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Surgery > Urology > Flashcards

Urology Flashcards

1
Q

The renal artery branches out from the aorta at which vertebral level?

A

L2

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2
Q

Why is there a presence of perinephric fluid that extends to the pelvis despite an intact gerota’s fascia?

A

Gerota’s fascia is open inferiorly

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3
Q

What is the normal weight of the kidney?

A

150 to 160g

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4
Q

How many peristaltic waves per minute are present in the ureter?

A

4

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5
Q

What is the normal ureter pressure?

A

30mmHg

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6
Q

What is the normal length of the ureter

A

28 to 30cm

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7
Q

trace the abdominal course of the ureter

A
  1. Renal Pelvis
  2. Tip of the transverse process of the lumbar vertebra
  3. Psoas major muscle
  4. Crosses the GENITOFEMORAL nerve
  5. Under the gonadal vessel
  6. Cross the common iliac and external iliac artery
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8
Q

Trace the pelvic course of the ureter (Female)

A
  1. cross the posterior ductus deferens (promixal to ureterovesical junction)
  2. Enters bladder obliquely
  3. Obliquely enters the bladder wall
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9
Q

Trace the pelvic course of the ureter (Male)

A
  1. Anterior to the internal iliac artery
  2. Posterior to the ovary
  3. Under the broad ligament
  4. Behind the uterine vessels
  5. Obliquely enter the bladder wall
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10
Q

What are the 3 ureteric constrictions

A
  1. Ureteropelvic junction
  2. Crossing the iliac vessel
  3. Ureterovesical junction

Remember, UIU

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11
Q

What is the true physical constriction of the ureter?

A

Ureterovesical junction

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12
Q

The ureter is ____ (anterior/posterior) to the iliac vessels

A

ANTERIOR

Yes. But it is posterior to the uterine artery

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13
Q

Which part of the ureter is the most common site of iatrogenic injury?

A

Distal third of the ureter

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14
Q

During hysterectomy, ureters are commonly injured during _____

A

ligation of ovarian and uterine vessels

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15
Q

During APR, ureter is commonly injured during ____

A

division of the lateral ligaments of the rectum

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16
Q

During pelvic surgery, ureter is commonly injured during ___

A

attempts to control bleeding

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17
Q

[Management of ureteral injury]

<1/2 of diameter is transected

A

Primary closure over ureteral stent

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18
Q

[Management of ureteral injury]

> 1/2 of diameter is transected

A

excision with reconstruction

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19
Q

[Management of ureteral injury]

complete transection

A

reconstruction is required

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20
Q

What is the normal size of the prostate gland?

A

4x3x2cm

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21
Q

What is normal weight of the prostate gland?

A

15 to 18 g

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22
Q

What are the blood supply of prostate gland?

A
  1. Inferior vesical
  2. Middle hemorrhoidal
  3. Internal pudendal
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23
Q

The reason why prostate CA can metastasize to the spinal cord

A

Batson plexus

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24
Q

What is the role of fructose that is present in the seminal vesicles?

A

sperm motility

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25
Q

What is the average growth per year (in grams) of the prostate gland after 50 years of age?

A

0.5 to 0.8 grams per year

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26
Q

Which zone of the prostate gradually enlarges that causes urinary outflow tract obstruction?

A

Periurethal zone = transitional zone

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27
Q

What receptors are present in the periurethal zone of the prostate causing urinary outflow tract obstruction

A

Alpha 1 adrenergic receptos

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28
Q

What is the initial compensatory response of the bladder in BPH?

A

compensatory muscular HYPERPLASIA

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29
Q

What is the PSA profile of patients with BPH? (decreased or elevated)

A

Elevated

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30
Q

What is the most sensitive and specific test to confirm presence of bladder outlet obstruction?

A

Pressure-flow urodynamics

Increased bladder pressure and low flow

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31
Q

What diagnostic test differentiates ureteral stricture from BPH?

A

Endoscopy

it also gives information on prostatic configuration

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32
Q

[Management of BPH]

IPSS <7

A

watchful waiting, annual follow up

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33
Q

What drug class helps relax prostatic smooth muscle?

A

alpha adrenergic receptor blocker

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34
Q

What drug class reduces intra-prostatic DHT levels which may shrink and slow progression of BPH?

A

5 alpha reductase

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35
Q

What is the percent reduction in prostatic size after 6 months of 5 alpha reductase treatment?

A

20%

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36
Q

What are the short term complications of Transurethral Resection of the prostate?

A
  1. Hyponatremia due to absorption of hypotonic irrigation fluid
  2. Urinary retention
  3. Infection
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37
Q

What are the long term complications of Transurethral Resection of the prostate?

A
  1. Incontinence
  2. Impotence
  3. Retrograde ejaculation
  4. Bladder neck contracture
  5. Urethral strictures
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38
Q

Aside from TURP, this surgical method is also effective for prostate glands <30g

A

Transurethral Incision of prostate

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39
Q

Advantage of Transurethral Incision of prostate over Transurethral resection of the prostate

A
  1. Less risk of retrograde ejaculation
  2. Less risk of impotence
  3. Less risk of blood loss
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40
Q

What is the surgical management of choice for prostates >80g

A

Prostatectomy (Retropubic or Suprapubic)

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41
Q

What are the indications for prostatectomy?

A
  1. Acute urinary retention
  2. Recurrent or persistent UTI
  3. Significant symptoms from bladder outlet obstruction not responsive to medical therapy
  4. Recurrent gross hematuria of prostatic origin
  5. Pathophysiologic changes of the kidney, ureter, bladder
  6. bladder calculi due to obstruction
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42
Q

What is the most common type of prostate CA?

A

Adenocarcinoma

43
Q

Common initial site of prostate CA?

A

periphery

That is why symptoms of urinary obstruction occur late

44
Q

PSA used as cancer marker for prostate CA is ____ ( sensitive/ specific)?

A

sensitive

SNNOUT

45
Q

What is the preferred imaging test for prostate CA?

A

Transrectal UTZ

46
Q

A high gleason score means that the prostatic CA is ____ (well/poorly) differentiated?

A

poorly differentiated

47
Q

What is the diagnostic method/test used for prostate cancer

A

Transrectal biopsy

48
Q

What is the normal weight of the testis?

A

20g

49
Q

Which part of the testis are not covered by tunica albuginea?

A

Dorsal area

Epididymis and dorsal pedicle are attached

50
Q

The right spermatic vein drains to the _____

A

directly to the IVC

51
Q

The left spermatic vein drains to the ____

A

left renal vein

52
Q

What maintains the bladder neck and proximal urethra closure?

A
  1. Alpha receptor of the bladder neck
  2. Proximal urethra shares excursions in intraabdominal pressure
  3. Increase in intraabdominal pressure causes increase in external urethral sphincter muscle contraction and closes distal urethra
53
Q

Where is the micturition center located?

A

pons

54
Q

How many corpora cavernosa are present in the penis?

A

2

corpus spongiousum = 1

55
Q

What erectile body of the penis is present in the ventral portion?

A

Corpus spongiosum

56
Q

If the patients has initial hematuria, where is the lesion?

A

Distal to bladder neck

57
Q

If the patients has terminal hematuria, where is the lesion?

A

proximal to bladder neck, proximal ureter, trigone

58
Q

If the patients has total hematuria, where is the lesion?

A

bladder, ureter, kidney

59
Q

[Incontinence]

continous, not associated with urgency and stress

A

Total incontinence

60
Q

[Incontinence]

leakage of urine associated with increase in abdominal pressure

A

stress incontinence

61
Q

[Incontinence]

urinary leakage preceded by the sensation of an urgen need to urinate caused by uninhibited bladder contraction due to infection, bladder CA, neurogenic

A

urge incontinence

62
Q

[Incontinence]

overflow of a small amount of urine from a distended bladder

A

overflow incontinence

63
Q

What is the RBC finding that is significant in urinalysis?

A

3/hpf

64
Q

What is the WBC finding that is significant in urinalysis?

A

5/hpf

65
Q

What are normal values of semenalysis?

A
  1. Volume 15mL
  2. 15 million
  3. 10% motile
  4. 4% morphology
  5. 2 abnormal semen analysis

Remember, 15 15 10 4 2

66
Q

____ is an imaging tool done during cystoscopy that evaluate kidneys, bladder,ureters,

A

Retrograde pyeloureterography

67
Q

___ diagnostic tool that reveals the dynamics of micturition and evidence of obstruction or reflux of urine

A

Voiding Cystourethrogram

Used to see patency of the urethra

68
Q

___ diagnostic technique used during therapeutic dilatation of narrow arteries; also used to evaluate renal vasculature

A

Renal arteriography

69
Q

___ diagnostic technique used for early detection and staging of prostate cancer

A

Ultrasonography

70
Q

What is the commonly used imaging technique for imaging urologic neoplasms?

A

Contrast-enhanced CT scan

71
Q

Emphysematous pyelonephritis is commonly seen in which patients?

A

DM patients

72
Q

___ syndrome

Arthritis, conjunctivitis, non-gonoccocal urethritis

A

Reiter Syndrome

73
Q

What is the manifestation of chronic prostatitis with sterile prostatic secretion

A

Prostatodynia

74
Q

Genital TB most commonly involves which part of the mate Genitourinary Tract?

A

Epididymis

75
Q

What type of nephrolith is associated with urea-splitting bacteria or proteus spp?

A

struvite stone

76
Q

[Location of ureteral stone]

flank pain radiating to the groin

A

proximal 1/3 of ureter

77
Q

[Location of ureteral stone]

anterior lower quadrant pain

A

stone in the middle third of ureter

78
Q

[Location of ureteral stone]

presence of bladder irritative symptoms

A

stone in the distal third of the ureter

79
Q

[Nephrolithiasis]

A basic urine pH >7 is associated with what organism

A

urea-splitting organism

80
Q

What is the hounsfield of water

A

0 HU

81
Q

What is the hounsfield of air

A

minus 1000 HU

82
Q

What is the hounsfield of bone

A

plus 1000HU

83
Q

Size of stone that rarely pass spontaneously

A

stones >6mm

84
Q

Nephrectomy is indicated if renogram of a stone-bearing kidney has a renal function of _____

A

<20%

85
Q

Drugs that are stone-provoking

A
  1. Acetazolamide
  2. Calcium supplements or Vitamin D
  3. Vitamin C
86
Q

Nephrolith formed that is associated with excesive vitamin C intake

A

Calcium oxalate stone

87
Q

What are the complications of extracorporeal shock wave lithotripsy?

A
  1. Direct injury to kidney

2. Streinstrasse (incomplete stone fragmentation)

88
Q

Location of stone in the kidney that is associated with lowest stone free rates

A

Lower pole

89
Q

Type of nephrolith that cannot be broken down by SWL

A

Cystine stone

90
Q

Surgical management of large, complex renal or ureteral calculi

A

Percutaneous Nephrectolithotomy

91
Q

What is the rationale behind leaving a ureteral stent after ureteroscopy

A

To prevent distal migration of stone fragment during intra-corporeal lithotripsy

92
Q

What are the common causes of upper tract ureteral obstruction

A
  1. Ureteral stone (most common)

2. Malignancy

93
Q

Most common causes of lower tract obstruction

A
  1. Bladder outlet stone or mass
  2. Urethral stones, stricture
  3. Prostate: BPH, Ca
94
Q

What are the signs and symptoms of Lower tract obstruction

A

WINSURF

Weak stream
Intermittency
Nocturia
Straining
Urgency
Retention
Frequency
95
Q

What is the triad of renal cell carcinoma

A
  1. Pain
  2. Mass
  3. Hematuria
96
Q

___ syndrome refers to renal cell CA + hepatic cell dysfunction

reversible hepatic cell dysfunction with removal of RCCA

A

Stauffer’s syndrome

97
Q

What imaging is able to determine the extent of vascular involvement in patient with RCCA

A

MRI

98
Q

What is removed in radical nephrectomy for patients with RCCA?

A
  1. Excision fo kidney
  2. Gerotas fascia
  3. Perinephric fat
99
Q

[Bosniak Classification]

Hairline thin wall, no septa

A

Bosniak 1

Malignancy = 1.7%

100
Q

[Bosniak Classification]

few hairline thin septa and fine calcifications; short segment, slightly thickened <3cm

A

Bosniak II

Malignant = 18.5%

101
Q

[Bosniak Classification]

multiple hairline septa, septa can have calcifications >/3cm

A

Bosniak IIF

Malignant = 18%

102
Q

[Bosniak Classification]

indeterminate cystic masses, thickened irregular or smooth walls or septa

A

Bosniak III

Malignant = 33%

103
Q

[Bosniak Classification]

Clearly malignant; contains enhancing soft-tissue components

A

Bosniak IV

malignant = 92.5%

Surgery (19 decks)

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