen in UTI with proteus, high urine pH
  3. Uric Acid (7%) -radiolucent (uric=unseen), seen in gout, lesch-nyhan, chronic diarrhea, cancer, low urine pH
  4. Cystine (1%)- genetic predisposition
135
Q

what kidney stones are seen in IBD/Bowel Bypass?

A

Calcium oxalate

136
Q

How to diagnose a kidney stone?

A

KUB (90% radiopaque), IVP, UA and culture, BUN/Cr, CBC

137
Q

what are the 3 common sites of obstruction?

A

Ureteropelvic junction (UPJ), Uretero Vesicular Junction (UVJ), Intersection of the ureter and iliac vessels

138
Q

what are the common types of incontinence?

A

stress incontinence, overflow incontinence, urge incontinence

139
Q

define stress incontinence?

A

loss of urine associated with coughing, lifting, exercise. Seen most often in women, secondary to relaxation of pelvic floor following multiple deliveries

140
Q

Define Overflow incontinence?

A

failure of the bladder to empty properly; may be caused by bladder outlet obstruction (BPH or stricture) or detrusor hypotonicity

141
Q

Define Urge incontinence

A

Loss of urinary secondary to detrusor instability in patieths iwth stroke, dementia, parkinsons disease

142
Q

What is the Marshall test?

A

Women with urinary stress incontinence placed in the lithotomy position with a full bladder leaks urine when asked to cough

143
Q

how do you treat?

  1. stress incontinence
  2. urge incontinence
  3. overflow incontinence
A
  1. bladder neck suspension
  2. pharmacotherapy (anticholinergics, a-agonists)
  3. self-catheterization, surgical relief of obstruction, a-blockers
144
Q

what are the 3 most common organisms in UTIs?

A

e. coli, proteus, klebsiella or pseudomonas

145
Q

what is the most common solid renal tumor of childhood?

146
Q

What is the most common site of distant mets in RCC?

147
Q

what are posterior urethral valves?

A

most common obstructive urethral lesion in infants and newborns; occurs in males; found at the distal prostatic urethra

148
Q

how can a small traumatic EXTRAperitoneal bladder rupture be treated?

A

Foley Catheter

149
Q

how should a traumatic INTRAperitoneal bladder rupture be treated?

150
Q

what unique bleeding problem can be seen with prostate surgery?

A

Release of TPA and urokinase (treat with e-aminocaproic acid)

151
Q

what is the scrotal “blue dot” sign?

A

torsed appendix testis

My Surgical Recall (2 decks)

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