1 Flashcards
(172 cards)
1
Q
Gomco clamp
A
Clamp used for circumcision; protects penis glans
2
Q
Bell clapper’s deformity
A
Condition of congenital absence of gubernaculum attachment to scrotum (bilateral)
(free like the clappers of a bell)
3
Q
Fournier’s gangrene
A
Extensive tissue necrosis/infection of the perineum in patients with diabetes
4
Q
Posthitis
A
Foreskin infection
5
Q
Varicocele
A
Abnormal dilation of the pampiniform plexus to the spermatic vein in the sper- matic cord; described as a “bag of worms”
6
Q
Spermatocele
A
Dilatation of epididymis or vas deferens
7
Q
Prehn’s sign
A
Elevation of the painful testicle that reduces the pain of epididymitis
8
Q
TRUS
A
TransRectal UltraSound
9
Q
Pseudohermaphroditism
A
Genetically one sex; partial or complete opposite-sex genitalia
10
Q
pyuria
A
WBCs in urine; UTI more than 10 WBCs/HPF
11
Q
IVP
A
IntraVenous Pyelogram (dye is injected into the vein, collects in the renal collecting system, and an x-ray is taken)
12
Q
Space of Retzius
A
Anatomic extraperitoneal space in front of the bladder
13
Q
TURP
A
TransUrethral Resection of the Prostate
14
Q
PVR
A
PostVoid Residual
15
Q
Balanitis
A
Inflammation/infection of the glans penis
16
Q
Balanoposthitis
A
Inflammation/infection of the glans and prepuce of the penis
17
Q
Peyronie’s disease
A
Abnormal fibrosis of the penis shaft, resulting in a bend upon erection
18
Q
layers covering testes from external to internal
A
Skin Dartos External spermatic fascia Cremaster muscle Internal spermatic fascia Parietal and visceral layers of tunica vaginalis Tunica albuginea
19
Q
ddx scrotal mass
A
Cancer, torsion, epididymitis, hydrocele, spermatocele, varicocele, inguinal hernia, testicular appendage, swollen testicle after trauma, nontesticular tumor (paratesticular tumor: e.g., rhabdomyosarcoma, leiomyosarcoma, liposarcoma)
20
Q
ddx hematuria
A
Bladder cancer, trauma, UTI, cystitis from chemotherapy or radiation, stones, kidney lesion, BPH
21
Q
ddx ureteral obstruction
A
Stone, tumor, iatrogenic (suture), stricture, gravid uterus, radiation injury, retroperitoneal fibrosis
22
Q
ddx kidney tumor
A
Renal cell carcinoma, sarcoma, adenoma, angiomyolipoma, hemangiopericytoma, oncocytoma
23
Q
Most common solid renal tumor (90%)
A
RCC, originates from proximal renal tubular epithelium
adults 40 to 60 years of age with a 3:1 male:female ratio; 5% of cancers overall in adults
24
Q
risk factors for RCC
A
Male sex, tobacco, von Hippel-Lindau syndrome, polycystic kidney
25
symptoms of RCC
Pain (40%), hematuria (35%), weight loss (35%), flank mass (25%), HTN (20%)
26
classic triad of RCC
1. Flank pain
2. Hematuria
3. Palpable mass (triad occurs in only
10%–15% of cases)
27
imaging for RCC
1. IVP
| 2. Abdominal CT scan with contrast
28
stages of RCC
I: Tumor less than 2.5 cm, - nodes/mets
II: Tumor more than 2.5 cm limited to kidney, -nodes/mets
III: Tumor extends into IVC or main renal vein; +regional LNs but 2 cm in diameter and no mets
IV: Distant metas or +LN 2 cm in diameter, or tumor extends past Gerota’s fascia
29
metastatic sites for RCC
Lung, liver, brain, bone; tumor thrombus entering renal vein or IVC is not uncommon
30
metastatic workup for RCC
CXR, IVP, CT scan, LFTs, calcium
31
What is the unique route of spread of RCC?
tumor thrombus into IVC lumen
32
treatment of RCC
Radical nephrectomy (excision of the kidney and adrenal, including Gerota’s fascia) for stages I through IV
33
treatment for metastatic spread
1. -interferon
2. LAK cells (lymphokine-activated
killer) and IL-2 (interleukin-2)
34
What is a syndrome of RCC and liver disease?
Stauffer's syndrome
35
What is the concern in an adult with new onset left varicocele?
Left RCC—the left gonadal vein drains into the left renal vein
(vs. right gonadal vein drains RIGHT into IVC)
36
incidence of bladder cancer
Second most common urologic malignancy Male:female ratio of 3:1
White patients are more commonly affected
than are African American patients
(TCC: transitional cell carcinoma)
37
risk factors for bladder cancer
Smoking, industrial carcinogens (aromatic amines), schistosomiasis, truck drivers, petroleum workers, cyclophosphamide
38
workup for bladder cancer
Urinalysis and culture, IVP, cystoscopy with cytology and biopsy
39
bladder cell cancer staging
0: superficial, carcinoma in situ
I: Invades subepithelial connective tissue, -LNs/mets
II: Invades superficial or deep muscularis propria, -LNs/mets
III: Invades perivesical tissues, -LNs/mets
IV: Positive nodal spread with distant metastases and/or invades abdominal/ pelvic wall
40
treatment according to bladder cancer
0: TURB and intravesical chemotherapy
I: TURB
II/III: Radical cystectomy, lymph node dissection, removal of prostate/uterus/ ovaries/anterior vaginal wall, and urinary diversion (e.g., ileal conduit) +/- chemo
IV: +/-Cystectomy and systemic chemotherapy
41
TURB
TransUrethral Resection of the Bladder
42
If after a TURB the tumor recurs, then what?
Repeat TURB and intravesical chemotherapy (mitomycin C) or bacillus Calmette-Guérin (Attenuated TB vaccine—thought to work by immune response)
43
what is the incidence of prostate cancer in the US?
Most common GU cancer (100,000 new cases per year in the US); MOST common carcinoma in men in the U.S.; 2nd most common cause of death in men in the U.S.
44
who gets prostate cancer?
| histology?
“Disease of elderly men” present in 33% of men 70 to 79 years of age and in 66% of men 80 to 89 years of age at autopsy; African American patients have a 50% higher incidence than do white patients
Adenocarcinoma (95%)
45
What percentage of patients have metastasis at diagnosis?
| site of metastasis?
40% of patients have metastatic disease at presentation, with symptoms of bone pain and weight loss
Osteoblastic bony lesions, lung, liver, adrenal
46
lymphatic drainage of prostate
Obturator and hypogastric nodes
47
What is the significance of Batson’s plexus?
Spinal cord venous plexus; route of isolated skull/brain metastasis
48
How to detect prostate cancer early
1. Prostate-specific antigen (PSA)—most sensitive and specific marker
2. Digital rectal examination (DRE)
49
When should men get a PSA-level check?
Controversial:
1. All men over 50 years old
2. over 40 years old if first-degree family
history or African American patient
50
What percentage of patients with prostate cancer will have an elevated PSA?
about 60%
51
What is the imaging test for bladder cancer?
| How is the diagnosis made?
```
TransRectal UltraSound (TRUS)
Transrectal biopsy
```
52
What is the Gleason score?
Histologic grades 2–10:
| Low score well differentiated High score poorly differentiated
53
What are the indications for transrectal biopsy with normal rectal examination?
PSA greater than 10 or abnormal transrectal ultrasound
54
Prostate cancer staging (AJCC)
I: Tumor involves less than 50% of 1 lobe, no nodes/mets, PSA less than 10, Gleason less than 6
II: Tumor within prostate; lobe less than 50% but PSA greater than 10, or Gleason greater than 6; or more than 50% of 1 lobe, no nodes/metastases
III: Tumor through prostate capsule or into seminal vesicles, no nodes/metastases
IV: Tumor extends into adjacent structures (other than seminal vesicles) or +nodes or +mets
55
What does a “radical prostatectomy” remove?
1. Prostate gland
2. Seminal vesicles
3. Ampullae of the vasa deferentia
56
What is “androgen ablation” therapy?
1. Bilateral orchiectomy or
2. Luteinizing Hormone-Releasing
Hormone (LHRH) agonists
57
How do LHRH agonists work?
Decrease LH release from pituitary, which then decreases testosterone production in the testes
58
What are the generalized treatment options for prostate cancer according to stage:
I: Radical prostatectomy
II: Radical prostatectomy, +/- lymph node dissection
III: Radiation therapy, +/- androgen ablation
IV: Androgen ablation, radiation therapy
59
What is the medical treatment for systemic metastatic disease?
Androgen ablation
60
What is the option for treatment in the early stage prostate cancer patient 70
years old with comorbidity?
XRT
| external radiation therapy
61
size of normal prostate?
20 to 25 gm
62
where does BPH occur in prostate?
Periurethrally
| Note: prostate cancer occurs in the periphery of the gland
63
symptoms of BPH
Obstructive-type symptoms: hesitancy, weak stream, nocturia, intermittency, UTI, urinary retention
64
how is the diagnosis of BPH made
History, DRE, elevated PostVoid Residual (PVR), urinalysis, cystoscopy, U/S
65
What lab tests should be performed for BPH?
Urinalysis, PSA, BUN, CR
66
ddx BPH
```
Prostate cancer (e.g., nodular)—biopsy
Neurogenic bladder—history of
neurologic disease
Acute prostatitis—hot, tender gland
Urethral stricture—RUG, history of STD
Stone
UTI
```
67
treatment options for BPH
Pharmacologic—alpha-1 blockade
Hormonal—antiandrogens Surgical—TURP, TUIP, open prostate resection
Transurethral balloon dilation
68
Why do alpha-adrenergic blockers work?
1. Relax sphincter
| 2. Relax prostate capsule
69
What is Proscar®?
Finasteride: 5-alpha-reductase inhibitor; blocks transformation of testosterone to dihydrotestosterone (DHT); may shrink and slow progression of BPH
70
What is Hytrin®?
Terazosin: alpha-blocker; may increase urine outflow by relaxing prostatic smooth muscles
71
What are the indications for surgery in BPH?
```
Due to obstruction:
Urinary retention
Hydronephrosis
UTIs
Severe symptoms
```
72
What is TURP?
TransUrethral Resection of Prostate: resection of prostate tissue via a scope
73
What is TUIP?
TransUrethral Incision of Prostate
74
What percentage of tissue removed for BPH will have malignant tissue on histology?
10%
75
What are the possible complications of TURP?
```
Immediate:
Failure to void
Bleeding
Clot retention
UTI
Incontinence
```
76
What is the incidence of testicular cancer?
| What is it infamous for?
Rare; 2 to 3 new cases per 100,000 men per year in the US
Most common solid tumor of young adult males (20 to 40 years)
77
risk factors of testicular cancer?
Cryptorchidism (6% of testicular tumors develop in patients with a history of cryptorchidism)
-Does orchiopexy as an adult remove the risk of testicular cancer?
78
symptoms of testicular cancer?
Most patients present with a painless lump, swelling, or firmness of the testicle; they often notice it after incidental trauma to the groin
10% present with a hydrocele
about 10% present with symptoms of metastatic disease (back pain, anorexia)
79
classifications of testicular cancer (Germ cell tumors (95%))
Seminomatous (35%) Nonseminomatous (65%) Embryonal cell carcinoma: Teratoma, Mixed cell, Choriocarcinoma
80
classifications of testicular cancer (Nongerminal (5%))
Leydig cell
Sertoli cell
Gonadoblastoma
81
What is the major classifica- tion of testicular cancer based on therapy?
Seminomatous and nonseminomatous tumors
82
What are the tumor markers for testicular tumors?
1. B-hCG: increased in choriocarcinoma (100%), embryonal carcinoma (50%), and rarely in pure seminomas (10%); nonseminomatous tumors (50%)
2. AFP: increased in embryonal carcinoma and yolk sac tumors; nonseminomatous tumors (50%)
83
Define the difference between seminomatous and NONseminomatous germ cell testicular tumor markers.
NONseminomatous common: 90% have a positive AFP and/or B-hCG
| Seminomatous rare: only 10% are AFP positive
84
Which tumors almost never have an elevated AFP?
Choriocarcinoma and seminoma
85
In which tumor is B-hCG almost always found elevated?
Choriocarcinoma
86
How often is B-hCG elevated in patients with pure seminoma?
only about 10% of the time
87
How often is B-hCG elevated with nonseminoma?
about 65% of the time
88
What other tumor markers may be elevated and useful for recurrence surveillance?
LDH, CEA, Human Chorionic Somatomammotropic (HCS), Gamma-Glutamyl Transpeptidase (GGT), PLacental Alkaline Phosphate (PLAP)
89
What are the steps in workup for testicular cancer?
PE, scrotal U/S, check tumor markers, CXR, CT (chest/pelvis/abd)
90
TMN staging for testicular cancer (AJCC)
I: Any tumor size, no nodes/mets
II: Positive nodes, no mets, any tumor
III: Distant metastases (any nodal status, any size tumor)
91
What is the initial treatment for all testicular tumors?
Inguinal orchiectomy (removal of testicle through a groin incision)
92
What is the treatment of seminoma at the various stages:
I/II: Inguinal orchiectomy and radiation to retroperitoneal nodal basins
III: Orchiectomy and chemotherapy
95% cured after treatment
93
What is the treatment of NONseminomatous disease at the various stages:
I/II: Orchiectomy and retroperitoneal lymph node dissection versus close follow-up for retroperitoneal nodal involvement
III: Orchiectomy and chemotherapy
94
Which type is most radiosensitive?
Seminoma (Think: Seminoma Sensitive to radiation)
95
Why not remove testis with cancer through a scrotal incision?
It could result in tumor seeding of the scrotum
96
What is the major side effect of retroperitoneal lymph node dissection?
Erectile dysfunction
97
causes of hypercalcemia
| "CHIMPANZEES"
```
Calcium supplementation IV
Hyperparathyroidism (1/3)
hyperthyroidism
Immobility/Iatrogenic (thiazide
diuretics)
Mets/Milk alkali syndrome
Paget’s disease (bone)
Addison’s disease/Acromegaly
Neoplasm (colon, lung, breast,
prostate, multiple myeloma)
Zollinger-Ellison syndrome (as part of
MEN I)
Excessive vitamin D Excessive vitamin A Sarcoid
```
98
risk factors and incidence of renal stones
Poor fluid intake, IBD, hypercalcemia (“CHIMPANZEES”), renal tubular acidosis, small bowel bypass
1 in 10 people will have stones
99
what are the 4 types of stones?
1. Calcium oxalate/calcium PO4 (75%)— secondary to hypercalciuria (^intestinal absorption, decreased renal reabsorption, ^bone reabsorption)
2. Struvite (MgAmPh)(15%)—infection stones; seen in UTI with urea-splitting bacteria (Proteus); may cause staghorn calculi; high urine pH
3. Uric acid (7%)—stones are radiolucent (Think: Uric=Unseen); seen in gout, Lesch-Nyhan, chronic diarrhea, cancer; low urine pH
4. Cystine (1%)—genetic predisposition
100
What stones are seen in IBD/bowel bypass?
Calcium oxalate
101
symptoms of calculus disease
| renal stones
Severe pain; patient cannot sit still: renal colic (typically pain in the kidney/ureter that radiates to the testis or penis), hematuria (remember, patients with peritoneal signs are motionless)
102
classic findings/symptoms of renal calculi
Flank pain, stone on AXR, hematuria
103
how to diagnose renal calculi
KUB (90% radiopaque), IVP, urinalysis and culture, BUN/Cr, CBC
104
treatment of renal calculi
Narcotics for pain, vigorous hydration, observation
Further options: ESWL (lithotripsy), ureteroscopy, percutaneous lithotripsy, open surgery; metabolic workup for recurrence
105
What are the indications for
| intervention in renal calculi cases?
Urinary tract obstruction Persistent infection Impaired renal function
106
What are the contraindications of outpatient treatment for renal calculi?
Pregnancy, diabetes, obstruction, severe dehydration, severe pain, urosepsis/fever, pyelonephritis, previous urologic surgery, only one functioning kidney
107
What are the three common sites of obstruction for stones?
1. UreteroPelvic Junction (UPJ)
2. UreteroVesicular Junction (UVJ)
3. Intersection of the ureter and the iliac
vessels
108
Percutaneous nephrolithotomy (PNL) procedures are reserved for patients with the following clinical characteristics (vs. shock wave lithotripsy-SWL)
```
Large (more than 2 cm in diameter) or complex calculi (filling the majority of the intrarenal collecting system, such as staghorn calculi)
Cystine stones (relatively resistant to SWL)
Anatomic abnormalities, including horseshoe kidneys or ureteropelvic junction obstruction
Stones within calyceal diverticula
```
109
Three minimally invasive surgical techniques that significantly reduce the morbidity of stone removal
Percutaneous nephrolithotomy (PNL)
Rigid and flexible ureteroscopy (URS)
Shock wave lithotripsy (SWL)
110
While flexible ureteroscopes are used primarily to access ?, the semi-rigid ureteroscopes can be utilized to reach lesions in ?
the proximal ureter and intrarenal collecting system
| the mid and distal ureter
111
Although routine placement of stents (post URS) is not required, stenting should be performed in patients with ?
urinary tract abnormalities
solitary kidneys
bilateral simultaneous ureteroscopy
residual edema or inflammation secondary to the stone or the endoscopic removal procedure
112
medical treatment to prevent renal stone formation
high fluid intake for all forms of stone disease
thiazide diuretic for hypercalciuria
allopurinol or potassium citrate for hyperuricosuria
potassium citrate for hypocitraturia
potassium citrate for uric acid stone formation due to persistently acid urine
113
Most stones less than ? mm in diameter pass spontaneously. For stones larger than that, there is a progressive decrease in the spontaneous passage rate, which is unlikely with stones greater than ?mm in diameter
less than 4mm
| greater than 10mm
114
What is the classic history of testicular torsion?
Acute onset of scrotal pain usually after vigorous activity or minor trauma
115
Bosniak classification of renal cysts: Category I
A benign simple renal cyst or multiple renal cysts, each with a thin wall without septa, calcifications, or solid components. The cyst has the density of water and does not enhance
116
Bosniak classification of renal cysts: Category II
Benign cystic lesions in which there may be a few thin septa and the wall or septa may contain fine calcifications or a short segment of slightly thickened calcification.
also includes uniformly high-attenuation lesions that are less than 3 cm in diameter, well marginated, and nonenhancing
117
Bosniak classification of renal cysts: Category IIF
generally well marginated and are more complicated than -II cysts but less than -III cysts. They may have multiple thin septa or minimal smooth thickening of the septa or wall, which may contain calcification that may also be thick and nodular.
no measurable contrast enhancement.
but may have perceived enhancement of the septa or wall, which is due to subjective (and not measurable) enhancement when the unenhanced and contrast-enhanced images are compared.
also includes totally intrarenal, nonenhancing, high-attenuating lesions that are greater than 3 cm in diameter. These cysts require follow-up to ascertain that they are not malignant.
118
Bosniak classification of renal cysts: Category III
Indeterminate cystic masses that have thickened, irregular or smooth walls or septa. Measurable enhancement is present.
about 40 to 60 percent are malignant (cystic RCC and multiloculated cystic RCC)
The remaining lesions are benign and include hemorrhagic cysts, chronic infected cysts, and multiloculated cystic nephroma.
119
Bosniak classification of renal cysts: Category IV
85 to 100 percent have been reported to be malignant in various studies
have all the characteristics of category-III cysts, plus they contain enhancing soft-tissue components that are adjacent to and independent of the wall or septum
120
the most important characteristic separating categories III and IV (which are associated with malignancy in 40 to 100 percent of reported cases)
The presence of true contrast enhancement of the lesion (a minimum increased attenuation of 10 to 15 Hounsfield units)
121
Further evaluation of Bosniak category-I and II lesions
generally not required, although a repeat ultrasonography may be done at 6 to 12 months in selected patients in order to confirm stability and a correct diagnosis.
122
Further evaluation of Bosniak category-IIF lesions
obtain prior studies for purposes of comparison with an additional imaging study (typically a good-quality contrast-enhanced MRI) for further characterization
123
Further workup of Bosniak category-III lesions
continued surveillance with periodic imaging, fine-needle biopsy, or surgery with partial nephrectomy, if feasible
surgery preferred, if not candidates: CT or MRI at six months, with follow-up imaging with either a CT or ultrasounds yearly
124
frequencies of malignancy were noted with specific cystic radiographic abnormalities
22% of lesions that contained fluid of heterogeneous signal intensity
44% of intense mural (ie, cyst wall) enhancement
63% of lesions with mural irregularity
71% of lesions with a thick wall (greater than 2 mm)
75% of lesions with mural masses or nodules and 50 percent of four lesions with septa
The combination of mural irregularity and intense mural enhancement had the highest correlation with malignancy
125
Category-IV lesions require ?
surgery since approximately 85 to 100 percent are malignant
126
three major criteria for a single simple renal cyst on ultrasonography
1. The mass is round and sharply demarcated with smooth walls.
2. There are no echoes (anechoic) within the mass.
3. There is a strong posterior wall echo, indicating good transmission through the cyst and enhanced transmission beyond the cyst.
127
three major criteria for a single simple renal cyst on CT
1. The cyst is sharply demarcated from the surrounding parenchyma and has a smooth, thin wall.
2. Fluid within the cyst is homogeneous, with a density of less than 20 Hounsfield units (similar to water). higher values may be seen with a benign proteinaceous or hemorrhagic cyst.
3. no enhancement of the mass following the administration of radiocontrast media, indicating the presence of an avascular lesion
128
testicular torsion signs
Very tender, swollen, elevated testicle; nonillumination; absence of cremasteric reflex
129
ddx testicular torsion
Testicular trauma, inguinal hernia, epididymitis, appendage torsion
130
how to diagnose testicular torsion
Surgical exploration, U/S (solid mass) and Doppler flow study, cold Tc-99m scan (nuclear study)
131
treatment of testicular torsion
Surgical detorsion and bilateral orchiopexy to the scrotum
132
How much time is available from the onset of symptoms to detorse the testicle?
less than 6 hours will bring about the best results; more than 90% salvage rate
-less than 10% chances of testicle salvage after 24 hours
133
epididymitis s/s
| cause?
Swollen, tender testicle; dysuria; scrotal ache/pain; fever; chills; scrotal mass
Bacteria from the urethra
E. coli: old men and kids
young men: STD: Gonorrhea, chlamydia
134
workup for testicular torsion
U/A, urine culture, swab if STD suspected, U/S with Doppler or nuclear study to rule out torsion
135
causes of priapism
Low flow: leukemia, drugs (e.g., prazosin), sickle-cell disease, erectile dysfunction treatment gone wrong
High flow: pudendal artery fistula, usually from trauma
136
treatment for priapism
1. Aspiration of blood from corporus cavernosum
| 2. alpha-Adrenergic agent
137
the six major causes of erectile dysfunction
1. Vascular: decreased blood flow or leak of blood from the corpus cavernosus (most common cause)
2. Endocrine: low testosterone
3. Anatomic: structural abnormality of
the erectile apparatus (e.g., Peyronie’s
disease)
4. Neurologic: damage to nerves (e.g.,
postoperative, IDDM)
5. Medications (e.g., clonidine)
6. Psychologic: performance anxiety,
etc. (very rare)
138
tests for ED
Fasting GLC (rule out diabetes and thus diabetic neuropathy)
Serum testosterone
Serum prolactin
139
stress incontinence
Loss of urine associated with coughing, lifting, exercise, etc.; seen most often in women, secondary to relaxation of pelvic floor following multiple deliveries
140
overflow incontinence
Failure of the bladder to empty properly; may be caused by bladder outlet obstruction (BPH or stricture) or detrusor hypotonicity
141
urge incontinence
Loss of urine secondary to detrusor instability in patients with stroke, dementia, Parkinson’s disease, etc.
142
mixed incontinence
stress and urge combined
143
how to diagnose incontinence
History (including meds), physical examination (including pelvic/rectal examination), urinalysis, postvoid residual (PR), urodynamics, cystoscopy/ vesicocystourethrogram (VCUG) may be necessary
144
What is the “Marshall test”?
Woman with urinary stress incontinence placed in the lithotomy position with a full bladder leaks urine when asked to cough
145
treatment for stress incontinence
Bladder neck suspension
146
treatment for urge incontinence
Pharmacotherapy (anticholinergics,
| alpha-agonists)
147
treatment for stress incontinence
Self-catheterization, surgical relief of obstruction, alpha-blockers
148
3 most common bugs in UTIs
1. E. coli (90%)
2. Proteus
3. Klebsiella, Pseudomonas
149
predisposing factors for UTI
Stones, obstruction, reflux, diabetes mellitus, pregnancy, indwelling catheter/ stent
150
how to dx UTI
Symptoms, urinalysis (10 WBCs/HPF,
| 105 CFU)
151
When should UTI workup be performed?
After first infection in male patients (unless Foley is in place)
After first pyelonephritis in prepubescent female patients
152
treatment for UTI
Lower: 1 to 4 days of oral antibiotics
Upper: 3 to 7 days of IV antibiotics
153
Why should orchiopexy be performed?
to decrease the susceptibility to blunt trauma
| and increase the ease of follow-up examinations
154
in what area of the prostate does BPH arise?
| prostate cancer?
Periurethral
Periphery
155
What percentage of renal cell carcinoma show evidence of metastatic disease at presentation?
about 33%
156
What is the most common site of distant metastasis in renal cell carcinoma?
Lung
157
What is the most common solid renal tumor of childhood?
Wilms' tumor
158
What are posterior urethral valves?
Most common obstructive urethral lesion in infants and newborns; occurs only in males; found at the distal prostatic urethra
159
What provides drainage of the left gonadal (e.g., testicular) vein?
Left renal vein
| Right gonadal vein goes RIGHT into IVC
160
What are the signs of urethral injury in the trauma patient?
“High-riding, ballottable” prostate, blood at the urethral meatus, severe pelvic fracture, ecchymosis of scrotum
161
What is the evaluation for urethral injury in the trauma patient?
RUG (Retrograde UrethroGram)
162
What is the evaluation for a transected ureter intraoperatively?
IV indigo carmine and then look for leak of blue urine in the operative field
163
What aid is used to help identify the ureters in
| a previously radiated retroperitoneum?
Ureteral stents
164
How can a small traumatic EXTRAperitoneal bladder rupture be treated?
Foley catheter
165
How should a traumatic INTRAperitoneal bladder rupture be treated?
Operative repair
166
What percentage of patients with an injured ureter will have no blood on urinalysis?
33%
167
What is the classic history for papillary necrosis?
Patient with diabetes taking NSAIDs or patient with sickle cell trait
168
What unique bleeding problem can be seen with prostate surgery?
Release of TPA and urokinase (treat with aminocaproic acid)
169
What is the scrotal “blue dot” sign?
Torsed appendix testis
170
What is a ureterocele?
Dilation of the ureter—treat with endoscopic incision or operative excision
171
What is a “three-way” irrigating Foley catheter?
Foley catheter that irrigates and then drains
172
workup for hematuria
| 4 Cs
cystoscopy
CT
culture (urine)
cytology
