Urology Flashcards
There is 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
Mx of Testicular torsion
After the testis is untwisted, an orchiopexy is done to prevent recurrence; simulataneous contralateral orchiopexy is also indicated
_______can be confused with testicular torsion. It is seen in young men old enough to be sexually active, and it also starts with severe testicular pain of sudden onset
Acute epididymitis
PE OF Acute epididymitis
There is fever and pyuria, and although the testis is swollen and very tender, is in the normal
position. The cord is also very tender
A typical scenario is a patient who is being allowed to pass a ureteral stone spontaneously, and who suddenly develops chills, fever spike (104–105°F), and flank pain
obstruction and infection of the urinary tract
_________ is the most common reason a newborn boy doesn’t urinate during day 1 of life (also look for meatal stenosis).
Posterior urethral valve
Dx and Tx of posterior urethral valve
Voiding cystourethrogram is the diagnostic test, and endoscopic fulguration or resection will get rid of them
The urethral opening is on the ventral side of
the penis, somewhere between the tip and the base of the shaft
Hypospadias
What should not be done in pt with Hypospadias
Circumcision should never be done on such a child, inasmuch as the skin of the prepuce will be needed for the plastic reconstruction that will eventually be done
UTI in children should always lead to a urologic workup. The cause may be _______, or some other congenital anomaly
vesicoureteral reflux
_________ and infection produce burning on urination, frequency, low abdominal and perineal pain, flank pain, and fever and chills in a child.
Vesicoureteral reflux
The patient feels normally the need to void, and voids normally at appropriate intervals (urine deposited into the bladder by the normal ureter); but is also wet with urine all the time (urine that drips into the vagina
Low implantation of a ureter
The anomaly at the UPJ allows normal urinary output to flow without difficulty, but if a large diuresis occurs, the narrow area cannot handle it
Ureteropelvic junction (UPJ) obstruction
________in its full-blown picture produces hematuria, flank pain, and a flank mass. It can also produce hypercalcemia, erythrocytosis, and elevated liver enzymes
Renal cell carcinoma
MX of Renal cell carcinoma
Surgery is
the only effective therapy and may include partial nephrectomy, radical nephrectomy, or even
inferior vena cava resection.
\_\_\_\_\_\_\_ has a very close correlation with smoking (even more so than cancer of the lung), and usually presents with hematuria.
Cancer of the bladder (transitional cell cancer in most cases)
Mx of Cancer of the bladder
Both surgery and intravesical BCG have therapeutic
roles, and a very high rate of local recurrence makes life-long close follow-up a necessity
Prostate CA
Surveillance frequently stops at age ____ beyond which survival is not affected by treatment.
75,
Widespread bone metastases respond for a few years to
1
2
3
androgen ablation, surgical (orchiectomy) or medical (luteinizing hormone-releasing hormone agonists, or antiandrogens like flutamide).
________ affects young men, in whom it presents as a painless testicular mass
Testicular cancer
Most testicular cancers are exquisitely ________ and _______ offering many options for successful treatment in advanced, metastatic disease.
radiosensitive and chemosensitive (platinum-based chemotherapy),
Triggers of urinary retention
It is often precipitated during a cold, by the use of antihistamines
and nasal drops, and abundant fluid intake
Initial Tx of urinary retention
First line of long-term therapy is alpha-blockers. 5-alpha-reductase inhibitors are used for very large glands (>40 g).
The patient may not feel the need to void because of post-op pain, medications, etc., but will report that every few minutes there is involuntary release of small amounts of urine.
Postoperative urinary retention
They leak small amounts of urine whenever intra-abdominal pressure suddenly increases.
This includes sneezing, laughing, getting out of a chair, or lifting a heavy object
Stress incontinence
PE of pts with Stress incontinence
weak pelvic floor, with the prolapsed bladder neck outside of the “high-pressure” abdominal area.
Small stones (≤3 mm) at the ureterovesical junction have a \_\_\_\_\_\_ chance of passing spontaneously. Such cases can be handled with analgesics, plenty of fluids, and watchful waiting
70%
On the other hand, a 7-mm stone at the UPJ only has a _____probability of passing. Intervention will be required
5%
MC MX of stone
extracorporeal shock-wave lithotripsy (ESWL).
ESWL cannot be used in
(pregnant women, bleeding diathesis, stones that are several centimeters large).
________is almost always caused by fistulization between the bladder and the GI tract, most commonly the sigmoid colon, and most commonly from diverticulitis (second possibility is cancer of the sigmoid, and cancer of the bladder is a very distant third
Pneumaturia
______ has sudden onset, is partner- or situation-specific, does not interfere with nocturnal erections (which can be tested with a roll of postage stamps), and can be effectively treated with psychotherapy only if it is done promptly.
Psychogenic impotence
First line medical Tx for impotence
Sildenafil, tadalafil, and vardenafil have become first choice therapy in many cases,
Sx Tx for impotence
vascular surgery (well-suited for those
with arterial injury), suction devices (can be used on almost everybody), and prosthetic
implants
