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Urology Flashcards

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1
Q

Right renal artery

A

Crosses posterior to IVC

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2
Q

Left renal vein

A

The left gonadal vein drains into the left renal vein; the left renal vein crosses anterior to the aorta and receives branches from: left adrenal, left gonadal, left lumbar

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3
Q

Ureters

A

Pass over iliac vessels

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4
Q

Calcium oxalate stones

A

Most common stones, radiopaque

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5
Q

Magnesium ammonium phosphate stones

A

Struvite stones, associated with infections, urea splitting, proteus. Staghorn calculi. Radiopaque

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6
Q

Uric acid stones

A

Radiolucent. Risk factors include ileostomy, gout, short gut.

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7
Q

Cysteine stones

A

Radiolucent. Prevent with tiopronin

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8
Q

Stone size for spontaneous passage

A

> 6 mm stone will not pass spontaneously

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9
Q

Testicular cancer

A

1 male killer 25-35

Majority of testicular masses = malignant
Any mass in testicle = orchiectomy through inguinal incision
More common on right, so is cryptochordism

Avoid scrotal approach and open testicular biopsy: can cause metastatic spread to both retroperitoneal and inguinal node

Primary metatstatic site:
-Left: para-aortic nodes
-Right: interaortocaval nodes

-Lymphoma involving both testis is more common cause of bilateral testicular masses in men over 50

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10
Q

Testicular mass in congenital adrenal hyperplasia

A

Is a hyperplastic nodule, treatment is glucocorticoid

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11
Q

Diagnosis of testicular cancer

A

Need US first

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12
Q

Staging for testicular cancer

A

CT abdomen/chest to look for retroperitoneum and chest metastasis

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13
Q

Labs needed before orchiectomy

A

LDH, B-HCG, AFP

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14
Q

Percentage of germ cell tumors

A

90% are Germ cell - Seminoma or non-seminoma

Seminoma most common histology in primary testis tumors

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15
Q

Undescended testes

A

Increased risk of seminoma; if corrected, increased risk of non-seminoma

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16
Q

MC seminoma characteristics

A

10% have B-HCG elevation, NEVER has AFP elevation. If AFP high = non-seminoma

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17
Q

Seminoma treatment

A

-Extremely sensitive to XRT. Spread to retroperitoneum.
- Tx:
o Start radical inguinal orchiectomy
o Stage I – no tumor outside of testicle  Close follow up
o Stage II spread to retroperitoneum lymph nodes
o If LN involved now need chemo vs XRT
o If LN < 2 cm  XRT
o If LN > 2 cm, any mets or if BGCG elevated: chemo
- Chemo (cisplatin, bleomycin, etoposide)
- Then need surgical resection of any residual disease after above

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18
Q

Non-seminoma types

A

Embryonal, teratoma, choriocarcinoma, yolk sac.

Spreads to retroperitoneum and hematogenously to lungs.

High AFP and BHCG

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19
Q

Non-seminoma treatment

A

o Start radical inguinal orchiectomy
o Stage I – no tumor outside of testicle  Close follow up
o Stage II spread to retroperitoneum lymph nodes
o If LN involved now need chemo vs retroperitoneum lymph node dissection
o If LN < 2 cm  retroperitoneum lymph node dissection
o If LN > 2 cm, any mets  chemo
- Tx: all stages get radical inguinal orchiectomy and retroperitoneal LN dissection
- Stage II or greater (beyond testicle) – also get chemo (cisplatin, bleomycin, etoposide)
- Surgical resection for residual disease after above

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20
Q

5-year survival for seminoma

A

90%, better than non-seminoma

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21
Q

MC location for primary germ cell tumor

A

Mediastinum

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22
Q

Prostate cancer concern

A

If alk phos high, worry about metastasis

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23
Q

Diagnosis of prostate cancer

A

TRUS biopsy. Most common in posterior lobe

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24
Q

Stage I prostate cancer

A

Found on TURP; do nothing

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25
Stage I or stage II, intracapsular T1 or T2 with no metastatic disease options:
1. XRT 2. Radical prostatectomy + pelvic LN dissection (if life span > 10 years) 3. Nothing (age > 75, short life expectancy)
26
Extracapsular (Stage III or IV) prostate cancer
Extends through capsule or metastatic disease. -Tx: XRT and androgen ablation -> (leuprolide (GnRH analogue, decreases FSH and LH), flutamide (testosterone receptor blocker) or bilateral orchiectomy)
27
MC kidney tumor
Metastasis from breast cancer
28
Renal cell carcinoma diagnosis
CT scan is sufficient for diagnosis. Never biopsy kidney lesions. -All kidney tumors need some sort of resection for official diagnosis
29
MC subtype of renal cell carcinoma
Clear cell carcinoma
30
MC site of metastasis for renal cell carcinoma
Lung
31
Paraneoplastic syndrome associated with renal cell carcinoma
Stauffer syndrome - increased LFT, improved with resection
32
Renal cell carcinoma treatment
Radical nephrectomy (don't take adrenal unless involved) with regional nodes, followed by postoperative chemo-radiation
33
Renal artery ligation during nephrectomy
Vital to ligate the renal artery before the renal vein to prevent congestion of the kidney
34
Partial nephrectomy indication
Only if resection would lead to dialysis, BL renal lesion or mass <4 cm and Cr >2.5
35
Transitional cell carcinoma of renal pelvis
Requires radical nephroureterectomy
36
Metastatic renal cell carcinoma treatment
Non-curable; treatment is immunotherapy with sunitinib or pazopanib (tyrosine kinase inhibitors)
37
Bladder cancer treatment for T1a and T1b
T1a (mucosa) T1b (submucosa) (no muscle involvement) do trans-urethral resection and a single dose of Intravesical mitomycin or BCG
38
Muscle wall invasion in bladder cancer (T2 or higher)
Need cystectomy with ileal conduit, BL pelvic node dissection, then chemo-XRT (MVAC- Methotrexate, vinblastine, Adriamycin, cisplatin) Men include prostatectomy Women include TAH-BSO and anterior vaginal wall
39
Testicular torsion most accurate sign
Loss of cremasteric reflex (rubbing inner thigh does not elevate scrotum)
40
Testicular torsion presentation
High riding testicle, testicle lies horizontally
41
Torsion direction
Usually towards midline (like closing a book)
42
Prehn sign in testicular torsion
Negative; elevating the scrotum does not alleviate pain. Found in epididymitis
43
Diagnosis of testicular torsion
Clinically diagnosed; no imaging needed if highly suspected
44
Testicular torsion treatment
All need bilateral orchidopexy +/- orchiectomy
45
Priapism cause
Caused by decreased venous outflow from corpora cavernosa corpora cavernosa involved, not corpus spongiosum
46
Priapism treatment
Tx: 1st corporal cavernosa aspiration and irrigation with epinephrine, can try injecting phenylephrine into corpora too 2nd cavernoglandular shunt procedure
47
BPH treatment
– transitional zone. -Finasteride -TURP only for recurrent UTI, gross hematuria, stones, renal damage, failure of medical management.
48
TURP side effects
Retrograde ejaculation
49
Varicocele location
Most common on left, on posterior surface of testicle Exam: “bag of worms” Treatment: Most do not require treatment. But if symptomatic, causing infertility  ligate spermatic vein
50
New onset left varicocele in adult
Means IVC obstruction; MCC renal cancer, get CT abdomen
51
Varicocele effects on fertility
Causes reduced fertility; improve fertility with high spermatic vein ligation
52
Nutcracker syndrome
Compression of left renal vein between aorta and SMA Left gonadal vein empties in left renal: can cause testicular pain and VARICOCELES
53
Nutcracker syndrome symptoms
Left flank pain, abdominal pain, and hematuria
54
Spermatocele
MC cystic structure of scrotum. cyst superior and separate from testis along epididymis. Tx: Leave alone if asymptomatic. surgical removal if symptoms. Spermatocele and hydrocele do not affect fertility
55
Hydrocele in pediatrics
Hydrocele: - most disappear by 1 year in pediatrics. Formed by tunica vaginalis. Can have connection to peritoneum  processus vaginalis, communicating hydrocele or non-communicating
56
Adult hydrocele acute onset
If acute and new onset, rule out cancer
57
Hydrocele diagnosis
Will transilluminate
58
Hydrocele treatment indication
Only indicated if symptomatic; otherwise leave alone
59
Hydrocele treatment if symptomatic
Excision of hydrocele sac; don't aspirate In adult males these are all non-communicating!!!! They don’t connect to peritoneal cavity - Lump that goes into the internal ring = hernia – differentiates from hydrocele - Non-Communicating will resolve - Failure to resolve indicates persistent processus vaginalis = communicating hydrocele - CAN BE IN INGUINAL CANAL OR SCROTUM - Dx: US will transilluminate if in scrotum - If < 1 year old and non-communicating. Wait until 1 year old and resect if still there - If thought to be communicating (size waxes and wanes), then resect hydrocele even if < 1 year old - Resect hydrocele and ligate processus vaginalis inguinal approach
60
Ureteropelvic junction obstruction treatment
Pyeloplasty
61
Ureteral duplication
Most common urinary tract abnormality. Treatment: reimplantation if obstruction occurs
62
Ureterocele location
Most common at junction of ureter and bladder. Symptoms: UTI, retention. Resect and reimplant if symptomatic
63
Patent urachus
Connection between bladder and umbilicus (wet umbilicus). Diagnosis: voiding cystourethrogram. Treatment: resect cyst and close bladder
64
Epididymitis cause
Most common cause of scrotal pain in adults. Need to rule out torsion with US: shows increased blood flow to epididymis. Most common cause is chlamydia
65
Neurogenic bladder
Neurogenic bladder = SPASTIC bladder Most commonly 2/2 to spinal injury Patient urinates all the time Nerve injury above T12 Tx: surgery to improve bladder resistance
66
Neurogenic obstructive uropathy
Incomplete emptying Nerve injury below T12, can occur with APR Tx: Intermittent cath
67
Stress incontinence
Stress incontinence (cough sneeze) Due to Pelvic floor weakness Causes hypermobile urethra or loss of sphincter mechanism MC Women Tx: Kegel exercises, alpha agonist, surgery for urethral suspension or pubovaginal sling (Best)
68
Overflow incontinence
Incomplete emptying of enlarged bladder MC men BPH leads to this Tx: Flomax, TURP
69
Urge incontinence treatment
Antimuscarinics, oxybutynin, tolterodine
70
Peyronie's disease
Thick plaque in tunica albuginea. Treatment: conservative management for 1 year (colchicine, vitamin E). If that fails, need Nesbit operation (tissue on opposite side of plaque is shortened). PLAQUE IS NOT EXCISED
71
Infundibular ligament
Carries ovarian vessels
72
Broad ligament
Carries uterine vessels. Medial to this is the ureter
73
Cardinal ligament
At the base of broad ligament contains uterine vessels

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