Urology Boy Flashcards
To avoid another L
What are the complications of bladder outflow obstruction?
- Renal insufficiency
- Infection (cystitis, epididymitis)
- Urinary retention
- Bladder calculi
- Bladder diverticulum
Minimum investigations for patient with BPH?
- IPSS
- DRE
- PSA
- Serum Creatinine
- Urine flow studies
- Urinalysis
- Ultrasound KUB
Causes of obstructive LUTS?
Male
- Bladder - neck contracture (primary/post prostatectomy)
- Prostate- BPH/Ca
- Urethra - Stricture
Female
- Bladder - prolapse
- Urethra- diverticulum/cancer/stricture
What are the causes of irritative LUTS?
- Bladder
Inflammation (UTI/irradiation/carcinoma in situ)
Outflow obstruction
Detrusor instability
Neuropathic bladder
Small capacity (TB/interstitial cystitis) - PID
Define incontinence
Inappropriate involuntary voiding or leakage of urine,producing social/hygienic problems
Classify the causes of urinary incontinence
- Failure to store
- Failure to void
- Other causes (fistulas)
What are the “failure to store” causes of incontinence?
1. Bladder Involuntary contractions (OAB/detrusor hyperreflexia) Decreased capacity (TB/irradiation) Sensory urgency (UTI/calculus/ca in situ)
2. Urethral Anatomical stress incontinence Post surgery (prostatectomy) Atrophic vaginitis Radiotherapy Neurological (myelomeningocele) Prostate ca with invasion of the ext. sphincter
What are the “failure to empty” incontinence causes?
- Bladder
Neurogenic bladder(LMN)
Myogenic bladder(atonic detrusor)
Drugs (TCA)
2. Urethral Anatomic obstruction (stricture/stenosis of bladder neck/prostate) Functional obstruction (detrusor sphincter dyssinergia)
Investigations in urinary incontinence
Urine culture (suspect UTI)
Urine cytology (suspect CIS)
Ultrasound
Urodynamics
Define enuresis
Persistence of involuntary voiding beyond age of anticipated control
Bedwetting >2 months in a child older than 5 years of age
What are the most common causes of enuresis?
Developmental delay Genetic factors Sleep disorders Nocturnal polyuria Decreased capacity Psychological factors
When are no further investigations needed in a child with enuresis?
All 3 of:
Monosymptomatic nocturnal enuresis
Normal exam
Normal urinalysis
What is the treatment of enuresis?
5 areas
- General measures (decrease fluid intake at night)
- Medical (older than age 7, Desmopressin, Imipramine, Oxybutinin)
- Behavior reinforcement (star charts)
- Conditioning (enuresis alarm)
- For polysymptomatic enuresis (treat diurnal symptoms)
What is the role of PDE5 and what effect does it cause?
Breakdown of cGMP to GMP
Detumescence
How would a psychogenic ED present?
Sudden onset
Morning erections present
Associated premature ejaculation
Causes of organic ED
- Vasculogenic
- Neurogenic
- Endocrine
- Chronic systemic disease
- Penile problems
- Surgery
- Radiotherapy
- Drugs
What is the treatment of enuresis?
5 areas
- General measures (decrease fluid intake at night)
- Medical (older than age 7, Desmopressin, Imipramine, Oxybutinin)
- Behavior reinforcement (star charts)
- Conditioning (enuresis alarm)
- For polysymptomatic enuresis (treat diurnal symtpms
Define retractile testis
Normally descended testis which has been displaced upwards by cremaster muscle spasm. Can be maneuvered back into scrotum.
Define undescended testis
A testis which has been arrested along the normal path of descent (between abdomen and bottom of scrotum)
Define ectopic testis
Testis has passed through inguinal canal and has then deviated away from the normal line of descent to lie outside the scrotum
What is the aetiology of an undescended testis?
- Intrinsically abnormal testis
- Hormonal (decreased testosterone)
- Mechanical (prune belly syndrome)
How are undescended testis classified?
Abdominal
Inguinal
Upper scrotal
What are the complications of undescended testis?
Malignancy Torsion Trauma Infertility Inguinal hernia
What is the management of undescended testis?
Surgery - orchidopexy
Medical - bHCG to stimulate testosterone
What is the DDx for cryptorchidism?
Undescended testis Ectopic testis Retractile testis Anorchia Orchidectomy
What are the medical indications for a circumcision?
Phimosis Paraphimosis Foreskin trauma Carcinoma of penis Condylomata acuminata Recurrent balanoposthitis Previous inadequate circumcision
What are the advantages of circumcision?
Decreased incidence of
HIV infection
UTI
Penile ca
What are contraindications for circumcision?
Neonatal factors:
Prematurity
Illness
Blood dyscrasia/fam hx of bleeding d/o
Congenital penile abnormalities: Hypoapadia Chordee Buried penis Webbed penis
What are the complications of circumcision? (7)
Hemorrhage Infection Glans injury Skin complications Meatal ulcer Necrosis Urethrocutaneous fistula
What is a hypospadia?
Congenital condition characterized by:
Abnormal opening of urethral meatus on ventral side of penis
Dorsal skin hood
Chordee
Hypospadias are classified according to _________________
The position of the meatus.
Distal - glanular, coronal, distal penile shaft
Middle - mid penile shaft
Proximal - proximal penile shaft, peno-scrotal, perineal
What are the principles of treatment for hypospadias?
Correction of chordee and straightening of penis (orthoplasty)
Urethral reconstruction
How can a RCC present?
- Asx- incidental finding
- Urological - pain, mass, hematuria
- Endocrine - hypercalcemia, polycythemia
- Toxic- anaemia, fever, myo/neuropathy, hepatopathy
- Vascular - HT, DVT, varicocele, oedema, HF
- GIT- anorexia, weight loss, non specific abd pain
- Mets- dyspnea, bone pain, neurological sx
What is the etiology of RCC?
- Adenoma
- Smoking
- Obesity
- Acquired renal cystic disease
- Von Hippel Lindau
What are ultrasound features of a simple cyst?
- Thin wall, round uniform borders
- Hypoechoic
- Posterior abdominal wall signal enhancement
What are ultrasound features of a solid mass?
- Irregular, poorly defined borders
- Hyperechoic
- No posterior abdominal wall enhancement
What are the indications for intervention in renal colic?
- Renal failure
- UTI
- Anuria
- Large stone
- Failure of stone to progress
- Uncontrollable pain
- Convenience
Antenatal dx of posterior urethral valves
On ultrasound
- oligohydramnios
- bilateral hydronephrosis
- thickened bladder wall
How do posterior urethral valves present in neonates/infants? (6)
- Renal failure
- Recurrent UT
- Palpable bladder/kidney
- Failure to thrive
- Urinary ascites
- Respiratory distress
How will posterior urethral valves present in an older child? (3)
Recurrent UTI
Chronic renal failure
Overflow incontinence
What are the invasive ways to treat renal calculi?
- Percutaneous nephrostomy
- JJ stent
- Stone basket via ureteroscopy
- Laser ureteroscopy
- ESWL
- PCNL
- Nephro/ureterolithotomy (open surgery)
What are causes of penile ulcers?
- Syphilis
- LGV (C. trachomatis)
- Chancroid (H. ducreyi)
- HSV
- Ca - SCC
- TB
- Trauma
- Allergies
- Fixed drug eruption
- Behcet disease
- Non specific
