Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
138 Cards in this Set
- Front
- Back
|
causes of increased PSA |
- PBH -prostatitis -tract instrumentation |
|
|
USOSTF |
class D on PSA screening in asymptomatic |
|
|
AUA rec |
-no threshold foro biopsy - Age adjusted--rises with age -density: 0.15+ - velocity 0.35ng/nl/yr - free vs complexed PSAA |
|
|
T1 |
disocered inadvert t1a benign disease t1b or by PSA t1c |
|
|
T2 |
palpable on dRE |
|
|
t3 |
palp outside prostsate |
|
|
gleason score |
two most common 1-5 -2-10 |
|
|
expectant management |
-low grade: gleason pattern 4 or less -low volume: less than 3 cores involved -less than 10 year life expectancy: illness or age |
|
|
radiation therapy/brachytherapy |
- external beam -ED, radiation proctitis - stress incontinence not common - voiding symptoms are |
|
|
young healthy |
do radiation or surgery |
|
|
contraind to brachytherapy |
- large prostates |
|
|
surgery type |
-no one type is better than others -risks: ED stress incontinence (not seen in radiation) |
|
|
hormonal therapy |
for nonlocalized cancer -anti-anddrogens -types: LHRH agonist: leurolide, goserelin -antiandrogens: flutamide, bicalutamide, nilutamide orhicectomy adrenal gland test blockers total blockade more effective the orchi or LHRH alone palliative NOT curative --hormone refractory |
|
|
ideal surgery candidate |
-30 year life expectancy -localized cancer |
|
|
ideal radiation or expectant management |
-patients over 70 with localized |
|
|
metastatic management |
hormonal |
|
|
obstructive symptoms |
decreased stream hesitancy straining incomplete seen with BPH |
|
|
irritative symptoms |
-less so with BPH -frequency, urgency, dysuria |
|
|
changes in BPH |
glandular enlargment increased smooth muscle tone decreased compliance ---decresed collagen |
|
|
% of men |
10% by 40 50% by 60 start by age 30 |
|
|
objective parametrs |
size of prostate urinary flow post void residual |
|
|
symptoms scale |
mild: 0-7 mod: 7-15 severe: 15+ |
|
|
urinary retention |
-need immediate surgery tiral of ofley alpha blocker surgery in future |
|
|
when to do immeidate surgery |
urinary retention UTI persistent or gross hematuria bladder stones |
|
|
finasteride |
prevents test to dHT |
|
|
alpha blockers |
relax smooth mucle of prostate and bladder neck terazosin doxazosin tamsulosin alfuzosin |
|
|
transurtehral microwave procedure |
-minimally invasive heat to destory excess prostate tissue TUMT ED and incontinence reduces frequency urgerncy strianing flow does not correct incomplete emptying |
|
|
transurethral need ablatoin |
minimally invasive TUNA low level radiofrequency burn selected areas improves flow no incontinence or impotence ---seen in microwave |
|
|
water induced thermotherapy |
water heated to destory excess tissue |
|
|
high intensity focues ultrasound |
low frequency of waves minimal invasive safe |
|
|
TURP |
surgical therapy gold standard most common 90% failed medical therapy have UTI, stones, hematuria |
|
|
open prostatectomy indications |
-large prostate -bladder stones -landmarks not visible by TURP |
|
|
BPH and risk of cancer |
-leave the peripheral zone in open prostatectomy---can still get prostate cancer |
|
|
transurtheral laser surgery |
-better than TURP: less blood, quicker recovery
|
|
|
AUA PSA screening |
men over 50 who also have life expectancy of 10+ years 45 if AA |
|
|
PSA and BPH |
elevated by manipulation, inflammation, infarction wait 4-8 weeks after cystoscopy, biopsy, prostatitis DRE has little effect |
|
|
dipstick for hematuria |
ability hemoglobin to oxidice chromogen need to confirm with miicro myogloni can turn it positive antiseptic solultions can: povidoneiodine 3+ red blood cells per high powered field |
|
|
risk factors |
40 yo male cigarette smoking chemical exposure radiation voiding symptoms prior urologic disease |
|
|
screening |
no routine screening in asymptomatic |
|
|
findings suggestive of glomerular source |
casts dysmorphic proteinuria |
|
|
significant protein urai |
1000mg/day suggest pareychmal process |
|
|
common causes og glomerular hematuria |
igA--most common thing glomerualr BM disease hereditary nephritis Alports |
|
|
upper track hematuria causes |
urolithiasis pyelo RCC TCC urinary obstruction benign hematuria |
|
|
lower tract hematuria causes |
UTI BPH exercise TCC menses instrumentation benign |
|
|
anticoag |
DOES NOT LEAD TO DENOVO HEMATURIA |
|
|
low risk patients |
-asymptomatic - no risk factors |
|
|
high risk |
-gross hematuria - risk factdors |
|
|
low risk workup |
renal US cytology |
|
|
cytology |
detect urothelial cancer not screening for renal cell cancer +---transitional cell cancer |
|
|
high risk |
imaging cystoscope cytology |
|
|
% of asymptomatic microhemuria with cancer |
20% |
|
|
netative workup |
repeat 48-72 months |
|
|
overflow incontinence |
bladder dysfunction |
|
|
urge intontinence |
bladder pressure overcomes sphincter mechanism---detrusor activity or poor compliance -can be triggered by coughing (typically seen in stress)--most have stress and urge |
|
|
stress incontinence |
urethral related
-hypermobility -intrinsic sphincter deficiency |
|
|
post void residula |
less than 50 or over 200-is abnormal obstruction or poor contractiity |
|
|
treatment of urge |
first line: timed voiding -every couple hours fluid intake, avoid bladder irritantnt, levice muscle excersises anticholinergics or antimuscarinincs |
|
|
surgery in urge inctoninence |
only with intractable detrusor overactivity |
|
|
treament of overflow |
-emptying bladder relieve obstruction trat BPH, prolapses clean intermittent cath |
|
|
overflow due to poor detrusor contractility |
clean intermittent catheterizatoin |
|
|
stress incontinence |
pelvic floor excercies weighted vaginal cones perineometer electrical stimulation alpha agonists: increase in smooth muscle tone TCA such as tofrani pessaries |
|
|
intrinsic sphincter deficiency: stress |
have well suported bladder neck need coapt of the proximal urethra bulking agents injected into bladder neck |
|
|
pubovaginal sling |
good if they have both intrinsic sphincter deficinecy anatomic stress incontince |
|
|
anatomic stress incontinence |
mid urethral sling |
|
|
tx mxied stress and urge |
imipramine |
|
|
recurrence rate stones |
50% |
|
|
highest incidence in.. |
white males |
|
|
calcium oxalate |
most comon form from initial calcium phophate in calyx epithelium --norms nidus for oxalate |
|
|
risk of caclium oxalate |
dehydration hypercalciuria hyperoxaliuria hypernatruituria hyperuricosuria HYPOcitrate |
|
|
uric acid stones |
second most common 100x more soluble at ph>6--percipitates in acidic urine dehyrationis common risk factor rental tubular acidosis is a risk factor gout risk factor hyperuricosiura: seen in lymphoma or leukemia treated with chemo |
|
|
struvite stones |
urinary infections--urease producing organisms proteus is most comon (kleb, enterobac, pseudo) ECOLI IS NOT UREASE PRODUCING cleaves urea into ammonium --frees H+ bound to produce Nh4 and OH---makes urine more basic phophate les soluble at basic pH get magnesium ammonium phosphate |
|
|
cystine stones |
homozygous recessive gene for cystin etransport COLA: cystine ornithine, lysine, arginine -secrete 100mg/day cysteine is normal---they secrete 200+ more soluble at ph>9.6 (basic urine causes calicum phosphate) |
|
|
initial obsturction |
- increased blood flow - GFR decreases: due to increased renal pelvic pressure |
|
|
6-24 hours of obstruction |
-pelvic pressure still elevated - blood flow decreases |
|
|
24hrs+ |
pelvic pressure toward baseline renal blood flow continues to decrease - eventually get ischemia (renal impairment in 2wks) |
|
|
pain with stones |
-cant sit still |
|
|
differential of acute renal colic |
renal or ureteral stone hydronephrosis bacterial cystitis or pyelo acute abdomen gynecologic radicular herpes zoster or sciatica referred from testes |
|
|
diagnosis |
- noncon CT (unless preg do US) |
|
|
indications for urgent intervention |
-obstructed upper tract with infection -renal deterioration -pain refactory to analgesics -intractable N/V -patient preference |
|
|
when to wait and watch |
stones less than 5mm (usually pass on own) 2/3 pass on own within 4 weeks |
|
|
medical expulsion therapy |
-alpha blockers -CCBs shorten passage time increase liklihod give with NSAIDs |
|
|
length until stone wont pass on own |
1-2 months |
|
|
uric stone management |
can be manageed medically urine alkalinization --potassium citrate or sodium bicarb |
|
|
stones 3cm and less |
shock wave lithotripsy |
|
|
stones in lower pole |
-less likely with shock wave - need percutaneous |
|
|
stones 3cm+ |
percutaneous |
|
|
stone prophylaxis |
metabolic evaulation - 24 hr volume, pH, calcium, oxalate, sodium, uric acid, citrate, phosphate, magnesium sulfate, creat, cystine -serum calcium, phosphorus, uric acid, bicarb, bun, creat, albumin, alk phos, PTH, D2 -stone composition analysis |
|
|
most common met issue |
low urine volume hypercalciuria hypocitraturia |
|
|
diet |
decreasing calcium is no longer recommended --- can restrict animal protein (oxalates) |
|
|
uncomplicated UTI |
-infection in a healthy patient with normal GU tract |
|
|
complicated UTI |
infection with factors that increase chance of acquiring bacteria or decreased efficacy of therapy 1) abnormal GU: BPH, stone, neurogenic blad 2)immunocom 3)multidrug resistent |
|
|
risk factors |
reduced urine flow: obstruction, neurogenic bladder, hypovol promote colonization: sex, spermicide, estrogen depletion, antimicrobials facilitated ascent: cath, urinary incont |
|
|
most common |
ecoli |
|
|
mediators of pathogenicity |
pili--adherence increase resistance: K antigen invasiveness: hemolysin |
|
|
biochemical factors increase risk |
acidic pH high urea high osmolality ---all make it difficult genetic predis certain lewis blood type |
|
|
natural defenses |
-periurethral/urethral: normal flora: lactobacilli coag neg staph, corne, strep --changes in E, IgA affect normal flora -urine: high osmolaltiy, high urea, lowpH, high organic acid are protective -bladder: TLRs to rec bacteria -kidney: antibody synthesis IgG and IgA |
|
|
diseases that increase suscept. to UTIs |
-obstruction -VUR -DM - papillary nrecrosis - HIV -spinal cord injury-high pressure bladder -pregnancy |
|
|
normal flora |
lactobacillus corynebacteria staph step aaerobes |
|
|
infective pathogens |
ecoli kelb, enterobacter proteus pseudomon staph sap enetrococcus candida adenovirus |
|
|
most common form of UTI |
cystitis urgency, frequency, dysuria hematuria suprapubic pain |
|
|
upper urinary tract symptmos |
fever figors flank pain abnominal pain N/V |
|
|
UA |
- leukesterase -nitrite WBC 10+ WBCs |
|
|
urine culture |
100+ colonies is diagnostic |
|
|
GU abnormalities that cause bacterial persistence |
-stones, chronic prostatitis, atrphic kidneys, ectopic ureters, foreign bodies, diverticula, medullary sponge kidnesy, infected urachal cyst, inffected cysts of renal calyces, papillary necrosis, perivesical abscess with fistula to bladder
|
|
|
indications for imaging with UTI |
dont respond to treatment predisposing factors |
|
|
ddx |
-gonorrhea, chlamydia, trich, vaginitis, prostatitis, nephrolithiasis, trauma, GU TB, GU neoplasma, intra-abdominal abscess, sepsis |
|
|
uncomplicated infections |
-acute cystitis in non preg - premen female -acute pyelo in healthy patient -post pub females suscept due to sex - delayed bladder emptying -use diaphgragm for spermicide (alter flora) |
|
|
complicated UTIs |
- predisposing factors present - obstructed urinary flow: congential cuase - prostatic obstruction - stones - incomplete bladder emptying: anatomical cause neurogenic -vesicoureteral reflux -forgeign body -systemic illness: DN - pregnancy - males participating in anal intercourse |
|
|
uncomplicated UTI tx |
3 days: TMP/SMX (7 days no more effective) |
|
|
tx pts with DM, symptoms for 7+ days, pregnancy, 65yo+, hx pyelo, UTI resistance organ |
7-10 day course |
|
|
complicated UTI tx |
(acute peylo) - empirirc after culture: ampicillin plus aminoglycoside or ampicillin/vnc plus amnioglyco - adjust by culture resutls - bloox cultures - switch to oral after 48hrs treat 14 days |
|
|
epididymitis tx |
TMP/SMX or fluro for 3 weeks |
|
|
acute bacterial prostatitis t |
TMP/SMX for fluoro for 4 weeks |
|
|
chronic bacterial prost |
TMP/SMX 6-12 weks |
|
|
test of cure |
done in pregnancy, peylo and complicated or relapsing UTI |
|
|
re-infection |
relatively rapid same or different organism tx each infection separately 6-12 months of prophylaxis can be don e recurrent cystitis: single dose abx post coital |
|
|
relapsing infectoin |
failure to clear trigger urologi investigation==anatomic cause |
|
|
asymptomatic bacteruria |
doesent need treatment==except in pregnancy tx not indicated for elderly or cathed pts |
|
|
torsion |
- high attachment of tunica vaginalis: rotates really on spermatic cord withinthe tunica "bell clapper deformity" - longitudinal lie - get venous occlusoin ---then artery - 720 degree twist needed to compromise flow throgh artery |
|
|
extravaginal testicular torsion |
- not descended yet - not attached to tunica vag |
|
|
most commoncause test loss |
torsion 70% prenatally 30% post |
|
|
salvage rate |
100% if less than 6 hours 20% 12 hours + 0% 24hrs+ |
|
|
exam of torsion |
- exquisite pain - high horizonal lie -progressive edema inflammation -bcomes confluent mass --looks like epididymoorchitis *afebrile, free voiding symptoms (dysuria), normal UA and white count |
|
|
imaging |
US with doppler ---look at testicular perfusion |
|
|
appendage torsion |
-mullerian or wollfian remnants - acute scrotal pain and mass - palpable with normal lie - palpate edematous appendage - blue dot sign -normal perfusion on doppler -self limited - dont need surgery: excise if you do |
|
|
penetrating injuries |
surgically explore |
|
|
blunt trauma |
-not ruptured if clearly palpate all the way around -US to look at homogeneity and continuity ot tunia |
|
|
need surgical eploration if |
break in tunica marked loss of homgeneity |
|
|
when to surgically reapair |
only rupture not in : hematoma, contusion, hematocele |
|
|
incision |
-penetrating: vertical (extend to groin) - blunt: transverse over injured compartment |
|
|
epididymitis cause |
<35yo---gonorrhea chlamydia older men: BPH or UTIs---gm negative |
|
|
physical exam epididymitis |
- tenderness posterior and lateral to testis - enlarged hypervascular epididymitis - normal blood to testes |
|
|
fournier's gangrene |
necrotic black tissue crepitus immediate abx, surgical drainage and debridement |
|
|
HSP |
thickenig and erythma in absence of infection scrotal edema due to hypoalbumin and portal HTN and LAD |
|
|
inginual hernia |
- pain swelling can do US or CT to clarify before exploration |
|
|
hydroceles |
increased fluid within tunical vaginalis space |
|
|
spermatoceles |
cystic dilations of fine ducts |
|
|
varicocele |
dilated pampiniform plexus |
