Urology Lecture Review: Reproductive and Male Genitourinary Conditions

A set of Q&A style flashcards covering congenital penile anomalies, Peyronie’s disease, ED evaluation and treatment, urethral conditions, incontinence types, UTIs and prostatitis, BPH, prostate and testicular cancers, testicular torsion/epididymitis, hydrocele/varicocele/cryporchidism, and imaging considerations such as VCUG for reflux. Each card poses a question on a key concept and provides a concise answer based on the lecture notes.

What are hypospadias and epispadias, and how do they differ in terms of urethral opening location and surgical relevance?

Hypospadias is a congenital anomaly where the urethral opening is on the ventral (bottom) aspect of the penis; epispadias is when the opening is on the dorsal (top) aspect. Both can affect urinary stream and fertility and may require surgical correction, with the left image showing mild hypospadias and the right showing significant epispadias.

What is Peyronie’s disease and what factors are involved in its development and treatment?

Peyronie’s disease is a painful bend deformity of the erect penis due to fibrous plaques in the tunica albuginea. It is more common in middle-aged and older men and may be associated with Dupuytren’s contracture and trauma. It can impair sexual function if severe. It is progressive if untreated and can be treated with oral phosphodiesterase inhibitors to reduce collagen deposition and with injections directly into the penis.

What is the clinical distinction between phimosis and paraphimosis and their management priorities?

Phimosis is difficulty retracting the foreskin (not inability) and may involve swelling, redness, tenderness, and purulent discharge. Paraphimosis is an emergency where the foreskin is stuck behind the glans, creating a tourniquet effect, causing painful swelling and potential arterial/necrotic damage; management includes relief with a block and sedation, dorsal slit, and circumcision.

What is balanitis and how is it managed when it is candidal, bacterial, or STI-related?

Balanitis is inflammation of the glans penis. Candidal balanitis is treated with antifungal cream; bacterial balanitis is treated with topical antibiotics such as mupirocin; balanitis from poor hygiene or irritation is treated with appropriate topical measures. If related to an STI, systemic antibiotics are used and circumcision may be considered after infection resolution.

Why is paraphimosis considered an emergency?

Paraphimosis occurs when the foreskin retracts behind the glans and cannot be returned, producing a tourniquet effect that can compromise blood flow. It requires urgent intervention (regional block, sedation, dorsal slit) and surgical circumcision.

What is erectile dysfunction (ED) and what factors contribute to it?

ED is the persistent difficulty in achieving or maintaining an erection firm enough for intercourse. It becomes more common with age (about half of men over 40). Causes include diabetes, cardiovascular disease, neurologic disorders, pelvic surgery, prostate cancer treatment, thyroid/adrenal/pituitary disorders, medications, hormones, and psychosocial factors.

What is the purpose of nocturnal penile tumescence (NPT) testing?

NPT testing monitors nighttime erections to differentiate organic (physical) from psychogenic (psychological) causes of ED; if nocturnal erections occur, ED is more likely psychogenic or vascular/sequelae rather than organic.

What are the common adverse effects and contraindications of PDE5 inhibitors used for ED?

Common adverse effects include headache, dyspepsia, flushing, hypotension, vision disturbances, and priapism. They are contraindicated with nitrates and used cautiously in patients with recent stroke, myocardial infarction, arrhythmias, cardiovascular disease, aortic stenosis, or sickle cell disease.

What non-surgical ED treatments are available besides PDE5 inhibitors?

Lifestyle modification, vascular testing (if vascular cause suspected), pelvic floor therapy, vacuum erection devices, intracavernosal or intraurethral vasodilator injections, and penile implants as surgical management for refractory cases.

What is a hydrocele, how is it diagnosed, and when is surgery indicated?

Hydrocele is a collection of fluid within the tunica vaginalis or along the spermatic cord. It often transilluminates and is common in infants. Ultrasound is more often used in older patients. Watchful waiting is common; surgery is rarely needed unless symptomatic or persisting.

What is a varicocele and how is it evaluated and managed?

Varicocele is engorgement of the internal spermatic vein due to incompetent valves. It feels like a bag of worms, worse when standing and often improves when lying down. Right-sided varicoceles or enlarging ones warrant scrotal ultrasound; usually managed conservatively, with surgery rarely indicated.

What is cryptorchidism and why is its early correction important?

Cryptorchidism is an undescended testis. It is more common in preemies; lifetime cancer risk is increased, and infertility risk rises if not corrected. Surgical correction before age 1 reduces infertility risk; physical exam is typically sufficient, and imaging is not routinely required.

What are the key features and management of testicular torsion?

Testicular torsion is a surgical emergency involving twisting of the testis and spermatic cord leading to ischemia. It is more common in neonates and post-pubertal males. Presentation includes acute scrotal pain and swelling with a horizontal lie and often a loss of cremasteric reflex. Doppler ultrasound assesses blood flow; prompt detorsion and surgical exploration are essential.

What is epididymitis and how is it treated in younger vs older patients?

Epididymitis presents with painful scrotal swelling and tenderness. In younger patients, it is often STI-related (gonorrhea/chlamydia); in older patients, it is typically non-STI (e.g., E. coli). Management includes antibiotics (e.g., levofloxacin or Bactrim for non-STI; STI treatment as indicated) and supportive measures.

What is orchitis and how does it relate to torsion and epididymitis?

Orchitis is inflammation of the testicle, which can be viral (e.g., mumps) or bacterial and may occur with epididymitis. It presents with tender, swollen testicle; management is supportive and targeted to the infectious agent. The cremasteric reflex may be preserved unless torsion is present.

What is a testicular cancer and what markers and treatment are involved?

Testicular cancer is the most common cancer in men aged 15–35, usually germ cell tumors. It often presents as a painless testicular nodule and can be associated with a hydrocele. Tumor markers include hCG, AFP, and LDH. Diagnosis involves scrotal ultrasound and CT/PET for staging; treatment typically includes orchiectomy followed by chemotherapy; cure rates are high (about 95%).

What is penile cancer and its typical risk factors and treatment options?

Penile cancer usually presents as a painless ulcer or mass on the penis, most commonly squamous cell carcinoma. Risk factors include HPV infection, tobacco use, phimosis, and poor hygiene. Treatment ranges from topical therapy, laser, radiation, chemotherapy, to surgery; circumcision prior to treatment is often recommended for better outcomes.

What are the basics of prostate cancer screening and common risk factors?

Prostate cancer is the second most common cancer in men; risk factors include age, African American race, family history, BRCA mutations, and high-fat diets. Screening typically involves PSA testing and digital rectal exam (DRE). PSA above 4 ng/mL is a common threshold for further evaluation, though age and risk factors can modify this. Biopsy is guided by transrectal ultrasound. Metastasis commonly involves the spine, with back pain as a symptom; treatment includes surgery, radiation, chemotherapy, and androgen deprivation therapy.

What are common testicular cancer tumor markers and the general approach to staging and treatment?

Common germ cell tumor markers are hCG, AFP, and LDH. After ultrasound, CT/PET scans assess metastasis. Treatment usually involves orchiectomy followed by chemotherapy; survival rates are high (around 95%).

What imaging study is best to evaluate vesicoureteral reflux and why?

Voiding cystourethrogram (VCUG) is the best imaging test to evaluate vesicoureteral reflux, as it directly visualizes reflux during voiding and helps guide management, including potential prophylaxis or surgery for severe cases.

What is vesicoureteral reflux and how is it diagnosed and managed?

Vesicoureteral reflux is the backflow of urine from the bladder into the ureters/kidneys. Diagnostic testing includes VCUG, ultrasound, cystourethrogram, contrast-enhanced voiding ultrasound, and radionucleotide cystography. Severe reflux may require daily prophylactic antibiotics to prevent infection, and surgery in some cases.

What is interstitial cystitis and its general treatment approach?

Interstitial cystitis is a chronic bladder pain syndrome diagnosed by exclusion, more common in females, with bladder pressure and frequent urge to urinate but no infection. Treatment focuses on bladder training, physical therapy, and medications like amitriptyline or pentosan polysulfate (Elmiron).

What distinguishes acute cystitis from other urinary infections, and what is the typical treatment approach?

Acute cystitis is an ascending bladder infection (often due to E. coli) presenting with dysuria, urgency, and frequency; fever and systemic symptoms are usually absent. Diagnosis may involve leukocytes in the urinalysis. Treatments include nitrofurantoin, TMP-SMX, or cephalexin (Keflex); culture is indicated in recurrent infections, pregnancy, men, children, diabetes, or immunocompromise.

What is benign prostatic hyperplasia (BPH) and its typical management strategies?

BPH is a benign enlargement of the prostate with stromal and epithelial proliferation causing urinary symptoms (frequency, nocturia, hesitancy, weak stream). Management depends on symptom severity: lifestyle changes, alpha-1 blockers (e.g., tamsulosin) with possible side effects like dizziness and retrograde ejaculation, and 5-alpha reductase inhibitors (finasteride) to reduce progression. PDE5 inhibitors (sildenafil) can help with ED but do not reliably improve flow. Combination therapy is common; surgery is indicated for refractory retention, recurrent UTIs, large bladder diverticula, bladder stones, or renal impairment.

How is acute bacterial prostatitis different from chronic bacterial prostatitis in presentation and treatment?

Acute bacterial prostatitis presents with fever, perineal/sacral pain, and systemic illness; DRE is avoided initially. It is usually caused by E. coli and treated with IV antibiotics (e.g., ciprofloxacin or levofloxacin with or without gentamicin) or oral antibiotics if stable. Chronic bacterial prostatitis presents with chronic pelvic or back pain and variable prostate exam findings; it is difficult to treat and often recurs; treated with prolonged antibiotics (4–12 weeks) and avoidance of prostate massage.

What is the typical presentation and management of Fournier-like infection and testicular torsion texting?

Pointer gangrene (necrotizing fasciitis) requires emergent surgical debridement and broad-spectrum antibiotics (carbapenem or piperacillin-tazobactam with vancomycin or linezolid). Testicular torsion is an emergency with acute pain and requires urgent detorsion and surgical exploration; imaging (Doppler ultrasound) assesses blood flow.