Name the structures of the renal hilum from anterior to posterior.
- vein
- artery
- ureter
Which renal vein can be ligated given more robust collaterals?
the left
Describe the course of the right renal artery.
posterior to the IVC
Describe the relationship of the ureter to major vessels.
- over the iliacs
- under the uterine artery
What is the most common cause of urinary retention in males?
prostatomegaly
How long does a suprapubic tract take to mature?
4-6 weeks
How often should chronic indwelling catheters be changed?
every 4-6 weeks
What are the most common type of kidney stones?
calcium oxalate
Staghorn calculi is a buzzword for what type of nephrolithiasis?
struvite
Which type of kidney stones are radiolucent?
- urate
- cysteine
What are five indications for surgical intervention for kidney stones?
- intractable pain
- non-resolving infection
- progressive obstruction/renal damage
- stones unlikely to spontaneously pass (>6mm)
- patient with a solitary kidney
What size kidney stone is unlikely to pass spontaneously?
one that is > 6mm
What are contraindications to extra-corporeal shock wave lithotripsy?
- pregnancy
- disposition to easily bleed
- stones that are several cm in size
Varicoceles have a predominance for which side? Why?
the left because the left gonadal vein drains into the L renal vein (R drains into the IVC)
Isolated right sided varicoceles are concerning for what?
a retroperitoneal process since the R gonadal drains directly into the IVC and shouldn’t be a source of high pressure
What is the differential for a painless enlarged scrotum?
- hydrocele
- inguinal hernia
- tumor
- varicocele
- spermatocele
Hydroceles are an accumulation in what space?
between the parietal and visceral layers of the tunica vaginalis
What is the natural history of a non-communicating hydrocele in a pediatric patient?
most will spontaneously resolve
How can you differentiate a spermatocele from a hydrocele on exam?
typically can palpate the fluid collection and the testicle for a spermatocele but not for a hydrocele
What is the number one cause of cancer-related mortality in young men?
testicular cancer
What is the diagnostic/staging workup for a testicular tumor?
- scrotal US
- CT C/A/P
- B-hCG, AFP, LDH
What are the two types of germ cell tumors and what is the fastest way to differentiate between the two?
- seminoma and non-seminoma
- seminomas have no AFP elevation
How are testicular seminomas differentiated from non-seminomas? How are they treated?
- seminomas have normal AFP
- treat with orchiectomy and retroperitoneal XRT for all stages
- chemotherapy is reserved for bulky RP metastatic disease
How are testicular non-seminomas differentiated from seminomas? How are they treated?
- have an elevated AFP
- treat with orchiectomy and RP lymph node dissection
- neoadjuvant therapy for anyone with spread beyond the testis
