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Urology Boy Flashcards

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1
Q

What are the complications of bladder outflow obstruction?

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

Minimum investigations for patient with BPH?

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

Causes of obstructive LUTS?

A

Male

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

Female

  1. Bladder - prolapse
  2. Urethra- diverticulum/cancer/stricture
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4
Q

What are the causes of irritative LUTS?

A
  1. Bladder
    Inflammation (UTI/irradiation/carcinoma in situ)
    Outflow obstruction
    Detrusor instability
    Neuropathic bladder
    Small capacity (TB/interstitial cystitis)
  2. PID
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5
Q

Define incontinence

A

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

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6
Q

Classify the causes of urinary incontinence

A
  1. Failure to store
  2. Failure to void
  3. Other causes (fistulas)
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7
Q

What are the “failure to store” causes of incontinence?

A 
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
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8
Q

What are the “failure to empty” incontinence causes?

A
  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)
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9
Q

Investigations in urinary incontinence

A

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

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10
Q

Define enuresis

A

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

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11
Q

What are the most common causes of enuresis?

A 
Developmental delay
Genetic factors
Sleep disorders
Nocturnal polyuria
Decreased capacity
Psychological factors
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12
Q

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

A

All 3 of:
Monosymptomatic nocturnal enuresis
Normal exam
Normal urinalysis

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13
Q

What is the treatment of enuresis?

5 areas

A
  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)
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14
Q

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

A

Breakdown of cGMP to GMP

Detumescence

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15
Q

How would a psychogenic ED present?

A

Sudden onset
Morning erections present
Associated premature ejaculation

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16
Q

Causes of organic ED

A
  1. Vasculogenic
  2. Neurogenic
  3. Endocrine
  4. Chronic systemic disease
  5. Penile problems
  6. Surgery
  7. Radiotherapy
  8. Drugs
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17
Q

What is the treatment of enuresis?

5 areas

Study These Flashcards
A
  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
Q

Define retractile testis

Study These Flashcards
A

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

19
Q

Define undescended testis

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A

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

20
Q

Define ectopic testis

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A

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

21
Q

What is the aetiology of an undescended testis?

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A
  1. Intrinsically abnormal testis
  2. Hormonal (decreased testosterone)
  3. Mechanical (prune belly syndrome)
22
Q

How are undescended testis classified?

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A

Abdominal
Inguinal
Upper scrotal

23
Q

What are the complications of undescended testis?

Study These Flashcards
A 
Malignancy 
Torsion
Trauma 
Infertility
Inguinal hernia
24
Q

What is the management of undescended testis?

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A

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

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