28 - Urology

Stress incontinence

This type of incontinence refers to leakage of urine associated with increase in abdominal pressure.

Urge incontinence

This type of incontinence involves a sensation of an urgent need to urinate due to uninhibited bladder contraction, possibly from infection, bladder cancer, neurogenic disease, or idiopathic etiology

Overflow / paradoxical incontinence

This type of incontinence involves overflow of a small amount of urine from a distended bladder

Stress incontinence

Likely from lax pelvic support

A 48-year-old G4P3 woman presents with a 6-month history of involuntary leakage of small amounts of urine that occurs specifically when she coughs, sneezes, laughs. Most likely diagnosis?

Plain CT of KUB

Contrast-enhanced CT scans are more useful for evaluating neoplasms

What type of CT scan is requested to evaluate kidney stones?

Distal third of the ureter

What is the most common site of iatrogenic injury to the ureter?

Batson’s plexus

Similar to breast cancer

Prostate cancer can metastasize to the spine through this structure:

Transition zone

It has a periurethral location being that it surrounds the proximal urethra

What zone of the prostate is most commonly involved in benign prostatic hyperplasia (BPH)?

Peripheral zone

This is the zone most easily palpated on DRE.

What zone of the prostate is most commonly involved in prostate cancer?

Benign prostatic hyperplasia

BPH arises in the transition zone near the urethra while prostate CA arises in the peripheral zone.

Between BPH and prostate cancer, which is more likely to present early in the course with urinary symptoms?

Digital rectal examination and prostate specific antigen (PSA)

What are the best tests to screen for prostate cancer? (2)

5-alpha reductase inhibitors (5-ARIs)

Includes finasteride, dutasteride

This drug class acts by reducing intra-prostatic DHT in order to shrink and slow progression of BPH

Alpha-1 adrenergic receptor blockers

Includes tamsulosin, terazosin

This drug class acts by relaxing prostatic smooth muscle to address lower urinary tract symptoms

Prostate-specific antigen (PSA)

Cancer marker used for prostate carcinoma

Non-cancer causes (e.g. atherosclerotic cardiovascular disease)

What is often the primary cause of death in elderly men with prostate cancer?

Seminoma

What is the most common germ cell tumor in adults?

Leydig cell (stromal tumor)

What is the most common non-GCT testicular tumor?

Both (undescended has higher risk)

But the contralateral descended also has increased risk for malignancy

In cryptorchidism, which testis has increased risk for malignancy?

Malignant lymphoma

What is the most common bilateral testis tumor?

Malignancy (2-5x increased risk)

What is the most significant complication in the undescended testis in cryptorchidism?

Smoking

What is the most common cause of bladder cancer?

Conjunctivitis

Arthritis

Urethritis

Mnemonic: can’t see, can’t pee, can’t climb a tree

Chlamydia trachomatis is known trigger of reactive arthritis, also known as Reiter’s syndrome. Reiter’s syndrome is composed of:

Frequency

Urgency

Nocturia

Weak stream

Intermittency

Straining

Retention/Emptying

FUN: irritative symptoms

WISE: obstructive symptoms

Lower urinary tract symptoms can be remembered by FUNWISE, which stands for:

Cystine stones

Calcium oxalate monohydrate stones are also resistant to SWL

The success of shockwave lithotripsy depends on stone composition. Which type of renal stones cannot be broken down by SWL?

Percutaneous nephrolithotomy (PCNL)

This procedure refers to endoscopic removal or fragmentation of stones through a tract from the skin into the kidney through the flank

Shockwave lithotripsy (SWL) or retrograde intrarenal surgery (RIRS)

For kidney stones < 10 mm (< 1 cm) in size, what is the preferred method of management?

Percutaneous nephrolithotomy (PCNL)

For kidney stones > 20 mm (> 2 cm) in size, what is the preferred method of management?

Renal cell carcinoma

What is the most common primary renal cancer in adults?

Simple renal cyst

The most common benign SOLID renal mass is papillary adenoma

What is the most common benign renal mass overall?

Pain

Abdominal mass

Hematuria

What is the triad of renal cell carcinoma?