Urology Flashcards
(103 cards)
1
Q
The renal artery branches out from the aorta at which vertebral level?
A
L2
2
Q
Why is there a presence of perinephric fluid that extends to the pelvis despite an intact gerota’s fascia?
A
Gerota’s fascia is open inferiorly
3
Q
What is the normal weight of the kidney?
A
150 to 160g
4
Q
How many peristaltic waves per minute are present in the ureter?
A
4
5
Q
What is the normal ureter pressure?
A
30mmHg
6
Q
What is the normal length of the ureter
A
28 to 30cm
7
Q
trace the abdominal course of the ureter
A
- Renal Pelvis
- Tip of the transverse process of the lumbar vertebra
- Psoas major muscle
- Crosses the GENITOFEMORAL nerve
- Under the gonadal vessel
- Cross the common iliac and external iliac artery
8
Q
Trace the pelvic course of the ureter (Female)
A
- cross the posterior ductus deferens (promixal to ureterovesical junction)
- Enters bladder obliquely
- Obliquely enters the bladder wall
9
Q
Trace the pelvic course of the ureter (Male)
A
- Anterior to the internal iliac artery
- Posterior to the ovary
- Under the broad ligament
- Behind the uterine vessels
- Obliquely enter the bladder wall
10
Q
What are the 3 ureteric constrictions
A
- Ureteropelvic junction
- Crossing the iliac vessel
- Ureterovesical junction
Remember, UIU
11
Q
What is the true physical constriction of the ureter?
A
Ureterovesical junction
12
Q
The ureter is ____ (anterior/posterior) to the iliac vessels
A
ANTERIOR
Yes. But it is posterior to the uterine artery
13
Q
Which part of the ureter is the most common site of iatrogenic injury?
A
Distal third of the ureter
14
Q
During hysterectomy, ureters are commonly injured during _____
A
ligation of ovarian and uterine vessels
15
Q
During APR, ureter is commonly injured during ____
A
division of the lateral ligaments of the rectum
16
Q
During pelvic surgery, ureter is commonly injured during ___
A
attempts to control bleeding
17
Q
[Management of ureteral injury]
<1/2 of diameter is transected
A
Primary closure over ureteral stent
18
Q
[Management of ureteral injury]
> 1/2 of diameter is transected
A
excision with reconstruction
19
Q
[Management of ureteral injury]
complete transection
A
reconstruction is required
20
Q
What is the normal size of the prostate gland?
A
4x3x2cm
21
Q
What is normal weight of the prostate gland?
A
15 to 18 g
22
Q
What are the blood supply of prostate gland?
A
- Inferior vesical
- Middle hemorrhoidal
- Internal pudendal
23
Q
The reason why prostate CA can metastasize to the spinal cord
A
Batson plexus
24
Q
What is the role of fructose that is present in the seminal vesicles?
A
sperm motility
25
What is the average growth per year (in grams) of the prostate gland after 50 years of age?
0.5 to 0.8 grams per year
26
Which zone of the prostate gradually enlarges that causes urinary outflow tract obstruction?
Periurethal zone = transitional zone
27
What receptors are present in the periurethal zone of the prostate causing urinary outflow tract obstruction
Alpha 1 adrenergic receptos
28
What is the initial compensatory response of the bladder in BPH?
compensatory muscular HYPERPLASIA
29
What is the PSA profile of patients with BPH? (decreased or elevated)
Elevated
30
What is the most sensitive and specific test to confirm presence of bladder outlet obstruction?
Pressure-flow urodynamics
Increased bladder pressure and low flow
31
What diagnostic test differentiates ureteral stricture from BPH?
Endoscopy
it also gives information on prostatic configuration
32
[Management of BPH]
IPSS <7
watchful waiting, annual follow up
33
What drug class helps relax prostatic smooth muscle?
alpha adrenergic receptor blocker
34
What drug class reduces intra-prostatic DHT levels which may shrink and slow progression of BPH?
5 alpha reductase
35
What is the percent reduction in prostatic size after 6 months of 5 alpha reductase treatment?
20%
36
What are the short term complications of Transurethral Resection of the prostate?
1. Hyponatremia due to absorption of hypotonic irrigation fluid
2. Urinary retention
3. Infection
37
What are the long term complications of Transurethral Resection of the prostate?
1. Incontinence
2. Impotence
3. Retrograde ejaculation
4. Bladder neck contracture
5. Urethral strictures
38
Aside from TURP, this surgical method is also effective for prostate glands <30g
Transurethral Incision of prostate
39
Advantage of Transurethral Incision of prostate over Transurethral resection of the prostate
1. Less risk of retrograde ejaculation
2. Less risk of impotence
3. Less risk of blood loss
40
What is the surgical management of choice for prostates >80g
Prostatectomy (Retropubic or Suprapubic)
41
What are the indications for prostatectomy?
1. Acute urinary retention
2. Recurrent or persistent UTI
3. Significant symptoms from bladder outlet obstruction not responsive to medical therapy
4. Recurrent gross hematuria of prostatic origin
5. Pathophysiologic changes of the kidney, ureter, bladder
6. bladder calculi due to obstruction
42
What is the most common type of prostate CA?
Adenocarcinoma
43
Common initial site of prostate CA?
periphery
That is why symptoms of urinary obstruction occur late
44
PSA used as cancer marker for prostate CA is ____ ( sensitive/ specific)?
sensitive
SNNOUT
45
What is the preferred imaging test for prostate CA?
Transrectal UTZ
46
A high gleason score means that the prostatic CA is ____ (well/poorly) differentiated?
poorly differentiated
47
What is the diagnostic method/test used for prostate cancer
Transrectal biopsy
48
What is the normal weight of the testis?
20g
49
Which part of the testis are not covered by tunica albuginea?
Dorsal area
Epididymis and dorsal pedicle are attached
50
The right spermatic vein drains to the _____
directly to the IVC
51
The left spermatic vein drains to the ____
left renal vein
52
What maintains the bladder neck and proximal urethra closure?
1. Alpha receptor of the bladder neck
2. Proximal urethra shares excursions in intraabdominal pressure
3. Increase in intraabdominal pressure causes increase in external urethral sphincter muscle contraction and closes distal urethra
53
Where is the micturition center located?
pons
54
How many corpora cavernosa are present in the penis?
2
corpus spongiousum = 1
55
What erectile body of the penis is present in the ventral portion?
Corpus spongiosum
56
If the patients has initial hematuria, where is the lesion?
Distal to bladder neck
57
If the patients has terminal hematuria, where is the lesion?
proximal to bladder neck, proximal ureter, trigone
58
If the patients has total hematuria, where is the lesion?
bladder, ureter, kidney
59
[Incontinence]
continous, not associated with urgency and stress
Total incontinence
60
[Incontinence]
leakage of urine associated with increase in abdominal pressure
stress incontinence
61
[Incontinence]
urinary leakage preceded by the sensation of an urgen need to urinate caused by uninhibited bladder contraction due to infection, bladder CA, neurogenic
urge incontinence
62
[Incontinence]
overflow of a small amount of urine from a distended bladder
overflow incontinence
63
What is the RBC finding that is significant in urinalysis?
3/hpf
64
What is the WBC finding that is significant in urinalysis?
5/hpf
65
What are normal values of semenalysis?
1. Volume 15mL
2. 15 million
3. 10% motile
4. 4% morphology
5. 2 abnormal semen analysis
Remember, 15 15 10 4 2
66
____ is an imaging tool done during cystoscopy that evaluate kidneys, bladder,ureters,
Retrograde pyeloureterography
67
___ diagnostic tool that reveals the dynamics of micturition and evidence of obstruction or reflux of urine
Voiding Cystourethrogram
Used to see patency of the urethra
68
___ diagnostic technique used during therapeutic dilatation of narrow arteries; also used to evaluate renal vasculature
Renal arteriography
69
___ diagnostic technique used for early detection and staging of prostate cancer
Ultrasonography
70
What is the commonly used imaging technique for imaging urologic neoplasms?
Contrast-enhanced CT scan
71
Emphysematous pyelonephritis is commonly seen in which patients?
DM patients
72
___ syndrome
Arthritis, conjunctivitis, non-gonoccocal urethritis
Reiter Syndrome
73
What is the manifestation of chronic prostatitis with sterile prostatic secretion
Prostatodynia
74
Genital TB most commonly involves which part of the mate Genitourinary Tract?
Epididymis
75
What type of nephrolith is associated with urea-splitting bacteria or proteus spp?
struvite stone
76
[Location of ureteral stone]
flank pain radiating to the groin
proximal 1/3 of ureter
77
[Location of ureteral stone]
anterior lower quadrant pain
stone in the middle third of ureter
78
[Location of ureteral stone]
presence of bladder irritative symptoms
stone in the distal third of the ureter
79
[Nephrolithiasis]
A basic urine pH >7 is associated with what organism
urea-splitting organism
80
What is the hounsfield of water
0 HU
81
What is the hounsfield of air
minus 1000 HU
82
What is the hounsfield of bone
plus 1000HU
83
Size of stone that rarely pass spontaneously
stones >6mm
84
Nephrectomy is indicated if renogram of a stone-bearing kidney has a renal function of _____
<20%
85
Drugs that are stone-provoking
1. Acetazolamide
2. Calcium supplements or Vitamin D
3. Vitamin C
86
Nephrolith formed that is associated with excesive vitamin C intake
Calcium oxalate stone
87
What are the complications of extracorporeal shock wave lithotripsy?
1. Direct injury to kidney
| 2. Streinstrasse (incomplete stone fragmentation)
88
Location of stone in the kidney that is associated with lowest stone free rates
Lower pole
89
Type of nephrolith that cannot be broken down by SWL
Cystine stone
90
Surgical management of large, complex renal or ureteral calculi
Percutaneous Nephrectolithotomy
91
What is the rationale behind leaving a ureteral stent after ureteroscopy
To prevent distal migration of stone fragment during intra-corporeal lithotripsy
92
What are the common causes of upper tract ureteral obstruction
1. Ureteral stone (most common)
| 2. Malignancy
93
Most common causes of lower tract obstruction
1. Bladder outlet stone or mass
2. Urethral stones, stricture
3. Prostate: BPH, Ca
94
What are the signs and symptoms of Lower tract obstruction
WINSURF
```
Weak stream
Intermittency
Nocturia
Straining
Urgency
Retention
Frequency
```
95
What is the triad of renal cell carcinoma
1. Pain
2. Mass
3. Hematuria
96
___ syndrome refers to renal cell CA + hepatic cell dysfunction
reversible hepatic cell dysfunction with removal of RCCA
Stauffer's syndrome
97
What imaging is able to determine the extent of vascular involvement in patient with RCCA
MRI
98
What is removed in radical nephrectomy for patients with RCCA?
1. Excision fo kidney
2. Gerotas fascia
3. Perinephric fat
99
[Bosniak Classification]
Hairline thin wall, no septa
Bosniak 1
Malignancy = 1.7%
100
[Bosniak Classification]
few hairline thin septa and fine calcifications; short segment, slightly thickened <3cm
Bosniak II
Malignant = 18.5%
101
[Bosniak Classification]
multiple hairline septa, septa can have calcifications >/3cm
Bosniak IIF
Malignant = 18%
102
[Bosniak Classification]
indeterminate cystic masses, thickened irregular or smooth walls or septa
Bosniak III
Malignant = 33%
103
[Bosniak Classification]
Clearly malignant; contains enhancing soft-tissue components
Bosniak IV
malignant = 92.5%
