GU #3

Question 1

Hypospadias
-What is it?
-Pathophysiology
-Symptoms/Exam
-Management

Answer 1

-Abnormal ventral placement of the urethral opening (under penis that is NOT erect)
-Failure of urogenital folds to fuse during development
-UTI’s, ED, abnormal penile curvature
-Do NOT circumcise in neonatal periods because the foreskin can be used to repair the defect. Hypospadias repair done between 6 months old and 1 year.

Question 2

Epispadias
-What is it?
-Pathophysiology
-Symptoms
-Management

Answer 2

-Abnormal dorsal placement of the urethral opening (on topside of penis that is NOT erect)
-Failure of midline penile fusion. Often associated with bladder exstrophy (protrusion through bladder wall through defect in abdominal wall)
-Sx: Upward curvature of penis
-Surgical correction

Question 3

Penile Cancer
-MC type
-What is Bowen’s Disease?
-Symptoms
-Diagnostics
-Management

Answer 3

-Squamous Cell Carcinoma
-Bowen’s: leukoplakia on shaft of penis or scrotum. Associated with HPV 16.
-Mass, palpable lesion, or ulcer on the penis. May have inguinal LAD.
-Biopsy is diagnostic
-Limited excision vs penile amputation

Question 4

Erectile Dysfunction
-Etiologies (What is MC)
-Diagnostics
-Management

Answer 4

-Vascular MC (atherosclerosis, DM), trauma, surgery, BB, Thiazide diuretics, CCB, SSRI’s
-Diagnostics: Duplex US to evaluate penile blood flow.
-Phosphodiesterase 5 inhibitors (Sildenafil, Tadalafil) are first line. Intracavernosal IJ therapy (prostaglandin E1 - Alprostadil), Vacuum pump, penile prosthesis or revascularization, hormone replacement if testosterone is low.

Question 5

Hematuria
-MCC in < 40 years old is…
-MCC of microscopic hematuria in men is…
-Regarding the timing of hematuria, if it is terminal, the cause is…
-If it is initial, the cause is…
-Diagnostics
–Initial
–If the first is negative for infection + gross hematuria with visible clots
–What is the initial diagnostic if the patient is pregnant or unable to receive contrast.

Answer 5

-If < 40, the MCC is inflammation/infection of the prostate or bladder, or nephrolithiasis.
-MCC of hematuria in men is BPH
-Terminal = bladder irritation (stone or infection), prostate
-Initial = urethral in origin
-Initial DX = UA. Repeat after 6 weeks of treatment for resolution of hematuria.
-CT urography and cystoscopy if negative for infection.
-US to evaluate the kidney and for kidney stones rule out.

Question 6

Nephrolithiasis
-MC type
-Uric Acid: why does this occur
-Struvite: composed of _______. May form _________ in the renal pelvis due to urea-splitting organisms such as ______.
-Symptoms
-Physical Exam Findings

Answer 6

-MC type is calcium oxalate
-Uric Acid: high protein foods, gout, chemotherapy.
-Struvite: composed of magnesium ammonium phosphate, forms stag horn calculi due to Proteus.
-Renal colic: sudden, constant upper lateral back or flank pain over CVA radiating to groin or anteriorly. Hematuria, urgency, frequency, vomiting, nausea. CVA tenderness, afebrile.

Question 7

Nephrolithiasis
-Diagnostics
–UA (think about pH)
–Imaging test of choice
–When is Renal US used?
–KUB radiographs
-Management
–If stones are < 5 mm in diameter
–If stones are 5-10 mm in diameter

Answer 7

UA: microscopic or gross hematuria. Acidic urine ( < 5.0) if uric acid or cystine. Alkaline urine ( > 7.2) if struvite stones.
-Noncontrast CT abdomen and pelvis DOC
-Renal US used in children or if CT contraindicated (pregnancy)
-KUB radiographs: only calcium and struvite stones are radiopaque.
-Mgmt
–If < 5 mm in diameter: IV fluids and analgesics, Tamsulosin may help. Stones at UVJ may be difficult.
–If 5-10 mm in diameter: Extracorporeal shock wave lithotripsy, ureteroscopy with or without stent to provide immediate relief. Percutaneous nephrolithotomy for large stones or struvite stones.

Question 8

Nephrolithiasis
-Prevention

Answer 8

-Decreased fluid intake is the highest risk factor of all.
-Increase fluid intake, use Thiazide diuretics, low sodium diet, decreased animal protein diet.
-Chemotherapy drugs are also a risk factor. Adequate intake of fluids before chemotherapy can help. Or alkalization of urine

Question 9

Urethral Injuries
-MC etiology
-Other etiologies
-Symptoms and Exam Findings
-Diagnostic test of choice
-What is the hallmark triad of a urethral injury
-Management
–Nonoperative
–Surgical repair

Answer 9

-Blunt trauma MC etiology: straddle type fall
-Physical or sexual assault, MVA
-Gross hematuria, difficulty urinating, blood at urethral meatus, swelling or ecchymosis. High-riding prostate.
-Retrograde urethrogram is the DOC and must be done prior to transurethral catheterization.
-Nonoperative: catheter placement and monitoring for healing.
-Surgical: Temporary suprapubic catheter placement prior to repair.

Hallmark triad: blood at urethral meatus, inability to void, distended bladder