Flashcards in Urology-Day 1 Deck (82)
Collection of fluid around the testicle, forming between the parietal tunica vaginalis and visceral tunica vaginalis
List the etiology of hydrocele
2. Torsed appendix testis
1. Needle aspiration with injection of sclerosis agent
Dilated veins of pampiniform plexus
2. Testis damage
3. Testis atrophy
Define Grade I Varicocele
Not grossly visible
Palpable during Valsava
Define Grade II Varicocele
Not grossly visible
Palpable while standing
Define Grade III Varicocele
2. Surgery: Varicocele repair/varicocelectomy
What could a right sided varicocele indicate?
2. Palpable varicocecle with abnormal semen analysis in eval of infertile couple
3. Varicocele with small testis
1. Palpable varicocele with normal semen analysis in young men: Semen analysis q 1-2 yr
2. Varicocele with normal testis size in children and pre-sexual adolescents:
Prepuce stuck distal to glans
Prepuce stuck proximal to glans
Foreskin unable to be reduced
IF Paraphimosis if left untreated, what can result?
If manual reduction is unsuccessful, what would be the next intervention for Paraphimosis?
Dorsal slit or circumcision
Testicular Torsion Risk Factor's
1. Undescended Testis
2. "Bell clapper" deformity
Testicular Torsion clinical presentation
1. ACUTE onset
2. Severe pain
3. Absent swelling
4. MC in males ages 12-18
Testicular Torsion Physical exam findings
1. Absent cremasteric reflex
2. Horizontal lie
3. No pain relief with elevation
4. High riding testis
Doppler US findings in testicular torsion
Decreased blood flow
Testicular Torsion treatment
If testis is viable, what would you perform during surgery?
If the testis is NOT viable, what would you perform during surgery?
Orchiopexy of contralateral testis.
Cystitis Risk Factors
2. Urinary stasis/obstruction
3. Congenital GU abnormality
4. Sexual activity
5. Urinary incontinence
6. Cystocele or pelvic prolapse
7. Spermicide/Diaphgragm use
Cystitis UA findings
1. Leukocyte esterase +
2. Nitrite +
3. Pyuria >5 WBC
MC organism in cystitis
1. TMP-SMZ x3 days
2. Nitrofurantoin x5-7 days
What is long term use of Nitrofurantoin associated with in the elderly?
What abx is effective against enterococcus?
1. Avoid spermicides/diaphragm
2. Topical vaginal estrogen
Infectious causes of urethritis
1. Gonococcal urethritis
2. Non-gonococcal urethritis: Chlamydia trachomatis
2. Urethral discharge
3. Urethral pruritis
What is the best diagnostic test for urethritis? Findings?
Frist Void UA: Leukocyte esterase >10 WBC
What do you want to make sure you test for in urethritis?
How do you test for gonorrhea and chlamydia?
1. Culture: urethral swab-gives sensitivities
2. NAAT- does not give sensitives
Ceftriaxone 250 mg IM x 1 dose
Azithromycin 1 g po x 1 dose OR Doxycylcline x 7d
Who needs to follow-up after chlamydia treatment?
When do patients need to follow-up after gonorrhea treatment?
1. Behcet's dz: Painful oral and genital ulcers, uveitis, non-mucous membrane skin lesions
3. Testis or epididymal tumor
4. Acute bacterial infection
What bacterial organisms causes Epididymitis in Men <35?
Neisseria gonorrhoeae Chlamydia trachomatous
What bacterial organisms causes Epididymitis in Men >35?
Epididymitis physical exam findings
1. Swollen, painful testicle
1. Scrotal support
Abx treatment if STD suspected in Epididymitis
Ceftriaxone 250 IM x1 AND Doxycycline x10 days
Abx treatment if STD is NOT suspected in Epididymitis
Chronic Epididymitis definition
3 months or more
What is the hallmark of prostatitis?
Acute bacterial prostatitis presentation
3. Warm, boggy tender prostate
MC organism that causes Acute bacterial prostatitis
Acute bacterial prostatitis evaluation
1. Urine culture-Not post prostate massage
3. Blood culture
4. H &P- No vigorous prostate exam
Indications for admission in acute bacterial prostatitis for IV abx
2. Highly elevated WBC
How long do you treat with abx after you discharge a patient with acute bacterial prostatitis?
If a patient is persistently febrile with acute bacterial prostatitis, what do you want to order? why?
R/O prostatic abscess
Chronic bacterial prostatitis presentation
1. Pain in: Genitals, Urinary tract, Perineum, Low back
5. Pain with ejaculation
Who does chronic bacterial prostatitis commonly occur in?
MC organism that causes chronic bacterial prostatitis
Lab evaluation of chronic bacterial prostatitis
1. Expressed prostatic secretion (EPS)
2. Post prostate massage urine culture
chronic bacterial prostatitis treatment
1. Abx- Empiric tx and adjust based on culture results
3. Alpha blockers
Inflammatory Chronic Pelvic Pain Syndrome clinical presentation
1. Hx of "UTI's" with negative cultures
2. Prostatic tenderness
Inflammatory Chronic Pelvic Pain Syndrome lab findings
Prostatic fluid with leukocytes, BUT cultures do not grow out bacteria
Inflammatory Chronic Pelvic Pain Syndrome Treatment
TMP-SMX x6-8 weeks
IF they are not responsive to TMP-SMX x6-8 weeks in the treatment of Inflammatory Chronic Pelvic Pain Syndrome, what would you. prescribe next?
Noninflammatory Chronic Pelvic Pain Syndrome lab findings
No bacteria on culture
No leukocytes in prostatic fluid
Pyelonephritis physical exam findings
2. CVA tenderness
UA findings in pyelonephritis
1. CT urogram (CTU)
2. Renal US
CT urogram findings in Pyelonephritis
1. Perinephric stranding
2. Kidney enlargement
3. Decreased nephrogram
4. Renal collecting system dilated but not obstructed
Pyelonephritis abx treatment
Fluoroquinolone x7 days
Indications for admission in Pyelonephritis
Fever >72 hrs
No clinical improvement
If patient is not improving with Pyelonephritis, what other conditions should you consider?
1. Acute bacterial nephritis
2. Renal abscess
Define Acute bacterial nephritis
Bacterial interstitial nephritis of the renal cortex, causing a renal mass
What organisms are the MC cause of renal abscess?
Who does renal abscess MCly occur in?
Renal Abscess treatment
1. IV abx
2. Percutaneous drainage
3. Surgical drainage
4. F/u with imaging
Chronic Pyelonephritis presentation
2. Anemia of chronic disease
4. Renal insufficiency
5. Recurrent UTIs
Radiographic findings in Chronic Pyelonephritis