Nephrology: Genitourinary Part 3

A scrotal mass that is painful, with a high riding or horizontal testicle and N/V is most likely caused by what? How should further evaluation be conducted?

Presumed torsion, perform doppler and schedule urology consultation

A scrotal mass that is painful, that does not have a high riding or horizontal testicle and N/V, and has a blue dot sign is most likely caused by what?

Torsion of testicular appendage

A scrotal mass that is painful, that does not have a high riding or horizontal testicle and N/V, and does not have a blue dot sign, lacks blood flow on doppler, and has CRP less than 24mg is most likely caused by what? How should further evaluation be conducted?

Testicular torsion. Urgent surgical evaluation required.

A scrotal mass that is painful, that does not have a high riding or horizontal testicle and N/V, and does not have a blue dot sign, lacks blood flow on doppler, and has CRP more than 24mg is most likely caused by what?

Likely epididymitis/orchitis, possibly incarcerated inguinal hernia or hemorrhagic cancer.

A scrotal mass that is non painful and illuminates is mostly caused by what?

Hydrocele

A scrotal mass that is non painful and does not illuminate, and has a "bag of worms" feeling on palpation that increases with valsalva maneuver is most likely caused by what?

Varicocele

A scrotal mass that is non painful and does not illuminate, does not have a "bag of worms" feeling on palpation, but can be reduced is most likely caused by what?

Hernia

A scrotal mass that is non painful and does not illuminate, does not have a "bag of worms" feeling on palpation, cannot be reduced, and is extratesticular and nontender is most likely caused by what?

Likely benign, further workup not needed

A scrotal mass that is non painful and does not illuminate, does not have a "bag of worms" feeling on palpation, cannot be reduced, and is tender needs what type of further workup?

Doppler and urology consult

What is a Urethrocele?

An idiopathic circumferential prolapse of the urethral mucosa through the urethral orifice.

What are the risk factors for Urethrocele?

Prepubertal girls and postmenopausal women

What are the clinical manifestations of Urethrocele?

Painless swelling

What is the treatment for Urethrocele?

Topical estrogen cream 2-3x a day and Sitz Bath. Surgical excision for recurrent/refractory cases

What is a Cystocele?

Prolapse of the urinary bladder through the vagina

What are the risk factors for Cystocele?

Childbirth, cough, constipation,heavy lifting

What are the clinical manifestations of Cystocele?

Pelvic fullness and pressure, incomplete bladder emptying

How is Cystocele diagnosed?

Voiding cystourethrography

What is the treatment for Cystocele?

Flexible ring pessary and surgical repair

What are the complications of Cystocele?

Recurrent UTI

What are the causes of Non-infectious cystitis?

Interstitial cystitis, drug induced cystitis, radiation cystitis, chemical cystitis

What are the clinical manifestations of non-infectious cystitis?

Dysuria, suprapubic pain, urge incontinence, urinary frequency

How is non-infectious cystitis diagnosed and evaluated?

Urinalysis and M/C/S to rule out infection

How is non-infectious cystitis treated?

Supportive treatment with urinary analgesics and fluids. If Interstitial cystitis, then administer pentosan polysulfate sodium (elmiron), bladder stretch by gas or fluid distension, and transcutaneous electrical nerve stimulation.

What is Incontinence?

Involuntary urinary leakage

What is Functional Incontinence?

Incontinence due to limited mobility or restricted access

What are the three types of Structural Incontinence?

Stress, urge, and overflow

What is stress incontinence and how is it treated??

A type of urinary incontinence characterized by involuntary leakage of urine, which occurs following any activity associated with increased intra-abdominal pressure (e.g., coughing, sneezing). It is caused by conditions that are marked by sphincteric resistance being overcome by bladder pressure (e.g., pelvic floor weakness, intrinsic sphincter deficiency, etc.). Treated with Kegel exercises.

What is urge incontinence and how is it treated??

A condition of urine leakage that is preceded or accompanied by a strong urge to void. Typically caused by overactivity of the bladder detrusor muscle. Treatment is conservative and includes bladder training and antimuscarinic agents (Oxybutynin)

What is overflow incontinence and how is it treated??

An involuntary leakage of urine secondary to overfilling of the bladder. Etiologies include underactivity of the detrusor muscle and bladder outlet obstruction.Treatment with catheterization.

What is Mixed Incontinence and how is it treated??

A condition of urinary incontinence with mixed features of both stress and urge incontinence that refers to incontinence that presents with symptoms of both stress and urge incontinence. Treated with cholinergics or anticholinergics.

What is Vesico-Ureteric Reflux?

The retrograde flow of urine from the bladder into the ureter. May be primary, due to a congenital defect of the terminal portion of the ureter (most common), or secondary, e.g., due to bladder outlet obstruction, cystitis, or congenital ureteral anomalies.

What are the clinical manifestations of Vesico-Ureteric Reflux?

Recurrent UTI

How is diagnosis of Vesico-Ureteric Reflux made?

Voiding cystourethrography

What is the treatment for Vesico-Ureteric Reflux?

Primary: Low does abx antibiotics and ureteral repair and re-implantation. Secondary: Treatment of the cause.

What is Penile Fracture?

A rupture of the tunica albuginea following a blunt trauma to an erect penis and may be associated with rupture of the urethra.

What is Urethral Rupture?

Secondary complication to pelvic fracture and involves the posterior urethra. It presents as blood at the meatus, a high riding prostate, extravasation of urine into the perineum, and an inability to void.

What is Bladder Rupture?

Rupture of the bladder that is either extraperitoneal (occupies the space of Retzius) or intraperitoneal (drains into the general peritoneal cavity).

Which type of Bladder Rupture always needs surgery?

Intraperitoneal Rupture

How is Genitourinary Trauma evaluated?

CT, cystogram, Urology consult

What are the clinical manifestations of Urethral Stricture?

Straining, hesitancy, intermittency, terminal dribbling, narrow caliber stream, incomplete bladder emptying

How is Urethral Stricture diagnosed?

Cystourethrography

How is Urethral Stricture treated?

Urethral dilatation and/or stenting

What are the complications of Urethral Stricture?

Hydronephrosis and Vesical Diverticulum

What are the causes of Urethral Stricture?

Iatrogenic (MC), bacterial urethritis, Lichen sclerosus at atrophicus, Idiopathic (second MC)

What is Horseshoe Kidney?

Congenital renal fusion

What are the risk factors for Horseshoe Kidney?

Seen in 15% of turner's syndrome

What are the clinical manifestations for Horseshoe Kidney?

Asymptomatic, or causing UT obstruction, UTI, and Urolithiasis

How is Horseshoe Kidney diagnosed?

Ultrasound and CT Urography

How is Horseshoe Kidney treated?

Symptomatic treatments

What is a complication of Horseshoe Kidney?

Malignancy (signaled by painless hematuria)

What is Polycystic Kidney Disease?

An inherited disorder in which multiple cysts develop in the kidneys.

What are the types of Polycystic Kidney Disease?

Autosomal dominant (more common and less severe) and Autosomal recessive (less common and more severe)

What are the clinical manifestations of Polycystic Kidney Disease?

Hypertension, flank masses, hematuria, intracranial hemorrhage

How is Polycystic Kidney Disease diagnosed?

Renal ultrasound

What is the treatment for Polycystic Kidney Disease?

Aggressive BP control with ACEi and ARBs, monitor total kidney volume with CT/MRI, and renal transplantation definitively

What is Renal Papillary Necrosis?

Necrosis at the opening of the tubules in the pyramids into the minor calyces caused by ischemia of the renal papillae

What are the clinical manifestations of Renal Papillary Necrosis?

Painless gross hematuria, or if complicated, pain with obstruction and fever with infection

How is Renal Papillary Necrosis evaluated and diagnosed?

UA, renal ultrasound, CT/MRI with and without contrast

How is Renal Papillary Necrosis treated?

IV fluids, analgesics for pain, antibiotics for infection