Surgery 3B - Urology Flashcards by Chris Caangay

Renal fxns

FIltration
Reabsorption
Secretion
x phagocytosis

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Ureteral blood supply

Abdominal aorta
Renal artery
Illiac artery
x thoracic artery

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Endocrine organs

Kidneys
Testes
x ureters
x bladder

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Male urethra

Prostatic
Bulbous
Penile
x vas deferens

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Areas of narrowing in ureter

Uretrovesical jxn
Area crossing iliac vessels
Uretero pelvic jxn
x Fossa navicularis

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Contained w/in gerota’s gascia

Adrenal glands
Kidney
Perinephric fat
x Psoas muscle

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Renal lymphatic drainage

Perihilar nodes
Interaortocaval nodes
Paraaortic nodes
x internal iliac nodes

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Urinary bladder structures

Detrussor m
Trigone
Transitional cell epithelium
x seminal vesicles

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Prostate gland consists of

Sm muscle
Glandular structures
Fibrous tissue
x Seminiferous tubues

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Penile structures

Corpora cavernosa
Urethra
Corpora Spongiosa
x Epididymis

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Obstructive urinary tract symptoms

Dec of uninary caliber
Terminal dribbling
Urinary retention
x dysuria

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Irritative urinary symptoms

Dysuria
x Hesitancy
x Terminal dribbling
x Urinary retention

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Bloody urine

Hematuria

x Chyluria, pneumaturia, dysuria

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Blood in semen

Hematospermia

x Hematuria, pneumaturia, chyluria

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Exam urilized for renal dse

Palpation
Kidney Punch
x vaginal exam, rectal exam

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UA components

Pus cells
RBC
pH
x Creatinine

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UTI

WBC: 20-30/hpf
>100k colonies of E. coli
x pH 6, SG 1.010

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Imaging studies for renal stones

UTZ
CT
XRay
x Angiography

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Evaluate renal fxn

Renal scan

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Acute prostatitis

Enlarged tender prostate
Dysuria
Fever
x hard nodular prostate

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Kidney produces

Renin
Angiotensin
Erythropoietin

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1’ physical characteristic of high osmolar contrast agents is that responsible for their toxicity

Hyper-tonicity

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Contrast agent-induced reactions including urtricaria, edema, hypotension, are thought to be

Anaphylactoid

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Agent of choice for renal cortical imaging

Tc99m DMSA

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WAGR syndrome most freq associated w/

deletion of chromosome 11

Risk factors associated w/nephrotoxicity in patients receiving high osmolar contrast media include ff except

``` renal insufficiency diabetic nephropathy multiple administrations w/short interval hyperuricemia x hypoalbuminemia ```

MC non invasive dx workup used for urological pt

UTZ

MC dx GU carcinoma in males

prostate CA

Tx for prostate CA

Ext beam radiation Radical prostatectomy Brachytherapy Chemotherapy

Radical nephrectomy includes

Kidney Gerota's fascia Hilar LN Contralateral adrenal glands

Straddle injury includes

Corpus spongiosum Bulbous urethra x prostatic urethra, bladder

Radical cystectomy in men includes

Perivesical fat

Complications of ureterolithiasis

Hydronephrosis Pyonephrosis Pyelonephritis x UB diverticulum

Radioluscent stones

Uric acid Cystine x Struvite Ca phosphate

Hematogenous route of infection

Tuberculous orchitis Tuberculous nephritis x pyelonephritis epididymitis

Asc route of infection

Pyelonephritis Cystitis x Tuberculous orchitis, Diverticulitis

Multiple scrotal sinuses

Actinomycosis Tuberculosis (testicular) x prostatitis, cystitis

Struvite stones/Staghorn calculi

Mg NH4 PO4 x cystine

Tx for renal calculi

ESWL Open nephrolithotomy Percutaneous nephrolithotomy Medical therapy

Major renal injury

Contusion 1cm parachymal laceration x urinary extravasetion, renal artery avulsion

Posterior urethral injury

Floating prostate Blood per urethral meatus Bladder distension Pelvic fracture

Ant urethral injury

Straddle injury Bulbous urethra x pelvic fracture, prostatic urethra

Distal third urethral injury

Ureteroscopic injury Pelvic Sx x Deceleration injury, Blunt injury

Stage B UB tumor includes

Mucosa Muscularis x Illiac LN, Adventia

Stage A prostatic CA involves

Peripheral zone of prostate | x illiac LN, seminal vesicles, bladder neck

REnal cell CA metastasizes to

Lung Liver Bones LN

Radical nephrectomy includes

Gerota's fascia Perinephric fat Kidneys Adrenal glands

Radical cystectomy for males includes

Prostate Seminal vesicles U bladder Distal part of vas deferens

Radical prostatectomy

Prostate Seminal vesicle Distal part of vas deferens Illian LN

Treatment for acute prostatitis

Antimicrobials Alpha blocker Anti inflammatory x finasteride

Tx for symptomatic BPH

5 alpha reductase inh Alpha blocker TURP Open prostatectomy

Tx for organ confied prostatic CA

Low dose rate brachytherapy Radical prostatectomy High dose rate bradytherapy Ext beam radiation

Immediate tx/mgt for urethral injury

Cystostomy | x primary anastomosis, urethral catherization, observation

Tx modalities for RCC

Radical nephrectomy Biologic response modifiers x simple nephrectomy, chemotherapy

Tx modalities for bladder malignancies

Radical cystectomy Intra-vesical chemo Radiation Bladder replacement

Where are renal pyramids

Inner medulla

Apices of renal pyramids project into

renal sinus

Urine in the renal papillae drain into

minor calices

Where are pacemaker muscle cells of kidney that initiate and exert peristalic activite

minor calices

Which part of kidney is not covered by renal fascia

hilum ?

R internal spermatic v drains

IVC

L gonadal vein drains

L Renal vein

Area of prostate traversed by ejaculatory ducts is known as the

central zone

Lower UT symptoms in BPH

Urgency Frequency Nocturia

What causes the pain assoc w/stone in the ureter

Obstruction of urine flow w/distension of renal capsule

Site where BPH arises

transitional zone

Colic caused by ureteral stone and RLQ pain in appendicitis

referred pain

MCC pain w/gross hematuria

ureteral obstruction d/t blood clots

MCC continuous incontinence

Vesiculovaginal fistula

Info from pelvic bimanual exam not obtained in radiologic eval

mobility/fixation of pelvic organs

MCC cloudy urine

alkaline

Hematuria distinguished from hemoglobinuria or myoglobinuria by

microscopic presence of RBC

Chronic scrotal pain most often d/t

hydrocoele

Terminal hematuria is usually seen in

prostatic inflammation

Enuresis is physiologic until

1-3

Measurement for catheters

French

1 mm in diameter = __ French

3 French

What is unique of obstructive nephropathy compared to hydronephrosis

Renal fxn impairment

Chance of renal recovery after ureteral obstruction most influenced by

early relief of obstruction

Characteristic of hydronephrosis of pregnancy

R side more affected

Male urethra corresponds to posterior urethra

Prostatic urethra

What part of the male urethra is longest

spongy penile urethra

Bilateral obstruction of UT what is noticed

max fxns excerted by both kidneys

Normal excusion of kidneys during respiration

4cm

Abnormal loc of kidneys are noted in

nephroptosis

Stress incontinence is common seen in

laxed pelciv floor musculature

CVA tenderness is elicited in

Pyelonephritis

Presence of gas (pneumaaturia) in UT is seen in

Sigmoid CA

Initial hematuria seen in ff

Meatal stricture

Condition assoc w/exstrophy of the bladder

epispadias

Oliguria =

< 400cc/day

Imaging of choice in scrotal pathology

UTZ

Calculi composed of what are not seen on plain radiographs

Uric acid

Absolute indication for open repair of blunt bladder rupture injury

sig intraperitoneal bladder rupture

Blunt trauma pt w/pelvic fracture was seen at the ER. No urine output, hypogastric area distended. Blood coming out of meatus. Dx choice?

Retrograde urethrography

Which environmental factor is most generally accepted as a risk factor for RCC

tobacco

Suppressor gene for Wilm's tumor

11p13

Voiding cystourethropgraphy shows reflux of contrast to upper tract, dilation of calyceal system, marked tortuosity of ureter. What grade

Grade V

Histologic type of bladder CA from remnant of urachus

adenocarcinoma

Incidence of prostatic CA strongly assoc w/

family history

what structure w/in renal hilum divides renal artery into ant and post

renal pelvis

Best renal imaging protocol for living renal donor to define renal anatomy and vasculature and to rule out renal stone

helical CT w/out and w/ IV contrast and a KUB radiograph

Risk of hyperacute rejection after kidney transplant is high when which of the ff crossmatch is (+)

B cell micro-lymphocyto-toxicity

Total hematuria is noted in

passage of ureteral stone

Assoc w/ extrophy of the bladder

Epispadias