GU

Question 1

Triad for renal cell carcinoma

Answer 1

(present 10-15%; indicative of advanced disease)

• hematuria
• flank pain
• abdominal mass

Question 2

Pt with weight loss + left-sided varicocele… think?

Answer 2

renal cell carcinoma that has invaded renal vein (left gonadal drains to left renal)

Question 3

left vs. right gonadal drains to…?

Answer 3

left -> left renal

right -> direct IVC

Question 4

Mgmt localized RCC

Answer 4

Radical nephrectomy

Question 5

Indications for operative mgmt of bladder rupture

Answer 5

• intraperitoneal rupture (contrast extrav with resulting outlines of loops of small bowel)
• bladder neck injury
• concomitant rectal injury or major vaginal injury
• open pelvic fx
• fragments, or foreign body, within bladder

Question 6

How to repair bladder lacerations

Answer 6

Repair in two layers of absorbable suture + drains + foley

1st: mucosa + muscularis
2nd: mucularis + serosa

Question 7

Incisional approach for extraperitoneal bladder rupture needing repair

Answer 7

Pfannenstiel incision

Question 8

Incisional approach for intraperitoneal bladder rupture

Answer 8

Midline incision

Question 9

Anatomical relationship of gonadal vessels vs. ureter vs. common iliac

Answer 9

Proximal ureter runs lateral to gonadal vessels, but at some point will cross (above aortic bifurcation level) posteriorly and then medially to vessels. Then ureter will run anteriorly across external iliacs, and then run lateral to internal iliacs into pelvis.

Question 10

Suspect urethral injury if…

Answer 10

• inability to void
• high-riding prostate
• blood at urethral meatus
• pubic symphysis fracture
• straddle pelvic fractures

Question 11

Gold standard imaging for bladder injuries

Answer 11

CT cystography