Week 1 Urology

Question 0

Epispadias

Answer 0

Congenital malformation of urethral meatus on dorsal side of the penis

Question 1

Hematospermia

Answer 1

Source could be epididymis, seminal vesicle, prostate, bulbourethral glands

Red flag: sxs > 1 month, palpable mass, hematuria, obstructive sx

Question 2

Hypospadias

Answer 2

Congenital malformation of urethral meatus on ventral side of penis

Question 3

Balanitis

Answer 3

Inflammation of glans penis

Question 4

Posthitis

Answer 4

Inflammation of the foreskin

Question 5

Balanoposthitis

Answer 5

Inflammation of glans and foreskin

Due to candida, GC, CT, scabies, contact derm, psoriasis, poor hygiene, diabetics

Sequelae: meatal stricture, phimosis, para phimosis, cancer

Question 6

Phimosis

Answer 6

Foreskin cannot be retracted back away from glans penis

Pathologic or physiologic

Question 7

Paraphimosis

Answer 7

Foreskin stuck in retracted position, becomes inflamed–> reduced blood flow –> necrosis

Question 8

Peyronie’s Disease

Answer 8

Scarring of tunica albuginea –> painful erection with dorsal curvature

Question 9

Chancre

Answer 9

Due to syphilis. Solitary, painless ulcer

Non exudative, indurated edge

Question 10

Chancroid

Answer 10

Painful, shallow non indurated ulcers, irregular edges and red borders
Gray or yellow purulent exudate
Infection of H. ducreyi
Regional tender adenopathy, may abscess

Question 11

SCC of the penis

Answer 11

More common in uncircumcised males with poor hygiene
HPV 16 and 18
fungating, non painful sore that does not heal
Dx by biopsy

Question 12

Priapism

Answer 12

Prolonged, painful erection > 4 hours. Emergency due to ischemia

Dx by color Doppler US, assessment of corporal blood gases

Question 13

Orchitis

Answer 13

Inflammation of testicle due to infection, usu viral/mumps

Question 14

Acute Epididymitis

Answer 14

Usu bacterial infection

Could be urine reflux/chemical irritation into ejaculatoru ducts from heavy lifting /trauma

Positive Prehn’s sign
Scrotal US to rule out torsion

Question 15

Chronic epididymitis

Answer 15

Inflammation with no infection present, enlarged, thickened, non tender epididymis

Question 16

Hematocele

Answer 16

Blood filled, secondary to trauma. Does not transilluminate

Question 17

Hydrocele

Answer 17

Non tender, serous filled
Acute– between 2-5yrs, due to inflammation
Chronic–middle age men from inflammation or injury

Question 18

Variocele

Answer 18

Due to gravity pulling on venous valves. Bag of worms. Worse with valsalva and standing

**Development of a new variocele: on L–tumor or mass. On R–occlusion of vena cava

Question 19

Testicular torsion

Answer 19

Emergency! De-torse <6 hours

Color Doppler US.

Question 20

Spermatocele

Answer 20

Small, painless cyst. Benign. With dead spermatozoa. Dx by US or aspiration.

Question 21

Cryptorchidism

Answer 21

Failure of testicles to descend into scrotum during infancy

High risk of developing infertility or testicular cancer later in life

Question 22

Testicular cancer

Answer 22

Most common solid a cancer in 15-34yrs

Risk factors: cryptorchidism, exogenous estrogen, trauma, gonadal dysgenesis, Klinefelter syndrome

Question 23

Rubbery prostate

Answer 23

BPH

Question 24

Boggy prostate

Answer 24

Congested

Question 25

Induration on prostate

Answer 25

Malignancy. Nodules

Question 26

Prostate labs

Answer 26

Serum PSA, PSA velocity, free/bound PSA

Question 27

BPH

Answer 27

Progressive urinary freq, urgency, nocturia, dribbling PE: enlarged, rubbery. Smooth, symmetric. May be distended bladder Lab: increased BUN, UA, PSA

Question 28

Acute bacterial prostatitis

Answer 28

Fever, chills, malaise, dysuria + E. coli, klebsiella, proteus, pseudomonas, enterobacter Lab: CBC left shift. UA shows WBCs, elevated CRP

Question 29

Contraindication for prostate massage

Answer 29

If acutely inflamed... Sepsis!!

Question 30

Chronic bacterial prostatitis

Answer 30

Sxs: recurrent UTIs, fatigue, pain, sexual dysfunction, ejaculatory pain PE: DRE--tender, boggy, enlarged, soft prostate Lab: post massage urine culture and sensitivity

Question 31

Chronic prostatitis/Prostadynia

Answer 31

Criteria: no objective cause, Sxs related to prostate area, refractory to tx Etiology: psych stress, low T, infection from normal bacteria, genetic

Question 32

Prostadynia Sxs and PE

Answer 32

Sxs: pain in pelvis > 3 mos, dysuria, urgency, low back/perineal pain, sexual dysfunction, post ejaculation pain, IBS, chronic fatigue PE: DRE--mildly tender, boggy, enlarged Lab: UA, urine culture and sensitivity, CBC *may need to rule out CT/GC

Question 33

Prostate cancer

Answer 33

Commonly adenocarcinoma. Risk factors: age, African American, family hx, obesity, SAD, meds, vasectomy Sxs: sexual dysfunction, incontinence, irritative/obstructive sxs, bone pain, weight loss PE: non tender prostate, firm, stony hard, irregular nodules Labs: PSA velocity (>.75ng/ml/year), total PSA 4-10/>10 ng/ml CMP, inc alk phos Dx: transrectal US with biopsy using Gleason score for grading Axial CT/MRI for staging