Urology Flashcards
(21 cards)
What are common complaints of retinal detachment?
- scotoma
- curtain-like blindness
- sudden onset of floaters.
Clinical findinds suggesting Huntington’s
Chorea
mood changes
cognitive dysfunction
What disorder presents with the triad of cognitive impairment, urinary incontinence, abnormal gait?
Normal pressure hydrocephalus
Causes of calcium oxalate stones.
Hypercalciuria, Hyperoxaluria, ethylene glycol ingestion
Most common renal stone, Hydration to help minimize.
Calcium phosphate stones d/t
Hyperparathyroidism and renal tubular acidosis
Cystine renal stones
Due to cystinuria.
(+) staghorn calculi.
Hereditary form, and therefore difficult to treat
What is the most appropriate approach to renal stone treatment.
- < 5mm: IVF and analgesia
- < 7mm = medication expulsive tx
- CCB - amlodipine
- a-blocker - terazosin.
- <1.5 cm = requires break down.
- ureteroscopy - distal stone
- Lithotripsy - proximal stone
- > 1.5 cm = surgical retrieval
- If obstructive sepsis is present = emergent decompression
- stent for distal disease
- nephrostomy for proximal disease
Cystitis
Pt, Dx, Tx
- Pt
- suprapubic pain, dysuria, frequency, urgency.
- Dx
- UA:
- E.coli, S.saprophyticus, Enterobacter, Klebsiella, Proteus,
- (+) cather = pseudomonas.
- UA:
- Tx
- Uncomplicated:
- nitrofurantoin, TMP-SMX, Fosfomycin
- Complicated
- Ciprofloxacin, levofloxacin.
- Uncomplicated:
Urge incontinence Tx
Darifenacin
Fesoterodine
Oxybutynin
solifenacin
tolterodine
trospium.
ADR: constipation, dry mouth, cognitive deficits in elderly.
Stress incontinence
Tx
- Kegel exercises
- Weight loss
- Pessary
- Duloxetine
- Midurethral sling surgery
Overflow incontinence
Tx
- Dx
- post-void residual volume > 50mL
- Tx
- decompress via catheter
- assess for obstruction
Most common form of bladder cancer in the US?
- Transitional cell carcinoma
- SCC - typically not in US. Associated w/ schistosoma heamatobium
- Adenocarcinoma- typically along dome of the bladder, via the urachal remnant.
What is the Tx for epididymitis in following age groups:
< 35.
>35.
- < 35 = GC/chlamydia
- ceftriaxone IM + doxycycline x10d
- > 35 = enterobacteriaceae
- fluoroquinolone x 10-14d.
Testicular cancer
- 95% are germ cell
- seminomatous, nonseminomatous
- 5% are stromal
- leydig cells
- Sertoli cell
- Granulosa cell
- Pt
- painless, firm testicular mass.
- Metastasis along: retroperitoneal to mediastinal LN.
Testicular cancer lab work and treatment
- Labs
- high B-hCG = choriocarcinoma
- AFP = yolk sac tumor
- Estrogen = stromal cell tumor
- Tx
- seminoma - stage 1 = radical orchiectomy
- seminoma - Stage 2 = chemotherapy
- Nonseminoma early = surveillance
- Nonseminoma late = retroperitoneal LN dissection +/- chemotherapy
Medical management for erectile dysfunction
- phosphodiesterase inhibitors
- sildenafil
- vardenafil
- tadalafil
- self injection penile
- papaverine, phentolamine, alprostadil
- Vacuum/ constriction device.
- penile prosthetic implants
Most common cause of acute prostatitis
- E. coli
- proteus, klebsiella, serratia, pseudomonas, enterobacter
- gonorrhea, chlamydia w/ urethritis
Tx: bactrim(1st), Fluoroquinolone (2nd)
Chronic pelvic pain syndrome
>3 mon pain in perineum, back, and testes.
- Dx of exclusion
- Tx
- a-blocker (tamsulosin)
- Ciprofloxacin (6wk)
- 5a-reductase inhibitor: mostly for older men only.
Treatment for BPH
- A1 antagonist
- terazosin, doxazosin, tamsulosin
- relaxes smooth mm in bladder neck
- risk of postural hypotension.
- 5a-reductase inhib
- finasteride, dutasteride.
- blocks testosterone to DHT conversion. Reduces prostate size.
- ADR of low libido, ED, lower PSA
- Phosphodiesterase inhib: tadalafil
- improve urinary symptoms.
- anticholinergics
- reduce urgency/frequency.
- Surgery
- TURP, radiofrequency ablation (best outcome)
Classic symptoms of BPH
- increase frequency
- reduced urine stream strength
- (+) end dribbling
- (+) urinary retention
Which two classes are used to treat BPH most often?
- A1-antagonist
- tamsulosin, terazosin
- 5a-reductase inhibitor
- finasteride, dutasteride.
