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Med > Urology > Flashcards

Urology Flashcards

1
Q

In new onset erectile dysfunction, check for?

A

DM

CAD RFs

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2
Q

The most common etiology of gross hematuria in 0-20 yr

A

UTI > GN

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3
Q

The most common etiology of gross hematuria in 20-40 yr

A

UTI > stones

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4
Q

The most common etiology of gross hematuria in 40-60

A

M: bladder tumor > stone

F: UTI > stoned

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5
Q

The most common etiology of gross hematuria in > 60

A

M: BPH > bladder tumor

F: bladder tumor > UTI

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6
Q

Initial gross hematuria

A

Anterior urethra

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7
Q

Terminal hematuria

A

Bladder neck and prostatic urethra

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8
Q

Total gross hematuria

A

Bladder and above

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9
Q

Inv for gross hematuria

A 
CBC
Lytes
Cr, BUN
INR/PTT
U/A, urine S&C, cytology
CT contrast
U/S (alone may not be sufficient)
Cystoscopy, retrograde pyelogram
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10
Q

Test of choice for renal parenchyma, calculi, infection?

A

CT urography

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11
Q

Renal U/S is superior to IVP in?

A

Evaluation of renal parenchyma, renal cyst

Insufficient for upper tract imaging.
Limited sensitivity for UCC and small renal masses

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12
Q

Acute Mx of severe bladder hemorrhage

A

Manual irrigation via catheter with NS to remove clots

Continuous bladder irrigation

Cystoscopy if active bleeding (Dx, coagulation)

If refractory bleeding:
Bilateral nephrostomy tube
Hyperbaric oxygen
Intravesical agents (Al-K-SO4, silver nitrate, formalin)
Embolization, ligation (iliac branches)
Cystectomy and diversion
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13
Q

Definition of microscopic hematuria

A

2 or more RBC/HPF in at least 2 separate samples

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14
Q

1st step in microscopic hematuria

A

R/O benign reversible causes:

Mense
Heavy exercise
Meds
Urethral trauma
Infection

And retest after underlying cause resolved

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15
Q

Indications of referal to nephrology

A 
Evidence of glomerular disease:
Raised Cr
Dysmorphic RBC
RBC cast
Proteinuria
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16
Q

If no benign/reversible condition identified and no indication for referral, what’s the next step?

A

Renal U/S

Urine cytology

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17
Q

Indications for referral to urology for cystoscopy

A

Positive findings on U/S or urine cytology

High-risk pt:
>40
Smoking Hx
Occupational chemical exposure
Gross hematuria
Hx of storage/voiding symptoms
Hx of recurrent UTIs
Hx of urological disorders
Pelvic radiation exposure
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18
Q

If negative for benign/reversible conditions and U/S and urine cytology in low-risk pts

A

Urinalysis, urine cytology, BP

At: 6, 12, 24 and 36 mo

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19
Q

Contraindications to CT contrast

A

Renal failure
Pregnancy
Allergy

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20
Q

Type of urinary incontinence caused by hypoestrogenemia

A

Stress incontinence (interinsic sphincter deficiency)

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21
Q

Types of stress incontinence

A 
Urethral hypermobility:
Childbirth
Pelvic surgery
Aging
Levator muscle weakness
Obesity
Intrinsic sphincter deficiency:
Pelvic surgery
Neurologic problem
Aging
Hypoestrogen state
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22
Q

Dx of urge incontinence

A

Hx

Urodynamic studies

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23
Q

Tx of urge incontinence

A

Lifestyle changes:
Fluid alterations
Diet

Bladder habit retraining

Anticholinergics

B-3-agonists

Botulinum toxin A

Neuromodulation

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24
Q

Dx of stress incontinence

A

Hx
Stress test (cough, valsalva)
Urodynamics

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25
Q

Tx of stress incontinence

A

Wt loss

Kegel exercise

Bulking agents

Surgery

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26
Q

Dx of mixed incontinence

A

Hx
Urodynamics
Stress test

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27
Q

Tx of mixed incontinence

A

Combination of stress and urge incontinence managements

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28
Q

Meds causing urinary retention

A 
Anticholinergics
Narcotics
Antihypertensives (ganglionic blocker, methyldopa)
Ephedrine/pseudoephedrine
Antihistamines
Ecstasy
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29
Q

Contraindications to urethral cath

A

Trauma pt unable to void

Trauma pt with blood at urethral meatus

Trauma pt with scrotal hematoma

Trauma pt with high riding prostate

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30
Q

Investigations for urinary retention

A 
CBC
Lytes
BUN, Cr
U/A, Urine S/C
U/S
Cystoscopy
Urodynamic studies
PVR
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31
Q

Tx of urinary retention

A

Underlying

Acute retension:
Immediate cath
Leave Foley in
Closely monitor fluid status/lytes

Chronic retention:
Intermittent cath by pt

Suprapubic cath if urethral not possible

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32
Q

Mx of post operative urinary retrntion

A

Encourage ambulation
a-blockers to relax bladder neck outlet
May need cath
Definitive treatment depends on etiology

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33
Q

BPH inv

A 
U/A
Cr
Renal U/S
PSA
Uroflowmetry
PVR
\+/- cystoscopy, bladder U/S, Bx
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34
Q

Tx of BPH

Asymptomatic pt or symptomatic without bother

A

Watchful waiting

50% improve spontaneously

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35
Q

Tx of BPH

Mod-sev symptoms that are distressing for pt

A

LSM:
Evening fluid restriction
Planned voiding

a-adrenergic antagonist

5-a-reductase inh

Combination is synergistic

Anti-cholinergic/B3-agonist: if storage symptoms without elevated PVR

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36
Q

Indications for surgical BPH Tx

A

Significant symptom burden

Acute urinary retention

Refractory hematuria

Recurrent infections

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37
Q

Pt with BPH who wishes to avoid surgery

A

Microwave therapy

TUNA

Stent

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38
Q

Med contraindicated in men with BPH who plan to undergo cataract surgery

A

a-adrenergic antagonist

Floppy iris syndrome during surgery

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39
Q

Absolute indications for BPH surgery

A

Renal failure with obstructive uropathy

Refractory urinary retention

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40
Q

Relative indications for BPH surgery

A

Recurrent UTIs

Recurrent refractory hematuria

Renal insufficiency

Bladder stone

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41
Q

Inv for urethral stricture

A

Uroflowmetry
(Flow rate < 10 ml/s)

U/A (pyuria)

RUG

VCUG

Cystoscopy

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42
Q

Tx of urethral stricture

A

Urethral dilatation (high recurrence rate)

Visual internal urethrotomy (high recurrence rate)

Open surgical reconstruction

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43
Q

Nerve roots for bladder function

A

Sympathetic: T10-L2

Somatic (pudendal): S2-4

Parasympathetic: S2-4

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44
Q

Pontine micturition center

A

Activated by information from stretch receptors in bladder wall

Activates parasympathetic neurons

Inhibits sympathetic and somatic neurons

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45
Q

Neurogenic detrusor overactivity, location of lesion

A

Above PMC

Intact pathway inferior to PMC

Coordination of bladder and sphincter maintained

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46
Q

Location of lesion in detrusor sphincter dyssynergia

A

Suprasacral lesion of spinal cord

Loss of coordination between detrusor and sphincter

Detrusor overactivity

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47
Q

Detrusor atony/areflexia location of lesion

A

Sacral cord or peripheral efferents

Flaccid bladder

May progress to poorly compliant bladder with high pressures

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48
Q

Deficient bladder sensation

A

Increasing residual urine, leading to decompensation

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49
Q

Evaluation for neurogenic bladder

A

Hx, P/E

Voiding diary

Cath volumes if CIC

U/A

Renal profile

U/S

Cystoscopy

Urodynamic studies:
Uroflowmetry (flow rate, flow pattern)
Filling CMG (Capacity, compliance, detrusor overactivity)
Voiding CMG (pressure flow study)
Video study
EMG and video (for Dx of DSD)
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50
Q

Goal of treatment of neurogenic bladder

A

Prevention of renal damage, infection

Achieve social continence

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51
Q

Tx of neurogenic bladder

A

Bladder hyperactivity:
Anticholinergics
If refractory: botulinum toxin injection,augmentation cystoplasty
Urinary diversion

Flaccid bladder:
CIC

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52
Q

Inv for disuria

A

Gonococcus/chlamydia testing of any discharge

Wet mount if vaginal discharge

U/A, urine C&S

+/- Empiric AB if suspect infection

+/- imaging of Urinary tract

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53
Q

Med causing hydronephrosis

A

a-adrenergic agonist

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54
Q

Inv for hydronephrosis

A 
CBC
Lytes
BUN, Cr
U/A, S&amp;C
U/S
MAG3 diuretic renogram
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55
Q

Goal of Tx of hydronephrosis

A

Improving symptoms
Treating infections
Improving renal function

May require percutaneous nephrostomy tube, ureteral stenting

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56
Q

Post-obstructive diuresis definition

A

> 3 L/24h
Or
200 cc/h over each of 2 comsecutive hours

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57
Q

Physiologic POD course

A

Resolves within 48h with PO fluids

May persist

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58
Q

Pathologic POD

A

Na wasting nephropathy (impaired concentrating ability of renal tubules)

Etiologies:
Reduced reabsorption of NaCl in the thick ascending limb and urea in the collecting tubule

Increased medullary blood flow

Increased flow and solute concentration in the distal nephrons

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59
Q

Mx of POD

A

Admit

Closely monitor hemodynamic status and lytes

Na, K q6-12h
Cr, BUN (follow to baseline)
U/O q 2h

Ensure total intake < U/O (replace every 1 mL U/O with 0.5 mL 1/2 NS IV)

PO fluid if physiologic POD

Avoid glucose containing fluid

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60
Q

Definition of frequency and nocturia

A

Frequency: voiding 8 or more times/24 h

Nocturia: awakening One or more times at night to void

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61
Q

Overactive bladder definition

A

Urgency+ frequency + nocturia

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62
Q

Inv for overactive bladder

A

U/A
+/- PVR
Cystoscopy
Urodynamics

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63
Q

Tx of overactive bladder

A

Bladder training

Bladder control strategies

Pelvic floor muscle training

Fluid management

Avoidance of caffeine, alcohol

Anticholinergics
B3-adrenergics (mirabegron)

If refractory: botulinum toxin bladder injection

Neuromodulations

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64
Q

Anti-muscarinics

A

Oxybutynin

Tolterodine

Solifenacin

Fesoterodine

Trospium

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65
Q

Complicated UTI

A

Structural or functional abnormality

Male

ImmComp

DM

Iatrogenic complication

Pregnancy

Pyelonephritis

Catheter-associated

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66
Q

Uncomplicated pyelonephritis with enterococcus infection, Tx?

A

Ampicillin

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67
Q

Typical UTI organisms

A

KEEPS

Klebsiella
E.Coli
Enterococcu
Proteus
Pseudomonas
S. Saprophyticus
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68
Q

Indications for investigation in UTI

A

Pyelonephritis

Persistence of pyuria/symptoms following adequate AB Tx

Severe infection with an increase in Cr

Recurrent/persistent infections

Atypical pathogens

Hx of structural abnormalities/decreased flow

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69
Q

UTI inv

A

U/A, urine S&C

Investigations if indicated: U/S, CT

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70
Q

Tx of UTI

A

If febrile, consider:
Admission, IV AB, R/O of obstruction

Simple uncomplicated UTI:
TMP-SMX, PO bid x3d
Or
Nitrofurantoin, PO bid x5d

If complicated:
Cipro PO/IV x 2-3 wk
Or
Ampi/genta IV x 2-3 wk
Or
Ceftriaxon IV x 2-3 wk
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71
Q

Recurrent/chronic cystitis definition

A

3 or more/ yr

80% bacterial re-infection: with a different organism, OR the same organism cultured > 2 wk following therapy OR any organism with an intermittent sterile culture

20% bacterial persistence:
Same organism cultured within 2 wk of sensitivity-based therapy

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72
Q

Inv for recurrent cystitis

A

Assess predisposing factors

+/- cystoscopy, U/S, CT

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73
Q

Tx of recurrent cystitis

A

LSM:
Limit caffeine
Increase fluid/H2O intake

AB: continuous (6-12mo) or post-coital (within 2h)
TMP-SMX
Nitrofurantoin

Topical/systemic estrogen for post-menopause

If asymptomatic bacteriuria: NO Tx

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74
Q

Indications for treatment if asymptomatic bacteriuria

A

Pregnancy

Pt undergoing urinary tract instrumentation

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75
Q

Prevention of UTI

A

Good hydration

Cranberry juice

Wipe from front to back

Avoid feminine hygiene sprays and scented douches

Empty bladder immediately before and after intercourse

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76
Q

Interstitial cystitis Sx

A

Bladder pain (relief with emptying)

Urgency, frequency

Cystoscoy:
Glomerulation (submucosal petechia)
Hunner’s lesions (ulcer)

U/A, urine culture and smear, cytology: negative

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77
Q

Inv for interstitial cystitis

A

U/A, microscopy, C&S, cytology

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78
Q

Tx of interstitial cystitis

A 
1st line:
LSM, pain Mx:
Diet
Stress
Lifestyle
2nd line:
Pentosan polysulfate sodium
Amitriptyline
Cimetidine
Hydroxyzine
Intravesical DMSO, heparin, lidocaine

3rd line:
Cystoscopy with bladder hydrodistention under GA (traditionally diagnostic), treat huner’s lesion

Others:
Neuromodulation, cyclosporine A, intradetrusor botulinum

Surgery: augmentation cystoplasty

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79
Q

Dysuria in pyelonephritis

A

Concurrent cystitis

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80
Q

Inv for pyelonephritis

A

U/A, S&C
CBC, diff

Imaging (CT, U/S) if:
Suspect complicated pyelonephritis
No resolution of symptoms within 48-72 of Tx

DMSO: helps secure the Dx
If Nl: pyelonephritis excluded

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81
Q

Tx of pyelonephritis

A

Hemodynamically stable:
Outpatient
Oral AB (ciprofloxacin) x 7d
+/- single initial IV dose (ceftriaxone)

If severe/Non-resolving:
Admit
Hydrate
IV AB (Q, ampi+genta, extended cephalo, extended penicillin, carbapenem) x 14 d (total IV + oral)

Emphysematouse:
IV AB
nephrectomy when pt stabilized
Temporization with nephrostomy tube

If obstruction:
Emergent stenting
Or
Percutaneous nephrostomy

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82
Q

Most common urological Dx in men < 50

A

Prostatitis/ prostatodynia

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83
Q

Acute bacterial prostatitis, the most common pathogen?

A

E-coli

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84
Q

Associations of Acute bacterial prostatitis

A

Often associated with:
Outlet obstruction
Recent cystoscopy
Prostatic Bx

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85
Q

Inv for Acute bacterial prostatitis

A

U/A

Blood CBC, C&S

If non-resolving: TRUS

If suspect abscess: TRUS

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86
Q

Tx of prostatitis

A

Supportive

AB PO/IV:
Cipro 2-4 wk
TMP-SMX 4 wk

Ampi/genta IV 4 wk
Penicillin with Betalactamase inhibitor IV 4wk
3rd Generation cephalo IV 4wk
Q IV 4 wk

If severe obstructive symptoms or retention: Cath

Consider abscess

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87
Q

Chronic bacterial prostatitis etiology

A

Recurrent exacerbations of acute prostatitis-like signs and symptoms

Recurrent UTI with same organism

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88
Q

Acute vs Chronic bacterial prostatitis Sx

A

Acute: fever, chills, malaise. Rectal, lower back, perineal pain. Lower UTSx

Chronic: pelvic pain, storage LUTS. Ejaculatory pain. Post-ejaculatory pain

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89
Q

Inv for chronic prostatitis

A

U/A, urine C&S
(4-glass test: 1: initial stream, 2:modstream, 3: expressed prostatic secretion, 4: post-massage urine)
+ inv same as acute prostatitis

If colony count in 3 and 4 are more than 10 times greater than 1 and 2: prostatic source

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90
Q

Tx of chronic bacterial prostatitis

A

ABx (cipro 4-6 wk)

+/- BB

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91
Q

Chronic pelvic pain syndrome (abacterial) subtypes

A

Inflammatory

Non-inflammatory

Etiology:
Intraprostatic urine reflux +/- urethral hypertonia

Multifactorial

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92
Q

Chronic pelvic pain syndrome Sx

A

Pelvic pain
Storage LUTS
Ejaculatory pain
Post-ejaculatory pain

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93
Q

Chronic pelvic pain syndrome inv

A

U/A, urine C&S
(4-glass test: 1: initial stream, 2:modstream, 3: expressed prostatic secretion, 4: post-massage urine)
+ inv same as acute prostatitis
+ psychological assessment

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94
Q

Chronic pelvic pain syndrome Tx

A

Supportive

AB trial if newly diagnosed

+/- BB, anti-inflammatories, phytotherapy (quercetin, cernilton)

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95
Q

Etiology of epididymitis and orchitis

A

<35:
N. Gonorrhea
C. Trachomatic

>35:
GI organisms (E.coli)

MSM:
GI organisms

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96
Q

Med causing epididymitis

A

Amiodarone

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97
Q

RFs of epididymitis and orchitis

A

UTI

Unprotected sexual contact

Instrumentation

Catheterization

Increased pressure in prostatic urethra (sterile epididymitis)

ImmComp

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98
Q

Inv for epididymitis and orchitis

A

U/A, S&C

Urethral discharge: gram stain, culture

If uncertain: Doppler U/S to R/O torsion

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99
Q

epididymitis and orchitis Tx

A

Scrotal support
Bed rest
Ice
Analgesia

if <35:
Ceftriaxone 1 dose + Doxy (10d)

If > 35:
Ofloxacin 10 d

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100
Q

If unsure between epididymitis and torsion

A

Go to OR

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101
Q

Prehn sign

A

Elevation of testicles

Relieves pain in epididymitis

No change in torsion

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102
Q

Discharge of gonococcal urethritis

A

Thick, profuse, yellow-gray, purulent

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103
Q

Inv for urethritis

A

Gram stain:
GN diplococci (gono)
Or
>4 PMN (non-gono)

Urine PCR

Urethral specimen culture

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104
Q

Urethral discharge in non-gonococcal infection

A

Mucoid, whitis, purulent

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105
Q

Urethritis with negative culture and unresponsive to Tx

A

Ureaplasma urealyticum

Mycoplasma genitalium

Trichomonas vaginalis

HSV

adenovirus

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106
Q

Life style factors precipitating stone formation

A

Minimal fluid intake

Excess:
Vit C
Oxalate
Purines
Ca
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107
Q

Hereditary RFs of renal stones

A

RTA

G6PD deficiency

Cystinuria

Xanthinuria

Oxaluria

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108
Q

Meds predisposing to renal stone

A

Loop diuretics

Acetazolamide

Topiramate

Zonisamide

Indinavir

Acyclovir

Sulfadiazine

Triamterene

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109
Q

Medical conditions predisposing to renal stone

A 
UTI
Myeloproliferative disorders
IBD
Gout
DM
Hypercalcemia
Obesity (BMI>30)
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110
Q

Which BMI increases the risk of renal stone?

A

30

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111
Q

Which UTI organisms can cause stone?

A 
Urea-splitting organisms:
Proteus
Pseudomonas
Providencia
Klebsiella
Mycoplasma
Serratia
S.aureus
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112
Q

Bladder stone hematuria

A

Terminal hematurua

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113
Q

Stone inhibitory factors

A

Citrate

Pyrophosphate

Mg

Tamm-Horsfall gb

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114
Q

Radiolucent stones, visualized on CT but not on KUB

A

Uric acid

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115
Q

Radiopaque stones

A

Calcium
Struvite
Cystine
Uric acid (only CT)

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116
Q

Radiolucent stones

A

Uric acid
Indinavir
Atazanavir

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117
Q

First step in diagnosis of renal stone

A

Helical CT abdomen/pelvis

If negative consider other diagnoses

If positive proceed to KUB x-ray

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118
Q

Indications of urgent intervention for kidney stone

A

Solitary kidney

Bilateral stones

Intractable pain or vomiting

Acute renal failure

Septic stone

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119
Q

Urgent intervention for uric acid stones

A

Dissolution therapy

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120
Q

Urgent intervention for non-uric acid stones

A

ESWL
Ureteroscopy
PCNL
Stent/nephrostomy

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121
Q

Urgent intervention for septic stone

A

Ureteric stent
Percutaneous nephrostomy

Definitive treatment of the stone should be delayed until the sepsis has cleared

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122
Q

Management of stone with no indication of urgent therapy

A

If high likelihood of stone passage:
Observation

If low likelihood of stone passage:
Intervention

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123
Q

Indications for PCNL

A

> 2 cm

Staghorn

UPJ obstruction with correction of obstruction

Calyceal diverticulum

Cystine stones, staghorn

Anatomical abnormalities

Failure of less invasive modalities

124
Q

Investigations for renal stone

A

CBC, U/A, Urine C&S (all)

CT (first episode of renal colic)

KUB (most of pts)

U/S (children, concern for obstruction)

Cystoscopy (if concerning for bladder stone)

125
Q

Extra Inv for recurrent stones or pediatric cases

A

24 h urine x 2 (volume, Cr, Ca, Mg, P, Na, citrate, oxalate, cystine)

126
Q

Acute Tx of renal stone

A 
Analgesic (NSAID)
Antiemetic
Medical expulsion therapy (a-blocker)
AB (if bacteriuria) 
IV fluid (if vomiting)

Surgical if sepsis, RF (obstruction endangering pt):
1st line: ureteric stent via cystoscopy
2nd: percutaneus nephrostomy

Admit if necessary

127
Q

Indications for admission

A

Intractable pain

Intractable vomiting

Fever

Compromised renal function

PregnNcy

128
Q

Indications for detailed metabolic studies

A

Recurrent stone

Pregnancy

Pediatrics

Strong FHx

Underlying kidney or systemic disease

129
Q

Elective treatment of renal stone

A

Conservative if:
Renal stone < 5 mm
Ureteral stone < 10mm

+ no complication + Sx well controlled

PO fluid ( urine volume > 2 L/d, 3-4 L/d if cystine)

Medical expulsive therapy

Periodic imaging ( stone position, hydronephrosis)

Treatment specific to stone type

If Sx worsen or fail to improve, progress to interventional removal

130
Q

Interventional Tx for kidney stone

A

Stone < 2 cm, ESWL
Stone > 2cm, PCNL

+/- stent prior to ESWL if 1.5-2.5 cm

131
Q

Interventional Tx for ureteral stone

A

If > 10mm

ESWL or URS

2nd line: PCNL

Laparscopic, open removal

132
Q

Interventional Tx for bladder stone

A

Transurethral stone removal

Cystolitholapaxy

133
Q

Stone prevention

A

Fluid intake > 2 L/d

K intake

Reduce animal protein, oxalate, Na, sucrose, fructose intake

Avoid high dose Vit C supplements

Meds:
Thiazides (for hypercalciuria)
Allopurinol (for hyperuricosuria)
Potassium citrate (for hypocitraturia, hyperuricosuria)

134
Q

F/U for stone formers

A

Periodic imaging:
Yr 1
Then q2-4 yr

135
Q

The most common type of stones

A

Calcium

136
Q

RFs for Ca stones

A

Hypercalciuria

Hyperuricosuria

Hyperoxaluria

Hypocitraturia

Hypomagnesemia (causes hypocitraturia and hyperoxaluria)

High dietary Na

Decreased urinary proteins

High urinary pH

Low urine volume

Hyperpara

Obesity

Gout

DM

137
Q

Specific Tx for Ca stones

A

Cellulose phosphate
Orthophosphate

Ca-oxalate:
Thizides
K-citrate
Allopurinol

Ca-struvite:
ABx (stone must be removed)

138
Q

RFs for uric acid stones

A

Low volume of urine

Acidic urine

Hyperuricosuria

ASA

Thiazides

Diet (purine-rich red meats)

Hyperuricosuria with hyperuricemia

Gout

High rate of cell turnover or cell death (leukemia, cytotoxic drugs)

139
Q

Urine in uric acid stones

A

Acidic urine
pH < 5.5

Urinary uric acid not necessarily elevated

140
Q

Specific treatment for uric acid stones

A

Alkalinization of urine to pH 6.5-7
(Bicarbonate, K-citrate)

Allopurinol

141
Q

RF for struvite stones

A

Alkaline urinary pH

Infection with urea-splitting organisms

E.coli: not culprit
M>F

142
Q

Constituents of struvite stones

A

Mg
PO4
NH4

143
Q

Special Tx for struvite stones

A

Stone and all foreign bodies must be removed

ABx for 6 wk

Regular F/U cultures

144
Q

Cystine stone etiology

A

AR

Defect in small bowel and renal absorption of dibasic aminoacids

COLA in urine:
Cystine
Ornithine
Lysine
Arginine
145
Q

Cystine stone features

A

Children and young adults

Recurrent

FHx

Staghorn

Faintly radiopaque

Positive urine Sodium nitroprusside test

Urine chromatography for cystine

146
Q

Specific Tx for cystine stone

A

Alkalinize urine

Penicillamine

a-MPG or Captopril (form complex with cystine)

ESWL not effective

147
Q

Cyst on renal ultrasound. Next step?

A

Nothing if:
Hypoechoic
No calcification
Thin wall

CT with contrast (+/- aspiration, Bx)if:
Dense
Calcified
Septated

148
Q

If solid mass on U/S, next step?

A

CT (exclude angiomyolipoma)

Large mass> 4cm:
Surgery

Small mass <4 cm:
Possible surveilence

149
Q

Renal mass in TS

A

Angiomyolipoma

Multiple, bilateral

150
Q

Cysts requiring resection on CT

A

Complex

Thick, irregular walls

Measurable enhancement
Or
Enhancing soft tissue components

151
Q

Cysts requiring F/U on CT

A

Minimally complex

Well marginated

Non-enhancing

Multiple thin septa

Some thickening/calcification of septa/walls

> 3 cm

F/U: imaging q6-12 mo. If evolved: surgical resection

152
Q

Cysts not requiring F/U on CT

A

Round,

No septation or a few thin septa

No true enhancement

No solid component

Well marginated

< 3cm

153
Q

Angiomyolipoma features

A

F>M

20% associated with TS

Clonal, may extend to regional lymphatics and other organs

Negative attenuation on CT

Hematuria, flank pain, palpable mass

154
Q

Tx of angiomyolipoma

A

If symptomatic, risk of bleeding (pregnancy):

Surgical resection, embolization

mTOR inh if unresectable, mets

Otherwise, F/U with U/S

155
Q

Renal oncocytoma features

A

Benign

M>F

Spherical
Capsulated
Central scar

Bx: eosinophilic cells, originating from intercalated cells of collecting ducts

156
Q

Tx of oncocytoma

A

Treat as RCC

Partial/radical nephrectomy if large

HIFU or RFA for smaller masses

157
Q

Renal adenoma features

A

Most common benign

M>F

<1cm

Cortical

Benign

158
Q

Tx of renal adenoma

A

If > 3 cm (likely not benign):

Partial/radical nephrectomy

159
Q

RFs for RCC

A

Smoking

HTN

obesity

Horseshoe

Acquired renal cystic disease

160
Q

Poor prognostic factors for RCC

A

Wt loss

Weakness

Anemia

Bone pain

161
Q

Inv for RCC

A

CBC, ESR, LFT, extended lytes

U/A

Renal U/S

Contrast-enhanced CT

MRI (vascular extension)

Renal Bx

162
Q

Staging w/u for RCC

A

CXR

CT

LFT

Liver enzymes

Bone/head imaging

163
Q

RCC staging

A

T1: < 7cm

T2: > 7cm

T3: extension into major veins, perinephric

T4: extension into Gerota, adrenal

164
Q

Tx of RCC

A

Radical nephrectomy

Partial nephrectomy if:
<4cm
Single kidney
Bilateral tumor

Metastasectomy (if solitary)

Palliative RT for painful bony lesions

Tx for advanced stage: 
tyrosine kinase inhibitors
Anti-angiogenesis/anti-VEGF
mTOR inh
IL-2
IFN-a
165
Q

RF for carcinoma of renal pelvis and ureter (UCC)

A

Smoking

Chemical/dietary exposure (industrial dyes and solvents):aristolochic acid, aniline
Analgesic abuse

Balkan nephropathy

166
Q

DDx of filling defect

A

Urothelial carcinoma

Uric acid stones

Blood clot

Pyelitis cystica

Papillary necrosis

Fungus ball

Gas bubble (gas producing organism)

167
Q

Inv for UCC

A

IVP/CT urogram

Cystoscopy

Retrograde pyelogram

168
Q

Tx for UCC

A

Radical nephrectomy with excision of ipsilateral bladder cuff

Distal ureterectomy for distal ureter tumors

Laser ablation for low grade disease

169
Q

RFs for bladder cancer

A

Smoking

Aromatic amines: naphthylamines, benzodine, tryptophan, phenacetine metabolites

Cyclophosphamide

Pelvis RT

Schistosoma hematobium (SCC)

Chronic irritation (SCC):
Cystitis, chronic cath, bladder stones

Aristolochic acid

Chinese herbal

170
Q

Features of bladder cancer

A

M>F

Whites

Mean age: 65

UCC: > 90%

Poorer prognosis if muscle invasion
High recurrence if non-invasive

Usually multifocal

171
Q

Key symptom of bladdercancer

A

Hematuria

172
Q

Inv for bladder cancer

A

U/A, C&S, cytology

U/S

CT with contrast

Cystoscopy and Bx

Tumor markers: NMP-22, BTA, Immunocyt, FDP

173
Q

Gold std of Dx of bladder cancer

A

Cystoscopy and Bx (initial procedure of choice)

174
Q

Inv for staging of bladder cancer

A

CT/MRI
CXR
LFT
Extended lytes

175
Q

Most important prognostic factor for bladder cancer

A

Tumor grade

176
Q

Intravesical Tx for prevention of bladder cancer progression

A

BCG

177
Q

Staging of bladder cancer

A

T0: insitu

T1: subepithelial connective tissue

T2: muscularis propria
T2a: superficial
T2b: deep

T3:
Perivesical tissue/fat

T4:
Adjacent organs

178
Q

Tx of bladder tumor

A 
No muscle invasion:
TURBT
\+/- intravesical chemo (mitomycin), immunotherapy (BCG)
\+/- repated TURBT
F/U: cystoscopy, cytology
T2-T3:
Radical cystectomy, lymphadenectomy
Or
TURBT + chemo/RT if small, non-obstructive
Neoadjuvant chemo

Advanced disease: T4, mets:
Systemic chemo
+/- RT
+/- surgery

179
Q

RFs for prostate cancer

A

> 50yr

African

High dietary fat

FHx

BRCA mutation

180
Q

Leading causes of male cancer death

A

Lung > colon > prostate

181
Q

Inv for prostate cancer

A 
DRE
PSA
TRUS-guided needle Bx
Bone scan (omitted if PSA<10)
CT
182
Q

Staging of prostate cancer

A

T1: clinically undetectable

T2: palpable. Confined to prostate

T3: extends through prostate capsule

T4: invades adjacent structures

183
Q

Tx of prostate cancer

A 
T1/2 (localized, low risk):
If adequate life expectancy:
Active surveillance 
Or
Definitive local treatment

If short life expectancy or other comorbidities:
Watchful waiting + palliative Tx for symptoms

T1/2 ( intermediate-high risk):
Definitive therapy

T3/4:
External beam radiation therapy
\+ androgen deprivation 
OR
RP + adjuvant EBRT
If node involvement or mets:
Hormonal Tx
Palliative RT
Bilateral orchiectomy
GnRH antagonist or agonist
Estrogens
Antiandrogens

If hormone-refractory:
Chemo

184
Q

Watchful waiting vs active surveillance for treatment of prostate cancer

A

Watchful waiting for short life expectancy:

Non-curative hormonal therapy if progression

active surveillance:

More curative options if progression

185
Q

Indication for radical prostatectomy

A

Young: < 75y

High riskdisease

186
Q

PSA determinants for prostate cancer Dx

A

Increased risk of cancer if:

Decreased free/total PSA

Elevated PSA velocity

Elevated PSA density

187
Q

Indications of PSA screening

A

Any man with > 10 yr life-expectancy and any of the following:

Suspicious finding on DRE
Mod-sev LUTS
High risk individuals
Investigating secondary carcinoma of unknown origin

188
Q

Canadian guideline for prostate cancer screening

A

Offer to all men > 50 and > 10 yr life-expectancy

Offer to all men > 40 and > 10 yr life-expectancy and high risk factors (FHx, African)

Explain harms and benefits of screening

Established informed shared decision

Initial screen: PSA &DRE

Annual screening (q 2-4 yr is acceptable)

189
Q

RFs for testicular tumor

A 
Cryptorchidism
Atrophy
Sex hormones
HIV
Infertility
Family Hx
PHx of testicular cancer
190
Q

Acute hydrocoele in young pt

A

R/O testicular cancer

191
Q

Testicular cancer is more common in which testis?

A

Rt

192
Q

The most common type of testis tumor

A

Germ cell tumors (95%)

Among which seminoma is the most common

193
Q

Inv for testicular cancer

A

Dx: radical inguinal orchidectomy

B-hCG, AFP, LDH

Testicular U/S

194
Q

Significance of tumor markers

A

Return to normal after operation (provided there’s no mets)

195
Q

Markers for seminoma

A

AFP: never increased

B-hCG: 7%

196
Q

Non-seminoma markers

A

B-hCG

AFP

197
Q

Significance of testicular microlithiasis

A

Nothing

198
Q

Staging evaluations for testicular cancer

A

CXR
Markers
CT abdomen/pelvis

199
Q

Testicular cancer staging

A

State 1: disease limited to Testes, epididymis, or spermatic cord

Stage 2: Limited to retroperitoneal nodes

Stage 3: mets to supradiaphragmatic nodal or viceral sites

200
Q

Mx of testicular cancer

A

Orchiectomy through inguinal ligament

Sperm banking

Testicular prosthesis

Adjuvant therapies

Adjuvant RT for:
Stage 2,3 seminoma.

Chemo:
Stage 2,3 seminoma, stage 2,3 non-seminoma.

RPLND:
For non-seminoma.

201
Q

Orchiopexy and risk of malignancy, infertility, torsion

A

Risk of malignancy: no reduction (may reduce)

Risk of infertility: reduced

Risk of torsion: reduced

202
Q

RFs of malignant penile cancers

A

Chronic inflammatory disease

STI

Phimosis

Uncircumcised penis

203
Q

Tx of penile malignancy

A

Wide excision

+/- lymphadenectomy

Cryo, laser… for CIS

204
Q

Torsion of testes features

A

Pain

Diffuse tenderness

Horizontal lie

Absent cremaster reflex

Negative Prehn’s sign

205
Q

Features of epididymitis

A

Pain

Epididymal tenderness

Present cremaster reflex

Positive Prehn

206
Q

Features of orchitis

A

Pain

Diffuse tenderness

Present cremaster reflex

Positive Prehn

207
Q

Hematocele features

A

Pain

Diffuse tendernesd

No transillumination

Hx of trauma

208
Q

Hydrocele

A

No pain

Testis not separable from hydrocele

Cord palpable

Transillumination

Hx of trauma

209
Q

Spermatocele

A

No pain

Testis separable from spermatocele

Cord palpable

Transillumination

210
Q

Varicocele

A

Bag of worms

No transillumination

Increase in size with valsalva

Decrease in size if supine

211
Q

Indirect inguinal hernia

A

Cord not palpable

Testis separable from hernia

No transillumination

212
Q

Generalized dependent edema (scrotom)

A

Diffuse swelling

Post-operative or immobilized

Liver dysfunction should be checked

213
Q

Varicocele happens on which side?

A

90% Lt

214
Q

Inv for varicocele

A

PEx

215
Q

Tx of varicocele

A

Conservative

Surgical ligation

Repair improves sperm count/motility

216
Q

Inv for spermatocele

A

P/E

U\S

217
Q

Tx of spermatocele

A

Conservative

Excise if symptomatic

NO NEEDLE ASPIRATION

218
Q

Types of hydrocele

A

Communicating( children)
Changes size during day

Non-communicating (adults)

219
Q

Inv for hydrocele

A

U/S

220
Q

Tx if hydrocele

A

Conservative

Needle aspiration

Surgery

221
Q

Predisposing factors for testicular torsion

A

Trauma

Cryptorchidism

Bell clapper deformity

50% during sleep

222
Q

Time of necrosis in testicular torsion

A

5-6 h

223
Q

Inv for testicular torsion

A

U/S doppler

Decreased uptake on scintillation scan (doughnut sign)

224
Q

Tx of testicular torsion

A

Emergency surgical exploration

Bilateral orchiopexy

Orchiectomy if poor prognosis

225
Q

When to suspect retroperitoneal problem in pt with varicocele?

A

Acute onset

Rt sided

Palpable abdominal mass

Does not reduce while supine

226
Q

Indications for Tx of varicocele

A

Impaired sperm quality/quantity

Pain/ache affecting QOL

Affected testis fails to grow in adolescence

Cosmetic indications

227
Q

Torsion of testicular appendix

A

Similar Sx to testicular torsion

vertical lie

Preserved cremaster reflex

Blue dot sign (children)

228
Q

Tx of testicular appendix torsion

A

Analgesia

Resolves over 5-7 d

Surgical exploration and excision if refractory pain

229
Q

Hematocele Dx

A

U/S to exclude testis fx

230
Q

Tx of hematocele

A

Ice pack

Analgesics

Surgical repair

231
Q

Site of pathology in Peyronie’s plaque

A

Fibrous thickening of tunica albuginea

232
Q

Etiology of Peyronie’s plaque

A

Unknown

Trauma

Repeated inflammation

FHx

Associations:

DM

Vascular disease

AI

Dupuytren’s contracture

Erectile dysfunctiin

Urethral instrumentation

233
Q

Tx of Peyronie’s plaque

A

Watchful waiting

Verapamil (IL, topical)

Incision/excision of plaque

Shortening of less affected side

Penile prosthesis

234
Q

Priapism definition

A

Erection > 4 h, in the absence of sexual excitement/desire

+/- pain

+/- signs of necrosis

235
Q

Etiology of priapism

A

50% idiopathic

Ischemic:
Thromboembolic (SCA)

Non-ischemic:
Trauma
Medication
Neurologic

236
Q

Priapism inv

A

Cavernal blood gas analysis

Doppler U/S of penis

237
Q

Tx of priapism

A

Underlying

High flow:
Self-limited
Arterial embolization

Low flow:
Needle aspiration for decompression
Phenylephrine intracorporeal injection
Surgical shunt

238
Q

Phimosis etiology

A

Congenital

Poor hygiene

Balanitis

239
Q

Tx of phimosis

A

Proper hygiene

Topical CS

Dorsal slit

Circumcision

240
Q

Paraphimosis etiology

A

Iatrogenic (post cleaning/ instrumentation)

Trauma

Infectious (balanitis, balanopsthitis)

241
Q

Tx of paraphymosis

A

Manual pressure (with analgesia)

Dorsal slit

Circumcision (urgent/electively to prevent recurrence)

242
Q

Inv for premature ejaculation

A

Testosterone levels if in conjunction with impotence

243
Q

Mx of premature ejaculation

A

R/O medical conditions

Address psychiatric concerns

Counseling

SSRI
Clomipramine
Topical lidocaine-prilocaine

244
Q

Erection is the function of which nerve?

A

Parasympathetic

245
Q

Emission is the function of

A

Sensory afferents from glands

Secretion from prostate, seminal vesicle, ejaculatory ducts, enter prostatic urethra (Sympathetic)

246
Q

Ejaculation is the function of

A

Bladder neck closure (sympathetic)

Spasmodic contraction of bulbo-cavernous and pelvic floor musculature (somatic)

247
Q

Detumescence is the function of

A

Sympathetic nerve

248
Q

Psychogenic erectile dysfunction characteristic

A

10%

Sudden onset

On and off

Variation with partner and circumstance

Younger age

No organic RF

Nocturnal/AM erection present

249
Q

Organic erectile dysfunction features

A

90%

Gradual onset

All circumstances

No variation with partner or circumstance

Older age

Vascular RFs present

No nocturnal/AM erection

250
Q

Inv for ED

A

Hx, P/E

Self administered questionnaires

lab (depending on clinic):
FBS, HbA1C, cholesterol profile
TSH, CBC, U/A, testosterone, PRL, LH

Specialized testing usually unnecessary

Evaluation of penile vasculature (if PHx of trauma)

251
Q

Tx of ED

A 
Non-invasive:
LSM (smoking, alcohol cessation)
Psychological (sexual counseling and education)
Change precipitating meds
Treat underlying cause

Minimally invasive:
Sildenafil, tadalafil (longer half-life, no cytopenia), vardenafil, avanafil
Vacuum devices
MUSE: men urethral suppository for erection

Invasive:
Intracavernous vasodilator injection

Surgical:
Penile implant
Penile artery reconstruction

252
Q

When to refer ED pt

A

Failed medical therapy

Penile anatomic abnormality

Pelvic/perineal trauma

Psychogenic cause

Endocrinopathy

Vascular/neurologic assessment

253
Q

Classification of renal trauma severity

A

Minor:
Contusion
Hematoma
Superficial laceration

Major:
Laceration extending into medulla and collecting system
Major renal vascular injury
Shattered kidney

254
Q

Inv for renal trauma

A

U/A:
Hematuria requires W/U

CT (contrast, triphasic) if pt stable

255
Q

When to send home pt with renal trauma

A

Microscopic hematuria + isolated well-staged minor injuries

256
Q

Wham to admit pt with renal trauma

A

If gross hematuria

+ contision/minor laceration

Tx: hospitalize, bed rest, repeat CT if bleeding continues

257
Q

Indications for intervention in renal trauma (surgical, embolization)

A

Absolute:
Hemorrhage and hemodynamic instability

Relative:
Non-viable tissue and major laceration.
Urinary extravasation.
Vascular injury.
Expanding or pulsatile perirenal mass
Laparotomy for associated injury
258
Q

Inv for bladder injury

A

U/A (90% gross hematuria)

CT cystogram and post drainage films for extravasation

259
Q

Tx of bladder trauma

A

Penetrating trauma:
Surgery

Contusion:
Urethral cath until hematuria completely resolved

Extraperitoneal perforation:
Foley. F/U with cystogram.
Surgery if:
Infected urine
Rectal/vaginal perforation
Bony spikes into bladder
Laparotomy for concurrent injury
Bladder neck involvement
Persistent urine leak
Failed conservative Mx

Intraperitoneal perforation:
Surgical repair + suprapubic cath

260
Q

Urethra trauma mechanism

A

Posterior (at the junction of prostatic and membranous urethra):

Blunt trauma, shearing forces, pelvis fx, MVC

Anterior urethra:
Straddle injury

Other causes:
Penile fx, masturbation with urethral manipulation, iatrogenic

261
Q

Inv for urethra trauma

A

Always R/O bladder rupture

RUG or Cystoscopy prior to cath

262
Q

Tx of urethra rupture

A

Simple contusion:
No Tx

Partial urethral disruption:
Very gentle attempt at cath by urologist
If no resistance: Foley for 2-3 wk
If resistance: suprapubic cystostomy or urethral cath alignment

Periodic flow rates/ urethrograms

Complete disruption:
Immediate repair if pt stable

Suprapubic cath with delayed repair if unstable pt

263
Q

Inv for infertility

A

Semen analysis:
At least 2 specimen, collected 1-2 wk apart

Hormonal evaluation:
Indicated with abnormal semen analysis.
Tests: testosterone, FSH (if abnormal, LH, PRL)

Genetic evaluation

Immunologic studies:
Anti-sperm ab (in ejaculate and blood)

Testicular Bx

Scrotal U/S

Vasography (patency of vas deferens)

264
Q

Tx of male fertility

A

Assessment of partner

LSM:
Exercise
Healthy diet
Eliminate alcohol, tobacco, illicit drugs

Medical:
Endocrine therapy
Tx retrograde ejaculation
D/C anti sympathomimetics
\+/- a-adrenergic
Tx underlying infection

Surgical:
Varicocelectomy
Vasovasostomy
Transulethral resection of blocked ejaculatory duct

Assissted reproductive technologies

265
Q

Normal semen

A

Volume: 2-5 mL

Concentration: > 15 million/ml

Morphology: 30% normal forms

Motility: > 40% adequate forward

Liquefaction: complete in 20 min

pH: 7.2-7.8

WBC: < 10 HPF or <106/mL

266
Q

Male reproductive system abnormalities in CF

A

Congenital bilateral absence of vas deferens and epididymal cysts

267
Q

Tracks causing male infertility

A

Alcohol
Tobacco
Cocaine
Marijuana

268
Q

If azospermia, next step?

A

FSH

If high/normal: testis Bx (if normal = obstruction)

If low: hypogonadotropic hypogonadism

269
Q

If absent/low volume ejaculation, next step?

A

R/O short abstinence, incomplete collection.

If non of the above:
Post ejaculatory U/A

270
Q

If liw/absent ejaculatory volume, and U/A negative for sperm, next step?

A

Transrectal U/S:

If abnormal anatomy: determine level of obstruction

If normal anatomy: emission failure

271
Q

Course of antenatal hydronephrosis

A

Most resolve during pregnancy or within the first year of life

(1-5% of fetal U/S)

272
Q

Education for antenatal in utero intervention bored Antenatal hydronephrosis

A

If there is evidence of lower urinary tract obstruction with oligohydramnios

273
Q

Dx of PUV

A

Most commonly recognized on prenatal U/S:
Bilateral hydronephrosis
Thickened bladder
Dilated posterior urethra or keyhole sign
Oligohydramnios

VCUG:
Dilated and elongated posterior urethra, trabeculated bladder, VUR

274
Q

Tx of PUV

A

Immediate cath (relieve obstruction)

Cystoscopic resection of PUV when baby stable

Vesicostomy if resection not possible

275
Q

The most common congenital defect of ureter

A

UPJ obstruction

M>F

40% bilateral

276
Q

Dx of UPJ obstruction

A

Mostly asymptomatic finding on Antenatal U/S

Renal scan +/- furosemide

277
Q

Tx of UPJ obstruction

A

Surgical correction

Nephrectomy if < 15% differential renal function

278
Q

RFs for VUR

A

White race

F>M

Age < 2y

Genetic predisposition

279
Q

Inv for VUR

A

BP

UTI: U/A, C&S

RF: serum Cr

Growth parameters: Ht, Wt

Renal U/S

DMSA renal scan

+/- sibling screening

280
Q

Course and Tx of VUR

A

Spontaneous resolution in 60% of primary cases

Goal of Tx in lower stages:
Prevention of UTI
Prevention of renal damage

Tx:
Daily AB (Px at half the treatment dose):
TMP/SMX, TMP, amoxicillin, nitrofurantoin

281
Q

Indications for surgical treatment of VUR

A

Failure of medical management

Renal scarring (renal insufficiency, HTN)

Breakthrough UTIs

Persistent high-grade reflux (stage 4,5)

282
Q

Tx of hypospadiasis

A

Optimal time of repair < 2yr

DO NOT CIRCUMCISE

283
Q

Associations of hypospadiasis

A

White race

Cryptorchidism

Inguinal hernia

Disorders of sexual differentiation

Ventral Penile curvature

Distal > proximal

284
Q

Tx of epispadias

A

Surgical correction at birth

285
Q

Wilm’s tumor

A

Average age: 3y

Congenital malformation: in 10%

Bilateral: 5%

286
Q

Inv for Wilm’s tumor

A

Investigate other kidney, and renal vein

287
Q

Tx of Wilm’s

A

Unilateral:
Radical nephrectomy
+/- RT/Chemo

Bilateral:
Nephron-sparing surgery + adjuvant chemo

288
Q

Most common site of testis in cryptorchidism

A

Denis Brown pouch ( between external oblique and Scarpa fascia)

External inguinal ring > inguinal canal > abdomen

289
Q

Fertility rate in treated cryptorchidism

A

Bilateral: 53%

Unilateral: 90%

Normal men: 93%

290
Q

Palpable gonads in Disorder of sexual differentiation

A

= chromosomal male

291
Q

Lab tests for Disordered sexual differentiation

A

17-OH-prog

11-desoxycortisol

Basal adrenal steroid levels

Testosterone and DHT (pre- and post- hCB stimulation)

Lytes

Chromosomal evaluation

U/S of adrenal, gonads, uterus, fallopian tubes

Endoscopy, genitography of urogenital sinus

292
Q

Tx of sexual differentiation disorder

A

Steroid supplementation as indicated

Sex assignment

Reconstruction of external genitalia (6-12 mo)

Long-term psychological guidance and support

293
Q

Male phenotype newborn with no palpable testes

A

Bilateral cryptorchidism

Or

Female with salt wasting CAH

294
Q

Catheter for BPH

A

Coudé

295
Q

Cath for urethral disruption/obstruction

A

Filiform

296
Q

Cath in pelvic fx

A

Contraindicated

297
Q

HIV and circumcision

A

Male circumcision reduces risk of HIV acquisition in heterosexual men

Not enough evidence in MSM

298
Q

Medical indications for circumcision

A

Phymosis

Recurrent paraphymosis

Recurrent UTI esp in infants

Balanitis xerotica obliterans

Other chronic inflammatory conditions

299
Q

Contraindications to circumcision

A

Unstable/sick infant

Congenital genital abnormalities

FHx of bleeding disorders (investigate first)

300
Q

Benefits of circumcision

A

Prevention of UTI

Prevention of penile cancer

Prevention of transmission of some STDs

benefits outweigh risks

Canadian pediatric society is opposed to routine circumcision

301
Q

Indications for cystoscopy

A

Gross hematuria

LUTS

Urethral and bladder neck stricture

Bladder stones

Bladder tumor surveillance

Evaluation of upper tracts with retrograde pyelography

302
Q

AB for cystoscopy?

A

Recommended prophylactically

303
Q

The part of prostate that is removed in TURP

A

Periurethral portion and transition zone

304
Q

Indications for TURP

A

Obstructive uropathy:
Large bladder diverticula
Renal insufficiency

Refractory urinary retention

Recurrent UTI

Recurrent gross hematuria

Bladder stones

Intolerance/failure of medical therapy

305
Q

Contraindications for ESWL

A

UTI

Obstruction distal to stone

Coagulopathy/ bleeding diathesis

Pregnancy

306
Q

Contraindications to PDE5 inh (sildenafil)

A

With nitrates

Hx of priapism

Conditions predisposing to priapism:
Leukemia
Myelofibrosis
Polycythemia
SCD
307
Q

Med useful for both stress and urge incontinence

A

Imipramine

Sympathomimetic effect

Med (25 decks)

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