Urology Flashcards
(151 cards)
1
Q
Perc nephrostomy
A
catheter placed through skin into kidney pelvis to drain urine with distal obstruction, etc.
2
Q
RUG
A
retrograde UrethroGram (dye injected into the urethra and films taken; rules out urethral injury, usually in trauma patients)
3
Q
Gomco Clamp
A
clamp used for circumcision; protects penis glans
4
Q
Bell clapper’s deformity
A
condition of congenital absence of gubernaculum attachment to scrotum
5
Q
Fournier’s gangrene
A
Extensive tissue necrosis/infection of the perineum in patients with diabetes
6
Q
Coude catheter
A
Basically a foley catheter with hook on the end to get around a large prostate
7
Q
Posthitis
A
foreskin infection
8
Q
hydrocele
A
clear fluid in the processus vaginalis
9
Q
communicating hydrocele
A
hydrocele that communicates with peritoneal cavity and, thus, gets smaller and larger as fluid drains and then reaccumulates
10
Q
Noncommunicating hydrocele
A
hydrocele that does not communicate with the peritoneal cavity; hydrocele remains the same size
11
Q
varicocele
A
abnomal dilation of the pampiniform plexus to the spermatic vein in the spermatic cord; described as a bag of worms
12
Q
spermatocele
A
dilation of epidiymis or vas deferens
13
Q
Prehn’s sign
A
elevation of the painful testicle that reduces the pain of epididymitis
14
Q
TRUS
A
TransRectal UltraSound
15
Q
Orchitis
A
inflammation of the testicle
16
Q
Crytorchidism
A
Undescended testicle
17
Q
IVP
A
intraVenous Pyelogram (dye injected into the vein, collects in the renal collecting system, and an xray is taken
18
Q
Space of Retzius
A
Anatomic extraperitoneal space in front of the bladder
19
Q
TURP
A
TransUrethral Resection of the Prostate
20
Q
PVR
A
Post Void Residual
21
Q
Paraphimosis
A
foreskin held (stuck) in the retracted position
22
Q
phimosis
A
inability to retract the foreskin
23
Q
Balanitis
A
inflammation/infection of the glans penis
24
Q
Balanoposthitis
A
inflammation/infection of the glans and prepuce of the penis
25
Peyronie's disease
Abnormal fibrosis of the penis shaft, resulting in a bend upon erection
26
`Appendix testis
common redundant testicular tissue
27
VUR
VesicoUrethral Reflux
28
Layers of the scrotum
Skin, Dartos, External spermatic fascia, Cremaster muscle, internal spermatic fascia, parietal and visceral layers of the tunica vaginalis, tunica albuginea (Some Damn Englishmen Call It The Testes)
29
DDx for scrotal mass
Cancer, torsion, epididymitis, hydrocele, spermatocele, varicocele, inguinal hernia, testicular appendage, swollen testes, nontesticular tumor (paratesticular tumor: rhabdomyosarcoma, leiomyosarcoma, liposarcoma)
30
causes of hematuria
bladder cancer, trauma, uti, cystitis from chemotherapy or radiotherapy, stones, kidney lesion, BPH
31
Most common cause of severe gross hematuria without trauma or chemotherapy/radiotherapy
Bladder CA
32
DDX for bladder outlet obstruction
BPH, foreign body, urethral stricture, urethral valve
33
DDX for ureteral obstruction
stone, tumor, iatrogenic (suture), stricture, gravid uterus, radiation injury, retroperitoneal fibrosis
34
DDX for kidney tumor
renal cell carcinoma, sarcoma, adenoma, angiomyolipoma, hemangiopericytoma, oncocytoma
35
What is Renal Cell Carcinoma?
Most common solid renal tumor (90%); originates from proximal renal tubular epithelium
36
what is the epidemiology of RCC?
Primarily a turmo of adults 40-60yrs with 3:1 male:female ratio; 5% of cancers overall in adults
37
what percentage of the RCC tumors are bilateral?
1%
38
what are the risk factors to RCC?
Male, tobacco, von-Hippel-Lindau syndrome, polycystic kidney
39
What are the symptoms of RCC?
Pain (40%), hematuria (35%), weight loss (35%), flank mass (25%), HTN (20%)
40
What is the classic TRIAD of renal cell carcinoma?
1. flank pain
2. hematuria
3. palpable mass (triad occurs in only 10-15% of patients)
41
how are most cases of RCC diagnosed?
Found incidentally on imaging (CT, MRI, U/S)
42
what radiological tests are performed for RCC?
1. IVP
| 2. Abdominal CT scan with contrast
43
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What are the stages of RCC per the AJCC?
Stage 1
Stage 2
Stage 3
Stage 4
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Stage 1 - tumor <2.5 cm, no nodes, no metastases
Stage 2-Tumor >2.5 cm limited to kidney, no nodes, no metastases
Stage 3- Tumor extends into IVC or main renal vein; positive regional lymph nodes but <2cm in diameter, no metastasis
Stage 4 - distant metastasis or positive lymph nodes>2cm in diameter, or tumor extends past gerota's fasci
44
What is the metastatic workup for RCC?
CXR, IVP, CT scan, LFTs, calcium
45
what are the sites of RCC metastasis
lung, liver, brain, bone; tumor thrombus entering renal vein or IVC is not uncommon
46
what is the unique route of spread of RCC?
tumor thrombus into the IVC
47
what is the treatment of RCC?
radical nephrectomy (excision of the kidney and adrenal, including gerota's fascia) for stages 1 - 4
48
what gland is removed with a radical nephrectomy
adrenal
49
what is the unique treatment for metastatic spread?
1. alpha-interferon
| 2. LAK cells lymphokin acativated killer) and IL-2 (interleukin 2)
50
what is the syndrome of RCC and liver disease?
Stauffer's sydnrome
51
what is the concern in an adult with new onset L varicocele?
L RCC - the left gonadal vein drains into the L renal vein
52
what is the incidence of bladder cancer?
second most common urologic malignancy. Male to female ratio 3:1. AA are most commonly affected
53
what is the most common histology of bladder cancer?
Transitional Cell Carcinoma (TCC) - 90%, remaining cases are squamous cell or adenocarcinomas
54
what are the risk factors for bladder cancer?
SMOKING, industrial carcinogens (aromatic amines), schistosomiasis, truck drivers, petroleum workers, cyclophosphamide
55
how do you work up bladder cancer?
urinalysis and culture, IVP, cystoscopy with cytology and biopsy
56
define the AJCC transitional cell bladder cancer stages?
| Stage 0-IV
Stage 0- superficial, carcinoma in situ
Stage I - invades subepithelial CT, no positive nodes, no mets
Stage 2- Invades superficial or deep muscularis propria, no positive nodes, no mets
Stage 3 - invades perivesical tissues, no positive nodes, no mets
Stage 4- Positive nodal spread with distant mets, and/or invades the abdominal/pelvic wall
57
what are the indications of partial cystoscopy in bladder cancer?
superficial, isolated tumor, apical with 3cm margin from any orifices
58
what is the treatment for bladder cancer?
| stage 0-IV
0- TURB and intravesical chemotherapy
1-TURB
2 and 3 - Radical cystectomy, lymph node dissection, removal of prostate/uterus/ovaries/anterior vaginal wall, and urinary diversion (eg. ileal conduit) +/- chemo
59
What is TURB?
transurethral resection of the bladder
60
after TURB the tumor recurs, then what?
repeat TURB and intravesical chemotherapy (mitomycin C) or bacillus Calmette-Guerin
61
What is and how does bacillus Calmette-Guerin work?
Attenuated TB vaccine- thought to work by immune response
62
What is the incidence of Prostate CA?
Most common GU cancer (>100,000 new cases per year), most common carcinoma in men, second most common cause of death
63
what is the epidemiology of prostate CA
"disease of elderly men" present in 33% of men 70-79, and 66% of men 80-89%, AA have a 50% higher chance of getting it
64
what are the common sites of metatasis of prostate CA?
osteoblastic bony lesions, lung, liver, adrenal
65
what provides lymphatic drainage of the prostate?
obturator and hypogastric nodes
66
what is the significance of Batson's plexus
spinal cord venous plexus, route of isolated skull/brain mets
67
how do you detect prostate CA?
PSA and DRE
68
when should men get a PSA check?
men >50 or >40yrs if first degree family history or AA
69
what percentage of patients with prostate CA will have an elevated PSA?
60%
70
what is the imaging test for prostate CA
TransRectal UltraSound (TRUS)
71
how do you diagnose prostate cancer?
transrectal biopsy
72
what is the Gleason Score?
Histologic grades 2-10: Low score=well differentiated, High score=poorly differentiated
73
what are the indications for transrectal biopsy with normal rectal examination
PSA>10 or abnormal TRUS
74
how do you stage prostate CA (AJCC)
| StageI-IV
1- tumor involves <50% of 1 lobe, no nodes, no mets, PSA<10, Gleason <6
2-Tumor within prostate; lobe<50% but PSA>10, or Gleason>6 or >50% of 1 lobe, no nodes no mets
3-Tumor thorugh the prostate capsule or into the seminal vesicles, no nodes no mets
4-tumor extends into adjacent structures (other than seminal vesicles) or +nodes or +mets
75
what does a radical prostatectomy remove?
1. prostate glands 2. seminal vesicles 3. ampullae of the vas deferens
76
what is "androgen ablation" therapy?
1. bilateral orchiectomy or 2. Luteinizing Hormone Releasing Hormone agonist (LHRH)
77
how do LHRH work?
decrease LH release from pituitary, which then decreases testosterone production in the testes
78
what are the generalized treatment options of prostate cancer according to stage I-IV
stage 1-radical prostatectomy
stage 2- radical prostatectomy +/-lymph dissection
stage3- radiation therapy +/- androgen ablation
stage 4- androgen ablation, radiation therapy
79
what is the medial treatment for systemic metastatic disease?
Androgen ablation
80
What is the option for treatment in early stage prostate CA patient >70yo with comorbidity?
XRT
81
What is the normal size of the prostate?
20-25gm
82
where does BPH occur?
periurethrally (prostate CA occurs in the periphery)
83
what are the symptoms of BPH
Obstructive type symptoms; hesitancy, weak stream, nocturia, intermittency, UTI, urinary retention
84
how is the diagnosis made? labs?
history, DRE, elevated PostVoid Residual (PVR), urinalysis, cystoscopy, U/S
labs- UA, PSA, BUN, CR
85
What is the ddx for BPH?
Prostate CA (nodular)- biopsy
Neurogenic bladder - history of neurologic disease
Acute prostatitis - hot, tender, gland
Uretral stricture - RUG, history of STD, UTI
86
how do you treat BPH
pharmacologic - a-1 antagonist
hormonal - antiandrogen
surgical - TURP, TUIP, open prostate resection
Transurethral balloon dilation
87
why do a1 antagonists work for BPH?
relax the sphincter relax prostate capsule
88
what is Proscar?
Finasteride: 5a-reductase inhibitor, blocks transformation of testosterone to dihydrotestosterone, may shrink and slow progression of BPH
89
what is Hytrin?
Terazosin: a1 antagonist, may inhibit urine outflow by relaxing the prostatic smooth mm
90
what aer the indications for BPH surgery
Due to obstruction: urinary retention, hydronephrosis, UTI, Severe symptoms
91
What is TUIP?
TransURethral Incision of Prostate
92
what percentage of tissue removed for BPH will have malignant tissue on histology?
up to 10%
93
what are the possible complications of TURP?
Immediate: failure to void, bleeding, clot retention, UTI, Incontinance
94
what is the incidence of testicular cancer?
rare, 2-3 new cases per 100,000 per year in the US
95
who is most likely affected by testicular cancer
most common solid tumor of 20-40yos
96
what are the risk factors of testicular cancer?
crytpochidism (6% of testicular tumors)
97
does orchiopexy as an adult remove the risk of testicular cancer?
NO?
98
what are the symptoms of testicular cancer?
painless lump, swelling, or firmness of the testicle; they usually notice after incidental trauma to the groin
99
what percentage of patients with testicular cancer present with an acute hydrocele?
10%
100
what percentage of patients with testicular cancers present with symptoms of metastatic disease (back pain, anorexia)?
10%
101
what are the classification of testicular cancers?
Germ cell tumors (95%)
| Nongerminal (5%)
102
what are the germ cell cell tumors?
Seminomatous (~35%), nonseminomatous (~65%), Embryonal cell carcincoma (teratoma, mixed, choriocarcinoma)
103
what are the Nongerminal cell tumors?
Leydig, Sertoli, Gonadoblastoma
104
what is the major classification of testicular cancer based on therapy?
seminomatous and nonseminomatous
105
what are the major tumor markers for testicular tumors?
1. Beta-human chorionic gonadotropin (B-HCG)
| 2. Alpha-fetoprotein (AFP)
106
what er the tumor markers by tumor type?
B-HCG - inc in choriocarcinoma (100%), embryonal carcinoma (50%) and rarely in pure seminomas (10%), nonseminomatous tumors (50%)
AFP - inc in embryonal carcinoma and yolk sac tumors; nonseminomatous tumors (50%)
107
Define the difference between seminomatous and NONseminomatous germ cell testicular tumor markers
NONseminomatous common = 90% have a +AFP and/or B-HCG
| Seminomatous -rare = only 15% are AFP+
108
Which tumors almost NEVER have an elevated AFP?
Choriocarcinoma and Seminoma
109
In which tumor is B-HCG almost always found elevated
Choriocarcinoma
110
How often is B-HCG elevated in patients with pure seminoma?
Only about 10% of the time!
111
How often is B-HCG elevated with nonseminoma?
~65%
112
What other tumor markers may be elevated and useful for recurrence surveillance?
LDH, CEA, Human Chorionic Sematomammotropic (HCS), Gamma-Glutamyl Transpeptidase (GGT), PLacental Alkaline Phosphate (PLAP)
113
What are the steps to diagnosing Testicular Cancer?
PE, Scrotal U/S, check tumor markers, CXR, CT (Chest, pelvis, Abdomen)
114
Define the stages according to Testicular Cancer staging I-III
I- any tumor size, no nodes, no mets
II-+nodes, no mets, any tumor
III-distant Mets (any nodal status, any size tumor)
115
What is the treatment of seminoma at the various stages? I-III
Stage I and II- Inguinal orchiectomy and radiation to retroperitoneal nodal basins
stage III-orchiectomy and chemotherapy
116
What is the treatment of NONseminomatous disease at various stages? I-III
Stages I and II - Orchiectomy and retroperitoneal lymph node dissection versus close follow-ups for retroperitoneal nodal involvment
Stage III-Orchiectomy and chemotherapy
117
What percentage of stage I seminomas are cured after treatment?
95%
118
which type of testicular type cancer is the most radiosensitive?
Seminoma (think Seminoma = Sensitive to radiation
119
why not remove testis with cancer through a scrotal incision?
it could result in tumor seeding of the scrotum
120
What is the major side effect of retroperitoneal lymph node dissection?
Erectile dysfunction
121
What is testicular torsion?
twist of the spermatic cord resulting in venous outflow obstruction and subsequent arterial occlusion and testicular infarction
122
what is a "bell clapper" deformity?
Bilateral nonattachment of the testicles by the gubernaculum to the scrotum (free like the clappers of bells
123
what are the signs of testicular torsion?
very tender, swollen elevated testicle; nonillumination; absence of cremasteric reflex
124
How is the diagnosis made?
Surgical exploration, U/S (solid mass) and doppler flow, cold Tc-99 scan (nuclear study)
125
what is the treatment of testicular torsion?
Surgical detorsion and bilateral orchiopexy to the scrotum
126
How much time is available from the onset of symptoms to detorse the testicle?
<6hours will bering the best results >90% salvage rate
127
What are the chances of testicle salvage after 24 hours?
<10%
128
What are the common bugs involved with epididymitis?
1. elderly/children
2. adults
1. e. coli
| 2. STD bacteria: gonorrhea, chlamydia
129
What is the work up for epididymitis?
U/A, Urine culture, STD swab +/- U/S with doppler or nuclear study to r/o torsion
130
what are some causes of priapism
Low flow: leukemia, drugs (eg. prazosin), sickle cell, ED treatment gone wrong.
High flow: pudendal artery fistula, usually from trauma
131
what is the treatment to priapism?
1. aspiration of blood from corporus cavernosum
| 2. a-adrenergic agent
132
What are the 6 MAJOR causes of ED?
1. Vascular - not enough flow
2. Endocrine - Low T
3. Anatomic - structural abnormality (peyronie's)
4. Neurologic
5. Meds
6. Psychologic
133
what lab tests should be performed?
Fasting Glu (r/o DM), Serum T, Serum Prolactin
134
what are the 4 types of kidney stones?
1. Calcium oxalate/Calcium phosphate (75%)- secondary to hypercalcuria (inc intestinal absorption, dec renal reabsorption, inc bone reabsorption)
2. Struvite (MgAmPh) (15%) - infection stones, seen in UTI with proteus, high urine pH
3. Uric Acid (7%) -radiolucent (uric=unseen), seen in gout, lesch-nyhan, chronic diarrhea, cancer, low urine pH
4. Cystine (1%)- genetic predisposition
135
what kidney stones are seen in IBD/Bowel Bypass?
Calcium oxalate
136
How to diagnose a kidney stone?
KUB (90% radiopaque), IVP, UA and culture, BUN/Cr, CBC
137
what are the 3 common sites of obstruction?
Ureteropelvic junction (UPJ), Uretero Vesicular Junction (UVJ), Intersection of the ureter and iliac vessels
138
what are the common types of incontinence?
stress incontinence, overflow incontinence, urge incontinence
139
define stress incontinence?
loss of urine associated with coughing, lifting, exercise. Seen most often in women, secondary to relaxation of pelvic floor following multiple deliveries
140
Define Overflow incontinence?
failure of the bladder to empty properly; may be caused by bladder outlet obstruction (BPH or stricture) or detrusor hypotonicity
141
Define Urge incontinence
Loss of urinary secondary to detrusor instability in patieths iwth stroke, dementia, parkinsons disease
142
What is the Marshall test?
Women with urinary stress incontinence placed in the lithotomy position with a full bladder leaks urine when asked to cough
143
how do you treat?
1. stress incontinence
2. urge incontinence
3. overflow incontinence
1. bladder neck suspension
2. pharmacotherapy (anticholinergics, a-agonists)
3. self-catheterization, surgical relief of obstruction, a-blockers
144
what are the 3 most common organisms in UTIs?
e. coli, proteus, klebsiella or pseudomonas
145
what is the most common solid renal tumor of childhood?
Wilms
146
What is the most common site of distant mets in RCC?
Lung
147
what are posterior urethral valves?
most common obstructive urethral lesion in infants and newborns; occurs in males; found at the distal prostatic urethra
148
how can a small traumatic EXTRAperitoneal bladder rupture be treated?
Foley Catheter
149
how should a traumatic INTRAperitoneal bladder rupture be treated?
operative
150
what unique bleeding problem can be seen with prostate surgery?
Release of TPA and urokinase (treat with e-aminocaproic acid)
151
what is the scrotal "blue dot" sign?
torsed appendix testis
