Week 1 Urology Flashcards
Epispadias
Congenital malformation of urethral meatus on dorsal side of the penis
Hematospermia
Source could be epididymis, seminal vesicle, prostate, bulbourethral glands
Red flag: sxs > 1 month, palpable mass, hematuria, obstructive sx
Hypospadias
Congenital malformation of urethral meatus on ventral side of penis
Balanitis
Inflammation of glans penis
Posthitis
Inflammation of the foreskin
Balanoposthitis
Inflammation of glans and foreskin
Due to candida, GC, CT, scabies, contact derm, psoriasis, poor hygiene, diabetics
Sequelae: meatal stricture, phimosis, para phimosis, cancer
Phimosis
Foreskin cannot be retracted back away from glans penis
Pathologic or physiologic
Paraphimosis
Foreskin stuck in retracted position, becomes inflamed–> reduced blood flow –> necrosis
Peyronie’s Disease
Scarring of tunica albuginea –> painful erection with dorsal curvature
Chancre
Due to syphilis. Solitary, painless ulcer
Non exudative, indurated edge
Chancroid
Painful, shallow non indurated ulcers, irregular edges and red borders
Gray or yellow purulent exudate
Infection of H. ducreyi
Regional tender adenopathy, may abscess
SCC of the penis
More common in uncircumcised males with poor hygiene
HPV 16 and 18
fungating, non painful sore that does not heal
Dx by biopsy
Priapism
Prolonged, painful erection > 4 hours. Emergency due to ischemia
Dx by color Doppler US, assessment of corporal blood gases
Orchitis
Inflammation of testicle due to infection, usu viral/mumps
Acute Epididymitis
Usu bacterial infection
Could be urine reflux/chemical irritation into ejaculatoru ducts from heavy lifting /trauma
Positive Prehn’s sign
Scrotal US to rule out torsion
Chronic epididymitis
Inflammation with no infection present, enlarged, thickened, non tender epididymis
Hematocele
Blood filled, secondary to trauma. Does not transilluminate
Hydrocele
Non tender, serous filled
Acute– between 2-5yrs, due to inflammation
Chronic–middle age men from inflammation or injury
Variocele
Due to gravity pulling on venous valves. Bag of worms. Worse with valsalva and standing
**Development of a new variocele: on L–tumor or mass. On R–occlusion of vena cava
Testicular torsion
Emergency! De-torse <6 hours
Color Doppler US.
Spermatocele
Small, painless cyst. Benign. With dead spermatozoa. Dx by US or aspiration.
Cryptorchidism
Failure of testicles to descend into scrotum during infancy
High risk of developing infertility or testicular cancer later in life
Testicular cancer
Most common solid a cancer in 15-34yrs
Risk factors: cryptorchidism, exogenous estrogen, trauma, gonadal dysgenesis, Klinefelter syndrome
Rubbery prostate
BPH
Boggy prostate
Congested
Induration on prostate
Malignancy. Nodules
Prostate labs
Serum PSA, PSA velocity, free/bound PSA
BPH
Progressive urinary freq, urgency, nocturia, dribbling
PE: enlarged, rubbery. Smooth, symmetric. May be distended bladder
Lab: increased BUN, UA, PSA
Acute bacterial prostatitis
Fever, chills, malaise, dysuria
+ E. coli, klebsiella, proteus, pseudomonas, enterobacter
Lab: CBC left shift. UA shows WBCs, elevated CRP
Contraindication for prostate massage
If acutely inflamed… Sepsis!!
Chronic bacterial prostatitis
Sxs: recurrent UTIs, fatigue, pain, sexual dysfunction, ejaculatory pain
PE: DRE–tender, boggy, enlarged, soft prostate
Lab: post massage urine culture and sensitivity
Chronic prostatitis/Prostadynia
Criteria: no objective cause, Sxs related to prostate area, refractory to tx
Etiology: psych stress, low T, infection from normal bacteria, genetic
Prostadynia Sxs and PE
Sxs: pain in pelvis > 3 mos, dysuria, urgency, low back/perineal pain, sexual dysfunction, post ejaculation pain, IBS, chronic fatigue
PE: DRE–mildly tender, boggy, enlarged
Lab: UA, urine culture and sensitivity, CBC
*may need to rule out CT/GC
Prostate cancer
Commonly adenocarcinoma.
Risk factors: age, African American, family hx, obesity, SAD, meds, vasectomy
Sxs: sexual dysfunction, incontinence, irritative/obstructive sxs, bone pain, weight loss
PE: non tender prostate, firm, stony hard, irregular nodules
Labs: PSA velocity (>.75ng/ml/year), total PSA 4-10/>10 ng/ml
CMP, inc alk phos
Dx: transrectal US with biopsy using Gleason score for grading
Axial CT/MRI for staging
