Repro - Katz - Lower Urinary Tract And Male; Kek

Front 1

In males, the bladder is _____ to the rectum and _____ to the prostate gland.

Back 1

anterior; superior

Front 2

In females, the bladder is ___ to the vagina and _____ to the uterus.

Back 2

anterior; inferior

Front 3

the apex, the anterior portion of the bladder, is connected to what ligament?

Back 3

medial umbilical ligament (urachus cyst remnants- most common cause of bladder adenocarcinoma)

Front 4

the superior surface of the bladder is covered with what?

Back 4

peritoneum

Front 5

name the area of the bladder where the ureters enter?

Back 5

ureters enter through the internal ureteric orifices at the posteriolateral angles of the TRIGONE (posterior base of the bladder)

Front 6

Name the three ureteral areas of constriction where calculi commonly get stuck.

Back 6

1) ureteropelvic junction; 2)pelvic inlet (over the iliacs); 3) entrance to bladder

Front 7

what are the advantages of retrograde imaging techniques?

Back 7

have control over the contrast amount injection and pressure; don't have to wait on contrast to go through blood and be excreted by the kidneys; with the retrograde pyelogram, the ureter is typically seen in its entirety; with retro cystography, abnormal vesicoureteral reflux can be seen if present

Front 8

what is the difference in retrograde pyelography vs cystography vs urethrography?

Back 8

Pyelography images the ureters and kidney collecting system; cystography images the bladder; urethrography images the urethra

Front 9

what is the significance of extravasation of contrast dye?

Back 9

extravasation may occur normally in a retrograde pyelogram study; you must control the amount of pressure used when injecting dye; if there is an allergy to the dye, it may be apparent if the dye gets out of the urinary system (extravasates)

Front 10

when doing a cystogram, contrast is optimally injected under what type of observation?

Back 10

ideally under fluoroscopic observation, more recently with CT; but occasionally with normal radiographs (esp. in trauma setting)

Front 11

This procedure is commonly done after a cystogram to view the urethra in action.

Back 11

voiding cystourethrogram (VCUG)

Front 12

name the 4 portions of the male urethra. from proximal to distal and separate into posterior and anterior.

Back 12

Posterior: Prostatic -> Membranous -> Anterior: Bulbous -> Pendulous (penile)

Front 13

why would you order a retrograde urethrogram?

Back 13

in males, mainly to detect injury (also for filing defects, masses, strictures and fistulas); in females: mainly for diverticula (need a special cath)

Front 14

name this pathology. On contrasted CT, it looks like a cobra head; herniation of the dilated distal ureter bulging into the bladder.

Back 14

ureterocele

Front 15

name this pathology. A micturition problem caused by neurologic dysfunction. Can be overactive or underactive; motor or sensory, etc.

Back 15

Neurogenic Bladder

Front 16

How are neurogenic bladders diagnosed?

Back 16

Accurate and thorough voiding history with urodynamics and selective radiographic imaging studies. - seen alot in diabetics and spinal injuries

Front 17

what is a common shape of a neurogenic bladder?

Back 17

conical shape (not round)

Front 18

If you see a filling defect in the bladder during a cystogram, what are the common causes?

Back 18

neoplasm, stone, blood clot, enlarged prostate

Front 19

If you see a filling defect in the bladder during a cystogram, what are the UNcommon causes?

Back 19

focal cystitis, ureterocele, benign neoplasms, endometriosis, fungus ball

Front 20

If you see a filling defect in the bladder during a cystogram, what do you want to exclude?

Back 20

malignancy

Front 21

90% of bladder carcinomas are this type?

Back 21

transitional cell carcinoma - (EXTRA INFO causes:SMOKING!)

Front 22

Of this 90%, what are the common microscopic findings?

Back 22

75% are papillary - recur but aren't as problematic, 25% are infiltrative

Front 23

Name some other (less common) malignant neoplasms of the bladder.

Back 23

Squamous Cell Carcinoma (after schistosomiasis infection after vacationing in egypt), adenocarcinoma(*urachal cyst remnants), leiomyosarcoma, lymphoma, embryonal rhabdomyosarcoma (<6 -*sarcoma botryoides)

Front 24

Name some benign lesions of the bladder.

Back 24

leiomyoma, fibroepithelial polyp, hemangioma, pheochromocytoma, adenoma

Front 25

Who and at what age do people get diagnosed with TCC? Name the risk factors.

Back 25

Men (3xs as high as women); (peak age 50-69); RISKS: SMOKING!, analgesics (*esp. cyclophosamide - used in RA Tx); chemical carcinogens (*aniline dyes)

Front 26

Infiltrative TCC is more likely to _____, and papillary TCC are often _______ with high recurrence rates.

Back 26

metastasize; multi-focal

Front 27

A Polypoid (mass)TCC will show up on contrasted CT as a ____ ____.

Back 27

filling defect

Front 28

when viewing a contrasted ureter, what is the difference in an IVP and a retrograde pyelogram?

Back 28

with normal ureters = IVP: should see peristalsis (it is abnormal to see the ureter in its entirety); Retrograde Pyelogram: it is normal to the entire ureter

Front 29

If you are viewing a convential IVP and you can see the entire ureter as well as a masslike filling defect in the bladder, what is your differential?

Back 29

carcinoma, tumor, blood clot, fungus ball - requires cystocopy with possible biopsy for further evaluation

Front 30

Bladder Diverticula occur as a result of focal herniations of the ____ and _____ and usually occur in the setting of chronic elevation of ____ ____.

Back 30

urothelium and submucosa; intravesical pressure

Front 31

Bladder diverticuli tend to occur near the ureteral orfices and are an important cause of what?

Back 31

urinary stasis (higher chance of infection); ureteral obstruction, and vesicoureteral reflux

Front 32

Name the pathology. An large outpouching close in proximity to the ureterovesicular junction that may lead to vesicoureteral reflux.

Back 32

Hutch Diverticulum

Front 33

Urethral diverticula possible arise from an obstructed/infected ___ ___.

Back 33

paraurethral glands - the glands become enlarged and inflammed forming a retention cyst and then abscess

Front 34

Urethral strictures occur secondary to ___, ___, or ____ and lead to a reduced flow of antegrade urine.

Back 34

inflammatory, ischemic, or traumatic process

Front 35

What is the purpose of the corpus spongiosum in erection?

Back 35

it prevents the urethra from pinching closed and maintains a canal for ejaculate to travel out of the body

Front 36

The posterior urethral strictures arise usually secondary to what?

Back 36

trauma or surgery, ie radical prostatectomy

Front 37

If a patient has recurrent gonococcal urethritis, what is he at risk for?

Back 37

infectious urethral strictures

Front 38

name the pathology. a protrusion of the bladder into the vagina due to defects in pelvic support.

Back 38

cystocele

Front 39

cystocele is defined radiographically by:

Back 39

the descent of the bladder base is below the inferior margin of the symphysis pubis

Front 40

name the type of bladder dysfunction. the bladder base extends below the pubic symphsis and leaks urine while straining or sneezing.

Back 40

Stress Incontinence

Front 41

Bladder fistulas are commonly caused by what?

Back 41

bladder catheterizations or instrumentation

Front 42

what are the most common causes of vesicoenteric fistulas (bladder connected to bowel)?

Back 42

Chron's Dz and Diverticulitis

Front 43

what is the best imaging method to locate bladder fistulas? What are the findings?

Back 43

Voiding cystourethrogram; find AIR within the bladder, (non-specifically: focal mural irregularity, or extrinsic mass effect

Front 44

If you order an oral and rectal contrast it would demonstrate what with a vesicoenteric fistula?

Back 44

AIR within the Bladder; Nonspecifically: focal bladder wall thickening; contiguous bowel wall thickening, and presence of air-containing paravesical soft-tissue mass

Front 45

Name and describe another test done to find a vesicoenteric fistula?

Back 45

Bourne Test - give oral barium, then get a urine sample, centrifuge it and look for barium

Front 46

This fistula would present with clear fluid leaking out of the vagina. Causes include: iatrogenic, cervical or bladder carcinoma, obstetric injury, radiation, foreign body.

Back 46

Vesicovaginal fistula - presents with continous urinary incontinence

Front 47

Give the differential dx of the abnormal finding of air in the bladder.

Back 47

vesicovaginal fistula, vesicoenteric fistula, infection, recent cath

Front 48

This pathogen causes a rare form of bacterial cystistis called ____ that occurs in patients iwht poorly controlled diabetes.

Back 48

e.coli; emphysematous cyctitis

Front 49

what does the previous pathology look like on CT?

Back 49

E.coli produce gas; see the abnormal air-fluid level; see gas within the wall of the bladder in a linear, streaky, or multi-cystic pattern

Front 50

Bladder stones are usually due to ____ or ____.

Back 50

urinary stasis or infection

Front 51

If the patient has BPH, what type of stones predominate?

Back 51

uric acid stones predominate in bladder outlet obstructions such as BPH

Front 52

If the patient has a UTI (esp. with Proteus) what types of stones predominate?

Back 52

magnesium ammonium phosphate and apatite stones

Front 53

normally bladder stones are asymptomatic, however, if your patient does have symptoms what are they most likely going to be?

Back 53

MICROSCOPIC painless HEMATURIA, suprapubic pain, interruption of urine stream

Front 54

if the stones are calcified, what imaging modalities are used?

Back 54

plain films and CT

Front 55

if stones are present and utilizing cystograms or IVUs, they appear as ____.

Back 55

filling defects because they are usually less dense than contrast

Front 56

A bladder may rupture (usually due to trauma) and is classified as either ___ or ___.

Back 56

intraperitoneal or extraperitoneal.

Front 57

If this bone is fractured you should suspect bladder trauma (and urethral injury in males).

Back 57

pubic rami with separation of the symphysis - fractured anterior pelvic ring

Front 58

the very rare spontaneous bladder rupture may occur by what means?

Back 58

an lesion that can weaken the bladder wall: tumor, cystitis, perivesical inflammation, bladder outlet obstruction, neurogenic bladder or radiation injury

Front 59

How could urine get into the intraperitoneal space?

Back 59

since the superior dome of the bladder is covered by peritoneum, if it gets punctured or ruptures it would be possible for urine to get into the intraperitoneal space and cause peritonitis

Front 60

name a common place in females to find extravasated urine?

Back 60

pouch of douglas - midline and posterior to the bladder and anterior to the rectosigmoid colon

Front 61

name the space located behind the pubic symphysis. it is also a common area to collect extravasated urine.

Back 61

Space of Retzius

Front 62

this is another name for "abdominal film" used in urology studies.

Back 62

KUB - Kidney, ureter, bladder

Front 63

name the fibrous capsule that surrounds the penis and testes and may "fracture".

Back 63

tunica albuginea - needs surgical intervention

Front 64

the ____ ___ enters the testis along the posterosuperior margin known as the mediastinum testes.

Back 64

spermatic cord

Front 65

the testis is divided into lobules composed of branching ____.

Back 65

seminiferous tubules

Front 66

The ____ is where sperm mature and achieve the ability to swim; it turns into the the vas deferens.

Back 66

epididymis

Front 67

the vas deferens joins the seminal vesicles to form the ______.

Back 67

ejaculatory duct

Front 68

This is the area between the internal and external urethral sphincters where the prostate fluids dump into the urethra.

Back 68

verumontanum

Front 69

Name the 3 zones of the prostate.

Back 69

Peripheral, Central, and Transitional

Front 70

This view shows both testicles on a grey scale ultrasound.

Back 70

Dolly Parton View - helpful in excluding a focal process

Front 71

This imaging technique is able to color-label arteries and veins are reveal normal or abnormal blood flow. It is used to detect testicular torsions.

Back 71

Duplex (doppler) ultrasound

Front 72

BPH is more common in who?

Back 72

blacks, diabetics, and hypertensive males

Front 73

Name the symptoms of BPH.

Back 73

hesitancy, decreased force of urine stream, dribbling, retention (incomplete emptying)

Front 74

Why do these symptoms occur?

Back 74

uninhibitied contractions of a hypertrophied detrusor muscle due to obstruction of the prostatic urethra b/c of its enlargement

Front 75

When a male comes in with symptoms like hesitancy, decreased force of urine stream, dribbling, retention (incomplete emptying) what should you look for on imaging?

Back 75

evaluate the upper urinary tract for ureteral obstruction and obstructive nephropathy; evaluate bladder size, and estimate post-void residual volume (PVR), bladder wall thickness, presence of trabeculation, and formation of diverticula

Front 76

what is the finding you are looking for on CT IVU (intra-venous urogram)?

Back 76

dome-like indentation along the floor of the bladder caused by an enlarged prostate gland

Front 77

From anterior to posterior, what do you see when looking inferior into the male pelvis.

Back 77

pubic symphysis -> space of retzius -> prostate -> rectum (bladder is superior to the prostate)

Front 78

BPH tends to be in what area of the gland? Carcinoma tends to be in what area of the gland?

Back 78

BPH: transitional zone; Prosate CA: Peripheral Zone

Front 79

Can you diagnose prostate cancer on ultrasound or CT?

Back 79

there are NO SPECIFIC FINDINGS OF CARCINOMA on US or CT; you'd have to biopsy

Front 80

what appears as a bowtie below the bladder?

Back 80

seminal vesicles

Front 81

what is the relationship of a PSA (prostate specific antigen) and prostate cancer?

Back 81

serum PSA levels may be elevated with BPH, infection, irritation, recent ejaculation, ect. - it is a better test when done year to year and note changes in PSA; normal is 0-4ng/mL; 4-10(get US -> then biopsied if indicated)

Front 82

Name the gold-standard in diagnosing prostate CA.

Back 82

Trans-rectal biopsy

Front 83

Spread of Prostatic Ca may spread by direct extension to what?

Back 83

seminal vesicles, bladder base, perivesical fat

Front 84

CT and MRI evaluate nodal metastases. If the nodes are >__mm they get _____.

Back 84

10; biopsied - if +, 80% will have bone mets within 5 years

Front 85

Name the most common lesions of the scrotum that may require imaging.

Back 85

epididymitis, testicular torsion, hydrocele, testicular tumors

Front 86

what imaging study can help differentiate epididymitis from testicular torsion?

Back 86

Doppler ultrasound; Epididymitis: see hyperemia on the affected side(INCREASED B.Flow); Acute torsion: decreased blood flow on affected (painful) side

Front 87

Torsions occur because of an abnormal configuration of the testicle on its pedicle (bell clapper deformity). Name the 2 types and what age group this is more common in.

Back 87

COmplete >360 (80% salvage rate if reversed in <5hours; MC in adult males) and Incomplete <360; more common in adolescents and infants

Front 88

Under doppler study, if there is no flow after __ minutes; diagnosis is testicular torsion.

Back 88

1 minute

Front 89

how does a twisted testicle look on ultrasound?

Back 89

hypoechoic

Front 90

Epididymitis is usually caused by a spread of infection from the urethra or prostate (usually STD) that will look how on Doppler?

Back 90

hyperemic - lots of flow; 90% of pts have pyuria

Front 91

Name the most frequent causes of the parenchymal infection, orchitis.

Back 91

Mumps, echovirus, group B arboviruses, lymphocytic choriomeningitis virus

Front 92

what is a varicocele of the testes and why is it important to study?

Back 92

distended pampiniform venous plexus due to incompetent valves of the spermatic vein; 95% of the time is left-sided (feels like a bag of worms); most common cause of male infertility

Front 93

How does a varicocele look on ultrasound?

Back 93

will see cystic spaces - multiple serpiginous anechoic spaces of similar size

Front 94

what is a hydrocele and where is it?

Back 94

accumulation of fluid between the visceral and parietal tunica vaginalis - start looking for epididymitis, orchitis, torsion, trauma, tumor

Front 95

in testicular trauma, when is surgical exploration and debridment needed?

Back 95

if the tunica albuginea has been violated and semifierous tubules have extruded or if there is a large scrotal hematoma

Front 96

name the term that means hidden or obscure testis. incidence is 3-5% in full term boys.

Back 96

cryptorchidism - usually descend by themselves by one year of age

Front 97

Testicles that do not naturally descend into the scrotum are considered ___ throughout the patient's life.

Back 97

abnormal; increased risk for developing cancer regardless of if they are surgically dropped

Front 98

any mass within the testicle should be considered _____ and will be removed.

Back 98

malignant; extratesticular tumors are usually benign

Front 99

95% of testicular tumors are of this type?

Back 99

Germ Cell Tumors - seminoma is most common (other germ: embyronal carcinoma, choriocarcinoma, and teratoma)

Front 100

Cryptorchidism, maternal DES use, and testicular atrophy are risk factors for this most common malignancy of males age 15-30.

Back 100

Seminoma - presents as a painless mass

Front 101

how will a seminoma appear on ultrasound?

Back 101

show areas of hypoechonicity