Urology

Question 1

Testicular Cancer Workup

Answer 1

• H&P
• AFP, beta-hCG, LDH
• Testicular US

Question 2

Primary Testicular Cancer Treatment

Answer 2

• Discuss sperm banking
• Radical inguinal orchiectomy

Question 3

Post-op Pure Seminoma Workup

Answer 3

• CT A/P
• CXR
• Repeat beta-hCG, LDH, AFP
• If indicated, Brain MRI
  
  • beta-hCG >5000 or extensive lung mets

Question 4

Post-op Nonseminoma Workup

Answer 4

• CT C/A/P
• Repeat beta-hCG, LDH, AFP
• If indicated, Brain MRI
  
  • beta-hCG >5,000, extensive lung mets, choriocarcinoma, neuro sx, AFP >10,000

Question 5

Post-op Seminoma Treatment

Answer 5

• All Stages (+/- Stage I) get chemo or XRT
  
  • Seminomas are extremely sensitive to XRT

Question 6

Post-op Nonseminoma Treatment

Answer 6

• Consider nerve-sparing retroperitoneal lymph node dissection in all stages
  
  • Consider Chemo in patients with pos LNs

Question 7

Seminoma Follow-up

Answer 7

q6months x3 years, then annually

• H&P
• CT A/P

Question 8

Nonseminoma Follow-up

Answer 8

q3 months x2 years, then q6 months

• H&P
• beta-HCG, AFP, LDH

q6 months x2 years, then annually

• CT A/P

Question 9

Key Steps in Inguinal Radical Orchiectomy

Answer 9

Question 10

Key Points of Ureteral Injury Repair

Answer 10

If doing end-to-end:

• Spatulate the ends
• Stent the ureter to decrease stenosis
• Use absorbale suture to decrease stone formation
• Place drains