Urology Flashcards
Suspect this in a pt w/ very severe testicular pain of sudden onset, but no fever, pyuria, or history of recent mumps. The testis is swollen, exquisitely tender, “high riding,” and with a “horizontal lie.” The cord is not tender.
Testicular torsion. Dire emergency
Consider this in young men old enough to be sexually active, who presents with severe testicular pain of sudden onset. There is fever and pyuria, and the testis although swollen and very tender is in the normal position. The cord is also very tender.
Acute Epididymitis.
What should you do for a person with Acute Epididymitis
Tx w/ Antibiotics. The possibility of missing a diagnosis of testicular torsion is so dreadful that sonogram is done to rule it out.
Suspect this in a pt who is being allowed to pass a ureteral stone spontaneously and who suddenly develops chills, fever spike (104° or 105° F), and flank pain
The urinary tract may be obstructed and infected. Dire emergency.
How do you treat an obstructed and infected urinary tract
IV antibiotics, immediate decompression of the urinary tract above the obstruction.
Treatment for pyelonephritis
Hospitalization, IV antibiotics (guided by cultures), and urologic workup (IVP or sonogram)
Suspect this in older men who have chills, fever, dysuria, urinary frequency, diffuse low back pain, and an exquisitely tender
prostate on rectal exam.
Acute bacterial prostatitis
Tx for acute bacterial prostatitis
IV antibiotics, and don’t do any more rectal exams. Prostatic massage could lead to septic shock.
Why not do circumcisions on kids with hypospadias
they need the foreskin for the plastic surgery to fix it
Tx for vesicoureteral reflux
long term antibiotics until he grows out of the problem
Suspect this in a little girl who voids normally but seems to always be wet with urine
low implantation of a ureter. correct with surgery.
First step in workup for hematuria suspicious for cancer
CT scan, then cystoscopy
suspect in pt w/ hematuria, flank
pain, and a flank mass. Also possibly produce hypercalcemia, erythrocytosis,
and elevated liver enzymes.
Renal cell carcinoma
Bladder Cancer has a super close assc w/ what
smoking
Presentation of prostate cancer
Most are asymptomatic and have to be sought by rectal exam (rock-hard discrete nodule) and prostatic specific antigen (PSA; elevated levels for age group).
Presentation of testicular cancer
painless testicular mass
Tx of testicular cancer
Because benign testicular tumors are virtually nonexistent, biopsy is done with a radical orchiectomy by the inguinal route. Blood samples are taken pre-op for serum markers (a-fetoprotein and b-HCG]), which will be useful for follow-up.
Workup for suspected prostate cancer
Transrectal needle biopsy (guided by sonogram when discovered by PSA) establishes diagnosis. CT helps assess extent and choose therapy. Surgery and/or radiation are choices
Short term therapy for urinary retention due to prostate hypertrophy? Long term?
Short term: indwelling catheter at least 3 days.
Long term: Alpha-blockers. Or 5-alpha-reductase inhibitors for very large glands..
Common kind of post-op urinary retention
Overflow incontinence
Suspect this in a middle-age multigravida woman who leaks small amounts of urine during sneezing, laughing, getting out of a chair, or lifting a heavy object. No incontinence at night. Examination shows a weak pelvic floor, with the prolapsed bladder neck outside of the “high-pressure” abdominal area.
Stress incontinence
Consider this in a pt w/ flank pain, with
irradiation to the inner thigh and labia or scrotum, and sometimes nausea and
vomiting.
Passing ureteral stones
If intervention is necessary for a kidney stone, what is most commonly done?
Extracorporeal shock-wave lithotripsy (ESWL). That, and abundant water intake is always indicated.
Most common cause of pneumaturia
Almost always caused by fistulization between the bladder and the GI tract, most commonly the sigmoid colon, and most commonly from diverticulitis
First steps when you have a pt w/ pneumaturia
Workup starts with CT scan, which will show the inflammatory diverticular mass. Sigmoidoscopy is needed later to rule out cancer. Surgical therapy is required.
How to tell the difference between organic and psychogenic impotence
Psychogenic does not interfere with nocturnal erections, organic does
Diagnosis when palpation of the testes reveals a small firm and tender nodule near the head of the epididymis that appears to have a blue discoloration
This is the blue dot sign, pathognomonic for testicular or appendix testes torsion
Four Cardinal Symptoms and Signs of Testicular Torsion?
Nausea/vomiting, testicular pain duration of less than 24 hours, a superiorly displaced testicle, and an absent cremasteric refl ex.
Gradual onset of testicular pain, most common cause of acute painful hemiscrotum in a child
Appendix testes torsion
Tx of testicular torsion
Presentation < 6 hours; attempt manual detorsion followed by elective orchiopexy.
>6 hours: surgical detorsion, followed by b/l orchiopexy
