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105 Cards in this Set

  • Front
  • Back
Foreskin can't be retracted over the glans
Phimosis
Foreskin has been left retracted behind the glans, resulting in painful engorement and edema of the glans
Paraphimosis
Presence of a persistent, usually painful erection of the penis
Priapism
Acute inflammatory condition of the penis associated with penile curvature and, in some case, pain
Peyronie's Disease
Collection of fluid between the 2 layers of the tunica vaginalis
Hydrocele
Should be suspected if history reveals fluctuation in the volume of the mass with crying, activity, or defecation and if it can be decompressed
Hydrocele
Hydrocele Dx
Transillumination
Engorgement of the internal spermatic veins above the testis
Varicocele
"Bag of worms"
Varicocele
Should diminish in size/disappear when patient supine
Vaicocele
Rotation of testis on its axis
Testicular Torsion
"Bell-Clapper's Deformity"
Testicular Torsion
Painful testis that have a "high-lie" as compared to other testis
Testicular Torsion
Pain often increases with scrotal elevation and usually have loss of ipsilateral cremasteric reflex
Testicular Torsion
Testicular Torsion Dx
US with Doppler
Testicular Torsion Tx
Surgery
Infection of the bladder most commonly due to Enterobacteriaceae
Acute Cystitis
3 causes of Acute Cystitis
E. coli
Klebsiella
Proteus (alkaline)
When should you do a urine culture to Dx Acute Cystitis?
Recurrent infections
Pregnant women
Men
Children
DM
Acute Cystitis Dx
Urinalysis
+ leukocyte esterase and nitrates
Acute Cystitis Tx
Bactrim
Infectious inflammatory disease of the kidney parenchyma/renal pelvis
Acute Pyelonephritis
Presents with fever, flank pain, shaking chills, and IVS
Fever often persists for 3-5 days after ABX initiated
Acute Pyelonephritis
Acute Cystitis Tx
Bactrim
Infectious inflammatory disease of the kidney parenchyma/renal pelvis
Acute Pyelonephritis
Presents with fever, flank pain, shaking chills, and IVS
Fever often persists for 3-5 days after ABX initiated
Acute Pyelonephritis
Acute Pyelonephritis Tx
Moderately = FQ x7-10 days
Severe = Ceftriaxone and FQ (inpatient)

F/U Urine culture
Presents with perineal, sacral, or suprapubic pain, fever and IVS
As swelling occurs, OVS and acute urinary retention
Markedly tender, warm, boggy prostate
Acute Bacterial Prostatitis
Prostatic massage in Acute Bacterial Prostatitis?
No bc may cause bacterermia
Acute Bacterial Prostatitis Tx
FQ for 2-4 wks
F/U urine culture
Most common cause of Acute Bacterial Prostatitis
E. coli
Most common causes of Chronic Bacterial Prostatitis
E. coli
Enterococcus
Expressed prostatic secretions demonstrate increased number of leukocytes
Chronic Bacterial Prostatitis
Chronic Bacterial Prostatitis Dx
Culture
Chronic Bacterial Prostatits Tx
FQ for 6-12 weeks
Acute inflammatory infection of the epididymis/testicles
Acute Epididymo-Orchitis
Acute Epididymo-Orchitis Causes
<40 yo = N. gonorrhoeae and C. trachomatis
>40 yo = E. coli
Acute Epididymo-Orchitis in <40 yo associated with
Urethritis
Acute Epididymo-Orchitis >40 yo associated with
UTI and Prostatitis
Presents with urethritis symptoms (penile tip pain and discharge) or cystitis symptoms
Pain develops in scrotum, which may radiate along spermatic cord or to the flank
Acute Epididymo-Orchitis
Prehn's sign
Acute Epididymo-Orchitis
Elevation of the scrotum above the pubic symphysis improves pain from epididymitis
Prehn's sign
Acute Epididymo-Orchitis Tx
Bed rest, scrotal elevation, and NSAIDs
PLUS
UTI/prostatitis = FQ x 1day
STI = ceftriaxone IM + doxy PO x10days
Orchitis or Testicular Torsion = Emergency?
Testicular Torsion
4 types of Renal Calculi
Calcium oxalate and phosphate
Struvite
Uric acid
Cystine
Radiopaque stone assocated with hypercalcemia, hypercalcuria or are idiopathic
Calcium oxalate and phosphate
Magnesium-ammonium-phosphate stone
Struvite
Associated with Proteus UTI
Struvite
Staghorn calculi
Struvite
Stone associated with gout, high purine diet, acid urine
Uric acid
Renal stone associated with genetic renal abnormalities
Cystine
What makes a urinary stone a medical emergency?
Fever. Suggests infection from obstruction.
Kidney stones Dx gold standard
Spiral CT
Ureteral Stone Tx
<6mm = conservative measures (pain control)
Failure of passage, larger stone = ureteroscopic stone extraction or extracorpeal shock wave lithotripsy
Renal Stone Tx
<2cm = ESWL
Larger stones best treated with percutaneous nephrolithotomy
Urinary Incontinence
DIAPPERS:
Delirium
Infection
Atrophic urethritis or vaginitis
Pharmaceuticals
Psychologic factors
Excess urinary output
Restricted mobility
Stool impaction
Detrusor overactivity
Urge incontinence
Overactive bladder
Urge incontinence
Loss of small amounts of urine with activities that increas intraabdominal psi
Stress incontinence
Dribbling incontince after voiding
Urethral obstuction
Detrusor underactivity
Overflow incontinence
Chronic urinary retention
Overflow incontinence
Urge incontinence Tx
Behavioral therapy
Pelvic floor rehab
Meds
Urge incontinence meds (5)
Oxybutinin
Toterodine
Trospium
Solifenacin
Darifenacin
Stress inconinence Tx
Behavioural theapy
Pelvic floor rehab
Surgery
Uretheral Obstruction Tx
BPH = alpha blocking agents
Intermittent or indwelling catheterization
Surgery
Overflow incontinence Tx
Augmented voiding techniques
Intermittent or indwelling cath
ED Tx
Sildenafil
Vardenafil
Tadalafil
Presence of less than 20 million sperm/mL
Oligospermia
Absence of sperm
Azoospermia
At what point is infertitlity workup needed?
After six months of unprotected sex
Most common benign tumor in men
BPH
BPH Dx
DRE and focused urological exam
BPH Tx
Alpha blockers
5alpha Reductase Inhibitors
Alpha blockers used in BPH (5)
Terazosin
Doxazosin
Tamsulosin
Alfuzosin
Silodosin
5alpha Reductase Inhibitors (2)
Finasteride
Dutasteride
Detrusor overactivity
Urge incontinence
Overactive bladder
Urge incontinence
Loss of small amounts of urine with activities that increas intraabdominal psi
Stress incontinence
Dribbling incontince after voiding
Urethral obstuction
Detrusor underactivity
Overflow incontinence
Chronic urinary retention
Overflow incontinence
Urge incontinence Tx
Behavioral therapy
Pelvic floor rehab
Meds
Urge incontinence meds (5)
Oxybutinin
Toterodine
Trospium
Solifenacin
Darifenacin
Stress inconinence Tx
Behavioural theapy
Pelvic floor rehab
Surgery
Uretheral Obstruction Tx
BPH = alpha blocking agents
Intermittent or indwelling catheterization
Surgery
2nd leading cause of cancer-related death
Prostate Cancer
Most common cancer diagnosed in men
Prostate Cancer
May be manifested as focal nodules or areas of induration within the prostate on DRE, but a large number of men will have normally palpable prostates with elevated PSA levels
Prostate Cancer
Prostate cancer screening
PSA combined with DRE
>= 50 yo
>= 40 yo with family history/African American
Prostate cancer Dx
Transrectal US (TRUS) guided biopsy
Used with MRI to stage
Majority of Prostate Cancers
Adenocarcinomas
Second most common urologic cancer
Bladder Cancer
Cancer linked to cigarette smoking and exposure to industrial dyes/solvents ("rubber factory")
Bladder Cancer
Bladder Cancer Dx gold standard
Cystoscopy with transurethral resection
Common presenting symptom of bladder cancer
Hematuria
Most common kind of bladder cancer
Transitional Cell Carcinomas
Solid tumors of the kidney are this until proven otherwise
Renal Cell Carcinoma
Renal Cell Carcinoma Triad
Flank pain
Hematuria
Mass
Renal Cell Carcinoma Dx
CT
Renal Cell Carcinoma Tx
Radical nephrectomy
Most common symptom is painless enlargement of the testis possibly with sensation of heaviness
Testicular Cancer
Testicular Cancer Dx
Inguinal orchiectomy
Testicular Cancer Tx
Inguinal orchiectomy
Most common type of Testicular Cancer
Germ Cell Tumors (Seminomas)