Urology CC Flashcards
BPH occurs in the __ zone which surrounds ___
as men age, inc amount of __/ ____
BPH Obstructive sx
WISE
BPH irritative sx
FUND
Presents w B
L
P
transition, the urethra
stroma/ alpha 1 receptors
weak stream, intermittency, straining, emptying poor
freq, urgerncy, nocturia, dysuria
Bladder outlet obstruction
lower urinary tract sx
prostatism
International Prostate Symptom Score AKA \_\_\_ Standardized \_\_\_ 0-7 is \_\_\_ 8-19 is \_\_ 20-35 is \_\_
Med management w __ to work on __ receptors
helps to ___ smooth muscle in bladder
A1A in P, B, S, V
A1B in B
A1D in N, B, S
this is ___ therapy
can lead to
AUA sx score questionairre mildly sx moderate sx severely sx
alpha blockers, A1 adrenergic
relax
prostate, bladder neck, seminal vesicles, vas deferens
blood vessels
nasal passages, bladder, spinal cord
first line
trouble passing urine
BPH nonselective A blockers med management
Need __
T, D, A
Selective for ___
T and S
less ___, dont have to __
Alpha blockers work __
as quick as __, may take _w
SE D F N O R
titration
terazosin, doxazosin, alfuzosin
A1A adrenergic receptor
tamsulosin, silodosin
systemic SE, titrate
acutely
8hrs
2-4 wks
dizziness fatigue nasal congestion ortho hypoTN retrograde ejaculation
BPH management
5A reductase inhibitors
5AR converts __ to ___
reduces ___
includes __ and __
takes __ to notice beneficial effects
Reduces \_\_\_ inc \_\_ improve \_\_\_ reduces risk of \_\_ and need for \_\_\_ reduces \_\_\_ decreases \_\_ over 1 yr
T to DHT
DHT
finasteride, dutasteride
6-9m
prostate volume max flow rate IPSS scores urinary retention, BPH surgery progression PSA
BPH surgical treatment
__ (TURP) gold standard
___ prostate endoscopic
SE
R__ w ___, irreversible
__ syndrome w __, __ overload from absorption of ___
Other options T\_\_ U\_\_\_ which tacks \_\_ open M/N \_\_\_ Simple \_\_\_
transurethral resection of prostate
core out
retrograde ejac, open bladder neck
TUR, hypoNa, fluid, hypotonic fluid
transurethral laser surgery
urolift, lobes of prostate
microwave/needle ablation
prostatectomy
BPH is a common cause of __, must rule out ___
Dizziness may require ___ of med or ___
Pt who fails therapy have possible ___ or need __
___ is not indicated for BPH
hematuria, cancer
discontinuation, reduction
neuro cx, surgery
open radical prostatectomy
Erectile fxn is __ event w __ and ___ modualtion
sex stimulation leads to ___ release of NO
eventual ___ of sm in arterioles
inc ___ w __ expansion
SM in ___ relaxes, filling/expanding ___
causes compression of ___ bw erectile tissues overlying ___, stopping __
PNS leads to inc ___ w dec __
neurovasc, psych/hormonal
PNS NT
relaxation
blood flow, cavernosal
sinusoidal system, corporal bodies
venous complexes, tunica, venous outflow
inc blood flow, venous outflow
Erectile fxn major NT ___
inc ___ leads to __ and erection
__ of cGMP by __ leads to detumescence
NO
cGMP, sm relaxation
hydrolysis, PDE5
Common causes of ED
Pyschogenic
Neurogenic
Jormonal
Vasc
Med induced
disorders, problem
performance anx/depression
dec libido/NO, overinhib
stroke, SC injury, diabetic retinopathy
lack of nerve impulse/dec trans
hypogonad, hyperprolactin
dec NO
athero, HTN
impaired arterial/venous flow
antiHTN, antidepressants, etoh/cigs
central suppression, vasc insufficiency
ED can occur in ___ or ___ or __ or __ or ___ or ___
new onset ED leads to __ inc risk for __, __, __, __
Possible tx oral \_\_\_\_ inhibs, like \_\_\_ \_\_ device \_\_\_ or other \_\_ injections intraurethral \_\_ admin surgical placement of \_\_ \_\_ supplementation
DM, CAD, hyperlipid, hyperTN, sc dz, pituitary tumor
MI, stroke, angina, mini-stroke
PDE. sildenafil vacuum constriction PG E1, intracavernosal PG E1 penile prosthesis testosterone
PDE5 inhibitors
__ first line tx for ED
inhibit breakdown of ___, enhancing ___
imrpove response to __, but do not cause __
Most men __
Others: T, A, S, V
SE H/F N B Impaired \_\_\_ bc \_\_ in retina
higher in __ and __
low in __ and __ (dec aff for __)
sildenafil
cGMP, NO
sexual stimulation, auto erections
respond
tadalafil, avanafil, sildenafil, vardenafil
HA, flushing
nasal congestion
blurry vision
color vision, PDE6
sildenafil/vardenafil
tadalafil/avanafil, PDE6
Avoid PDE5 inhibs w
Resting ___ or __
__ or inherited disorders of ___
____
absolute contraindication __
should not be taken w/in 4hrs of ___
RF for ED S D/H/H Prolonged \_\_ V Trauma to \_\_\_/\_\_\_ Pelvic \_\_/\_\_
hypoTN (90/50), HTN (170/110)
retinitis pigmentosa, retinal PDE6
CV dz
nitrates
alpha blockers
smoking DM/HTN/hypercholesterolemia bike riding vasc dz penis/perineum surgery/radiation
PG E1 injection in __
directly relaxes ___
no __ needed for errection
if no errection, pt has __ from severe ___ or __ from leak in ___ mech of penis
option is ___ w pump to inflate ___ in ___
penis
penile arterioles
neural input
inflow, PVD
outflow prob, veno-occlusive
surgical device, tubes, corpora
Phimosis
inability to __
only emergent if ___
can tx w ___ as outpt
may include __ in tx
other options
D/C
retract foreskin
cant void
steroid cream
antifungal
dorsal slit
circumsision
Paraphimosis
can result in __
due to ___
manage w ___
compress ___
dunk glands past ___
+/- ___
__ if cant reduce
necrosis of glans
circumferential constriction
emergent reduction
edema
constricting ring
penile block
dorsal slit
DDx of acute scrotum T A E T T H
Testiculr torsion w ___
Testis covered by __, creating ___
if high attachment, can __ on cord
salvage w/in ___
MCC of __ in US
testicular torsion appendiceal torsion epididymitis tumor trauma hernia
bell clapper deformity
tunica vaginalis, potential space
rotate
6hr
testicular loss
Testicular torsion CM
__ onset
age is __
no __
testis is __ and ___
severe __, ___, ___, loss of ___
no flow on ___, normal __ and __ initially
Tx w emergent ___, can __ or __
peform __ on other side to prevent ___
acute
pubertal
infection sx
elevated, horizontal
TtP, erythema, edema, cremasteric reflex
Doppler US, UA/labs
scrotal exploration, preserve/remove
orchiopexy
torsion
Appendiceal torsion
Various __ can exist and torse, causing sx that mimic ___
__ sign
usually ___, can be __
embryo appendages, test torsion
blue dot
self limited, excised
__ and ___ can mimic CM of tosion
__ or __ suggests infection
__ is most definitive dx
If < __ or high risk, treat for ____
older pt, usallly ___
scrotal abscess requires __ + ___
epididymitis/epididymo-orchiitis
UA/CBC
US
25, gonorrhea/chlamydia
gram - rods
infection/drainage, antibiotics
Necrotizing fasciitis aka __
__ emergency
MC ___
tx w __ antibiotics and __
skin is \_\_, w \_\_ rapidly \_\_ assc w \_\_ or \_\_\_ often require \_\_ can be \_\_/\_\_\_
typically __ w fast spreading ___
typically involves __ of perineum, ___ of scrotum/penis and __ of ab wall
__ spared
may present w E/S/E
Fournier Gangrene
surgical
polymicrobial
broad spectrum, resuscitation
black/gray, crepitus progressive DM, IC ICU admittance fatal/disfiguring
superficial, necrotizing infection
colles fascia, dartos fascia, scarpas fascia
testes
edema, skin excoriation, eschar
__ require surgical exploration
__ less likely to cause testes injury
decision for surgery depends on __ and __
__ excised and __ closed
\_\_ important to distinguish may be assx w \_\_ or \_\_ PE often \_\_ \_\_ is diagnostic can be \_\_ for general surgery
Penetrating injuries
blunt trauma
exam/US
extruded contents, tunica
Hernia bowel sx/obstruction suggestive imaging surgical emergency
Prostatitis is __ of prostate
Bacterial can be __/__
chronic prostatitis or ___
Sx ___
Pain w __, __, __
Blood in __ or __
Difficulty w __
Tx is \_\_\_ Long course \_\_\_, \_\_ mc Prostate \_\_\_ if not \_\_ S S F Anti-\_\_\_
inflam/infect
acute/chronic
chronic pelvic pain
vary
sex, urination, sitting
semen/urine
urination
difficult antibiotics, E coli massage, acute/febrile supplements sitz baths flomax inflam
Prostate cancer tx varies based on __ and __ of dz
Tx A R R C
stage/grade
active surveillance
radical prostatectomy
radiation
cryotherapy
PSA is an __ that allows for __ of seminal fluid
can be increased in P, B, P, M/T such as cystoscopy/DRE
offer ___ and __ for men at age 50 with life expectancy of ___
enzyme, liquefaction
prostate cancer, BPH, Prostatitis, manipulation/trauma
PSA test, DRE, 10+ yrs
ADT, used for ___
90% of androgens from __, other from ___
can be __
bilateral __
has fastest rate to __
still have ___
adrogen deprivation therapy
metastatic prostate cancer
testes
adrenals
surgical
orchiectomy
castration
adrenal sources
GnRH agonist
initial inc in __
neg feedback then dec __, followed by dec __
castrate in ___
Ex L/H/G
T flare can __ sx
inc ___
lead to ___ copression
___ obstruction
prevent testosterone receptor blockade w __ or ___ or __
start __ prior to GnRH agonist, continue for __
Testosterone
LH sec, Testosterone
30 days
leuprolide, histrelin, goserelin
worsen
bone pain
spinal cord
urinary
Flutamide, nilutamide, bicalutamide
7d, 30d
Castrate resistant prostate cancer
Abiraterone
Irreversible inhibitor of __, required for __ in adrenals/testis
enzalutamide- _ antag
CYP17, adrogen synthesis
testosterone receptor
