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Pestana Urology Ch 12

Terms in this set (30)

Testicular torsion
-epi/who
-sx
-tx
-young adolescents.
-sx: severe sudden onset testicular pain. No fever, pyuria, or mumps. "High riding" and with a "horizontal line". TENDER testis but not cord.
-tx: untwisted and orchiopexy done.
Acute epididymis
-epi/who
-sx
-tx
-who: young men (20s)
-sx: severe testicular pain AND fever, pyuria and swollen testis in normal position.
-dx: U/S
-tx: abx
Obstruction and infix or urinary tract
-etiology/sx
-tx
-while passing ureteral stone spontaneously but develops fever spike (104-105) and flank pain.
-tx: decompression above obstruction ureteral stent or percutaneous nephrostomy.
Cystitis: Urinary tract infection
-epi/who
-sx
-tx
-who: women or reproductive age
-sx: frequency, painful urination, small volumes of cloudy, malodorous urine.
-tx: empiric antimicrobial
Urologic workup: 4 types
-IVP: intravenous pyelogram (kidneys, collecting sx, ureters, sort of bladder/not cancer). Limitations: allergy to dyes and poor renal fx
-CT: good for renal tumors
-US: dilation/obstruction
-Cystoscopy: bladder mucosa, early cancer detection
Pyelonephritis
-sx
-dx
-tx
-sx: chills, high fever, nausea, vomitting, flank pain
-dx: IVP or sonogram and culture
-tx: IV
Acute bacterial prostatitis
-epi/who
-sx
-tx
- older men
-sx chills, fever, dysuria, urinary frequency, diffuse low back pain and tender prostate on rectal exam
-tx: IV abx; no more rectal exams --> sepsis
Posterior urethral valves (congenital)
-epi/who
-dx
-tx
-who: newborn boy doesn't urinate on first day of life (check metal stenosis too)
-dx: voiding cystourethrogram
-tx: catheterization to empty bladder. Endoscopic fulguration or resection will get rid of them.
Hypospadias (congenital)
-physical exam
- tx
-PE: urethral opening is on ventral side of penis.
-tx: plastic reconstruction
Vesicoureteral reflux (congenital)
-etiology/sx
-dx
-tx
-sx: reflux + infx produce burning on urination, frequency, low abdominal and perineal pain, flank pain, and fever and chills in a child.
-dx: IVP and voiding cystogram looking for reflux.
-tx: empiric abc then guided by cultures. Kids "grow out of it"
Low implantation of a ureter (congenital)
-epi/who
-sx
-dx
-tx
-who: sx girls (asx in boys)
-sx: feels need to void and voids normally at intervals but is also wet with urine all the time (urine drips into the vagina from low-implanted ureter).
-dx: Physical exam abn ureteral opening or IVP
-tx: corrective surgery
Ureteropelvic junction (UPJ) obstruction
-sx
-epi/who
-sx: normal urinary output to flow that becomes difficult with large diuresis
-epi/who: teenager who drinks beer for the first time
Hematuria ddx
- kidney, ureter or bladder cancer
-post trauma
Hematuria workup
-CT scan then cystoscopy (rule out cancer)
Renal cell carcinoma:
-sx
-dx
-tx
-sx: hematuria, flank pain, flank mass. Hypercalcemia, erythrocytosis elevated liver enzymes.
-dx: CT scan of heterogenic solid tumor
-tx: surgery/effective therapy
Cancer of the bladder (transitional cells)
-risk factor
-sx
-dx
-tx
-rf: smoking (more than lung cancer)
- sx: irritative voiding sx, incorrectly treated for UTI.
-dx: CT scan then cystoscopy
-tx: surgery and intravesical BCG have therapeutic roles, high rate of recurrence
Prostatic cancer
-epi/who:
-sx
-dx
-tx
-who: inc w/ age
-sx: asx, hard as a rock nodule on rectal exam and PSA (prostatic specific antigen)
-dx: transrectal needle biopsy, CT to guide surgery
-tx: surgery or radiation. Mets respond to androgen ablation, surgical (orchiectomy) or medical (luteinizing hormone-releasing hormone agonists, or androgens like flutamide)
Testicular cancer:
-epi/who
-sx
-dx
-tx
- young men
-sx: painless testicular mass
-dx: radical orchiectomy biopsy via inguinal route. B-HCG pre-op markers used for f/u.
- tx: radiotx and platinum-based chemotherapy even w/ mets
Acute urinary retention
-epi/who
-sx
-dx
-who: men who already have BPH. Precipated during a cold (antihistamine use, nasal drops and fluid intake)
-tx: indwelling bladder catheter for 3 days. Long term alpha-blockers (tamsulosin) or 5-alpha reductase inhibitors (finasteride). Rarely, transurethral resection of the prostate (TURP)
Post-op urinary retention
-etiology
-sx
-tx
-doesn't feel need to void b/c of post-op pain, medication, but dribbles urine every few minutes
-sx: huge distended bladder
-tx: indwelling bladder catheter
Stress incontinence:
-epi/who
-sx
-who: middle-age women who had many vag deliveries.
-sx: leak out small amounts of urine with inc intrabd pressure (sneeze, laugh, lift). Weak pelvic floor, w/ prolapsed bladder neck.
-tx: pelvic floor exercises or repair if large cystocele
Ureteral Stones
-sx
-dx
-tx small
-tx big
-sx: classic colicky flank pain with irradiation to inner thigh, n/v
-dx: CT scan
-tx small: (3mm) or less pass spontaneously 70% of the time. analgesia, fluids and watch
-tx big: 7mm at UPJ. extracorporeal shock-wave lithotripsy (ESWL), basket extractions, sonic probes, laser beams, open surgery and WATER.
Contraindication for extracorporeal shock-wave lithotripsy
-Pregnant women
-bleeding diathesis
-stones that are several centimeters large
Pneumaturia
-etiology
-dx
-tx
Caused by fistulization between bladder and GI tract (sigmoid colon) from diverticulitis, or sigmoid/bladder cancer
- dx: CT scan (diverticular mas)
-tx: surgical
Impotence
-psychogenic causes
-psychogenic tx
-organic causes
-organic tx
-psychogenic: sudden onset, does not interfere with nocturnal erections.
-psychogenic tx: psychotherapy
-organic causes: trauma, sudden onset (pelvic surgery damage) OR gradual onset chronic dz (arteriosclerosis, DM)
-organic tx: sildenafil, tadalafil, vardenafil, vascular surgery, suction devices or prosthetic implants (irreversible)
Only absolute contraindication to organ donation
HIV positive
3 types of transplant rejection and timeline
-Hyperacute
-acute
-chronic rejection
-Hyperacute
- Acute rejection:
Hyperacute
-timeline
-mediated
-prevented
-timeline: minutes
- mediated: Ab
- prevented: by ABO blood match and lymphocytotoxic crossmatch
Acute rejection
-timeline
-sx
-tx
-timeline: 5d-3mos
-sx: organ dysfx
-tx: first steroid bolus then OKT3 (lymphocyte agents)
Chronic rejection
-timeline
-sx
-tx
-timeline: years after transplant
-sx: gradual insidious loss of organ fx
-tx: none
THIS SET IS OFTEN IN FOLDERS WITH...