Surgery EOR Renal and Genitourinary (Smarty PANCE)

Benign Prostatic Hyperplasia (BPH)

What is the most common symptom of BPH?

Urinary frequency, urgency, nocturia, and weak stream

What is the first-line treatment for BPH?

Alpha-1 blockers (e.g., tamsulosin)

What is the role of 5-alpha-reductase inhibitors in BPH?

They reduce prostate size (e.g., finasteride) but may take months to show effect

What is a key complication of untreated BPH?

Urinary retention and bladder hypertrophy

What is a common finding on a digital rectal exam (DRE) in BPH?

Smooth, firm, enlarged prostate without nodules

How is BPH diagnosed?

Clinically with symptoms and confirmed by elevated post-void residual volume or ultrasound

What surgical options are available for BPH if medications fail?

Transurethral resection of the prostate (TURP)

How does BPH affect PSA levels?

BPH may cause mildly elevated PSA, but rapid increase may indicate malignancy

What lifestyle changes can help manage mild BPH?

Limiting caffeine, alcohol, and evening fluid intake

What imaging modality is used if malignancy is suspected in BPH?

Transrectal ultrasound or MRI

Nephrolithiasis (Kidney Stones)

What is the most common type of kidney stone?

Calcium oxalate stones

What is the classic presentation of nephrolithiasis?

Sudden onset of severe flank pain radiating to the groin, hematuria

What is the first-line imaging study for suspected kidney stones?

Non-contrast CT of the abdomen and pelvis

What dietary modification can help prevent calcium oxalate stones?

Increasing fluid intake, reducing sodium, and avoiding oxalate-rich foods

What size stone is likely to pass spontaneously?

Stones <5mm are more likely to pass without intervention

What medication can be used to help facilitate stone passage?

Alpha-blockers such as tamsulosin

What is the treatment for larger stones (>10mm) or those causing severe symptoms?

Ureteroscopy, shock wave lithotripsy, or percutaneous nephrolithotomy

What is the role of urinalysis in nephrolithiasis?

To detect hematuria and assess for infection

What electrolyte abnormality increases the risk for uric acid stones?

Hyperuricemia

What is the most effective way to prevent future kidney stones?

Increasing fluid intake to maintain a urine output of at least 2L/day

Paraphimosis/Phimosis

What is phimosis?

Inability to retract the foreskin over the glans penis

What is paraphimosis?

Entrapment of the retracted foreskin behind the glans, causing a medical emergency

What is the primary treatment for paraphimosis?

Manual reduction, followed by circumcision if necessary

What is a common complication of untreated paraphimosis?

Ischemia of the glans leading to necrosis

What conservative treatments are recommended for phimosis?

Topical corticosteroids and gentle stretching

What are the indications for circumcision in phimosis?

Recurrent infections or urinary obstruction

What causes paraphimosis?

Typically due to forceful retraction of the foreskin during catheterization or hygiene

How can phimosis affect urination?

It may cause difficulty or pain with urination and ballooning of the foreskin

What population is most commonly affected by phimosis?

Uncircumcised males, particularly children and older adults

What is the definitive treatment for recurrent or severe phimosis?

Circumcision

Testicular Torsion

What is the most common age group affected by testicular torsion?

Adolescents, ages 12-18 years

What is the classic presentation of testicular torsion?

Acute onset of severe unilateral testicular pain with swelling, high-riding testicle

What reflex is commonly absent in testicular torsion?

The cremasteric reflex

What is the time frame for salvageability in testicular torsion?

Ideally within 6 hours of symptom onset to save the testicle

What imaging is preferred for suspected testicular torsion?

Doppler ultrasound to assess blood flow

What is the definitive treatment for testicular torsion?

Immediate surgical detorsion and orchiopexy

What physical exam finding suggests testicular torsion?

The affected testicle is often elevated and in a horizontal position (bell-clapper deformity)

What are the long-term complications if testicular torsion is not treated promptly?

Testicular necrosis and infertility

What is the most common underlying cause of testicular torsion?

Congenital bell-clapper deformity

How is the contralateral testicle managed during surgery for testicular torsion?

Prophylactic orchiopexy to prevent torsion in the future

Urethral Stricture

What is a common cause of urethral stricture in males?

Trauma or infection (e.g., sexually transmitted infections)

What is the classic symptom of urethral stricture?

Weak urinary stream or difficulty voiding

What is the diagnostic test of choice for urethral stricture?

Retrograde urethrogram

What is the initial management for a short segment urethral stricture?

Dilation or urethrotomy

What surgical option is considered for long or recurrent urethral strictures?

Urethroplasty

What complication can result from untreated urethral stricture?

Recurrent urinary tract infections or urinary retention

How can urethral stricture affect the bladder?

It may lead to bladder hypertrophy or diverticula

What is a non-invasive method to evaluate suspected urethral stricture?

Flow rate studies or post-void residual measurement

How does urethral stricture present on cystoscopy?

Narrowing of the urethral lumen

What is the long-term outcome of untreated severe urethral strictures?

Renal damage due to backpressure on the urinary system

Urologic/Renal Neoplasms

What is the most common type of renal cell carcinoma?

Clear cell carcinoma

What is the classic triad of symptoms in renal cell carcinoma?

Flank pain, hematuria, and palpable abdominal mass

What imaging modality is most commonly used to diagnose renal neoplasms?

CT scan of the abdomen with contrast

What is the primary treatment for localized renal cell carcinoma?

Radical or partial nephrectomy

What is the most common presenting symptom of bladder cancer?

Painless gross hematuria

What is the major risk factor for bladder cancer?

Smoking

What is the typical treatment for superficial bladder cancer?

Transurethral resection of the bladder tumor (TURBT) and intravesical chemotherapy

What tumor marker is associated with testicular cancer?

Elevated alpha-fetoprotein (AFP), beta-HCG, or LDH

What is the gold standard treatment for seminoma?

Radical orchiectomy followed by radiation or chemotherapy

What is the most important risk factor for testicular cancer?

Cryptorchidism (undescended testicle)