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Urology Flashcards

1
Q

What gene causes sexual differentiation?

A

SRY gene

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2
Q

What needs to be functional for testosterone to become DHT

A

5 alpha reductase

Critical for normal male: DHT

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3
Q

What are the two most common forms of disorders of sexual development?

A

46 XX CAH- 95% have 21 hydroxylase enzyme deficiency

45X/46XY mixed gonadal dysgenesis

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4
Q

What do Leydig cells produce

A

Testosterone

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5
Q

What do Sertoli cells produce?

A

anti mullerian hormone

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6
Q

Name the 3 defects seen with hypospadias

A

Foreskin is incomplete ventrally
Urethral meatus not at tip of penis
Erections curved downward (AKA chordee)

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7
Q

Congenital hydronephrosis affects what percentage of pregnancies?

A

CH affects 1% of pregnancies (most common fetal anomaly)
no correlation between severity of congenital hydronephrosis and risk of VUR
positive correlation between severity of congenital hydronephrosis and risk of obstruction

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8
Q

What are the 4 most common causes of high grade congenital hydronephrosis?

A

PUV- posterior urethral valves
UVJO- ureterovesical junction obstruction
UPJO- ureteropelvic junction obstruction
High grade VUR

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9
Q

Congenital hydronephrosis and APD 7-10mm, when do they need ultrasound?

A

Within 1-3 months

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10
Q

Congenital hydronephrosis and APD >15mm, when do they need ultrasound?

A

Within 2 weeks

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11
Q

What are the signs of posterior urethral valves?

A 
Male
Keyhole sign
Distended, thick walled bladder
Bilateral hydronephrosis
Oligohydramnios
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12
Q

What are the recommendations for prevention of renal stones?

A

Increased fluid intake
Avoid excess salt intake
Normal calcium intake

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13
Q

Most common solid renal mass of infant <1 or antenatal?

A

congenital Mesoblastic nephroma- usually benign

Tx- complete surgical excision

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14
Q

Most common solid renal mass if >1

A

Wilms

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15
Q

Testicular torsion versus torsion of appendix testis

A 
Testicular torsion:
Pain: severe, sudden onset of severity
Nausea and vomiting: often
Testis position: +/-high riding
\+/- transverse lie
Testis tenderness: throughout
Cremasteric reflex: often absent
Blue dot sign: never

Torsion of appendix testis:
Pain: milk to severe, gradual onset
Nausea and vomiting: occasional
Testis position: normal
Testis tenderness: localized to upper pole
Cremasteric reflex: often present
Blue dot sign: rarely present but pathognomonic

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16
Q

Name 2 indications for VCUG

A

Assess for:

  1. VUR
  2. PUV
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17
Q

Name one disadvantage of Nuclear Cystogram

A

Does not assess for PUV

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18
Q

Which renal scan detects renal scarring?

A

DMSA- best for differential renal function

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19
Q

Mag3 lasix scan tells you what 2 things?

A

differential renal function
Obstruction
(kidney function and drainage)

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20
Q

Name 4 types of urodynamics

A
  1. Voiding calendar- two day home data collection of time and volume of voids. Provides urinary frequency and functional bladder capacity. Helpful to diagnose overactive bladder
  2. Post residual void- US bladder scanner. Assesses bladder emptying
  3. uroflowmetry (velocity curve of urinary system). Assesses for urethral obstruction.
  4. cystometry (invasive urodynamics)- assessment of relaxation/contraction of pelvic floor muscles during bladder filling and voiding. Assess for normal pelvic floor relaxation with voiding.
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21
Q

90% of urinary stones contain________ as a major constituent, and 60% are composed of _________

A

Nearly 90% of urinary stones contain calcium as a major constituent, and 60% are composed of calcium oxalate.

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22
Q

What do we use to treat kidney stones

A

Pain- NSAIDs
80-90% of stones <5mm will pass on their own
alpha adrenergic blocker (tamsulosin) may facilitate passage
Interventional treatment: reserved for large stones
lithotripsy
extracorpeal shock wave lithotripsy
percutaneous nephrostolithotomy

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23
Q

what are signs of low grade congenital hydronephrosis on ultrasound?

A 
minimal hydronephrosis
mild hydronephrosis
SFU grade 1 or 2
Calyces not dilated
APD <10mm
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24
Q

what are signs of high grade congenital hydronephrosis on ultrasound

A 
moderately severe hydronephrosis
severe hydronephrosis
dilated calyces
parenchymal thinning
SFU grade III or IV
APD >15mm
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25
what is UPJO and how is it different from the other causes of significant CH
uretero-pelvic junction obstruction | significant hydronephrosis WITHOUT hydroureter
26
what is the postnatal management for suspected PUV (7)
``` stabilize if respiratory issues urgent postnatal RBUS bladder decompression (catheter) Serial serum creatinine levels Confirmatory VCUG consult nephrology (fluid, acid-base, electrolyte management) consult urology (surgical management) ```
27
what is the main cause of acquired hydronephrosis? how does it present?
UPJ obstruction presents with recurrent abdominal pain/flank pain recurrent pyelonephritis vomiting (+/- pain) after increased fluid intake
28
what investigations would you do for UPJ obstruction
Initial: RBUS | If hydronephrosis then urology may confirm obstruction with diuretic renal scan
29
what is the most common non-infectious cause of daytime incontinence?
idiopathic overactive bladder
30
what are the treatment options for idiopathic overactive bladder?
1. Treat constipation (diet/PEG 3350) Treat UTI observation is an option if not bothersome to family/child timed voiding (Every 1.5-2h) 2. Anticholinergics (oxybutinin, tolteridine, solifenacin)
31
what is a duplex kidney?
kidney with 2 renal pelvises
32
what are patients with horseshoe kidney at risk of?
Increased risk of UPJO (only relevant if hydronephrosis)
33
what is the first line investigation for renal stones?
renal ultrasound
34
what investigation will most reliably identify small stones?
``` CT KUB (if confirmation required after ultrasound) but not first line ```
35
what are some dietary measures for treating kidney stones?
increased fluid intake** (dilutes urine and prevents urinary solutes from crystallizing) decrease sodium intake ** normal dietary calcium ** citrus juice contains citrate which is a urinary inhibitor of stone formation
36
what is a hydrocele? how do you diagnose?
fluid around or adjacent to the testis generally asymptomatic diagnose with transillumination
37
what is the risk associated with having a hydrocele? when should you refer?
risk is development of indirect hernia | allow up to age 18 months for resolution before referral
38
why would you do an U/S for hydrocele (4)
to confirm scrotal testis (>6mo age) to differentiate from inguinal hernia to rule out testis tumor (adolescent age) when it is associated with scrotal pain NYD
39
what is the initial investigation for palpable abdominal mass?
abdominal ultrasound | - to differentiate solid from cystic masses
40
what is the treatment for congenital mesoblastic nephroma?
complete surgical excision
41
what 2 congenital syndromes are associated with wilm's tumor
50% risk of wilms tumor with Denys Drash WAGR
42
does the CPS recommend newborn male circumcision?
NO! | increased risk of STI transmission and penile cancer does not justify recommendaton of routine circumcision
43
how can meatal stenosis be prevented following newborn circumcision?
apply petroleum jelly to the glans for up to 6 mo following circumcision
44
what can be used to hasten retraction of foreskin and release adhesions?
topical steroids
45
what are indications for surgical consultation for circumcision (4)
scarred phimosis recurrent balanoposthitis recurrent UTIs delayed retraction of the foreskin >10 yo
46
what investigation should be done after first febrile UTI? when should VCUG be considered?
RBUS | VCUG is reserved for those with an abnormal RBUS or if they have a 2nd febrile UTI
47
what is VUR
retrograde flow of urine from the bladder to the kidneys | asymptomatic, low grade VUR does not require intervention
48
what should you tell boys to do when collecting a midstream urine
retract retractable foreskins as contamination is very common
49
what is cystitis
bacteruria resulting in local "bladder" symptoms only (voiding symptoms/suprapubic or lower back pain)
50
what antibiotics should be used for prophylaxis for UTI
septra nitrofurantoin - used for no more than 3-6 months - switch antimicrobials if urine culture shows resistant organism - if urine shows resistance to both antibiotics then consider stopping prophylaxis rather than using broad spectrum antimicrobials
51
DDx painful scrotal swelling (6)
``` testicular torsion incarcerated inguinal hernia trauma epididymitis torsion of appendix testis intermittent testicular torsion (torsion- detorsion) ```
52
DDx painless scrotal mass (6)
tumor- firm varicocele- bag of worms noncommunicating hydrocele- fluid filled/transilluminates spermatocele- localized cyst/transilluminates reducible inguinal hernia local insect bite
53
what abnormality is associated with testicular torsion?
bell clapper deformity
54
what are the most common testicular tumors
95% germ cell tumors- seminomas and non seminomas
55
what is the most common malignant testicular germ cell tumor in prepubertal children
yolk sac tumor (high AFP) | although teratoma is more common
56
what workup should be done for testicular tumor?
Ultrasound Tumor markers (AFP, bHCG) Chest x-ray CT abdo, pelvis and chest for staging
57
what is the treatment for testicular tumor
orchiectomy +/- RPLND (retroperitoneal lymph node dissection) +/- chemo, radiation
58
what is testicular microlithiasis
uncommon condition where small clusters of calcium form in the testicles (seen on ultrasound) - do not need further imaging but should be instructed in testicular self examination, exception = DSD
59
what should be on the differential for an undescended testis?
retractile testis- most common!
60
what is the most sensitive method for determining volume discrepancy between testes?
ultrasound | 15-20% reduction in volume (hypotrophy) of a testis with varicocele is common
61
what is the ideal time for repair of hypospadias?
between 6-12 months
62
what is the treatment for primary phimosis
corticosteroid cream (betamethasone 0.1% for 6 weeks)
63
what are some benefits of circumcision (4)
prevention of penile cancer reduces UTI reduces STI (HIV) reduced balanitis, phimosis
64
what are some complications of neonatal circumcision
``` hemorrhage wound infection glans injury urethrocutaneous fistula inadvertent circumcision of neonate with hypospadias ```
65
what is the treatment of testicular torsion
Treatment is prompt surgical exploration and detorsion. If the testis is explored within 6 hr of torsion, up to 90% of the gonads survive. Following detorsion, the testis is fixed in the scrotum with nonabsorbable sutures, termed scrotal orchiopexy, to prevent torsion in the future. The contralateral testis should also be fixed

Pediatrics- Noelle (28 decks)

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