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GU2 - Urology > Benign Male GU Conditions > Flashcards

Benign Male GU Conditions Flashcards

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1
Q

mesonephric duct aka Wolffian duct

A
  • becomes vas deferents and seminal vesicle

- degenerates in female

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2
Q

paramesonephric duct aka Mullerian duct

A
  • becomes fallopian tubes, uterus, vagina

- degenerates in males

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3
Q

ureteral ectopia

A
  • ureter doesn’t properly fuse into the bladder

- will almost always be above the true ureter and then dive under it

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4
Q

perinatal hydronephrosis

A
  • swelling of a kidney in a fetus/infant caused by buildup of urine in the kidney d/t poor flow or blockage
  • commonly revealed on screening US
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5
Q

first step when finding perinatal hydronephrosis

A

-refer to pediatric urologist prior to delivery

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6
Q

management of perinatal hydronephrosis

A
  • document urine output
  • if no urine in 24 hr then cath
  • renal US w/i 24 hrs after birth
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7
Q

b/l vs. unilateral perinatal hydronephrosis

A

-b/l is worse - it could be a bladder obstruction

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8
Q

checking kidney function in perinatal hydronephrosis

A

-can’t check renal fxn for 48 hrs b/c it will be the same as moms

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9
Q

abx prophylaxis in perinatal hydronephrosis

A
  • do this if you suspect ureteral reflux b/c they would be predisposed to infection
  • no sulfa drugs
  • must use cephalosporin or penicillin
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10
Q

imaging in perinatal hydronephrosis

A
  • voiding cystourethrogram
  • w/i 2-3 days of life
  • r/o bladder obstruction and ureteral reflux
  • if no reflux, dc abx
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11
Q

nuc med renogram in perinatal hydronephrosis

A
  • document function and drainage
  • if kidney fxns well, no need for surgery
  • if poor, drainage and surgery may be needed
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12
Q

vesicoureteral reflux

A
  • urine flows retrograde from the bladder into the ureters/kidneys
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13
Q

short term vs long term vesicoureteral reflux

A
  • short: allows bacteria into kidney causing febrile infections
  • long: repeated infections cause scarring and fxn loss
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14
Q

tx of vesicoureteral reflux

A
  • grades 1-3: usually resolve spontaneously or:
  • start abx and repeat studies
  • grades 4-5: commonly need early intervention:
  • hyaluronic acid bubble insertion surgery
  • reimplantion of ureter
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15
Q

what is the MC cause of hydronephrosis in newborns?

A

ureteropelvic junction obstruction

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16
Q

ureteropelvic junction obstruction (UPJ)

A
  • obstruction of the flow of urine from the renal pelvis to the proximal ureter
  • aperistaltic segment of proximal ureter
  • may resolve spontaneously
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17
Q

dx of UPJ obstruction is done by what?

A

nuclear renal scan

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18
Q

general principles of conservative management of hydronephrosis

A
  • 50% of antenatal resolve postpartum
  • unable to accurately diagnose true obstruction
  • asymptomatic hydro could resolve spontaneously
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19
Q

dismembered pyeloplasty

A
  • sx tx of hydronephrosis

- vertical incision into the ureter then approximation and closure of the pelvis

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20
Q

2nd MC cause of ESRD in children?

A

posterior urethral valves

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21
Q

what are posterior urethral valves?

A
  • obstructive membranes that develop in the urethra and can obstruct or block the outflow of urine
  • can be deadly
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22
Q

posterior urethral valves can cause what? (3)

A
  • oligohydramnios
  • b/l hydronephrosis
  • abnl development of bladder: inability to empty and incontinenece.
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23
Q

cryptorchidism

A
  • hidden testis
  • failure of testis to descend into scrotum
  • may be inhibited at any point along its pathway from abdomen to scrotum
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24
Q

fxn of the scrotum

A

-produce viable and mature spermatagonia, testis must be 1.5-2 degrees cooler than abdomen so they descend to the scrotum

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25
embryology of descent of testes
- develop in abdomen week 6-8 - gubernaculum shortens - testis pulled slowly into scrotum after month 7 - may not be until after birth
26
incidence of cryptorchidism
- one of the MC congenital anomalies found at birth - more common in pre term babies - usually descend spontaneously by 1 year
27
what is the principal determinant of cryptorchidism at birth and 1 yo?
birth weight
28
what is the cause of misdiagnosis of cryptorchidism at ages 2-7?
retractile testes secondary to cremasteric reflex
29
if cryptorchidism is b/l, what should you consider?
- intersex condition - esp if hypospadias - karyotype to determine
30
classifications of cryptorchidism
- abdominal (inside internal ring) - canalicular (b/w internal and external rings) - extracanalicular (supra or infra pubic) - ectopic
31
what is the MC location for ectopic testes?
-w/i a superficial pouch b/w external oblique fascia and Scarpas
32
pt has b/l nonpalpable testis what test do you want to run?
FSH
33
if FSH is elevated in b/l nonpalpable testes, what do you suspect?
b/l anorchia
34
if FSH is non elevated in b/l nonpalpable testes, what are the following steps?
- give trial of hCG | - if no increase in testosterone, b/l anorchia
35
imaging in cryptorchidism
-NEVER do it
36
laparoscopy in cryptorchidism
- if vessels end blindly, testis absent - if vessels enter inguinal canal, perform inguinal exploration - if testis is intra-abdominal, perform orchiopexy
37
result of the length a testis is cryptorchid
- longer = more likely to be histologically abnl - impaired spermatogenesis - Leydig cells may or may not be affected - higher testis CA rate
38
surgical correction options for cryptorchidism
- 1 stage open orchiopexy (for canalicular) - 1 stage laparoscopic orchiopexy (for the peeping testis) lol - 2 stage laparoscopic - consists of revascularization
39
non surgical options for cryptorchidism
- hCG | - on used in rare cases
40
what sx make up the presentation of an acute scrotum?
- acute scrotal pain - scrotal tenderness to palpation - swelling - n/v
41
ddx in an acute scrotum
- testicular torsion - epididymitis/orchitis - incarcerated inguinal hernia - torsion of testicular or epididymal appendage
42
hx to take in acute scrotum
- activity - awakened from sleep - onset of pain - duration - bowel habits - dysuria - referred pain - previous similar episodes - immunocompromised
43
manual detorsion of testicle
- gently elevate testis toward the ipsilateral inguinal ring - use thumb and forefinger to turn testis laterally while stabilizing cord - if not relieved, attempt turning medially
44
how would you know if manual detorsion was successful?
the spermatic cord will lengthen and the testis will assume nl anatomical position w/ nearly immediate relief of pain
45
cremasteric reflex is elicited by what?
light stroking of the superior and medial part of the thigh
46
nervous pathway of the cremasteric reflex
- sensory and motor fibers of L1 spinal n. | - sensory fibers of ilioinguinal n. --> spinal cord --> genitogemoral n. --> cremasteric contraction
47
conditions in which the cremasteric reflex is absent
- 100% of cases of testicular torsion - in motor neuron disorders - spinal injury of L1 and L2
48
when you think of testicular torsion, what imaging goes hand in hand?
US
49
US for testicular torsion
- color doppler US = gold standard | - shows diminished or blocked flow
50
what deformity is likely the cause of testicular torsion?
- bell clapper deformity | - lack of fixation to the testicular gubernaculum during descent
51
time frame for testicular torsion
-irreversible ischemic injury to testicular parenchyma w/i 4 hrs
52
tx of testicular torsion, reguardless if it was manually detorsed or not
-scrotal exploration and b/l testicular fixation (orchiopexy)
53
how can testicular torsion effect fertility?
-seriously interferes w/ 50% of pts fertility
54
possible causes of UTI
- infected stones - chronic bacterial prostatitis - fistulae (from gut) - foreign bodies . . . i can't find my swizzle stick . . . - infected kidney - instrumentation - poor hygiene
55
predisposing factors for UTI
- urinary obstruction - DM - neurogenic bladder - pregnancy - ESRD - immunosuppression - congenital anomalies
56
absolute gold standard for a certain clean catch UA sample
suprapubic needle aspiration
57
pyocystitis commonly occurs in what pts?
dialysis pts w/ low UOP - bladder becomes one big abcess
58
emphysematous cystitis
- rare - gas w/i bladder - seen in DM, trauma, instrumentation, fistulae
59
what condition is often confused with chronic prostatitis?
-chronic pelvic pain syndrome
60
when you r/o testicular torsion, what is the likely diagnosis?
epididymitis or orchitis | -heaviness, aching, hemiscrotum, radiating pain upward, edema
61
common causes of epididymitis/orchitis
- < 35 yo: GC, chamydia | - > 35 yo: e. coli
62
what is the once instance that orchitis can be caused by something other than epididymitis
mumpt orchitis
63
tx of epididymitis/orchitis
- doxy 100 mg BID x 2-3 weeks | - bactrim x 4 wks
64
possible causes of urethritis in women
- STD | - vaginitis
65
big 3 causes of vaginits
- candidal - bacterial - trachomonal
66
microscopy findings for candida
-hyphae w/ sausage-link appearance
67
clinical findings for trichomonas
- strawberry cervix (only in 10% of infections) | - asymptomatic in men so if female has it tx both to prevent reinfection
68
microscopy for bacterial vaginosis
- clue cells (egg w/ pepper on it) | - predominance of coccobacilli
69
clinical diagnosis of pyelonephritis
- triad: chills, fever, flank pain | - UA consistent w/ UTI
70
renal abcess arise from . .
focus of pyelonephritis (e.coli) or hematogenous spread (staph)
71
size cutoff for renal abscess
> 3cm usually has to be drained
72
xanthogranulomatous pyelonephritis
- uncommon renal infection misdiagnosed as tumor - unknown etiology - persistent bacteriuria - tx: nephrectomy
73
what ligaments provide external penile support?
- fundiform ligament: * from Colles fascia * superficial - suspensory ligament: * from Buck's fascia * attaches tunica to pubis
74
major causes of ED
- many are listed on slide but he mentions: - arterial insuffeciency (men in 50s) - venous leak syndrome
75
systemic diseases that are risk factors for ED
- HTN - DM - CRI - CAD - hyperlipidemia - obesity - liver failure - endocrine disorders - hypogonadism - alcoholism - neurologic dz

GU2 - Urology (10 decks)

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