Urology Flashcards
What is a cystogram?
Contrast study of the bladder
What are ureteral stents?
Plastic tubes placed via cystoscope into the ureters for stenting, identification, etc.
What is a cystoscope?
Scope placed into the urethra and into the bladder to visualize the bladder
What is a perc nephrostomy?
Catheter placed through the skin into the kidney pelvis to drain urine with distal obstruction
What is a retrograde pyelogram?
Dye injected into the ureter up into the kidney, and films taken
What is a RUG?
Retrograde UrethroGram
Dye injected into the urethra and films taken.
Rules out urethral injury, usually in trauma patients.
What is a Gomco clamp?
Clamp used for circumcision.
Protects penis glans.
What is a Bell clapper’s deformity?
Condition of congenital absence of gubernaculum attachment to scrotum
What is Fournier’s gangrene?
Extensive tissue necrosis/infection of the perineum in patients with diabetes
What is a Foley catheter?
Straight bladder catheter placed through the urethra
What is a Coude catheter?
Basically, a Foley catheter with hook on the end to get around a large prostate
What is a suprapubic catheter?
Bladder catheter place through the skin above the pubic symphasis into the bladder
What is posthitis?
Foreskin infection
What is a hydrocele?
Clear fluid in the processus vaginalis membrane
What is a communicating hydrocele?
Hydrocele that communicates with peritoneal cavity and, thus, gets smaller and larger as fluid drains and then reaccumulates
What is a non-communicating hydrocele?
Hydrocele that does not communicate with the peritoneal cavity.
Remains the same size.
What is a varicocele?
Abnormal dilation of the pampiniform plexus to the spermatic vein in the spermatic cord.
Described as a “bag of worms”.
What is a spermatocele?
Dilatation of epididymis or vas deferens
What is epididymitis?
Infection of the epididymis
What is Prehn’s sign?
Elevation of the painful testicle that reduces the pain of epididymitis
What is a TRUS?
TransRectal UltraSound
What is a DRE?
Digital Rectal Examination
What is orchitis?
Inflammation/infection of the testicle
What is pseudohermaphroditism?
Genetically one sex, partial or complete opposite-sex genitalia
What is urgency?
Overwhelming sensation to void immediately
What is dysuria?
Painful urination (usually burning sensation)
What is frequency?
Urination more frequently than usual
What is polyuria?
Urination in larger amounts than usual
What is nocturia?
Awakening to urinate
What is hesitancy?
Delay in urination
What is pneumaturia?
Air passed with urine via the urethra
What is pyuria?
WBCs in urine (UTI: > 10 WBCs/HPF)
What is cryptorchidism?
Undescended testicle
What is an IVP?
IntraVenous Pyelogram:
Dye is injected into the vein, collects in the renal collecting system, and an x-ray is taken
What is hematuria?
RBCs in urine
What is the space of Retzius?
Anatomic extraperitoneal space in front of the bladder
What is enuresis?
Involuntary urination while asleep
What is incontinence?
Involuntary urination
What is a TURP?
TransUrethral Resection of the Prostate
What is PVR?
PostVoid Residual
What is priapism?
Prolonged, painful erection
What is paraphimosis?
Foreskin held (stuck) in the retracted position
What is phimosis?
Inability to retract the foreskin
What is balanitis?
Inflammation/infection of the glans penis
What is balanoposthitis?
Inflammation/infection of the glans and prepuce of the penis
What is a UTI?
Urinary Tract Infection
What is Peyronie’s disease?
Abnormal fibrosis of the penis shaft, resulting in a bend upon erection
What is BPH?
Benign Prostatic Hyperplasia
What is epispadias?
Abnormal urethral opening on the dorsal surface of the penis
What is hypospadias?
Abnormal urethral opening on the ventral surface of the penis.
May occur in anterior, middle or posterior of penis.
What is erectile dysfunction?
Inability to achieve an erection
What is sterility?
Inability to reproduce
What is an appendix testis?
Common redundant testicular tissue
What is VUR?
VesicoUreteral Reflux
What are the layers of the scrotum?
(1) Skin, (2) Dartos fascia, (3) External spermatic fascia, (4) Cremaster muscle, (5) Internal spermatic fascia, (6) Parietal and Visceral layers of tunica vaginalis, (7) Tunica albuginea
What is the differential diagnosis of scrotal mass?
Cancer, torsion, epididymitis, hydrocele, spermatocele, varicocele, inguinal hernia, testicular appendage, swollen testicle after trauma, non-testicular tumor (e.g. rhabdomyosarcoma, leiomyosarcoma, liposarcoma)
What are the causes of hematuria?
Bladder cancer, trauma, UTI, cystitis from chemotherapy or radiation, stones, kidney lesion, BPH
What is the most common cause of severe gross hematuria without trauma, chemotherapy, or radiation?
Bladder cancer
What is the differential diagnosis for bladder outlet obstruction?
BPH, stone, foreign body, urethral stricture, urethral valve
What is the differential diagnosis for ureteral obstruction?
Stone, tumor, iatrogenic (suture), stricture, gravid uterus, radiation injury, retroperitoneal fibrosis
What is the differential diagnosis for kidney tumor?
Renal cell carcinoma, sarcoma, adenoma, angiomyolipoma, hemangiopericytoma, oncocytoma
What is renal cell carcinoma?
Most common solid renal tumor (90%).
Originates from proximal renal tubular epithelium.
What is the epidemiology of renal cell carcinoma?
Primarily a tumor of adults 40-60 years with 3:1 M:F ratio.
What percentage of renal cell tumors are bilateral?
1%
What are the risk factors for renal cell carcinoma?
Male, smoking, von Hippel-Lindau syndrome, polycystic kidney
What are the symptoms of renal cell carcinoma?
Pain, hematuria, weight loss, flank mass, HTN
What is the classic triad of renal cell carcinoma?
- Flank pain
- Hematuria
- Palpable mass
How are most cases of renal cell carcinoma diagnosed?
Found incidentally on an imaging study
What radiologic test are performed for renal cell carcinoma?
IVP, Abdominal CT with contrast
What is stage I renal cell carcinoma?
Tumor < 2.5 cm no nodes, no metastases
What is stage II renal cell carcinoma?
Tumor > 2.5 cm limited to kidney, no nodes no metastases
What is stage III renal cell carcinoma?
Tumor extends into IVC or main renal vein.
Positive regional lymph nodes but < 2 cm in diameter and no metastases.
What is stage IV renal cell carcinoma?
Distant metastasis or positive lymph node > 2 cm in diameter, or tumor extends past Gerota’s fascia
What is the metastatic workup for renal cell carcinoma?
CXR, IVP, CT, LFTs, calcium
What are the sites of metastases for renal cell carcinoma?
Lung, liver, brain, bone.
Tumor thrombus entering renal vein or IVC is not uncommon.
What is the unique route of spread with renal cell carcinoma?
Tumor thrombus in IVC lumen
What is the treatment of renal cell carcinoma?
Radical nephrectomy (excision of the kidney, adrenal gland, including Gerota’s fascia) for stages I-IV
What gland is removed with a radical nephrectomy?
Adrenal gland
What is the unique treatment of metastatic spread of renal cell carcinoma?
- alpha-interferon
2. LAK cells (lymphokine-activated killer) and IL-2
What is a syndrome of renal cell carcinoma and liver disease?
Stauffer’s syndrome
What is the concern in an adult with new onset left varicocele?
Left renal cell carcinoma (the left gonadal vein drains into the left renal vein)
What is the most common histology in bladder cancer?
Transitional cell carcinoma (90%).
Remaining cases are squamous or adenocarcinomas.
What are the risk factors for bladder cancer?
Smoking, industrial carcinogens (aromatic amines), schistosomiasis, truck drivers, petroleum workers, cyclophosphamide
What are the symptoms of bladder cancer?
Hematuria +/- irritative symptoms, frequency
What is the classic presentation of bladder cancer?
Painless hematuria
What tests are included in the workup for bladder cancer?
Urinanalysis and culture, IVP, cystoscopy with cytology and biopsy
What is stage 0 bladder cancer?
Superficial, carcinoma in situ
What is stage I bladder cancer?
Invades subepithelial connective tissue, no positive nodes, no metastases
What is stage II bladder cancer?
Invades superficial or deep muscularis propria, no positive nodes, no metastases
What is stage III bladder cancer?
Invades perivesical tissues, no positive nodes, no metastases
What is stage IV bladder cancer?
Positive nodal spread with distant metastases and/or invades abdominal pelvic wall
What is the treatment of stage 0 bladder cancer?
TURB and intravesical chemotherapy
What is the treatment of stage I bladder cancer?
TURB
What is the treatment of stage II and III bladder cancer?
Radical cystectomy, lymph node dissection, removal of prostate/uterus/ovaries/anterior vaginal wall, and urinary diversion (e.g. ileal conduit) +/- chemotherapy
What is the treatment of stage IV bladder cancer?
+/- cystectomy and systemic chemotherapy
What are the indications for partial cystectomy?
Superficial, isolated tumor, apical with 3-cm margin from any orifices
What is TURB?
TransUrethral Resection of the Bladder
If after a TURB the tumor occurs, then what?
Repeat TURB and intravesical chemotherapy (mitomycin C) or bacillus Calmette-Guerin