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EOR Exam 1 > Renal and Genitourinary System > Flashcards

Renal and Genitourinary System Flashcards

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1
Q

What is the clinical presentation of BPH?

A
  • Weak urinary stream
  • Urinary hesitancy
  • Stream intermittency
  • Post void dribbling
  • Nocturia
  • Urinary retention
  • Recurrent urinary tract infections
  • Hx of cystolithiasis, other urolithiasis
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2
Q

Tests that can be done to evaluate BPH?

A
  • U/A
  • PSA
  • Uroflow study (Voided volume, Peak flow in mL/sec, Mean flow in mL/sec)—low flow rate
  • Post void residual (in mL)— high residual
  • Cystoscopy—trabeculation, obstructive prostate encroaching into urinary outlet lumen, “kissing lobes”
  • Urodynamic study (UDS) may be indicated—low flow, elevated intravesical pressures
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3
Q

Tx for BPH?

A
  1. Watchful waiting: monitor sx and recheck labs
  2. Lifestyle modification:
    - Avoid fluid intake and diuretics in evening to decrease nocturia
    - If leg edema, elevate legs in evening to mobilize and eliminate fluid before hs
    - Avoid drinks/food that exacerbate sx (caffeine, EtOH, acidic or spicy foods)
    - Double void to completely empty bladder
    - Avoid pseudoephedrine/ alpha agonists
    - Caution with anticholinergics: can cause retention
  3. Medications
    - Phytotherapy: saw palmetto
    - PDE5-I
    - Alpha blockers: relaxes smooth muscle and allows for freer passage of urine. Alpha 1- terazosin and doxazosin, alpha 1A- tamsulosin, silodosin, alfuzosin
    - 5 alpha reductase inhibitors: finasteride and dutasteride
  4. Surgery
    - Transurethral Microwave Thermotherapy (TUMT)
    - Transurethral Incision of Prostate (TUIP)
    - Urolift
    - Transurethral Resection of Prostate (TURP)
    - Photoselective Vaporization of Prostate (PVP)
    - Open simple prostatectomy
    - Holmium Laser Enucleation of Prostate (HoLEP)
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4
Q

Side effects of alpha blockers for BPH?

A
  • Dizziness
  • Asthenia
  • Nasal congestion
  • Orthostatic hypotension/syncope (rare)
  • Retrograde ejaculation
  • Intra-operative floppy iris syndrome (IFIS)—don’t start pt on alpha-blockers if he has cataract surgery coming up. Pt needs to inform cataract surgeon in advance if he is taking alpha-blocker.
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5
Q

What is the gold standard surgical tx for BPH?

A

TURP

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6
Q

What are the complications with TURP?

A

-Retrograde ejaculation
-TURP Syndrome: Hyponatremia, Mental confusion, Hypertension,
Visual changes
-Hematuria

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7
Q

Which BPH medication class causes a decrease in PSA readings of 50%

A

5 alpha reductase inhibitors

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8
Q

What are the side effects of 5 alpha reductase inhibitors?

A
  • Impotence <5%
  • Decreased libido <4%
  • Lower ejaculatory volume <3%
  • Gynecomastia <1%
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9
Q

Which medication is useful in patients with both BPH and ED?

A

Tadalifil

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10
Q

What is the function of 5 alpha reductase inhibitors? Characteristics?

A
  • Block conversion of testosterone to DHT
  • Lower DHT levels
  • Decrease prostatic glandular volume
  • Increase max urinary flow rates
  • Improve AUA sx scores
  • Decrease risk of BPH progression
  • Can take 6 months to see effect (as opposed to weeks for alpha-blockers)
  • Decreases PSA readings by 50%
  • May stop chronic hematuria 2ndary to prostatic varices
  • Most beneficial in larger volume prostates >40 cc and PSAs greater than 1.4
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11
Q

What is a phimosis?

A

Prepuce stuck distal to glans

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12
Q

What causes phimosis?

A
  • Hygiene

- Balanitis

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13
Q

How is phimosis treated?

A

Circumcision

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14
Q

What is a paraphimosis?

A

Prepuce stuck proximal to glans, unable to be reduced

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15
Q

What is a complication of untreated paraphimosis?

A
  • Penile necrosis

- In immunocompromised: Fournier’s gangrene

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16
Q

How is paraphimosis treated?

A
  • Manual push/pull

- If manual reduction not successful, dorsal slit or circumcision

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17
Q

Risk factors for testicular torsion?

A
  • Undescended testis

- Bell clapper deformity

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18
Q

Clinical presentation for testicular torsion?

A
  • Age: 12-18 yr old male (most common)
  • Onset: acute
  • Intensity: severe
  • Swelling: absent
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19
Q

Physical exam findings for testicular torsion?

A
  • Tender, firm testis
  • High riding testis
  • Horizontal lie
  • Absent cremasteric reflex
  • No pain relief with elevation
  • Thick/knotted sperm cord
  • Epididymis not posterior to testis
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20
Q

Tx for testicular torsion?

A
  • Manual detorsion: “Open the book”
  • Detorse surgically: testis viable then orchiopexy both sides, non-viable testis then orchiectomy and orchiopexy of contralateral side.
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21
Q

Was is the time frame for a viable testis in a testicular torsion?

A

< 6 hrs

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22
Q

How is testicular torsion diagnosed?

A
  • Physical exam and clinical suspicion
  • Doppler ultrasound
  • Nuclear testicular scan
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23
Q

What is a varicocele?

A

Dilated veins of the pampiniform plexus

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24
Q

Clinical presentation of varicocele?

Study These Flashcards
A
  • Pain
  • Testis damage—fibrosis and decreased spermatogenesis
  • Testis atrophy
  • Infertility: Stress pattern on semen analysis (Decreased sperm count, decreased sperm motility, increased abnormal sperm)
25
Physical exam finding for varicocele?
Bag of worms feeling
26
Where is a varicocele MC located?
Left side
27
How is a varicocele treated?
-Surveillance: -Palpable varicocele with normal semen analysis in young men: Semen analysis q 1-2 yr -Varicocele with normal testis size in children and pre-sexual adolescents: Measurement of testicular size annually to detect size decrease -Surgery: embolization or vein ligation
28
When is surgery indicated for a varicocele?
- Symptomatic - Palpable varicocele with abnormal semen analysis in evaluation of infertile couple (if female nl or correctable) - Varicocele with small testis---repair can reverse atrophy
29
What is a hydrocele?
Collection of fluid around the testicle, forming between the parietal tunica vaginalis and the visceral tunica vaginalis
30
Causes of hydrocele?
-Majority are idiopathic -Associated with inflammatory conditions: Epididymitis, torsed appendix testis Resolves with resolution of underlying condition
31
Clinical presentation of hydrocele?
- Unilateral scrotal enlargement MC - Asx - Sx such as pain
32
How is hydrocele diagnosed?
- Palpation - Transillumination - Scrotal US --gold standard
33
Hydrocele is treated if?
-Bothersome or sx
34
How are hydroceles treated?
- Needle aspiration, with injection of sclerosing agent | - Hydrocelectomy
35
What is the disadvantage of needle aspiration?
May recur
36
Complications of needle aspiration?
- Possible infection - Bleeding (hematoma) - Pain
37
What is the advantage of hydrocelectomy?
Not likely to recur
38
Complications of hydrocelectomy?
- Possible infection - Bleeding (hematoma) - Pain - Poss loss of testis
39
What are the risk factors for cystitis?
Immunocompromised: - DM - HIV - Malignancy - Steroids - Chemotherapy - Malnutrition Urinary stasis/obstruction: - Urinary retention - Ureteral obstruction - Vesicoureteral reflux - Bladder diverticulum - Congenital GU abn - Sexual activity - Spermicide use - Diaphragm use - Urinary incontinence - Cystocele or pelvic prolapse
40
What things won't lead to cystitis?
- Voiding after intercourse - Wiping from front to back - Tight clothing - Voiding as soon feel urge to void - Hot tubs - Douches - Tampons
41
What is the clinical presentation of cystitis?
- Irritative voiding symptoms: dysuria, urgency, frequency - Suprapubic discomfort - Cloudy, malodorous urine - Fever - Mental status change - SCI: Autonomic dysreflexia, incr muscle spasticity
42
How is cystitis diagnosed?
Urinalysis: - Leukocyte esterase positive (WBC enzyme) - Nitrite positive (reductase enzymes convert nitrate to nitrite. Most do. Strep does not) - Pyuria > 5 WBC/hpf - Bacteria Urine culture: > 100,000 organisms, monoculture
43
What is the MC cause of cystitis? Other organisms that cause cystitis?
- MC cause: E.coli - Other common pathogens: Klebsiella, Enterobacter, Proteus, Pseudomonas, Staphylococcus saprophyticus, Enterococcus, Candida
44
How is cystitis treated?
- Trimethoprim/Sulfamethoxazole (TMP/SMZ, Bactrim, Septra) DS bid x 3 day treatment course - Nitrofurantoin (Macrodantin, Macrobid) - Ampicillin and amoxicillin effective against enterococcus - Beta lactamase inhibitor for beta-lactam resistant bacteria - Fluoroquinolones - Fosfomycin 3 gm po single dose (though not if pyelo suspected) (Monurol) - Cefdinir (Omnicef) - Amoxicillin-clavulanic acid (????) - Cefaclor (Ceclor) - Cefpodoxime proxetil (Vantin)
45
T/F: Bacteruria equals infection
False
46
Complicated cystitis occurs in....
- Immunosuppression - Pregnancy - Male - Pediatric - Indwelling urinary catheter, stent, drain - Anatomic abnormality (e.g. vesicoureteral reflux, calyceal diverticulum, ureteropelvic junction obstruction) - Urinary obstruction - Urolithiasis - Renal insufficiency
47
What is the hallmark symptom of prostatitis?
Prostatic pain
48
What are the types of prostatitis?
- Acute Bacterial Prostatitis - Chronic Bacterial Prostatitis - Inflammatory Chronic Pelvic Pain Syndrome (Non-bacterial Prostatitis) - Non-inflammatory Chronic Pelvic Pain (Prostatodynia)
49
What is the clinical presentation of acute bacterial prostatitis?
- Fever - Irritative poss obstructive voiding sx - Warm boggy tender prostate.
50
Acute Bacterial Prostatitis occurs commonly in what age group?
Young men
51
MC organism causing acute bacterial prostatitis?
E. coli
52
How to test for acute bacterial prostatitis?
- H+P | - Urine culture
53
Tx for acute bacterial prostatitis?
Abx
54
What is the cliical presentation for chronic bacterial prostatitis?
- Recurrent prostatic infections - Pain in genitals, urinary tract, perineum, low back - Irritative urinary symptoms (dysuria, urgency, frequency) - Pain w/ejaculation
55
What age group is chronic bacterial prostatitis common in?
Older men
56
MC organism causing chronic bacterial prostatitis? Other organisms that cause this?
- MC: E. coli - Klebsiella - Pseudomonas - Proteus - Enterococcus - Staphylococcus saprophyticus - Chlamydia trachomatis - Ureaplasma urealyticum - Mycoplasma hominis
57
How is chronic bacterial prostatitis diagnosed?
-H+P -History of recurrent UTIs -Physical Exam: tender boggy prostate -Expressed prostatic secretion (EPS) -Post prostate massage urine culture -Meares Stamey 4 glass test (Initial, Midstream, EPS, Post prostatic massage)
58
How is chronic bacterial prostatitis treated?
- Fluoroquinolones -Sulfamethoxazole/ Trimethoprim - NSAIDs - Alpha blockers - Anticholinergics/antimuscarinics - Phytotherapy (Saw palmetto) - Zinc - Diet - Stress management - Prostate massage, ejaculation - Sitz baths

EOR Exam 1 (3 decks)

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