Day 9 - GU3 Flashcards Preview

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Flashcards in Day 9 - GU3 Deck (11):

BPH dx

Clinical scoring system based on sx; R/o other pathologies using history; Considerations; DRE to r/o malignancy, Hematuria (prostatitis, etc.), Post void residual, serum BUN/Cr (pre-renal), Max urinary flow rate (weak/intermittent stream)



Isoflavones, Saw palmetto (proven as effective as Finasteride); (1) Non-selective alpha blockers (-zosin) if HTN; OR Tamsulosin (aka Flomax) = selective (to urethra) alpha blocker; (2) 5-alpha reductase inhibitor (e.g., Finasteride) OR Saw palmetto; Combine 1 & 2


Prostate CA screening consideration in pts being tx for BPH

These drugs decrease PSA level by about 50%, so double it to assess for prostate CA; Also cause impotence, etc.


Most common surgery for BPH

TURP = transurethral resection of prostate


Next step 65 yo M p/w inability to urinate & painful bladder distention

Decompression bladder w/ 15-18 gauge French foley catheter; If hx of BPH, may require cathether with stiff tip (Kuday?); If unable to pass urethral catheter, then suprapubic cath with ultrasound guidance; or suprapubic needle decompession as last resort


60 yo M p/w well male exam, DRE hard nodules prostate, elevated PSA

Transrectal US & prostate needle bx


Characteristic feat of varicocele

Dilated of parapiniform plexus of scrotum; Testicular mass that transilluminates, dull-aching scrotal pass, testicular atrophy on affected side, infertility common; most commonly on left side; Color doppler us - retrograde flow; May point to RCC


Meds causing Erectile dysfunction

SSRIs, spironolactone, sympathetics (clonidine, methyldopa, guanidine), beta-blockers, ketoconazole, cimetidine, antipsychotics



Phosphodiesterase inhibitors (e.g., sildenafil), Penile self-injectable drugs (e.g., alprostadil), Vacuum & constriction devices, Penile prosthesis/implantation, Hormone replacement (if low levels)


Classic presentation of most common renal tumor in children

Wilm's tumor; P/w age 2-4 yrs, palpable flank mass; Ab pain, hematuria, HTN, possible congenital anomalies (WAGR)


Enuresis - age of dx & tx

5 yo physically & developmentally for dx; 7 yo Tx; 1st line - behavioral - motivational, fluid restriction before bed, nighttime , enuresis alarm (most effective); 2nd line - pharm - imipramine or indomethacin suppository (pharm may lead to relapse once meds stopped)

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