MALE GU 2

Question 1

Lower UTI:

Answer 1

bladder (cystitis),

prostate (prostatitis)

Question 2

Upper UTI

Answer 2

pyelonephritis

Urethritis

Question 3

normal renal structure and function

Answer 3

Uncomplicated UTI:

Question 4

structural/functional abnormality of the GU tract

Answer 4

Complicated UTI :

Question 5

Risk factors for UTI

Answer 5

↑bacterial inoculation
i.e. sexual activity

↑binding of uropathogenic bacteria
i.e. decrease estrogen, menopause

↓urine flow
i.e. dehydration, obstruction

Question 6

Frequency, dysuria, urgency, polyuria, hematuria

Suprapubic pain/ tenderness/ distension

Answer 6

Cystitis

Vaginal d/c: consider PID

Question 7

Fever, chills, nausea, vomiting

NO DYSURIA
Pain/ tenderness: flank, CVA

Answer 7

Acute pyelonephritis

Dysuria only if with cystitis

Question 8

Pain: perineum, rectum, scrotum, penis, bladder, lower back

Fever, malaise, nausea, vomiting

Urinary Sx

Swollen or tender prostate

Answer 8

Prostatitis

Question 9

Infection-induced inflammation of the urethra (typically from a STI)

Majority are asymptomatic
Urethral discharge

Dysuria (in men)

Answer 9

Urethritis

Question 10

UTI investigations

Answer 10

Urinalysis
Gram stain and urine culture
DNA probe/ NAAT
CBC

Question 11

Imaging should be considered in a MALE patient with

Answer 11

Hx of kidney stones (esp. struvite - staghorn calculi
Diabetic Pt
Polycystic kidneys
TB

Question 12

Plain film imaging (KUB)

Answer 12

May show radiopaque stones

Question 13

Renal Ultrasound

Answer 13

to detect hydronephrosis, pyonephrosis, and perirenal abscess

Question 14

Transrectal U/S

Answer 14

prostate abscess

Question 15

CT scan

Answer 15

helpful for stones

Non-contrast: obstructive nephrolithiasis

Question 16

F>M
Associated with psychiatric disorders (anxiety) & pain syndromes (fibromyalgia)

Clinical presentation:
Chronic bladder (suprapubic) pain with filling, relief with voiding
Urgency, frequency
Dyspareunia

Diagnosis:
Bladder pain with no other attributable cause for > 6 weeks*
Urinalysis: normal; Culture: negative
Cystoscopy: Hunner lesions or glomerulations (submucosal petechiae)

Answer 16

Interstitial Cystitis

Question 17

Age < 35: Sexually transmitted (Chlamydia, gonorrhea)
Age > 35: Bladder outlet obstruction (E. coli)

Gradual* onset of testicular pain
Epididymal tenderness

Positive Prehn’s sign: pain relief with testicular elevation

U/S: Enlarged, thickened epididymis with increased blood flow on color Doppler;

Answer 17

Acute Epididymitis

Ultrasound r/o testicular torsion

Question 18

Mumps (most common)
Could be bacterial

Abrupt onset of testicular pain

U/S**
Swollen testicles with hypoechoic and hypervascular areas; striated testicle

Answer 18

Acute Orchitis

Ddx: Testicular torsion

Question 19

also called condyloma acuminata

Caused by human papillomavirus

verrucous and moist papules on the penis and perianal areas

Answer 19

Genital warts

Question 20

A cluster of small vesicles and pustules that turn to shallow, painful, nonindurated ulcers on a red base

Associated with systemic Sx

Usually fewer lesions on reinfection

Answer 20

Genital Herpes

Question 21

Caused by *Haemophilus ducreyi

Tender papule to pustule to nonindurated, painful ulcer with a purulent base and undermined or ragged borders.

Unilateral tender(painful) inguinal adenopathy to bubo

Answer 21

Chancroid

Question 22

Caused by *Treponema pallidum

Occurs in stages:
Primary: chancre*- oval or round, dark red, painless erosion or ulcer with an indurated base

Nontender enlarged inguinal lymph nodes

Secondary: rash, *condyloma lata, swollen glands, systemic symptoms

Answer 22

Syphilis

Question 23

Subfertility - bc increase temperature

Dull, scrotal pain or heaviness

Soft scrotal mass (“bag of worms

dilation of the pampiniform venous plexus and the internal spermatic vein

11% of men with RCC have this

L sided is most common

Answer 23

Varicocele

Question 24

Varicocele investigation

Answer 24

U/S and Doppler

Dilation of pampiniform plexus veins
Retrograde venous flow
Tortuous, anechoic tubules adjacent to the testis

Question 25

Collection of serous fluid resulting from a defect or irritation in the tunica vaginalis Patent (peds) or non-patent (adults) procesus vaginalis Association: indirect inguinal hernia, trauma, infection, testicular tumor Investigation U/S: fluid collection around the testis

Answer 25

Hydrocele

Question 26

PE: 10-20 yo Acutely inflamed testis Abnormal elevation and/or axis (horizontal lie) of the affected testicle *Ipsilateral loss of the cremasteric reflex (-) Prehn’s sign Recurrent/ acute twisting of the spermatic cord “Bell clapper” deformity Ultrasound and doppler: absent flow*

Answer 26

testicular torsion | + reflex does not R/O torsion

Question 27

Solid firm mass within the testis Painless testicular swelling 10% have an associated hydrocele which transilluminates More common before age 40 Risk factor: cryptorchidism Seminoma: + ↑beta-hCG, normal AFP

Answer 27

testicular cancer

Question 28

Painless mass (unless strangulated) Inguinal bulge that may increase in size and disappear when recumbent Testis separable from hernia No transillumination unless with hydrocele

Answer 28

indirect inguinal hernia

Question 29

Irritative Sx: F/U/D Obstructive Sx: dribbling & hesitancy Perineal/ suprapubic pain Very tender, warm, swollen, boggy, enlarged gland risk factors: Unprotected anal intercourse UTI, Acute epididymitis Mid-stream urine C/S: usually E. coli

Answer 29

Acute Bacterial Prostatitis

Question 30

Recurrent exacerbations of acute prostatitis-like symptoms Post-ejaculatory pain Normal prostate OR enlarged, boggy, moderately-severe tender prostate Expressed prostatic secretion (EPS) > 10 WBC/HPF AND Urine culture: E. coli most common

Answer 30

Chronic Bacterial Prostatitis

Question 31

Bone pain may be the presenting symptom Urinary frequency, urgency, nocturia, and hesitancy 2ndary to BPH : Slightly enlarged asymmetric prostate with nodularity noted elevated PSA

Answer 31

Prostate Cancer

Question 32

BPH vs Prostate Cancer slide 37

Answer 32

``` BPH: •Age >50 •Central portion (transitional zone) •Symmetrically enlarged, smooth prostate •Can have ↑PSA ``` Prostate cancer •Age> 40 •African American •Family Hx •Usually peripheral zone but can be anywhere •Asymmetrically enlarged, nodular, firm prostate •Markedly ↑PSA

Question 33

Urine + for HB and RBC casts

Answer 33

glomerulonephritis

Question 34

Urine + for HB but no RBC

Answer 34

hemoglobinuria (hemolytic anemia) | myoglobinuria (↑creatine kinase (CK) levels)

Question 35

painful hematuria

Answer 35

RCC ADPKD Calculus Trauma

Question 36

painless hematuria

Answer 36

bladder cancer RCC ADPKD

Question 37

Urine - for Hb and no RBC | psuedohematuria

Answer 37

Foods: Beets, blackberries, rhubarb Meds: Levodopa, rifampin, phenytoin Metabolites: Porphyrin, bilirubin

Question 38

asymptomatic, usually incidental finding “Painless hematuria” (40%) “Too Late Triad”(10%) – advanced disease flank pain, hematuria, and a palpable abdominal renal mass Paraneoplastic Syndrome: 1/3 of patients: EPO, renin, PTHrP Risk Factors Smoking HTN Obesity U/A: +RBC Abdominal CT is imaging of choice

Answer 38

RCC

Question 39

persistent (> 3 mos) inability to achieve or maintain a penile erection precedes angina by 3 years Investigations: Testosterone, HgbA1C, Lipid Panel

Answer 39

Erectile Dysfunction

Question 40

Non-colicky flank pain | Recurrent infections, or infections that will not clear

Answer 40

Kidney Stone:

Question 41

Severe waxing and waning flank pain radiating to groin, testis, or tip of the penis Painful hematuria Writhing, nausea, vomiting, diaphoresis

Answer 41

Ureteral Stone:

Question 42

Most common in men secondary to BPH | Storage and voiding LUTS, terminal hematuria, suprapubic pain

Answer 42

Bladder Stone:

Question 43

Branched stones that occupy a large portion of the collecting system, Typically filling the renal pelvis and several or all of the calyces

Answer 43

Staghorn Calculus

Question 44

Hypertension (early onset) Palpable abdominal masses (usually bilateral) Urinalysis: Proteinuria, hematuria Progressive renal insufficiency to chronic kidney disease Ultrasonography: enlarged kidneys + multiple renal cysts

Answer 44

Autosomal Dominant Polycystic Kidney Disease (ADPKD)

Question 45

Asymptomatic Intermittent, gross, painless hematuria, present throughout micturition Irritative symptoms: frequency, urgency, dysuria, incontinence NO FLANK MASS

Answer 45

Bladder Cancer