Surgery Clerkship > Urology > Flashcards

Urology Flashcards

(77 cards)

Study These Flashcards
1
Q

Benign prostatic hyperplasia

A
  • Tx:
    • If not bothered by symptoms, expectant management and education is appropriate.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Urodynamic testing

A
  • Proedure to determine how well the bladder empties urine on demand
  • Manometry catheter is placed into the rectum, then bladder is slowly filled with warm watter and the patient reports when they develop the urge to urinate. Urinary flow is measured as the patient is asked to empty their bladder.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Abnormalities identified during prostate exam can be further worked up via. . .

A

. . . transrectal ultrasonography

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Alpha blockers for BPH

A
  • Alfuzosin
  • Doxazosin
  • Tamsulosin
  • Terazosin
  • Silodosin
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

5-alpha-reductase inhibitors for BPH

A
  • Alfatradiol
  • Dutasteride
  • Epristeride
  • Finasteride
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Alpha blockers vs 5-alpha-reductase inhibitors in their use for BPH

A

Alpha blockers act within days and reduce the contraction of the prostate

5-alpha-reductase inhibitors take several months to start working and reduce the plasiticty of the prostate parenchyma. They also have the side effects of reduced libido, erectile dysfunction, and abnormal ejaculation.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Role of desmopressin in treatment of LUTS

A
  • Induces water reabsorption and thus decreases volume of urine produced
  • Useful for patients with persistent and bothersome nocturia
  • Taken once at bedtime
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Role of muscarinic receptor anatagonists in treatment of LUTS

A
  • Mostly indicated for overactive bladder
  • Reduce urinary urgency by reducing bladder contraction and bladder sensory threshold
  • Side effects are dry mouth, constipation, micturition difficulty, dizziness
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Combination therapy for BPH

A
  • Many patients with moderate to severe BPH take both an alpha-1-blocker and a 5-alpha-reductase inhibitor
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Factors that may indicate high risk of disease progression in BPH

A
  • High prostate volume
  • High PSA
  • Advanced age
    • These may be indicatons for combination BPH therapy in more mild cases to prevent progression, as this may avoid a surgical procedure at a later date.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Transurethral resection of the prostate

A
  • Resection of the transition zone of the prostate
  • Indicated for patients with severe bladder outlet obstruction secondary to a large prostate
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Transurethral incision of the bladder neck

A
  • Another option for severe BPH
  • Small-sized, highly symptomatic BPH is the best candidate for this procedure
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Complications of transurethral resection and incision procedures

A

Urinary incontinence

Bladder neck strictures

Retrograde ejaculation

Erectile dysfunction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Transurethral needle ablation

A
  • Deliver of low-level radiofrequency energy through a needle inserted into the prostate through the urethra
  • Produces controlled destruction of the prostate and relief of bladder outlet obstruction
  • Has a higher risk of recurrence and need for retreatment than transurethral resection
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Open prostatectomy

A
  • Most invasive surgical operation for BPH, but also more effective and durable than the rest
  • Patient selection is key to balance complications and long-term benefits
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Transurethral laser vaporization of the prostate

A
  • Laser energy delivery devices are introduced transurethrally to deliver laser energy to the prostate
  • Short-term results very good, however this treatment is relatively new and long-term outcomes data are not yet available
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Next step after detection of an elevated PSA

A

Transrectal ultrasound and prostate biopsy

If suspicious for cancer, a staging CT abdomen and pelvis is indicated

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

__ can artificially increase the PSA for a period of time

A

Digital prostate exam can artificially increase the PSA for a period of time

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

A nontender, non-transilluminating testicular mass in a man under 40 is ___ until proven otherwise.

A

A nontender, non-transilluminating testicular mass in a man under 40 is testicular cancer until proven otherwise.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Tumor markers for testicular cancer

A

AFP and beta-hCG

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Workup of testicular mass

A
  1. Testicular exam
  2. Testicular ultrasound
    • A solid, hypoechoic mass suggests malignancy
    • Biopsy is contraindicated in suspected testicular cancer due to the risk of tumor contamination of the scrotum and alterations in lymphatic drainage of the region
    • If symptomatic, CT of the thorax (lung involvement) or abdomen (back pain) is indicated for further staging at this time
  3. If suspicious for malignancy, first obtain beta hCG, AFP, LDH and then radical orchiectomy should be performed for pathology
  4. If pathology indicates cancer, retriperitoneal lymphadenectomy and full CT staging are indicated
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Elevated ___ is correlated to high tumor burden in testicular cancer

A

Elevated LDH is correlated to high tumor burden in testicular cancer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

It has been observed that individuals with testicular cancer have ___ fertility relative to their peers without cancer

A

It has been observed that individuals with testicular cancer have lower fertility relative to their peers without cancer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

In general, the prognosis for early stage testicular cancers is. . .

A

. . . excellent

Even with relapse, “cure” rates are > 99%

This is one of the most treatable forms of cancer.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Virchow node
The last lymph node in the thoracic duct, receiving afferent lymphatic drainage from the left head and neck, as well as the entirety of the chest, abdomen, pelvis, and bilateral lower extremities. Enlargement of this node may be seen in patients with intraabdominal malignancies. Identification of an enlarged virchow lymph node suggests that there is metastatic malignancy present somewhere in the body.
26
Seminomas are exquisitely sensitive to \_\_\_
Seminomas are exquisitely sensitive to **radiation therapy** Therefore, any extratesticular sites of extension of seminoma can be treated reliably with external beam radiation
27
Breakdown of testicular cancers
* 90% germ cell tumors * Half of these are seminomas * A substantial number of germ cell tumors are mixed cell type * 10% stromal cell tumors
28
Surgical management of undescended teste
* Cryptorchidism greatly increases the risk of germ cell tumor, even after the maldesecended testicle is repositioned * Orchioplexy is still recommended prior to 13 years of age, but the RR for cancer is still 2x greater than for the baseline population
29
Family history and testicular cancer
* Brother with history of testicular cancer: 8-10 x baseline risk * Father with testicular cancer: 4-6 x baseline risk
30
Tumor markers for non-seminomatous testicular cancer
AFP beta-HCG LDH
31
Patient presents with a firm, nontender testicular mass. What do you do?
This is cancer until proven otherwise, and the only way to prove it is to perform a radical orchiectomy. You should never to trans-scrotal biopsy or FNA for these as this will seed the tumor into the lymphatics -- don't fuck around. Workup includes: * **Bilateral scrotal ultrasound** * **Serum AFP, beta-hCG, LDH** * **Radical inguinal orchiectomy**
32
Testicular cancer is the most common cancer in males ages \_\_\_, and has its peak incidence at age \_\_\_.
Testicular cancer is the most common cancer in males ages **15-35**, and has its peak incidence at age **35**.
33
Approach to pediatric hematuria
34
How a voiding cystourethrogram works
You put dye into the bladder. You let the patient urinate. Then, you image the urinary system to see if there is residual dye and where it is. This is an excellent test for demonstration of **vesico-ureteral reflux,** since there will be dye in the ureters by the end of the study
35
In a pediatric patient, kidney ultrasound can tell you if someone has hydronephrosis or not. What are the two over-arching etiologies of hydronephrosis in pediatric patients?
* Obstruciton * Reflux
36
You should never use ___ when you are trying to assess for kidney stones with imaging
You should never use **contrast** when you are trying to assess for kidney stones with imaging You won't be able to see your stones!
37
Posterior urethral valves
38
Way to remember hypo- vs epi-spadias Which causes a kid to pee in his own face?
Epispadias
39
What is the only important thing to know about hypospadias/epispadias from a management standpoint?
You NEVER circumsize these kids. They will need that tissue for the surgical repair.
40
Ureteropelvic vs ureterovesicular junction obstruction
* Ureteropelvic: Obstruction is at the renal pelvis * Ureterovesicular: Obstruction is at the ureterovesicular junction
41
Patient is an 18 year old male who presents with five hours of colicky abdominal pain. Pain began after drinking a large volume of beer at their first college party. While waiting at the ER, the pain gradually and spontaneously resolves. Ultrasound shows hydronephrosis without hydroureter. Voiding cystourethrogram does not demonstrate reflux. What is the diagnosis and what is the appropriate treatment?
Dx: Ureteropelvix junction obstruction Tx: Surgery +/- stenting Note: This patient has probably had this obstruction for their whole life, it is congenital. However, at normal flow rates the obstruction was not sufficient to produce symptoms. Only when they took a large volume load (lots of beer) and a diuretic (EtOH) did their obstruction become flow-limiting and thereby symptomatic.
42
When XY embryos develop ectopic ureter, it will implant \_\_\_. When XX embryos develop ectopic ureter, it will implant \_\_\_.
When XY embryos develop ectopic ureter, it will implant **above the internal sphincter**. -- This means that they will be **asymptomatic.** When XX embryos develop ectopic ureter, it will implant **either below the internal sphincter OR into the vagina**. -- This means that it will be symptomatic, with a **constant urine leak.** These patients will present as being **persistently incontinent of urine past** normal potty-training age (~5 years old). Dx: **US** to rule out hydronephrosis. Then, **VCUG** to rule out reflux. Then, **radionuclide scan** to visualize anatomy. Tx: **Reimplantation** of ureter into bladder.
43
Vesicoureteral reflux
44
Which is a better way to biopsy prostate cancer: transrectal or transurethral?
Transrectal Prostate cancer tends to grow out of the posterior prostate into the potential space of the rectum.
45
Analine dyes
* Used in old painting and dry-cleaning equipment * Risk factor for bladder cancer
46
Risk factors for bladder cancer
#1: Smoking #2: Aniline dye exposure
47
When do you actually remove the bladder in bladder cancer?
1. If cancer is invasive 2. If there are multiple recurrences in the bladder These are pretty rare. Most bladder cancers can be locally resected with adjuvant therapy and without need for bladder resection.
48
You NEVER do a biopsy for suspected ___ cancer
You NEVER do a biopsy for suspected **testicular** cancer You will seed the needle tract. Just cut it out.
49
Teratomas are often ___ in women but often ___ in men
Teratomas are often **benign** in women but often **malignant** in men
50
Prostate cancer
51
Bladder cancer
52
Biopsying renal cell carcinoma
**Not done if malignancy is suspected.** This will just cause bleeding If there is a **small cyst** and you aren't sure whether or not it is malignant, **biopsying that is okay** -- it is less likely to cause a significant bleed.
53
Renal cell carcinoma
Note: Renal cell may secrete EPO and cause polycythemia as a paraneoplastic syndrome. However, it may also sequester blood and cause anemia.
54
Who do you screen for prostate cancer?
Only those who had a first-degree relative with prostate cancer Otherwise, no screening, just diagnostic PSAs when patients present with symptoms or findings on exam
55
Testicular cancer overview
56
Preferred alpha blocker for BPH
Tamsulosin It is the most bladder specific and has the least orthostatic hypotension as a side effect
57
Things NOT to order on someone with run-of-the-mill BPH
DO NOT order a prostate biopsy, DO NOT order a PSA These are tests you would only ever order if you *think they have cancer* Otherwise you are going to do more harm then good. **Instead, your diagnostic test is a therapeutic trial for BPH.** You should also order **urinalysis and culture** to rule out UTI, which can mimic BPH with LUTS.
58
Nighttime tunescence test for erectile dysfunction
Place a special tape or stamp over the penis at night. Men normally have erections at night -- this will break the tape/stamp. This shows you that erectile dysfunction is psychological, not physiological, in origin.
59
Treating diagnosed organic erectile dysfunction
* First, control medical diseases that may contribute (smoking, obesity, diabetes) * PDE-i (sildenafil) -- first-line * Pumps * Prosthesis
60
When won't phosphodiesterase inhibitors (like sildenafil) work for organic erectile dysfunction?
In the case of spinal trauma, radiation, or prostate surgery. Still try them first, but they are unlikely to work.
61
Never give __ with PDE inhibitors
Never give **nitrates** with PDE inhibitors Causes an unsafe drop in blood pressure
62
Features specific to testicular torsion
* Spotaneous, unprovoked pain * Horizontal lie of testicle * Elevation of testicle produces severe pain
63
If someone has an episode of testicular torsion, they will need. . .
. . . **bilateral testicular orchoplexy** Basically tie-down and secure the blood supply to the testicle so that it cannot twist on itself again. This is done **bilaterally**, since if it happens to one testicle the other one is also at risk.
64
Etiology of epididymitis by age
\< 35 y.o. Gonorrhea, chlamydia 35-55 y.o. Gonorrhea, chlamydia, E. coli \> 55 y.o. E coli
65
Features specific to epididymitis
* Spontaneous scrotal pain which develops gradually * Vertical lie of testicle * Relief of pain on elevation of testicle
66
Testicular torsion vs epididymitis
67
Prostatitis
68
On the exam, they will have you differentiate between prostatitis and \_\_\_.
On the exam, they will have you differentiate between prostatitis and **pyelonephritis**. They can actually look pretty similar. Patient will be sick as shit and appear to have pyelo but for no casts in UA and no CVA tenderness. Instead, they will have exquisite tenderness on DRE.
69
If you can't get a CT scan to evaluate for kidney stones (like in a pregnant patient), then use __ instead.
If you can't get a CT scan to evaluate for kidney stones (like in a pregnant patient), then use **ultrasound** instead.
70
Kidney stone therapy by size of stone
* **\< 0.5 cm** -- pain control only * **0.5 - 0.7 cm** -- CCB or alpha blocker to facilitate clearance * **0.7 - 1.5 cm** -- stenting or lithotrypsy * **\> 1.5 cm** -- surgery * **Any significant size with infection/sepsis:** Nephrostomy tube for drainage, figure out the stone later
71
Prehn's sign
Positive: Pain relief upon elevation of the testes (suggests epididymitis) Negative: No pain relief upon elevation of the testes (suggests torsion)
72
Struvite stones almost always require. . .
. . . surgery
73
Kidney stone management
* For imaging tests: * Non-contrast CT -- preferred * Ultrasound -- if patient is pregnant, better for proximal stones * KUB: Can be used to track known/diagnosed kidney stones
74
Optimal conditions for uric acid stone formation
* **Risk factors:** * Gout * Obesity * Diabetes * Chronic diarrhea (due to associated urine acidity) * **Conditions:** * Acidic pH * High uric acid urinary excretion * Concentrated urine
75
Urethral strictures
* Often idiopathic * Relatively common
76
Varicocele
77
Relationship between malabsorption and kidney stones
**When fat is malabsorbed, more oxalate is absorbed from the GI lumen** With more oxalate absorption, you are more prone to kidney stones. So, those with **IBD, Celiac's, or post-bariatric surgery** are at increased risk.
Surgery Clerkship
flashcards
Decks in class (42)
# Cards
Brainscape helps you reach your goals faster, through stronger study habits.
© 2026 Bold Learning Solutions. Terms and Conditions