Week 4

Question 1

What are the only two exceptions to instances in which we treat asymptomatic bacteriuria? Bonus points for why.

Answer 1

1) Pregnant Women – while the prevalence of bacteriuria does not change with pregnancy, spontaneous resolution is less likely and there is a higher likelihood of progression to acute pyelonephritis (20 to 40% of untreated pregnant patients).
2) Prior to urologic intervention – spreading bacteria is bad, spreading bacteria to potentially more compromised sites is very bad.

Lecture: Urinary Tract Infections
Objective 5: Understand which patients require treatment for asymptomatic bacteriuria; which patients do not require such therapy; and the rationale for these decisions.

Question 2

Why is maintaining high compliance of the bladder wall important to normal kidney function? Discuss factors that may affect this.

Answer 2

The compliance of the bladder wall is critical to maintaining kidney function because pressures from the bladder are transferred back to the kidney – therefore, low compliance (e.g., from a distended bladder) leads to an increase in back pressure on the kidney, reducing its ability to deliver urine to the lower urinary tract and increasing the risk of hydronephrosis and kidney damage. Factors that may affect this include physical properties of the bladder wall (e.g., collagen content, flattening of the urothelium, etc…) and innervation.

Lecture: Bladder Dysfunction
Objective 2: Define bladder compliance and describe how this can affect renal function

Question 3

What are the common presenting signs and symptoms of testicular torsion, and why is it necessary for immediate surgical management?

Answer 3

Testicular torsion is on the differential of acute scrotal conditions and common presenting features are abrupt onset of pain, high-riding testis, hard/firm testis, “bell-clapper” deformity, and an absent cremasteric reflex. Surgical management within 6 hours is necessary due to the fact that ischemia for greater than 6 hours is associated with a high likelihood of unsalvageable necrosis of the testis.

Lecture: Benign Scrotal Conditions/Benign Genital Disorders
Objective 2: Describe the anatomic abnormalities predisposing to testicular torsion, the common presenting signs/symptoms, useful diagnostic tests, and the rationale underlying prompt surgical management

Question 4

What is the most common pathologic condition associated with persistent urinary tract dilation? How do you confirm the diagnosis and what determines your best next step?

Answer 4

Ureteropelvic Junction Obstruction (UPJO). It is suspected upon prenatal ultrasound showing severe hydronephrosis and confirmed with a MAG3 diuretic renogram. Definitive management is dependent on the danger of renal deterioration.

Lecture: Congenital Pediatric GU Abnormalities
Objective 3: List the differential diagnosis of antenatal hydronephrosis and identify their initial management

Question 5

What are the absolute indications for transurethral resection of prostate (TURP)?

Answer 5

1) Acute Urinary Retention
2) Bladder Calculi
3) Azotemia
4) Recurrent Urinary Tract Infection
5) Recurrent hematuria
6) Worsening LUTS refractory to medical therapy

Lecture: Benign Prostatic Hyperplasia
Objective 5: To acquire a baseline understanding of the role/types of surgical management of BPH

Question 6

What is the most common cause of reversible cause of male factor infertility and how does it cause male factor infertility?

Answer 6

Varicoceles. The abnormal dilation of the pampiniform plexus leads to a disruption of normal spermatogenesis – implicated pathophysiologic mechanisms include: increased intratesticular temperature secondary to impaired scrotal countercurrent cooling, increased oxidative stress, and reflux of gonadotoxic metabolites.

Lecture: Male Infertility and Contraception
Objective 2: The learner will be able to discuss the pathophysiology of varicocele in causing male factor infertility.