Urology Treatments

Question 1

3 Tx for hydrocele

Answer 1

1. If Asx: reassurance and surveillance
2. needle aspiration w/sclerosing agent
3. hydrolectomy: transcrotal incision

Question 2

Varicocele if asx

Answer 2

surveillance

Question 3

management of young adult with palpable varicocele and normal semen analysis

Answer 3

perform semen analysis q 1-2 yrs

Question 4

management of pre-sexual adolescents and children w/normal testis size and varicocele

Answer 4

measure tesitcular size annually

Question 5

varicocele

PLUS 1 or more of the following conditions:

symptomatic

palpable

abnormal semen analysis (w or w/o evaluation of infertile couple)

small testis

Answer 5

ligate vein through open/laporoscopic surgery

percutaneous embolization

Question 6

Phimosis

OR

“muzzle”

Answer 6

circumcision

Question 7

Paraphimosis = EMERGENCY!

Answer 7

reduction necessary:

squeeze edema out of glans, thumb on glands, fingers on prepuce, push/pull.

Question 8

Paraphimosis if manual reduction not successful

Answer 8

dorsal slit/circumcision

Question 9

Testicular torsion

Answer 9

manual detorsion: “open the book”

surgery

Question 10

testicular torsion if testis viable (detorsed in <6 hrs)

Answer 10

orchiopexy of both sides

Question 11

testicular torsion if testis not viable (detorsed >24 hrs)

Answer 11

orchiectomy + orchiopexy of contralateral testis

Question 12

1st line tx for cystitis

Answer 12

Bactrim (TMP/SMZ) x 3 days

Nitrofurantoin x 5-7 days

Question 13

Enterococcus cystitis

Answer 13

ampicillin + amoxycillin

Question 14

Beta-lactamase inhibitors for beta-lactamase bacteria: tx of cystitis

Answer 14

Augmentin (clavulanic acid + amoxicillin)

Sulbactam

Tazobactam

Question 15

Last line of tx for cystitis

Answer 15

16 y/o or older: FQ (cipro, levo) b/c of tendinitis/tendon rupture

Question 16

Tx for persistent sx post-tx cystitis

Answer 16

urgency: antimuscarinics
dysuria: phenazopyridine (turns urine orange)

pelvic pain: NSAIDS

Question 17

Complicated cystitis

Answer 17

remove catheter

replace catheter

abx

Question 18

urethritis caused by gonorrhea

Answer 18

ceftriaxone IM x 1 dose

alt: cefixime

Question 19

urethritis caused by chlamydia

Answer 19

azithromycin 1 dose

OR

doxycycline x 7 days

Question 20

When do you test for cure if you received cefixime for urethritis caused by gonorrhea?

Answer 20

1 week post tx

AND

3mos post tx

Question 21

when do you f/up for uncomplicated urethritis caused by chalmydia?

Answer 21

f/up testing not required.

Question 22

when do you f/u w/ pregnant pt after tx her for urethritis caused by chamlydia?

Answer 22

3-4 wks post tx

Question 23

Epididymitis caused by STD (gonorrhea or chlamydia)

Answer 23

ceftriaxone + doxycycline

Question 24

Epididymitis due to non-STD cause

Answer 24

Levofloxacin

Question 25

**severe cases of Epididymitis**

Answer 25

IV abx

Question 26

**chronic epididymitis** conservative tx | (\>3mo)

Answer 26

analgesics, scrotal support, abx

Question 27

chronic epididymitis **due to obstruction** ## Footnote **(\>3 mo)**

Answer 27

vasovasostomy/epididymectomy

Question 28

chronic epididymitis due to **intermittent torsion** (\>3mos)

Answer 28

orchiopexy

Question 29

Pt w/**acute bacterial prostatitis + significant fever, highly elevated WBC, sepsis**

Answer 29

**admit + IV abx**

Question 30

**acute bacterial prostatitis** + urinary retention

Answer 30

**suprapubic tube \> urethral catheter**

Question 31

**acute bacterial prostatitis**; when no longer acutely toxic

Answer 31

switch from IV abx to po abx

Question 32

**acute bacterial prostatitis on discharge**

Answer 32

**_4-6 wk_ course of abx**

Question 33

chronic bacterial prostatitis (4)

Answer 33

**Abx:** FQ (cipro, levo), TMP/SMZ **NSAIDS** **A-blockers (-zosins)** **anticholinergics/antimuscarinics**

Question 34

**inflammatory chronic pelvic pain syndrome (non bacterial prostatitis)**

Answer 34

**empiric abx: FQ or SMX/TMP x 6-8 wks**

Question 35

inflammatory chronic pelvic pain syndrome

Question 36

**noninflammatory chronic pelvic pain syndrome (prostadynia)**

Answer 36

NSAIDS anticholinergics A-blockers sitz baths

Question 37

pyelonephritis & mildly ill

Answer 37

**FQ x 7 days**

Question 38

**pyelonephritis mod/severely ill**

Answer 38

**IV abx: FQ, aminoglycoside**

Question 39

Renal Abscess

Answer 39

IV abx Percutaneous drainage surgical drainage

Question 40

Chronic pyelonephritis

Answer 40

manage UTI RF control HTN nephrectomy

Question 41

BPH (4)

Answer 41

watchful waiting lifestyle modifications medications surgery

Question 42

BPH watchful waiting

Answer 42

monitor sx recheck labs and testing

Question 43

BPH lifestyle modification (5)

Answer 43

**avoid fluid intake & diuretics** in evening to prevent nocturia **elevate legs** in evening **avoid caffeine, alcohol, spicy/acidic foods** **double void** **avoid pseudophedrine/alpha agonists/anticholinergics**

Question 44

BPH Medications (3)

Answer 44

phytotherapy (**saw palmetto)** alpha blockers (**-zosin)**: controls urinary effects 5-ARI (**tadalafil, finasteride**) Combination: **dutasteride + tamsulosin**

Question 45

BPH surgery (7)

Answer 45

Transurethral Microwave Thermotherapy **(TUMT)** Transurethral Incision of Prostate (**TUIP)** **Urolift ®** Transurethral Resection of Prostate **(TURP)** Photoselective Vaporization of Prostate **(PVP)** Open simple prostatectomy Holmium Laser Enucleation of Prostate **(HoLEP)**

Question 46

BPH surgery **gold standard**

Answer 46

**TURP** **Transurethral Resection of Prostate**

Question 47

TUMT for BPH

Answer 47

minimally invasive, outpatient, awake

Question 48

**TUIP** for BPH

Answer 48

good for s**maller collar type prostate** less chance of **retrograde ejaculation**

Question 49

Urolift for BPH

Answer 49

permanent implant into prostate

Question 50

**TURP** for BPH

Answer 50

electrocautery energy scoops out **"chips"** of prostatic tissue chips go into bladder and are evacuated out & sent to pathology

Question 51

**3 complications/side effects of TURP for BPH**

Answer 51

**retrograde ejaculation** **TUR syndrome** **Hematuria**

Question 52

Describe **TUR syndrome** from **TURP for BPH**

Answer 52

hyponatremia mental confusion HTN visual changes

Question 53

PVP for BPH

Answer 53

can be done on anticoagulated pt

Question 54

What **surgery** is done for **pts with BPH who have very large prostates \> 80 cc**

Answer 54

open simple prostatectomy

Question 55

What surgery is done for pts with BPH who have very large prostates \> 80, 100, 200g?

Answer 55

HoLEP