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Flashcards in Urology Boy Deck (42):
1

What are the complications of bladder outflow obstruction?

1. Renal insufficiency
2. Infection (cystitis, epididymitis)
3. Urinary retention
4. Bladder calculi
5. Bladder diverticulum

2

Minimum investigations for patient with BPH?

1. IPSS
2. DRE
3. PSA
4. Serum Creatinine
5. Urine flow studies
6. Urinalysis
7. Ultrasound KUB

3

Causes of obstructive LUTS?

Male
1. Bladder - neck contracture (primary/post prostatectomy)
2. Prostate- BPH/Ca
3. Urethra - Stricture

Female
1. Bladder - prolapse
2. Urethra- diverticulum/cancer/stricture

4

What are the causes of irritative LUTS?

1. Bladder
Inflammation (UTI/irradiation/carcinoma in situ)
Outflow obstruction
Detrusor instability
Neuropathic bladder
Small capacity (TB/interstitial cystitis)

2. PID

5

Define incontinence

Inappropriate involuntary voiding or leakage of urine,producing social/hygienic problems

6

Classify the causes of urinary incontinence

1. Failure to store
2. Failure to void
3. Other causes (fistulas)

7

What are the "failure to store" causes of incontinence?

1. Bladder
Involuntary contractions (OAB/detrusor hyperreflexia)
Decreased capacity (TB/irradiation)
Sensory urgency (UTI/calculus/ca in situ)

2. Urethral
Anatomical stress incontinence
Post surgery (prostatectomy)
Atrophic vaginitis
Radiotherapy
Neurological (myelomeningocele)
Prostate ca with invasion of the ext. sphincter

8

What are the "failure to empty" incontinence causes?

1. Bladder
Neurogenic bladder(LMN)
Myogenic bladder(atonic detrusor)
Drugs (TCA)

2. Urethral
Anatomic obstruction (stricture/stenosis of bladder neck/prostate)
Functional obstruction (detrusor sphincter dyssinergia)

9

Investigations in urinary incontinence

Urine culture (suspect UTI)
Urine cytology (suspect CIS)
Ultrasound
Urodynamics

10

Define enuresis

Persistence of involuntary voiding beyond age of anticipated control
Bedwetting >2 months in a child older than 5 years of age

11

What are the most common causes of enuresis?

Developmental delay
Genetic factors
Sleep disorders
Nocturnal polyuria
Decreased capacity
Psychological factors

12

When are no further investigations needed in a child with enuresis?

All 3 of:
Monosymptomatic nocturnal enuresis
Normal exam
Normal urinalysis

13

What is the treatment of enuresis?
(5 areas)

1. General measures (decrease fluid intake at night)
2. Medical (older than age 7, Desmopressin, Imipramine, Oxybutinin)
3. Behavior reinforcement (star charts)
4. Conditioning (enuresis alarm)
5. For polysymptomatic enuresis (treat diurnal symptoms)

14

What is the role of PDE5 and what effect does it cause?

Breakdown of cGMP to GMP
Detumescence

15

How would a psychogenic ED present?

Sudden onset
Morning erections present
Associated premature ejaculation

16

Causes of organic ED

1. Vasculogenic
2. Neurogenic
3. Endocrine
4. Chronic systemic disease
5. Penile problems
6. Surgery
7. Radiotherapy
8. Drugs

17

What is the treatment of enuresis?
(5 areas)

1. General measures (decrease fluid intake at night)
2. Medical (older than age 7, Desmopressin, Imipramine, Oxybutinin)
3. Behavior reinforcement (star charts)
4. Conditioning (enuresis alarm)
5. For polysymptomatic enuresis (treat diurnal symtpms

18

Define retractile testis

Normally descended testis which has been displaced upwards by cremaster muscle spasm. Can be maneuvered back into scrotum.

19

Define undescended testis

A testis which has been arrested along the normal path of descent (between abdomen and bottom of scrotum)

20

Define ectopic testis

Testis has passed through inguinal canal and has then deviated away from the normal line of descent to lie outside the scrotum

21

What is the aetiology of an undescended testis?

1. Intrinsically abnormal testis
2. Hormonal (decreased testosterone)
3. Mechanical (prune belly syndrome)

22

How are undescended testis classified?

Abdominal
Inguinal
Upper scrotal

23

What are the complications of undescended testis?

Malignancy
Torsion
Trauma
Infertility
Inguinal hernia

24

What is the management of undescended testis?

Surgery - orchidopexy
Medical - bHCG to stimulate testosterone

25

What is the DDx for cryptorchidism?

Undescended testis
Ectopic testis
Retractile testis
Anorchia
Orchidectomy

26

What are the medical indications for a circumcision?

Phimosis
Paraphimosis
Foreskin trauma
Carcinoma of penis
Condylomata acuminata
Recurrent balanoposthitis
Previous inadequate circumcision

27

What are the advantages of circumcision?

Decreased incidence of
HIV infection
UTI
Penile ca

28

What are contraindications for circumcision?

Neonatal factors:
Prematurity
Illness
Blood dyscrasia/fam hx of bleeding d/o

Congenital penile abnormalities:
Hypoapadia
Chordee
Buried penis
Webbed penis

29

What are the complications of circumcision? (7)

Hemorrhage
Infection
Glans injury
Skin complications
Meatal ulcer
Necrosis
Urethrocutaneous fistula

30

What is a hypospadia?

Congenital condition characterized by:
Abnormal opening of urethral meatus on ventral side of penis
Dorsal skin hood
Chordee

31

Hypospadias are classified according to _________________

The position of the meatus.
Distal - glanular, coronal, distal penile shaft
Middle - mid penile shaft
Proximal - proximal penile shaft, peno-scrotal, perineal

32

What are the principles of treatment for hypospadias?

Correction of chordee and straightening of penis (orthoplasty)
Urethral reconstruction

33

How can a RCC present?

1. Asx- incidental finding
2. Urological - pain, mass, hematuria
3. Endocrine - hypercalcemia, polycythemia
4. Toxic- anaemia, fever, myo/neuropathy, hepatopathy
5. Vascular - HT, DVT, varicocele, oedema, HF
6. GIT- anorexia, weight loss, non specific abd pain
7. Mets- dyspnea, bone pain, neurological sx

34

What is the etiology of RCC?

1. Adenoma
2. Smoking
3. Obesity
4. Acquired renal cystic disease
5. Von Hippel Lindau

35

What are ultrasound features of a simple cyst?

1. Thin wall, round uniform borders
2. Hypoechoic
3. Posterior abdominal wall signal enhancement

36

What are ultrasound features of a solid mass?

1. Irregular, poorly defined borders
2. Hyperechoic
3. No posterior abdominal wall enhancement

37

What are the indications for intervention in renal colic?

1. Renal failure
2. UTI
3. Anuria
4. Large stone
5. Failure of stone to progress
6. Uncontrollable pain
7. Convenience

38

Antenatal dx of posterior urethral valves

On ultrasound
- oligohydramnios
- bilateral hydronephrosis
- thickened bladder wall

39

How do posterior urethral valves present in neonates/infants? (6)

1. Renal failure
2. Recurrent UT
3. Palpable bladder/kidney
4. Failure to thrive
5. Urinary ascites
6. Respiratory distress

40

How will posterior urethral valves present in an older child? (3)

Recurrent UTI
Chronic renal failure
Overflow incontinence

41

What are the invasive ways to treat renal calculi?

1. Percutaneous nephrostomy
2. JJ stent
3. Stone basket via ureteroscopy
4. Laser ureteroscopy
5. ESWL
6. PCNL
7. Nephro/ureterolithotomy (open surgery)

42

What are causes of penile ulcers?

1. Syphilis
2. LGV (C. trachomatis)
3. Chancroid (H. ducreyi)
4. HSV
5. Ca - SCC
6. TB
7. Trauma
8. Allergies
9. Fixed drug eruption
10. Behcet disease
11. Non specific