Urology Boards terms

Memorize the below definitions for day of test

Post obstructive diuresis

urine output > 200 mL/hour for two consecutive hours or > 3L/24 hours after the obstruction is relieved

Global Polyuria

total daily urine production > 40 mL/kg (ex. 80 kg man = expected volume 2800 mL).

Nocturnal polyuria index (NPi)

urine at night/ total 24-hour urine volume > 33%

Metastatic RCC: IMDC Risk factors

Karnofsky Performance < 80%

Time from initial diagnosis to treatment < 1 year

Dec. Hemoglobin

Inc. corrected serum calcium

Neutrophilia

Thrombocytosis

Sampling bias

Patients are enrolled in a non-random manner

Verification bias

study design foregoes testing of a subset of patients included in the study

Confirmation bias

occurs when there is dismissal of evidence that appears to go against preconceived notions

Dietl’s crisis

episodic abdominal pain and hydronephrosis caused by extrinsic pressure from an artery —> episodes usually happen after high fluid intake. Pyeloplasty resolves it.

Treatment for meatal vs. penile vs. bulbar strictures

Anterior urethra includes …

urethral meatus, fossa navicularis, penile urethra, and bulbar urethra.

All parts of the urethra that are Associated with corpus spongiosum.

What is absent in the posterior urethra?

corpus spongiosum is absent in the posterior urethra

Imaging for posterior urethral stricture

if the stricture extends past the level of the bulbomembranous junction, RUG and VCUG at the same setting may be necessary to effectively characterize the stricture disease as the RUG alone poorly evaluates the posterior urethra

Normal urethral mucosa and its associated corpus spongiosum is replaced with scar tissue

Anterior urethral stricture disease

Abx contraindicated in peel (due to poor tissue penetration)

nitrofurantoin (dont use in peel or prostatitis)

MC SE of fluoroquinolone

GI upset, tendinopathy, QT prolongation, CNS effects (elderly), and risk of aortic aneurysm

Detrusor leak point pressure >_____ is associated with renal deterioration

>40

Bladder Outlet Obstruction Index (BOOI)

Pdet@Qmax – 2 x Qmax

-       >40 = Obstructed

-       20-40 = equivocal

-       <20 = unobstructed

PDet =

= Pves – Pabd

AUA symptom score/IPSS stratification

Symptom Score (Severity):

0 to 7 (Mild)

8 to 19 (Moderate)

20 to 35 (Severe)

What does IPSS include in addition?

Quality of Life Due to Urinary Symptoms

0 = delighted

6 = Terrible

When to give what alpha-1 blocker:

1) Person on antihypertensives/ or old with cardiac issues

Silodosin —> least impact on blood pressure

When to give what alpha-1 blocker:

Sexually active guy wants to maintain fertility

Doxazosin & Terazosin

When to give what alpha-1 blocker:

Man getting ready for cataracts surgery

All alpha-1 blockers carry risk for Intraoperative floppy Iris syndrome. But Tamsulosin is the worst!

Tamsulosin carried the highest risk for IFIS (40x that of alfusozin).

Discontinuation of tamsulosin 4 to 7 days prior to cataract surgery is routine practice, but it does not completely eliminate risk

5 - alpha reductase indicated in men with…(Hint 3 things).

1) prostate volume of > 30g on imaging

2) PSA > 1.5ng/mL, or

3) palpable prostate enlargement on (DRE)

What are storage symptoms?

Storage symptoms include frequency, urgency, nocturia and urinary incontinence.

Primary toxicity: Cisplatin

Nephrotoxicity & Ototoxicity

Chemo man = kidneys + ears are “C”

Primary toxicity: Bleomycin

Pulmonary fibrosis

Chemo man = Lungs are “B”

Primary toxicity: Vincristine + Taxanes (Docetaxel /Paclitaxel)

Peripheral neuropathy

Chemo man = Legs and arms are “ V”

Primary toxicity: Doxorubicin

Cardiotoxicity

Chemo man = heart is “D”

Primary toxicity: Cyclophosphamide

Hemorrhagic cystitis

Chemo man = Bladder is “P”

Primary toxicity: Methotrexate/ 5-flourauracil

Myelosuppresion

What chemotherapy is the least myelosuppresive

BLEOMYCIN!

Antibiotic Prophylaxis:

Transurethral cases (TURP/TURBT etc)

First line: Cefazolin (Ancef) or Bactrim

Second line:

amoxicillin/clavulanate

aminogylcoside ± ampicillin

Aztreonam ± ampicillin

Antibiotic Prophylaxis:

Transrectal prostate biopsy

First line:

flouroquinolone

3rd gen cephalosporin

1st/2nd gen cephalosporin ± aminoglycoside

Second line: Aztreonam

Antibiotic Prophylaxis:

PCNL

First line:

1st/2nd gen cephalosporin

aminoglycoside + metronidazole

aminoglycoside + clindamycin

aztreonam + metronidazole

aztreonam + clindamycin

Second line:

Ampicillin/sulbactam

Antibiotic Prophylaxis:

Ureteroscopy

First line:

1st/2nd gen cephalosporin

Bactrim

Second line:

Aminoglycoside ± Ampicillin

Aztreonam ± Ampicillin

Amoxicillin/clavulanate

Antibiotic Prophylaxis:

Urethroplasty

First line: Cefazolin (Ancef)

Second line:

Cefoxitin

Cefotetan

Ampicillin/sulbactam

Antibiotic Prophylaxis:

Penile surgery/circumcision

None required

Antibiotic Prophylaxis:

Implanted device: AUS, IPP, sacral neurostimulator

First line:

Aminoglycoside + 1st/2nd gen cephalosporin

Aminoglycoside + Vancomycin

Aztreonam + 1st/2nd gen cephalosporin

Aztreonam + vancomycin

Second line:

Antibiotic Prophylaxis:

Vaginal surgery: slings, fistula repair, urethral diverticulectomy etc

First line:

2nd gen cephalosporins (Cefoxitan & cefotetan)

Cefazolin (Ancef) can be used in slings

Second line:

Aztrenomam, clindamycin, metronidazole

What stone is pathognomonic for hypercalciuria and elevated urinary pH

BRUSHITE STONE!!

Think primary hyperparathyroidism (resorptive hypercalciuria)

Renal hypercalciuria is associated with what type of stones?

calcium oxalate!!!

Equation for Child’s bladder capacity

average bladder capacity in mL = (age in years + 2) X 30

Patient has bilateral adrenalectomy → years later develops visual disturbances and has skin hyperpigmentation. The most likely explanation is:

NELSON’S SYNDROME!

Pituitary adenoma develops due to increased ACTH secretion.

Metabolic derangement associated with ileal conduit

hypokalemic, hyperchloremic metabolic acidosis

Metabolic derangement associated with stomach used for urinary diversion

hypochloremic, hypokalemic, metabolic alkalosis

First line treatment for uncomplicated UTI in women: list the drug and duration of treatment

Nitrofurantoin: 5 days (100 mg BID)

TMP–SMX: 3 days (1 DS BID)

Fosfomycin: single dose (3 grams)

Bounce effect

PSA rise greater than 0.1 to 0.5 ng/mL followed by a durable decline and is especially common after brachytherapy,

Which antibiotic is preferred for UTI in pregnancy?

Amoxicillin-clavulanate, cephalexin, or fosfomycin.

What are the side effects of aminoglycosides (e.g., gentamicin)?

Nephrotoxicity, ototoxicity, neuromuscular blockade

What is the mechanism of action of fluoroquinolones?

Inhibit bacterial DNA gyrase and topoisomerase IV, preventing DNA replication.

What are key side effects of TMP-SMX?

Hyperkalemia, rash (including Stevens-Johnson), bone marrow suppression, nephrotoxicity.

What antibiotic class should be avoided in patients on warfarin due to increased bleeding risk?

Flouroquinolones & Bactrim elevated INR —> bleeding

Which antibiotic is commonly used for epididymitis in men <35 years old?

Ceftriaxone (IM) + doxycycline (10 days) for gonorrhea/chlamydia coverage.

Sensitivity

Given you have disease, you tested positive.

True positive/ True positive + False negative

Specificity

Given you dont have disease, you tested negative.

True Negative/True negative + False positive

Positive vs. Negative Predictive value

PPV: probability a person has disease if test result is positive.

PPV = TP/(TP + FP)

NPV: probability a person does not have the disease if the test result is negative.

NPV = TN/(FN + TN)

Lose control/coordination of movement, blood pressure, and urination [ Hint: open bladder neck on filling seen on UDS]

Shy Drager = Multiple system atrophy

Penile Doppler what is normal arterial and end diastolic

Normal arterial inflows (peak systolic velocities > 30 cm/sec)

End diastolic velocities < 5 cm/sec

Peyronies + ED what do guidelines recommend for treatment?

what is the cutoff for curvature that impacts treatment?

Inflatable penile prosthesis implant results in curvature correction and restoration of satisfactory sexual function for most men with <60 degree curvature.

If man has > 60 deg curvature, adjunctive procedures are frequently necessary, penile plication or graft incision along With IPP

Histology: concentrically laminated calcific inclusions

Michaelis-Gutmann bodies

Histology: large histiocytes

Von Hansemann cells

Yellow, raised, and soft lesions of bladder associated with Michaelis-Gutmann bodies & Von Hansemann cells

Malakoplakia

Malakoplakia tx

Usually caused by E.coli UTI so Bactrim vs. flouroquinolones

Weigert - Meyer rule

For duplicated renal system.

Ureter of the upper pole moiety obstructs. The ectopic ureter and its orifice inserts medially and inferiorly to the ureter of the lower pole moiety, and frequently ends as a ureterocele.

Ureter from lower pole moiety of the kidney refluxes and inserts laterally and superiorly to the ectopic ureter of the upper pole moiety, and reflux at its level often causes pyelonephritis.

What does impedence mean in context of neurostim

Impedance refers to the resistance to flow of electrons through a circuit. If there is too much resistance, the flow is limited.

Vas deferens travels posterior along the spermatic cord then courses ______ to the epigastric vessels & _________ to the ureter

Lateral to epigastric

Anterior to ureter

Tibial nerve stimulation is associated with ….

flexion of the great toe and tickling of the sole of the foot

Tibial nerve travels behind the _______ of the ankle. Needle for PTNS is placed 3-4 cm ____ of the _______.

medial malleolus

3-4 cm cephalic (superior) to the medial malleolus.

Squamous cell Tx

cystectomy!!!!!

Small cell tx

chemo radiation

Complete deletions of AZFa or AZFb assoc w/ ________.

No sperm! Men should not have attempts at sperm retrieval

AZFc deletions are associated with ________.

oligospermia or azoospermia but men have success with sperm retrieval!

Eligibility for cisplatin-based NAC is largely guided by renal function, with a minimum GFR of

50-60

Renal trauma, one major limitation of a CT scan is the inability to adequately define a renal ______ injury.

RENAL VEIN!!!!

Radical pelvic surgery can result in a lower motor neuron lesion and permanent voiding dysfunction.

Abdominoperineal resection: 20-68%; radical hysterectomy: 16-80%; low anterior resection: 20-25%; proctocolectomy: 10-20%.

Describe what you seen UDS.

Bladder compliance?

Detrusor activity?

External sphincter tone?

Decreased bladder Compliance

Detrusor Underactivity

Fixed external sphincter tone

cN1 disease on imaging for pca , current guidelines recommend what tx?

best treatment would be XRT combined with long-term ADT

How can you differentiate bet a urinoma & renal hematoma on CT non con.

High speed MVC what do you see?

R urinoma (you can tell because its darker, closer to water/ like a cyst)

What is this?

Left retroperitoneal hematoma (you can tell because its brighter, more hounsfields than water)

Cystatin C vs. Creatinine

Cystatin C is made in all cells with a nucleus vs. creatinine made by just muscle.

Creatinine varies a lot bet individuals based on muscle mass.

Blood concentrations of cystatin C are fairly similar between individuals with the same GFR, therefore is a better predictor of renal function in kids w/ neurogenic bladder.

Penile cancer: Non palpable lymph nodes (Hint: Low risk vs High Risk)

Low risk: surveillance or DSNB

High Risk: B/L lymph node dissection

Penile cancer: Palpable lymph nodes ( Hint: Bulky vs. Non Bulky)

Non Bulky:

• low risk: FNA biopsy

• High risk: B/L lymph node dissection

Bulky:

-Chemo/radiation vs. consolidation ILND