Urology / GU Flashcards
epididymitis vs orchitis
epididymitis usually bacterial
orchitis usually viral
MC cause epididymitis-orchitis by age
men <35 - chlamydia (2nd gonorrhea)
men >35 + children - enteric organisms e.coli, klebsiella
viral in children - mumps mc
testicular torsion
spermatic cord twists and cuts off testicular blood supply
-65% in teenagers 10-20yo
cryptorchidism
undescended testicle
- mc in premature infants (70% descend spontaneously)
- MC right side
complications of cryptorchidism
TESTICULAR CANCER (both in affected and unaffected side), subfertility, torsion and hernia
mc type of testicular cancer
germinal cell tumors (seminoma or nonseminomatous) - usually malignant
testicular cancer - germinal cell (MC) tumor types
seminoma (mc men 30-40s): simple (lack tumor markers) sensitive (to radiation) slower growing step-wise spread
non-seminomatous (mc <10 yo): embryonal cell, teratoma, yolk sac
-increased serum a-fetoprotein, inc B-hCG and radiorestistance
communicating hydrocele
peritoneal/abdominal fluid enters via patent processus vaginalis (swelling worse w/ valsalva)
varicocele
varicose veins in testes
MC left side; primary usually idiopathic; secondary can occur in abdominal mass compression of renal veins (mc w/ right side) or superior mesenteric artery compression of left renal vein (nutcracker syndrome)
-sudden onset on left side in older men –> possible renal cell carcinoma
-right-sided in children <10 –> possible retroperitoneal malignancy
spermatocele (epididymal cyst)
- scrotal mass that contains sperm
- painless, superior, posterior and separate from teste
- transilluminates and no tx necessary
paraphimosis
foreskin trapped behind corona of glans, constricting –> urologic emergency (tx by reduction of edema w/ cool compress and push OR granulated sugar, injection of hyaluronidase OR incision on dorsal)
phimosis
inability to retract foreskin over the glans (tx by circumcision)
- normal until adolescence (13-22 yo)
- pathologic can be caused by DM - chronic glycosuria can lead to infx
prostatitis
prostate gland inflammation 2ndary to ascending infection
acute prostatitis differential by age
> 35 yo - e.coli MC, pseudomonas, klebsiella, proteus
<35 yo - chlamydia + gonorrhea (other e.coli, treponema, trichomonas, Gardnerella)
-viral may be seen in children (mumps mc)
chronic prostatitis causes
e.coli 75-80%, enterococci
trich, HIV, stx or fx abnormality, recurrent UTIs
risk factors for prostate cancer
genetics, high fat intake, obesity, AA
adenocarcinoma (95%)
-hormonally dependent on inc dihydrotestosterone production
prostate cancer clinical sx
asymptomatic until invasion of bladder
urethral obstruction (freq, urg, retention, dec stream)
back pain/ bone pain (inc incidence mets to bone)
when to do DRE + PSA
@ 50 yo
AA or family history @ 40
bladder cancer MC type
transitional cell (TCC) -other, squamous, adeno, sarcoma, small cell
bladder cancer RF
smoking MC
exposure to dyes, rubber, leather, age >40, cauc M 3x mc
*highest rate of recurrence of all cancers
renal cell carcinoma
- tumor of proximal convoluted tubule (v metabolically active so most prone to dysplasia)
- RF: smoking, dialysis, HTN, obesity, men
erection physiology
parasympathetic –> artery dilation and muscle relaxation
flaccid state via sympathetic –> norepi –> arterial vasoconstric and venous dilation (reduce inflow and increase outflow)
pathophysiology of ED
- abrupt usually psychological, gradual worsening more likely systemic causes
- neurologic (DM), psychogenic, vascular (atherosclerosis), prolactinoma, trauma, sx
- meds: BB, HCTZ, CCB, SSRIs, TCAs
priapism
prologned erections w/out sex stimulation
- ischemic MC - decreased venous outflow may lead to compartment syndrome
- nonischemic - due to increased arterial inflow (related to trauma)
differential for hematuria
<40 mc GU infx, nephrolithiasis
>40 mc urinary tract cancer, prostatic dz
upper GU: nephrolithiasis, kidney dz, renal cell CA, trauma, DM, sickle cell
lower GU: BPH, urothelial cell cancer
pseudo hematuria: rhabdo, beets, rhubarb, myoglobinuria, hemoglobinuria
meds: ibuprofen, phenazopyridine, rifampin
urethritis
gonoccocal urethritis - acute onset of sx (3-4 days), opaque, yellow, white or clear discharge, pruritus
non-gonococcal - clamydia MC, 5-8 days –> purulent or mucopurulent discharge, pruritus.
- hematuria, pain with intercourse
- other types: ureaplasma urealyticum, trichamonas
enuresis
primary monosymptomatic bedwetting - in children >5 in the absence of sx of infx
bladder control (parasympathetic/sympathetic)
sympathetic tone closes bladder neck and increased pelvic floor tone
parasympathetic tone increases in micturation, allowing relaxation
functional incontinence
problem that keeps the patient from quickly getting up to the bathroom
mixed incontinence
combo of stress + urge in 40-60%
stress incontinence
urnie leakage due to increased intraabdominal pressure
- laxity of pelvic floor muscles (childbirth, sx, postmenopause or post-prostatectomy)
- sneeze, cough, laugh
urge incontinence
leakage accompanied by or preceded by urge
- detrusor muscle overactivity “overactive bladder”
- detrusor stim by muscarinic acetylcholine receptors
overflow incontinence
urinary retention (incomplete emptying)
- decreased detrusor muscle “underactive bladder” atony
- bladder outlet obstruction in BPH
gleason score
for prostate cancer –> 1-10 (1 well-differentiated, not as bad; 10 is not well-formed and worse prognosis) staged into 1-5 (after score)
MC STDs
HPV, chlamydia, gonorrhea (in order)
MC UTI in infants
group B strep
>1yo - e.coli
Struvite stone
staghorn calculi, urease producing bacteria
stone size for passage
<5 mm likely to pass on own
bladder calculi
elderly men
-associated w/ urinary stasis –> mc cause is infection of residual bladder urine w/ urea-splitting organisms
name 5 urea-splitting bacteria (contribute to stones)
proteus pseudomonas klebsiella staphylococcus mycoplasma
