Urology Potpourri Flashcards
what classifies microhematuria?
> 3 RBCs per hpf on microscopic UA
*postive dipstick should ALWAYS be confirmed w/ microcsopic
evaluation for asymptomatic hematuria
- CT urography
- can get US if pt is pregnant
asymptomatic hematuria is . . .
CA until proven otherwise
RF for malignancy
- > 35 yrs
- smoking
- occupational exposure to chemicals
- chronic indwelling foley
when to refer to urology
-hematuria in absence of obvious cause
anticoagulated patients and hematuria
-do not assume blood is related to the meds, these pts still need work up
clinical presentation of stone
sudden onset of sharp pain to ipsilateral side w/ radiation to pelvis or labia/scrotum
when do stones cause pain?
- only when they are obstructing
- if nonobstructing, consider other cause of pain
gold standard imaging for stone
CT abd/pelvis without contrast
important point about uric acid stone
they are radiolucent
stone size likely to pass on its own
4 mm or less have 95% chance of passing
aditional tx when waiting to pass stone
- flomax .4 mg PO daily
- give pt a strainer
indications for prompt tx of a stone
- prolonged complete or high grade unilateral obstruction
- any b/l obstruction
- any obstruction in a solitary kidney or w/ urinary infection or sepsis
- obstruction w/ rising creatinine
- intractable pain, n/v
ureteroscopic extraction
- outpatient
- preferred option if stone is infected
- only option if stone is below bony pelvis
- generally needs stent placement for 7-10 days following
ESWL
- outpatient
- stones MUST be visible on KUB
- stone broken up w/ US waves then fragments passed by pt
- stent placed
when is ESWL contraindicated?
- pregnancy
- coagulopathy
- urinary infection
- obesity
- large renal a. or AAA >4 cm
percutaneous nephrolithomy (PCNL)
- for staghorn calculi or stones >2cm
- access through nephrostomy tube
- 1-2 night stay in hospital
- higher risk of complication
types of stones
- caclium oxalate (MC)
- calcium phosphate
- uric acid (radiolucent)
- struvite (associated w/ infection; staghorn)
- cystine (too hard for ESWL )
w/u for metabolic evaluation of stones
- 24 hr urine
- labs: BMP, Ca, PTH, uric acid, phosphorus
- dipstick UA
stone prevention guidelines
- WATER WATER WATER (UOP of 2-2.4 L/day)
- reduce Na intake
- reduce dietary oxalate
- moderate Ca intake
hypogonadism
low serum testosterone and clinical sx
T level indication for tx
-no tx indicated for a T level >350
when to draw serum T
- early morning
- always confirm w/ 2 lab draws
sx of low T
- low libido
- fatigue
- ED
- infertility
- muscle loss
- altered mood disturbances
interstitial cystitis
- diagnosis of exclusion in pts w/ urgency, frequency, and dysuria for >6mos
- chronic inflammatory condition of the bladder
- no cure
- have high suspicion in women w/ chronic UTI sx and neg culture
lifestyle changes in interstitial cystitis
- IC diet
- reduce stress
- daily exercise
meds for interstitial cystitis
- elmiron, elavil, atarax, H2 blockers
- anti-inflammatory meds, pyridium
- NEVER narcotics
alternative tx for interstitial cystitis
- cystocscopty w/ hydrodistension
- bladder instillations
- neuromodulation
- intravesical botox
- urinary diversion - extremely last resort
presentation of renal cell carcinoma
- most found incidentally during eval of unrelated medical issue
- typically asymptomatic
classic triad in renal cell carcinoma
- flank mass
- hematuria
- pain
*generally indicated advanced dz
imaging for renal cell carcinoma
- renal US
- CT abdomen w/ and w/o
- MRI w/ gadolinium
RF for RCC
- smoking
- obesity
- HTN
- horseshoe kidney
- aquired cysts from chronic renal failure
what is the main genetic RF for RCC?
von Hippel lindau
risk of mets with RCC
- increases w/ size
- <4cm is typically confined to kidney
common sites of met in RCC
- lungs
- bone
- regional lymph nodes
- liver
- adrenal glands
- contralateral kidney
- brain
tx of RCC
- surgical excision is only cure
- if not a canidate for surgery: surveillance
radical nephrectomy
- removal of everything contained w/i Gerota’s fascia
- may include adrenal gland and regional lymph nodes
- open or laparoscopic
renal sparing surgery options
- partial nephrectomy
- enucleation
- ablation
partial nephrectomy
- tumor removed w/ margin of normal tisssue
- preferred option based on long term data
enucleation
-tumor removed by dissecting b/w the tumor pseudocapsule and nl kidney
ablation
- tumor destruction w/o excision
- higher risk of recurrence
when to consider the surgeries that don’t remove the entire kidney:
- solitary kidney
- b/l renal tumors
- poor renal fxn
- definitive diagnois of benign tumor
- tumor < 7 cm
