Urology, C76 P743-766 Flashcards
(258 cards)
1
Q
Define the following terms:
Cystogram
P743
A
Contrast study of the bladder
2
Q
Define the following terms:
Ureteral stents
P743
A
Plastic tubes placed via cystoscope into
the ureters for stenting, identification, etc.
3
Q
Define the following terms:
Cystoscope
P743
A
Scope placed into the urethra and into
the bladder to visualize the bladder
4
Q
Define the following terms:
Perc nephrostomy
P743
A
Catheter placed through the skin into the
kidney pelvis to drain urine with distal
obstruction, etc.
5
Q
Define the following terms:
Retrograde pyelogram
P743
A
Dye injected into the ureter up into the
kidney, and films taken
6
Q
Define the following terms:
RUG
P744
A
Retrograde UrethroGram (dye injected into the urethra and films taken; rules out urethral injury, usually in trauma patients)
7
Q
Define the following terms:
Gomco clamp
P744
A
Clamp used for circumcision; protects
penis glans
8
Q
Define the following terms:
Bell clapper’s deformity
P744
A
Condition of congenital absence of
gubernaculum attachment to scrotum
9
Q
Define the following terms:
Fournier’s gangrene
P744
A
Extensive tissue necrosis/infection of the
perineum in patients with diabetes
10
Q
Define the following terms:
Foley catheter
P744
A
Straight bladder catheter placed through
the urethra
11
Q
Define the following terms:
Coudé catheter
P744
A
Basically, a Foley catheter with hook on
the end to get around a large prostate
12
Q
Define the following terms:
Suprapubic catheter
P744
A
Bladder catheter placed through the skin
above the pubic symphysis into the bladder
13
Q
Define the following terms:
Posthitis
P744
A
Foreskin infection
14
Q
Define the following terms:
Hydrocele
P744
A
Clear fluid in the processus vaginalis
membrane
15
Q
Define the following terms:
Communicating
hydrocele
P744 (picture)
A
Hydrocele that communicates with
peritoneal cavity and, thus, gets smaller
and larger as fluid drains and then
reaccumulates
16
Q
Define the following terms:
Noncommunicating
hydrocele
P745 (picture)
A
Hydrocele that does not communicate
with the peritoneal cavity; hydrocele
remains the same size
17
Q
Define the following terms:
Varicocele
P745
A
Abnormal dilation of the pampiniform
plexus to the spermatic vein in the spermatic
cord; described as a “bag of worms”
18
Q
Define the following terms:
Spermatocele
P745
A
Dilatation of epididymis or vas deferens
19
Q
Define the following terms:
Epididymitis
P745
A
Infection of the epididymis
20
Q
Define the following terms:
Prehn’s sign
P745
A
Elevation of the painful testicle that
reduces the pain of epididymitis
21
Q
Define the following terms:
TRUS
P745
A
TransRectal UltraSound
22
Q
Define the following terms:
DRE
P745
A
Digital Rectal Examination
23
Q
Define the following terms:
Orchitis
P745
A
Inflammation/infection of the testicle
24
Q
Define the following terms:
Pseudohermaphroditism
P745
A
Genetically one sex; partial or complete
opposite-sex genitalia
25
Define the following terms:
Urgency
P745
Overwhelming sensation to void
| immediately
26
Define the following terms:
Dysuria
P745
```
Painful urination (usually burning
sensation)
```
27
Define the following terms:
Frequency
P745
Urination more frequently than usual
28
Define the following terms:
Polyuria
P746
Urination in larger amounts than usual
29
Define the following terms:
Nocturia
P746
Awakening to urinate
30
Define the following terms:
Hesitancy
P746
Delay in urination
31
Define the following terms:
Pneumaturia
P746
Air passed with urine via the urethra
32
Define the following terms:
Pyuria
P746
WBCs in urine; UTI >10 WBCs/HPF
33
Define the following terms:
Cryptorchidism
P746
Undescended testicle
34
Define the following terms:
IVP
P746
```
IntraVenous Pyelogram (dye is injected
into the vein, collects in the renal
collecting system, and an x-ray is taken)
```
35
Define the following terms:
Hematuria
P746
RBCs in urine
36
Define the following terms:
Space of Retzius
P746
Anatomic extraperitoneal space in front
| of the bladder
37
Define the following terms:
Enuresis
P746
Involuntary urination while asleep
38
Define the following terms:
Incontinence
P746
Involuntary urination
39
Define the following terms:
TURP
P746
TransUrethral Resection of the Prostate
40
Define the following terms:
PVR
P746
PostVoid Residual
41
Define the following terms:
Priapism
P746
Prolonged, painful erection
42
Define the following terms:
Paraphimosis
P746
```
Foreskin held (stuck) in the retracted
position
```
43
Define the following terms:
Phimosis
P746
Inability to retract the foreskin
44
Define the following terms:
Balanitis
P746
Inflammation/infection of the glans penis
45
Define the following terms:
Balanoposthitis
P746
Inflammation/infection of the glans and
| prepuce of the penis
46
Define the following terms:
UTI
P746
Urinary Tract Infection
47
Define the following terms:
Peyronie’s disease
P746
Abnormal fibrosis of the penis shaft,
| resulting in a bend upon erection
48
Define the following terms:
BPH
P747
Benign Prostatic Hyperplasia
49
Define the following terms:
Epispadias
P747
Abnormal urethral opening on the dorsal
| surface of the penis
50
Define the following terms:
Hypospadiasis
P747
Abnormal urethral opening on the
ventral surface of the penis; may occur in
anterior, middle, or posterior of penis
51
Define the following terms:
Erectile dysfunction
P747
Inability to achieve an erection
52
Define the following terms:
Sterility
P747
Inability to reproduce
53
Define the following terms:
Appendix testis
P747
Common redundant testicular tissue
54
Define the following terms:
VUR
P747
VesicoUreteral Reflux
55
SCROTAL ANATOMY
What are the layers of the
scrotum?
P747 (picture)
(see picture)
56
UROLOGIC DIFFERENTIAL DIAGNOSIS
What is the differential
diagnosis of scrotal mass?
P747 (picture)
Cancer, torsion, epididymitis, hydrocele,
spermatocele, varicocele, inguinal hernia,
testicular appendage, swollen testicle after
trauma, nontesticular tumor (paratesticular
tumor: e.g., rhabdomyosarcoma,
leiomyosarcoma, liposarcoma)
57
UROLOGIC DIFFERENTIAL DIAGNOSIS
What are the causes of
hematuria?
P748
Bladder cancer, trauma, UTI, cystitis
from chemotherapy or radiation, stones,
kidney lesion, BPH
58
```
UROLOGIC DIFFERENTIAL DIAGNOSIS
What is the most common
cause of severe gross
hematuria without trauma
or chemotherapy/radiation?
P748
```
Bladder cancer
59
```
UROLOGIC DIFFERENTIAL DIAGNOSIS
What is the differential
diagnosis for bladder outlet
obstruction?
P748
```
BPH, stone, foreign body, urethral
| stricture, urethral valve
60
```
UROLOGIC DIFFERENTIAL DIAGNOSIS
What is the differential
diagnosis for ureteral
obstruction?
P748
```
Stone, tumor, iatrogenic (suture),
stricture, gravid uterus, radiation injury,
retroperitoneal fibrosis
61
UROLOGIC DIFFERENTIAL DIAGNOSIS
What is the differential
diagnosis for kidney tumor?
P748
Renal cell carcinoma, sarcoma, adenoma,
angiomyolipoma, hemangiopericytoma,
oncocytoma
62
RENAL CELL CARCINOMA (RCC)
What is it?
P748
Most common solid renal tumor (90%);
originates from proximal renal tubular
epithelium
63
RENAL CELL CARCINOMA (RCC)
What is the epidemiology?
P748
Primarily a tumor of adults 40 to 60 years
of age with a 3:1 male:female ratio; 5% of
cancers overall in adults
64
RENAL CELL CARCINOMA (RCC)
What percentage of the
tumors are bilateral?
P748
1%
65
RENAL CELL CARCINOMA (RCC)
What are the risk factors?
P748
Male sex, tobacco, von Hippel-Lindau
| syndrome, polycystic kidney
66
RENAL CELL CARCINOMA (RCC)
What are the symptoms?
P748
Pain (40%), hematuria (35%), weight loss
| 35%), flank mass (25%), HTN (20%
67
RENAL CELL CARCINOMA (RCC)
What is the classic TRIAD of
renal cell carcinoma?
P748
1. Flank pain
2. Hematuria
3. Palpable mass (triad occurs in only
10%–15% of cases)
68
RENAL CELL CARCINOMA (RCC)
How are most cases
diagnosed these days?
P749
Found incidentally on an imaging study
| (CT, MRI, U/S) for another reason
69
RENAL CELL CARCINOMA (RCC)
What radiologic tests are
performed?
P749
1. IVP
| 2. Abdominal CT scan with contrast
70
RENAL CELL CARCINOMA (RCC)
Define the stages (AJCC):
Stage I?
P749
Tumor <2.5 cm, no nodes, no metastases
71
RENAL CELL CARCINOMA (RCC)
Define the stages (AJCC):
Stage II?
P749
Tumor >2.5 cm limited to kidney, no
| nodes, no metastases
72
RENAL CELL CARCINOMA (RCC)
Define the stages (AJCC):
Stage III?
P749
Tumor extends into IVC or main renal
vein; positive regional lymph nodes but
<2 cm in diameter and no metastases
73
RENAL CELL CARCINOMA (RCC)
Define the stages (AJCC):
Stage IV?
P749
Distant metastasis or positive lymph node
>2 cm in diameter, or tumor extends past
Gerota’s fascia
74
RENAL CELL CARCINOMA (RCC)
What is the metastatic
workup?
P749
CXR, IVP, CT scan, LFTs, calcium
75
RENAL CELL CARCINOMA (RCC)
What are the sites of
metastases?
P749
Lung, liver, brain, bone; tumor thrombus
entering renal vein or IVC is not
uncommon
76
RENAL CELL CARCINOMA (RCC)
What is the unique route of
spread?
P749
Tumor thrombus into IVC lumen
77
RENAL CELL CARCINOMA (RCC)
What is the treatment of
RCC?
P749
Radical nephrectomy (excision of the
kidney and adrenal, including Gerota’s
fascia) for stages I through IV
78
RENAL CELL CARCINOMA (RCC)
What gland is removed with
a radical nephrectomy?
P749
Adrenal gland
79
```
RENAL CELL CARCINOMA (RCC)
What is the unique
treatment for metastatic
spread?
P749
```
1. a-interferon
2. LAK cells (lymphokine-activated
killer) and IL-2 (interleukin-2)
80
RENAL CELL CARCINOMA (RCC)
What is a syndrome of RCC
and liver disease?
P749
Stauffer’s syndrome
81
```
RENAL CELL CARCINOMA (RCC)
What is the concern in an
adult with new onset left
varicocele?
P750
```
Left RCC—the left gonadal vein drains
| into the left renal vein
82
BLADDER CANCER
What is the incidence?
P750
Second most common urologic malignancy
Male:female ratio of 3:1
White patients are more commonly affected
than are African American patients
83
BLADDER CANCER
What is the most common
histology?
P750
Transitional Cell Carcinoma (TCC)—
90%; remaining cases are squamous or
adenocarcinomas
84
BLADDER CANCER
What are the risk factors?
P750
Smoking, industrial carcinogens (aromatic
amines), schistosomiasis, truck drivers,
petroleum workers, cyclophosphamide
85
BLADDER CANCER
What are the symptoms?
P750
Hematuria, with or without irritative
| symptoms (e.g., dysuria), frequency
86
BLADDER CANCER
What is the classic presentation
of bladder cancer?
P750
“Painless hematuria”
87
BLADDER CANCER
What tests are included in
the workup?
P750
Urinalysis and culture, IVP, cystoscopy
| with cytology and biopsy
88
```
BLADDER CANCER
Define the AJCC transitional
cell bladder cancer stages:
Stage 0?
P750
```
Superficial, carcinoma in situ
89
```
BLADDER CANCER
Define the AJCC transitional
cell bladder cancer stages:
Stage I?
P750
```
Invades subepithelial connective tissue,
| no positive nodes, no metastases
90
```
BLADDER CANCER
Define the AJCC transitional
cell bladder cancer stages:
Stage II?
P750
```
Invades superficial or deep muscularis
| propria, no positive nodes, no metastases
91
```
BLADDER CANCER
Define the AJCC transitional
cell bladder cancer stages:
Stage III?
P750
```
Invades perivesical tissues, no positive
| nodes, no metastases
92
```
BLADDER CANCER
Define the AJCC transitional
cell bladder cancer stages:
Stage IV?
P750
```
Positive nodal spread with distant
metastases and/or invades abdominal/
pelvic wall
93
```
BLADDER CANCER
What is the treatment
according to stage:
Stage 0?
P751
```
TURB and intravesical chemotherapy
94
```
BLADDER CANCER
What is the treatment
according to stage:
Stage I?
P751
```
TURB
95
```
BLADDER CANCER
What is the treatment
according to stage:
Stage II and III?
P751
```
Radical cystectomy, lymph node
dissection, removal of prostate/uterus/
ovaries/anterior vaginal wall, and urinary
diversion (e.g., ileal conduit) +/- chemo
96
```
BLADDER CANCER
What is the treatment
according to stage:
Stage IV?
P751
```
+/- Cystectomy and systemic
| chemotherapy
97
BLADDER CANCER
What are the indications for
a partial cystectomy?
P751
Superficial, isolated tumor, apical with
| 3-cm margin from any orifices
98
BLADDER CANCER
What is TURB?
P751
TransUrethral Resection of the Bladder
99
BLADDER CANCER
If after a TURB the tumor
recurs, then what?
P751
Repeat TURB and intravesical
chemotherapy (mitomycin C) or
bacillus Calmette-Guérin
100
BLADDER CANCER
What is and how does bacillus
Calmette-Guérin work?
P751
Attenuated TB vaccine—thought to work
| by immune response
101
PROSTATE CANCER
What is the incidence?
P751
```
Most common GU cancer (100,000
new cases per year in the United States);
most common carcinoma in men in the
U.S.; second most common cause of death
in men in the U.S.
```
102
PROSTATE CANCER
What is the epidemiology?
P751
```
“Disease of elderly men” present in
33% of men 70 to 79 years of age and in
66% of men 80 to 89 years of age at
autopsy; African American patients have
a 50% higher incidence than do white
patients
```
103
PROSTATE CANCER
What is the histology?
P751
Adenocarcinoma (95%)
104
PROSTATE CANCER
What are the symptoms?
P752
```
Often asymptomatic; usually presents
as a nodule found on routine rectal
examination; in 70% of cases, cancer
begins in the periphery of the gland
and moves centrally; thus, obstructive
symptoms occur late
```
105
PROSTATE CANCER
What percentage of patients
have metastasis at diagnosis?
P752
40% of patients have metastatic disease
at presentation, with symptoms of bone
pain and weight loss
106
PROSTATE CANCER
What are the common sites
of metastasis?
P752
Osteoblastic bony lesions, lung, liver,
| adrenal
107
PROSTATE CANCER
What provides lymphatic
drainage?
P752
Obturator and hypogastric nodes
108
PROSTATE CANCER
What is the significance of
Batson’s plexus?
P752
Spinal cord venous plexus; route of
| isolated skull/brain metastasis
109
PROSTATE CANCER
What are the steps in early
detection?
P752
1. Prostate-specific antigen (PSA)—most
sensitive and specific marker
2. Digital rectal examination (DRE)
110
PROSTATE CANCER
When should men get a
PSA-level check?
P752
Controversial:
1. All men >50 years old
2. >40 years old if first-degree family
history or African American patient
111
```
PROSTATE CANCER
What percentage of patients
with prostate cancer will
have an elevated PSA?
P752
```
≈60%
112
PROSTATE CANCER
What is the imaging test for
bladder cancer?
P752
TransRectal UltraSound (TRUS)
113
PROSTATE CANCER
How is the diagnosis made?
P752
Transrectal biopsy
114
PROSTATE CANCER
What is the Gleason score?
P752
Histologic grades 2–10:
Low score = well differentiated
High score = poorly differentiated
115
```
PROSTATE CANCER
What are the indications for
transrectal biopsy with
normal rectal examination?
P752
```
PSA >10 or abnormal transrectal
| ultrasound
116
PROSTATE CANCER
Staging (AJCC):
Stage I?
P753
Tumor involves <50% of 1 lobe, no nodes,
| no metastases, PSA 10, Gleason ≤6
117
PROSTATE CANCER
Staging (AJCC):
Stage II?
P753
Tumor within prostate; lobe 10, or Gleason >6; or >50% of
1 lobe, no nodes, no metastases
118
PROSTATE CANCER
Staging (AJCC):
Stage III?
P753
Tumor through prostate capsule or into
| seminal vesicles, no nodes, no metastases
119
PROSTATE CANCER
Staging (AJCC):
Stage IV?
P753
Tumor extends into adjacent structures
(other than seminal vesicles) or + nodes
or + metastases
120
PROSTATE CANCER
What does a “radical
prostatectomy” remove?
P753
1. Prostate gland
2. Seminal vesicles
3. Ampullae of the vasa deferentia
121
PROSTATE CANCER
What is “androgen ablation”
therapy?
P753
1. Bilateral orchiectomy or
2. Luteinizing Hormone-Releasing
Hormone (LHRH) agonists
122
PROSTATE CANCER
How do LHRH agonists
work?
P753
Decrease LH release from pituitary,
which then decreases testosterone
production in the testes
123
```
PROSTATE CANCER
What are the generalized
treatment options according
to stage:
Stage I?
P753
```
Radical prostatectomy
124
```
PROSTATE CANCER
What are the generalized
treatment options according
to stage:
Stage II?
P753
```
Radical prostatectomy, +/- lymph node
| dissection
125
```
PROSTATE CANCER
What are the generalized
treatment options according
to stage:
Stage III?
P753
```
Radiation therapy, +/- androgen ablation
126
```
PROSTATE CANCER
What are the generalized
treatment options according
to stage:
Stage IV?
P753
```
Androgen ablation, radiation therapy
127
```
PROSTATE CANCER
What is the medical
treatment for systemic
metastatic disease?
P753
```
Androgen ablation
128
```
PROSTATE CANCER
What is the option for
treatment in the early stage
prostate cancer patient >70
years old with comorbidity?
P754
```
XRT
129
BENIGN PROSTATIC HYPERPLASIA
What is it also known as?
P754
BPH
130
BENIGN PROSTATIC HYPERPLASIA
What is it?
P754
Disease of elderly men (average age is
60 to 65 years); prostate gradually
enlarges, creating symptoms of urinary
outflow obstruction
131
BENIGN PROSTATIC HYPERPLASIA
What is the size of a normal
prostate?
P754
20 to 25 gm
132
BENIGN PROSTATIC HYPERPLASIA
Where does BPH occur?
P754
Periurethrally
(Note: prostate cancer occurs in the
periphery of the gland)
133
BENIGN PROSTATIC HYPERPLASIA
What are the symptoms?
P754
Obstructive-type symptoms: hesitancy,
weak stream, nocturia, intermittency,
UTI, urinary retention
134
BENIGN PROSTATIC HYPERPLASIA
How is the diagnosis made?
P754
History, DRE, elevated PostVoid Residual
| (PVR), urinalysis, cystoscopy, U/S
135
BENIGN PROSTATIC HYPERPLASIA
What lab tests should be
performed?
P754
Urinalysis, PSA, BUN, CR
136
BENIGN PROSTATIC HYPERPLASIA
What is the differential
diagnosis?
P754
```
Prostate cancer (e.g., nodular)—biopsy
Neurogenic bladder—history of
neurologic disease
Acute prostatitis—hot, tender gland
Urethral stricture—RUG, history of STD
Stone
UTI
```
137
BENIGN PROSTATIC HYPERPLASIA
What are the treatment
options?
P754
```
Pharmacologic— a-1 blockade
Hormonal—antiandrogens
Surgical—TURP, TUIP, open prostate
resection
Transurethral balloon dilation
```
138
BENIGN PROSTATIC HYPERPLASIA
Why do -adrenergic
blockers work?
P755
1. Relax sphincter
| 2. Relax prostate capsule
139
BENIGN PROSTATIC HYPERPLASIA
What is Proscar®?
P755
Finasteride: 5--reductase inhibitor;
blocks transformation of testosterone to
dihydrotestosterone; may shrink and slow
progression of BPH
140
BENIGN PROSTATIC HYPERPLASIA
What is Hytrin®?
P755
Terazosin: -blocker; may increase urine
outflow by relaxing prostatic smooth
muscles
141
BENIGN PROSTATIC HYPERPLASIA
What are the indications for
surgery in BPH?
P755
```
Due to obstruction:
Urinary retention
Hydronephrosis
UTIs
Severe symptoms
```
142
BENIGN PROSTATIC HYPERPLASIA
What is TURP?
P755
TransUrethral Resection of Prostate:
| resection of prostate tissue via a scope
143
BENIGN PROSTATIC HYPERPLASIA
What is TUIP?
P755
TransUrethral Incision of Prostate
144
```
BENIGN PROSTATIC HYPERPLASIA
What percentage of tissue
removed for BPH will have
malignant tissue on histology?
P755
```
Up to 10%!
145
BENIGN PROSTATIC HYPERPLASIA
What are the possible
complications of TURP?
P755
```
Immediate:
Failure to void
Bleeding
Clot retention
UTI
Incontinence
```
146
TESTICULAR CANCER
What is the incidence?
P755
Rare; 2 to 3 new cases per 100,000 men
| per year in the United States
147
TESTICULAR CANCER
What is its claim to fame?
P755
Most common solid tumor of young adult
| males (20 to 40 years)
148
TESTICULAR CANCER
What are the risk factors?
P755
Cryptorchidism (6% of testicular tumors
develop in patients with a history of
cryptorchidism)
149
TESTICULAR CANCER
What is cryptorchidism?
P756
Failure of the testicle to descend into the
| scrotum
150
```
TESTICULAR CANCER
Does orchiopexy as an adult
remove the risk of testicular
cancer?
P756
```
NO
151
TESTICULAR CANCER
What are the symptoms?
P756
Most patients present with a painless lump,
swelling, or firmness of the testicle; they often
notice it after incidental trauma to the groin
152
```
TESTICULAR CANCER
What percentage of patients
present with an acute
hydrocele?
P756
```
10%
153
```
TESTICULAR CANCER
What percentage present
with symptoms of metastatic
disease (back pain, anorexia)?
P756
```
≈10%
154
TESTICULAR CANCER
What are the classifications?
P756
```
Germ cell tumors (95%):
Seminomatous (35%)
Nonseminomatous (65%)
Embryonal cell carcinoma
Teratoma
Mixed cell
Choriocarcinoma
Nongerminal (5%):
Leydig cell
Sertoli cell
Gonadoblastoma
```
155
TESTICULAR CANCER
What is the major classification
based on therapy?
P756
Seminomatous and nonseminomatous
| tumors
156
TESTICULAR CANCER
What are the tumor markers
for testicular tumors?
P756
1. Beta-human chorionic gonadotropin
( ℬ -HCG)
2. Alpha-fetoprotein (AFP)
157
TESTICULAR CANCER
What are the tumor markers
by tumor type?
P756
```
ℬ-HCG—↑ in choriocarcinoma (100%),
embryonal carcinoma (50%), and
rarely in pure seminomas (10%);
nonseminomatous tumors (50%)
AFP—↑ in embryonal carcinoma and
yolk sac tumors; nonseminomatous
tumors (50%)
```
158
```
TESTICULAR CANCER
Define the difference
between seminomatous and
NONseminomatous germ cell
testicular tumor markers.
P757
```
NONseminomatous common = 90%
have a positive AFP and/or ℬ-HCG
Seminomatous rare = only 10% are
AFP positive
159
TESTICULAR CANCER
Which tumors almost never
have an elevated AFP?
P757
Choriocarcinoma and seminoma
160
TESTICULAR CANCER
In which tumor is -HCG
almost always found elevated?
P757
Choriocarcinoma
161
```
TESTICULAR CANCER
How often is -HCG elevated
in patients with pure
seminoma?
P757
```
Only about 10% of the time!
162
TESTICULAR CANCER
How often is -HCG elevated
with nonseminoma?
P757
≈65%
163
```
TESTICULAR CANCER
What other tumor markers
may be elevated and useful
for recurrence surveillance?
P757
```
LDH, CEA, Human Chorionic
Somatomammotropic (HCS),
Gamma-Glutamyl Transpeptidase (GGT),
PLacental Alkaline Phosphate (PLAP)
164
TESTICULAR CANCER
What are the steps in
workup?
P757
PE, scrotal U/S, check tumor markers,
| CXR, CT (chest/pelvis/abd)
165
```
TESTICULAR CANCER
Define the stages according
to TMN staging (AJCC):
Stage I?
P757
```
Any tumor size, no nodes, no metastases
166
```
TESTICULAR CANCER
Define the stages according
to TMN staging (AJCC):
Stage II?
P757
```
Positive nodes, no metastases, any tumor
167
```
TESTICULAR CANCER
Define the stages according
to TMN staging (AJCC):
Stage III?
P757
```
```
Distant metastases (any nodal status,
any size tumor)
```
168
TESTICULAR CANCER
What is the initial treatment
for all testicular tumors?
P757
```
Inguinal orchiectomy (removal of
testicle through a groin incision)
```
169
```
TESTICULAR CANCER
What is the treatment of
seminoma at the various
stages:
Stage I and II?
P757
```
Inguinal orchiectomy and radiation to
| retroperitoneal nodal basins
170
```
TESTICULAR CANCER
What is the treatment of
seminoma at the various
stages:
Stage III?
P757
```
Orchiectomy and chemotherapy
171
```
TESTICULAR CANCER
What is the treatment of
NONseminomatous disease
at the various stages:
Stages I and II?
P758
```
Orchiectomy and retroperitoneal lymph
node dissection versus close follow-up
for retroperitoneal nodal involvement
172
```
TESTICULAR CANCER
What is the treatment of
NONseminomatous disease
at the various stages:
Stages III?
P758
```
Orchiectomy and chemotherapy
173
```
TESTICULAR CANCER
What percentage of stage I
seminomas are cured after
treatment?
P758
```
95%
174
TESTICULAR CANCER
Which type is most
radiosensitive?
P758
Seminoma (Think: Seminoma = Sensitive
| to radiation)
175
```
TESTICULAR CANCER
Why not remove testis with
cancer through a scrotal
incision?
P758
```
It could result in tumor seeding of the
| scrotum
176
```
TESTICULAR CANCER
What is the major side effect
of retroperitoneal lymph
node dissection?
P758
```
Erectile dysfunction
177
TESTICULAR TORSION
What is it?
P758
Torsion (twist) of the spermatic cord,
resulting in venous outflow obstruction,
and subsequent arterial occlusion →
infarction of the testicle
178
TESTICULAR TORSION
What is the classic history?
P758
Acute onset of scrotal pain usually after
| vigorous activity or minor trauma
179
TESTICULAR TORSION
What is a “bell clapper”
deformity?
P758 (picture)
Bilateral nonattachment of the testicles
by the gubernaculum to the scrotum
(free like the clappers of a bell)
180
TESTICULAR TORSION
What are the symptoms?
P759
Pain in the scrotum, suprapubic pain
181
TESTICULAR TORSION
What are the signs?
P759
Very tender, swollen, elevated testicle;
nonillumination; absence of cremasteric
reflex
182
TESTICULAR TORSION
What is the differential
diagnosis?
P759
Testicular trauma, inguinal hernia,
| epididymitis, appendage torsion
183
TESTICULAR TORSION
How is the diagnosis made?
P759
Surgical exploration, U/S (solid mass) and
Doppler flow study, cold Tc-99m scan
(nuclear study)
184
TESTICULAR TORSION
What is the treatment?
P759
Surgical detorsion and bilateral orchiopexy
| to the scrotum
185
```
TESTICULAR TORSION
How much time is available
from the onset of symptoms
to detorse the testicle?
P759
```
90% salvage rate
186
TESTICULAR TORSION
What are the chances of testicle
salvage after 24 hours?
P759
<10%
187
EPIDIDYMITIS
What is it?
P759
Infection of the epididymis
188
EPIDIDYMITIS
What are the
signs/symptoms?
P759
Swollen, tender testicle; dysuria; scrotal
| ache/pain; fever; chills; scrotal mass
189
EPIDIDYMITIS
What is the cause?
P759
Bacteria from the urethra
190
```
EPIDIDYMITIS
What are the common bugs in
the following types of patients:
Elderly patients/children?
P759
```
Escherichia coli
191
```
EPIDIDYMITIS
What are the common bugs in
the following types of patients:
Young men?
P759
```
STD bacteria: Gonorrhea, chlamydia
192
EPIDIDYMITIS
What is the major
differential diagnosis?
P759
Testicular torsion
193
EPIDIDYMITIS
What is the workup?
P759
U/A, urine culture, swab if STD suspected,
+/- U/S with Doppler or nuclear study
to rule out torsion
194
EPIDIDYMITIS
What is the treatment?
P759
Antibiotics
195
PRIAPISM
What is priapism?
P760
Persistent penile erection
196
PRIAPISM
What are its causes?
P760
Low flow: leukemia, drugs (e.g., prazosin),
sickle-cell disease, erectile dysfunction
treatment gone wrong
High flow: pudendal artery fistula, usually
from trauma
197
PRIAPISM
What is first-line treatment?
P760
1. Aspiration of blood from corporus
cavernosum
2. -Adrenergic agent
198
ERECTILE DYSFUNCTION
What is it?
P760
Inability to achieve an erection
199
ERECTILE DYSFUNCTION
What are the six major
causes?
P760
```
1. Vascular: decreased blood flow or
leak of blood from the corpus
cavernosus (most common cause)
2. Endocrine: low testosterone
3. Anatomic: structural abnormality of
the erectile apparatus (e.g., Peyronie’s
disease)
4. Neurologic: damage to nerves (e.g.,
postoperative, IDDM)
5. Medications (e.g., clonidine)
6. Psychologic: performance anxiety,
etc. (very rare)
```
200
ERECTILE DYSFUNCTION
What lab tests should be
performed?
P760
Fasting GLC (rule out diabetes and thus
diabetic neuropathy)
Serum testosterone
Serum prolactin
201
CALCULUS DISEASE
What is the incidence?
P760
1 in 10 people will have stones
202
CALCULUS DISEASE
What are the risk factors?
P760
Poor fluid intake, IBD, hypercalcemia
(“CHIMPANZEES”), renal tubular
acidosis, small bowel bypass
203
CALCULUS DISEASE
What are the four types of
stones?
P761
1. Calcium oxalate/calcium PO(4) (75%)—
secondary to hypercalciuria (↑ intestinal
absorption, ↓ renal reabsorption,
↑ bone reabsorption)
2. Struvite (MgAmPh)(15%)—infection
stones; seen in UTI with urea-splitting
bacteria (Proteus); may cause staghorn
calculi; high urine pH
3. Uric acid (7%)—stones are radiolucent
(Think: Uric = Unseen); seen in gout,
Lesch-Nyhan, chronic diarrhea,
cancer; low urine pH
4. Cystine (1%)—genetic predisposition
204
CALCULUS DISEASE
What type of stones are not
seen on AXR?
P761
Uric acid (Think: Uric = Unseen)
205
CALCULUS DISEASE
What stone is associated
with UTIs?
P761
Struvite stones (Think: Struvite = Sepsis)
206
CALCULUS DISEASE
What stones are seen in
IBD/bowel bypass?
P761
Calcium oxalate
207
CALCULUS DISEASE
What are the symptoms of
calculus disease?
P761
Severe pain; patient cannot sit still: renal
colic (typically pain in the kidney/ureter
that radiates to the testis or penis),
hematuria (remember, patients with
peritoneal signs are motionless)
208
CALCULUS DISEASE
What are the classic
findings/symptoms?
P761
Flank pain, stone on AXR, hematuria
209
CALCULUS DISEASE
Diagnosis?
P761
KUB (90% radiopaque), IVP, urinalysis
| and culture, BUN/Cr, CBC
210
CALCULUS DISEASE
What is the significance of
hematuria and pyuria?
P761
Stone with concomitant infection
211
CALCULUS DISEASE
Treatment?
P761
```
Narcotics for pain, vigorous hydration,
observation
Further options: ESWL (lithotripsy),
ureteroscopy, percutaneous lithotripsy,
open surgery; metabolic workup for
recurrence
```
212
CALCULUS DISEASE
What are the indications for
intervention?
P762
Urinary tract obstruction
Persistent infection
Impaired renal function
213
```
CALCULUS DISEASE
What are the
contraindications of
outpatient treatment?
P762
```
Pregnancy, diabetes, obstruction, severe
dehydration, severe pain, urosepsis/fever,
pyelonephritis, previous urologic surgery,
only one functioning kidney
214
CALCULUS DISEASE
What are the three common
sites of obstruction?
P762
1. UreteroPelvic Junction (UPJ)
2. UreteroVesicular Junction (UVJ)
3. Intersection of the ureter and the iliac
vessels
215
INCONTINENCE
What are the common types
of incontinence?
P762
Stress incontinence, overflow
| incontinence, urge incontinence
216
INCONTINENCE
Define the following terms:
Stress incontinence
P762
Loss of urine associated with coughing,
lifting, exercise, etc.; seen most often in
women, secondary to relaxation of pelvic
floor following multiple deliveries
217
INCONTINENCE
Define the following terms:
Overflow incontinence
P762
Failure of the bladder to empty properly;
may be caused by bladder outlet
obstruction (BPH or stricture) or
detrusor hypotonicity
218
INCONTINENCE
Define the following terms:
Urge incontinence
P762
Loss of urine secondary to detrusor
instability in patients with stroke,
dementia, Parkinson’s disease, etc.
219
INCONTINENCE
Define the following terms:
Mixed incontinence
P762
Stress and urge incontinence combined
220
INCONTINENCE
Define the following terms:
Enuresis
P762
Bedwetting in children
221
INCONTINENCE
Define the following terms:
How is the diagnosis made?
P762
```
History (including meds), physical
examination (including pelvic/rectal
examination), urinalysis, postvoid residual
(PR), urodynamics, cystoscopy/
vesicocystourethrogram (VCUG) may
be necessary
```
222
INCONTINENCE
What is the “Marshall test”?
P763
Woman with urinary stress incontinence
placed in the lithotomy position with a
full bladder leaks urine when asked to
cough
223
```
INCONTINENCE
What is the treatment of the
following disorders:
Stress incontinence?
P763
```
Bladder neck suspension
224
```
INCONTINENCE
What is the treatment of the
following disorders:
Urge incontinence?
P763
```
Pharmacotherapy (anticholinergics,
| Ə-agonists)
225
```
INCONTINENCE
What is the treatment of the
following disorders:
Overflow incontinence?
P763
```
Self-catheterization, surgical relief of
| obstruction, -blockers
226
URINARY TRACT INFECTION (UTI)
What is the aetiology?
P763
Ascending infection, instrumentation,
| coitus in females
227
URINARY TRACT INFECTION (UTI)
What are the three common
organisms?
P763
1. E. coli (90%)
2. Proteus
3. Klebsiella, Pseudomonas
228
URINARY TRACT INFECTION (UTI)
What are the predisposing
factors?
P763
Stones, obstruction, reflux, diabetes
mellitus, pregnancy, indwelling catheter/
stent
229
URINARY TRACT INFECTION (UTI)
What are the symptoms?
P763
Lower UTI—frequency, urgency, dysuria,
nocturia
Upper UTI—back/flank pain, fever, chills
230
URINARY TRACT INFECTION (UTI)
How is the diagnosis made?
P763
Symptoms, urinalysis ( >10 WBCs/HPF,
| >105 CFU)
231
URINARY TRACT INFECTION (UTI)
When should workup be
performed?
P763
After first infection in male patients
(unless Foley is in place)
After first pyelonephritis in prepubescent
female patients
232
URINARY TRACT INFECTION (UTI)
What is the treatment?
P763
Lower: 1 to 4 days of oral antibiotics
Upper: 3 to 7 days of IV antibiotics
233
MISCELLANEOUS UROLOGY QUESTIONS
Why should orchiopexy be
performed?
P764
↓ the susceptibility to blunt trauma
| ↑ the ease of follow-up examinations
234
MISCELLANEOUS UROLOGY QUESTIONS
In which area of the
prostate does BPH arise?
P764
Periurethral
235
```
MISCELLANEOUS UROLOGY QUESTIONS
In which area of the
prostate does prostate
cancer arise?
P764
```
Periphery
236
```
MISCELLANEOUS UROLOGY QUESTIONS
What type of bony lesions is
seen in metastatic prostate
cancer?
P764
```
Osteoblastic (radiopaque)
237
```
MISCELLANEOUS UROLOGY QUESTIONS
What percentage of renal
cell carcinoma show
evidence of metastatic
disease at presentation?
P764
```
≈33%
238
```
MISCELLANEOUS UROLOGY QUESTIONS
What is the most common
site of distant metastasis in
renal cell carcinoma?
P764
```
Lung
239
```
MISCELLANEOUS UROLOGY QUESTIONS
What is the most common
solid renal tumor of
childhood?
P764
```
Wilms’ tumor
240
MISCELLANEOUS UROLOGY QUESTIONS
What type of renal stone is
radiolucent?
P764
Uric acid (Think: Uric = Unseen)
241
MISCELLANEOUS UROLOGY QUESTIONS
What are posterior urethral
valves?
P764
Most common obstructive urethral lesion
in infants and newborns; occurs only in
males; found at the distal prostatic urethra
242
MISCELLANEOUS UROLOGY QUESTIONS
What is the most common
intraoperative bladder tumor?
P764
Foley catheter—don’t fall victim!
243
```
MISCELLANEOUS UROLOGY QUESTIONS
What provides drainage
of the left gonadal (e.g.,
testicular) vein?
P764
```
Left renal vein
244
MISCELLANEOUS UROLOGY QUESTIONS
What provides drainage of
the right gonadal vein?
P765
IVC
245
```
MISCELLANEOUS UROLOGY QUESTIONS
What are the signs of
urethral injury in the
trauma patient?
P765
```
“High-riding, ballottable” prostate, blood
at the urethral meatus, severe pelvic
fracture, ecchymosis of scrotum
246
```
MISCELLANEOUS UROLOGY QUESTIONS
What is the evaluation for
urethral injury in the trauma
patient?
P765
```
RUG (Retrograde UrethroGram)
247
```
MISCELLANEOUS UROLOGY QUESTIONS
What is the evaluation
for a transected ureter
intraoperatively?
P765
```
IV indigo carmine and then look for leak
| of blue urine in the operative field
248
```
MISCELLANEOUS UROLOGY QUESTIONS
What aid is used to help
identify the ureters in
a previously radiated
retroperitoneum?
P765
```
Ureteral stents
249
```
MISCELLANEOUS UROLOGY QUESTIONS
How can a small traumatic
EXTRAperitoneal bladder
rupture be treated?
P765
```
Foley catheter
250
```
MISCELLANEOUS UROLOGY QUESTIONS
How should a traumatic
INTRAperitoneal bladder
rupture be treated?
P765
```
Operative repair
251
```
MISCELLANEOUS UROLOGY QUESTIONS
What percentage of patients
with an injured ureter will
have no blood on urinalysis?
P765
```
33%
252
MISCELLANEOUS UROLOGY QUESTIONS
What is the classic history
for papillary necrosis?
P765
Patient with diabetes taking NSAIDs or
| patient with sickle cell trait
253
MISCELLANEOUS UROLOGY QUESTIONS
What is Fournier’s gangrene?
P765
Necrotizing fasciitis of perineum,
polymicrobial, diabetes = major risk
factor
254
```
MISCELLANEOUS UROLOGY QUESTIONS
What unique bleeding
problem can be seen with
prostate surgery?
P765
```
Release of TPA and urokinase (treat with
| -aminocaproic acid)
255
MISCELLANEOUS UROLOGY QUESTIONS
What is the scrotal “blue
dot” sign?
P765
Torsed appendix testis
256
MISCELLANEOUS UROLOGY QUESTIONS
What is Peyronie’s disease?
P766
Curved penile orientation with erection
| due to fibrosis of corpora cavernosa
257
MISCELLANEOUS UROLOGY QUESTIONS
What is a ureterocele?
P766
Dilation of the ureter—treat with
| endoscopic incision or operative excision
258
MISCELLANEOUS UROLOGY QUESTIONS
What is a “three-way”
irrigating Foley catheter?
P766 (picture)
Foley catheter that irrigates and then
| drains
