GU System

incontinence where woman involuntarily pees herself without feeling it

overflow incontinence

first line tx of overflow incontinence

urinary catheter

definitive therapy for stress incontinence

midurethral sling

localized fibrotic changes leading to abnl penile curve

peyronie dz

tx vesicoureteral reflux

bactrim, nitrofurantoin

labs for acute cystitis

pos leukocyte esterase (pyuria), inc WBC, pos nitrates

mc etiology of pyelonephritis

e coli

pt has fever, chills, back/flank pain, n/v. + CVA tenderness. UA shows pyuria and WBC casts

pyelonephritis

tx acute pyelonephritis

cipro/levo

how to tx pyelo in preg lady

ceftriaxone

best test to dx if a pt has chlamydia, gonorrhea

NAAT

etiology of prostatitis in >35 yrs old

e coli

etiology of prostatitis in <35 yrs old

gonorrhea and chlamydia

pt has boggy prostate on DRE (firm, edematous). very tender, hot

acute prostatitis

what do you want to avoid in a pt with prostatitis

prostate massage

tx prostatitis in pt >35 yrs

FQ (levo/cipro/oflox) or bactrim

pt has nontender boggy prostate

chronic prostatitis

pt has symmetrically enlarged, firm, nontender, rubbery prostate

BPH

pt has rock hard prostate

prostate ca

best initial test for epidydimitis

scrotal US. shows enlarged epididymitis and inc test blood floq

mcc of orchitis

viral - mumps (paramyxovirus)

pt has unilateral scrotal pain. overlying skin is red and edematous. there is pain on palpation but not when on epididymis

orchitis

tx orchitis

tx sx w NSAIDs and bed rest

what is the windw of time to perform surgical detorsion on a testicular torsion

6 hours

RF for cryptorchidism

preterm delivery, low birth weight

complications of cryptorchidism

inc risk of test ca, dec fertility, test torsion, and inguinal hernia

what are testicular ca nonseminomas

assoc with high serum alpha fetoprotein and beta hCG and more resistant to radiation

what are testicular ca seminomas

simple (no tumor marker), sensitive (to radiation), slower growing, stepwise spread

pt has painless testicular mass whats next indicated test

scrotal US. if seminoma then you see hypoechoic, if nonsem you see cysts

how does a hydrocele form

fluid colelcts within layers of tunica vaginalis

what is a communicating hydrocele

when the patent processus vaginalis doesn’t close right so peritoneal fluid can leak into the scrotum

pt has painless scrotal swelling that can be transilluminated. if communicating then on valsalva the bulge gets bigger

hydrocele

initial test for hydrocele

scrotal US

tx hydrocele

waiting bc usually no tx needed

cyst on epidydimis that contains sperm.

spermatocele

pt has round freely movable soft mass on head of epidydimis that is superior and posterior. it is not connected to the testicle. it transilluminates

spermatocele

tx spermtocele

no tx

most varicoceles ar eon what teste

left testicle

pt has a soft scrotal mass with a bag of worms feel superior to the testicle. the dilation of the mass worsens when the pt valsalvas or stands up

varicocele

tx varicocele

observe in most, surgery if pain or infertility

what is a varicocele

cystic test mass of varicose veins

how to dx urethral stricture

uroflowmetry and US postvoid residual measurement. shows poor bladder emptying and low rate of urine flow. THEN retrograde urethrogram

RF for bladder ca

tobacco smoking, chemical exposure on site, cyclophosphamide

p thats painless hematuria that is intermittent. you did a UA and it ruled out benign causes. how do you work up for malignancy

cystoscopy (w biopsy to dx), renal fxn, CT urography of GU tract WITH contrast.

what chemotherapy is used to tx bladder ca

cisplatin

severe pain and swelling of shaft and glans of prnis distal to the constricting ring

paraphimosis

where does the BPH enlargement occur

periurethral (transition) zone

how to tx BPH

alpha 1 blocker tamsulosin to relax the muscle. tx the sx not the problem itself

5 alpha reductase inhibitors to dec the size of the prostate over time (finasteride)

m/c type of prostate cancer

adenocarcinoma

RF for prostate cancer

inc age >40, genetics, black, hi fat diet

pt can be asx or have urethral obstruction, or back/bone pain. on DRE there is a hard discrete nodular enlarged asymmetrical prostate

prostate ca

how to dx prostate ca

PSA inc, transrectal US guided fine needle biopsy, gleason score for aggressiveness of ca

AE to prostatectomy

incontinence and ED

chemo drug for prostate c

leuprolide

if average risk fo prostate cancer when should you start screening

50 with only a PSA

if high risk of prostate ca then when should you start screening for it

40-45 yrs

all pts with enuresis should be evaluated with a

UA

tx enuresis

behavioral therapy, desmopressin or imipramine for refractory cases

acidic urine promotes the production of what type of stone

uric acid

what are struvite stones made out of

magnesium ammonium phosphate

imaging test of choice for nephrolithiasis

CTap NO contrast

first line test for nephrolithiasis in preg

renal/bladder US

if kidney stone pt did a KUB scan what stones ar eradiopaque

calcium and struvite

if a kidney stone is <5mm how to tx

pass on its own

tx stones 5-10 mm

alpha blocker tamsulosin, shock wave lithiotripsy, ureteroscopy with stent,

how to tx stone >10 mm

refer to uro for percutaneous nephrolithotomy

RF for calcium oxalate stone

dec fluid intake

what organism can produce a struvite kidney stone

proteus

AE of cyclophosphamide chemo drug

hemorrhagic cystitis

penile cancer is assoc with

HPV 16, tobacco exposure, uncircumsized (lack of hygiene)

tx ED

PDE5 inhibitors sildenafil, tadalafil

PDE5 inhibitors are CI in

pts taking nitrates and pts with CVD

reasons for priapism

ischemic (low flow) or nonischemic (high flow)

what is ischemic priapism

dec venous outflow

what is nonischemic priapism

inc arterial inflow bc of a fistula from trauma. penis is semierect and painless

etiologies for priapism

idiopathic m/c, sickle cell dz, PDE 5 inhibitors, trazodone

dx priapism

cavernosal blood gas

what does cavernosal blood gas show in a pt with high flow (nonischemic) priapism

similar to ABG and nl glucose

what does cavernosal blood gas show in pt with low flow ischemic priapism

hypoglycemia, hypoxemia, hypercarbia, acidemia

tx ischemic priapism

corporal aspiration. inject with phenylephrine if <4 hrs duration. needle aspiration of corpus cavernosum and irrigation esp if > 4 hrs duration

tx nonischemic priapism

observe

abnl ventral placement of urethral opening with abnl ventral penile curve (chordee)

hypospadias

how do pts get hypospadias

failure of urogenital folds to fuse in embryo

hypospadias is also assoc with what other dz

cryptorchidism and inguinal hernia

abnl dorsal placement of urethral opening.

epispadias

epispadias is also assoc with what other abnl

bladder exstrophy

how to work up for urethral injury

retrograde urethrogram

RF for fourniers gangrene

immunocomp state like DM or alcohol abuse

best initial imaging of fourniers gangrene

CT scan

tx fourniers gangrene

IVF, abx (carbapenem or pip-tazo + vanco + clinda, surgical debridement of tissue, ICU admit.