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

PDE5 inhibitors are metabolized by cytochrome P450 pathway, therefore what drugs are concerning due to their ability to increase serum levels of PDE5 inhibitors.

Cytochrome P450 Inhibitors

“SICKFACES.COM”

• S: odium valproate

• I: soniazid/ INDINOVIR

• C: imetidine

• K: etoconazole

• F: luconazole

• A: lcohol

• C: hloramphenicol

• E: rythromycin

• S: ulfonamides

• C: iprofloxacin

• O: meprazole

• M: etronidazole/ MACROLIDES

According to AUA Best practice statement who gets antimicrobial prophylaxis at removal of catheter?

And what antibiotics are recommended?

Patients with risk factors (i.e., advanced age, anatomic anomalies of the urinary tract, chronic steroid use, smoking, etc.). The antimicrobials of choice are fluoroquinolones or trimethoprim/sulfamethoxazole.

What is solfenacin? and what is it used for?

Solifenacin (Vesicare) is a anticholinergic drug selective for M_3.

_{First line for UUI}

For men with non obstructive azoospermia, aka testis is the problem what do we see for FSH & testes size?

FSH > 7.6

testes small < 4.6 cm

Hydroceles form between what layers?

Parietal and visceral layers of the tunica vaginalis.

Congenital paraureteral diverticula are most frequently associated with

VUR

Gold standard for diagnosis = VCUG

Patient on Topiramate a 24 hour urine will show_______.

And they are likely to have what kinds of stone?

hypocitraturia

Calcium phosphate

An injury below vertebral level _____ would result in a sacral spinal cord injury.

What do we see in these patients

L1

1) Detrusor underactivity/hypocontractility

2) lack of volitional control of the external sphincter

3) SUI or overflow incontinence due to weak sphincter

Weakness, muscle cramps and fatigue are common side effects of thiazide therapy…what electrolyte changes cause this?

Diuretic-induced hypokalemia or hyponatremia.

In this clinical scenario, potassium and sodium levels should always be checked!!!!

Tx: hypokalemia —> potassium supplements or switching to a combined thiazide - potassium sparing diuretic preparation.

Tx if there is hyponatremia _→ STOP thiazide use, cation repletion, and oral fluid restriction.

What nerve is impacted during Laparoscopic varicocelectomy?

The Genitofemoral nerve lies directly atop the psoas muscle in close proximity to where the gonadal vessels are ligated during this procedure.

Approximately 4-5% of patients undergoing laparoscopic varicocelectomy will complain of either temporary or permanent alterations in the sensory innervation of the anterior thigh consistent with injury to the genitofemoral nerve.

Men with Congenital absence of Vas deferens/cystic fibrosis mutation have semen parameters consistent with a pattern seen with ejaculatory duct obstruction.

What are they?

Sperm count:

Semen volume:

Semen pH

Semen coagulum

Semen liquefaction:

Semen fructose level:

Azoospermia: 0 sperm on 2 centrifuged specimens

Low semen volume (< 1.5 mL)

Acidic semen pH (< 7.0)

Can’t form semen coagulum

Prolonged semen liquefaction >30 minutes

Semen fructose levels are low

Urinary retention in young women that is associated with abnormally increased EMG activity that results in impaired external sphincter relaxation.

What is this & what’s the tx?

Fowler’s Syndrome

Tx: Sacral neuromodulation

Patient has BCR s/p RT or ablative therapy what must you do do before any salvage therapy.

GET PROSTATE BIOPSY

BCR post focal ablation, clinicians should offer

whole gland treatment by RP or RT

Men with mCRPC who have mutations in DNA repair enzymes central to homologous recombination DNA repair ( EX. BRCA1/2) should get

PARP INHIBITORS

In patients with mismatch repair deficient or MSI-H mCRPC, clinicians should offer

Pembrolizumab

Who with advanced PCA gets bone protective agent denosumab or zoledronic acid ?

Metastatic Castrate resistant prostate cancer W/ BONY METS

To prevent skeletal related events

Post biopsy, if you see HGPIN, ASAP, or AIP (atypical intraductak proliferation) which of the following should have repeat testing that includes biopsy.

Who does NOT get a repeat biopsy without further evaluation.

ASAP & AIP

Who does NOT get a repeat biopsy without further evaluation.

HGPIN

T staging for PCA

Describe Moderate hypo fractionated EBRT

Higher doses of RT given in fever sessions

What toxicity is of concern in with moderate hypofractionation in comparison to conventionally fractionated EBRT?

Small increased risk of ACUTE gastrointestinal (GI) toxicity with moderate hypofractionation.

GU toxicity (both acute & late) as well as Late GI are the same between types of RT!

What is Ultra hypo fractionated mean?

Its basically concept of higher dose with less frequency. Ultra-hypofractionation, referring to the use of fraction size ≥5 Gy, so even more given.

Ultra by-fractionation is NOT recommended to ______ unless clinical trial

High risk patients

Best predictor of pca mortality in the setting of recurrent disease post local therapy

PSA doubling time (< 10 months)

The SELECT trial showed selenium _____ against pca , and Vitamin E ______ risk of pca

SELECT trial showed selenium DOES NOT PREVENT against pca , and Vitamin E INCREASES risk of pca

voiding dysfunction post midurethral sling placement …what next?

Get cysto first prior to making any surgical decision because you want to r/o urethral erosion.

Global Polyuria

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

mag 3/renal Lasix scan cut offs for T 1/2

0-10: non obstructed

10-20 : equivocal

>20: obstructed

First line therapy for chancroid (H. Ducreyi)

Single-dose treatment with azithromycin 1 gram orally or ceftriaxone 250 mg intramuscularly

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)

Next step for patient with low risk NMIBC and a normal post op cystoscopy.

Cysto in 6- 9 months. NO cytology

NMIBC Guideline #10:

In a patient with a history of low-risk cancer and a normal cystoscopy, a clinician should not routinely use a urinary biomarker or cytology during surveillance.

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 [Think: vomiting]

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!!!!!