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Urology Review: BPH, Nephrolithiasis, and Urological Malignancies, Study Guides, Projects, Research of Urology

Virginia State University (VSU)Urology

A concise overview of common urological conditions, including benign prostatic hyperplasia (bph), nephrolithiasis, paraphimosis, phimosis, testicular torsion, urethral stricture, bladder cancer, penile cancer, prostate cancer, testicular cancer, and renal cell carcinoma. It covers clinical manifestations, diagnostic approaches, and treatment options for each condition. Additionally, it addresses perioperative renal risk assessment and management of renal/gu complications, lithotripsy, urinary catheter use, vasectomy, and dialysis indications and procedures. Useful for medical students and healthcare professionals seeking a quick reference guide to urological disorders.

Typology: Study Guides, Projects, Research

2025/2026

Available from 10/18/2025

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Surgery Rotation - Renal/GU Study Guide
1.
BPH:
- Prostatic epithelial and stromal cell hyperplasia in the periurethral (transition) zone
’obstructed urinary
outlet
-
Hyperplasia
promoted
by
sex
hormone
and
cytokines
-
50%
develop
by
60yr,
>90%
by
85yr
2.
BPH CM: HI FUN:
-
Hesitancy
-
Intermittence,
Incontinence
-
Frequency,
Fullness
-
Urgency,
UTIs
-
Nocturia
3.
BPH
dx:
-
DRE:
uniformly
enlarged,
nontender,
rubbery
-
‘PSA
>4
-
Urinalysis/Cx:
hematuria,
bacteriuria
if
UTI
-
US:
size
of
bladder,
prostate,
hydro
-
Cystoscopy:
bladder
diverticula/calculi
pf3
pf4
pf5
pf8
pf9
pfa
pfd
pfe
pff

Partial preview of the text

Download Urology Review: BPH, Nephrolithiasis, and Urological Malignancies and more Study Guides, Projects, Research Urology in PDF only on Docsity!

Surgery Rotation - Renal/GU Study Guide

  1. BPH: - Prostatic epithelial and stromal cell hyperplasia in the periurethral (transition) zone ’obstructed urinary outlet
  • Hyperplasia promoted by sex hormone and cytokines
  • 50% develop by 60yr, >90% by 85yr
  1. BPH CM: HI FUN:
  • Hesitancy
  • Intermittence, Incontinence
  • Frequency, Fullness
  • Urgency, UTIs
  • Nocturia
  1. BPH dx: - DRE: uniformly enlarged, nontender, rubbery
  • ‘PSA >
  • Urinalysis/Cx: hematuria, bacteriuria if UTI
  • US: size of bladder, prostate, hydro
  • Cystoscopy: bladder diverticula/calculi
  1. BPH tx: - Watchful waiting if mild sx
  • Terazosin, Tamsulosin (a-blocker): “muscle tone
  • Finasteride (5-alpha reductase inhibitor): “size
  • Tadalafil (PDE-5 inhibitor)
  • Refractory: TURP (transurethral resection of the prostate)
  1. TURP indications: - Moderate-severe sx and small prostate (<30g)
  • Refractory urinary retention
  • Recurrent UTIs
  • Persistent gross hematuria
  • Recurrent bladder calculi
  • Bladder decompensation
  • Upper urinary tract compromise with renal insuflciency or hydronephrosis
  1. nephrolithiasis: - urinary calculi (solid particles) in the urinary system
  • MC in the uterovesical junction
  1. nephrolithiasis RF: - Hyperparathyroidism
  • Prior episode
  • Famhx
  1. nephrolithiasis inpatient indications: - concomitant obstruction and infection
  • significant obstruction and solitary kidney
  • intractable vomiting
  • urinary extravasation (anuria)
  • hypercalcemic crisis
  • renal colic + UTI and/or fever
  • pain not controlled with PO meds
  1. nephrolithiasis tx: <5mm: 80% spontaneous passage:
  • IVF, analgesics (IV morphine/NSAID) 5-10mm: 20% spontaneous passage
  • Tamsulosin
  • Lithotripsy (extracorporeal shock or laser)
  • Ureteroscopy ± stent

10mm:

  • Percutaneous nephrolithotomy or ureteral stent
  1. nephrolithiasis prevention: 1.6L/24hrs of water (7 cups or 1/2 gallon) per day
  1. paraphimosis: - acute entrapment of the foreskin behind the glans
  • tourniquet ettect = urological emergency,
  1. paraphimosis CM: - severe penile pain and swelling distal to the constricting ring
  • erythema and engorgement
  1. paraphimosis tx: - Manual reduction of the glans
  • Refractory: dorsal slit
  • Circumcision once edema resolves
  1. phimosis: - chronic inability to retract the foreskin
  • often resolves by 5yr
  1. phimosis tx: - Topical betamethasone
  • Refractory: Circumcision
  1. testicular torsion: - Twisted spermatic cord ’“blood flow to the testis
  • Often after vigorous activity or minor trauma
  • MC in postpubertal boys (10-20yr)
  1. testicular torsion CM: - Acute unilateral testicular pain and swelling
  • N/V
  • "Bell clapper deformity": asymmetric high-riding testicle
  • (-) Prehn's sign: lifting does NOT relieve pain (that's epididymitis)
  1. bladder cancer: - MC urinary tract malignancy
  • MC: transitional cell carcinoma
  • RF: smoking, occupational exposure, cyclophosphamide
  1. bladder cancer CM: - painless, gross hematuria
  • dysuria, urgency, and frequency
  1. bladder cancer dx: - Cystoscopy + Bx
  • CT urography with contrast to evaluate extent
  1. bladder cancer tx: - Complete transurethral resection of bladder tumor (TURBT)
  • Cystoscopy q3 months
  • Cisplatin-based chemotherapy intravesical if recurrent/multiple lesions
  1. penile cancer: - MC SCC in uncircumcised males
  • RF: HSV and HPV
  1. penile cancer CM: - Exophytic mass or blister progresses into a wart-like growth
  • MC on the glans > coronal sulcus > prepuce
  • Bloody or foul-smelling discharge
  • ± inguinal lymphadenopathy
  1. penile caner dx: Biopsy: inguinal lymph nodes followed by pelvic and retroperitoneal lymph nodes
  1. penile cancer tx: - Early: limited excision
  • Late: Penile amputation + lymph node dissection
  1. prostate cancer: - MC adenocarcinoma in the peripheral zone
  • RF: >40yr, genetics, black, high animal fat diet
  1. prostate cancer CM: - Asx until advanced
  • Urinary frequency, urgency, retention, “urinary stream
  • hard, irregular, nodular prostate
  • back/bone pain if metastatic
  1. prostate cancer dx: - PSA <4 + (-) DRE: f/u in 1yr
  • PSA 4.1-10 + (-) DRE: biopsy
  • PSA >10 or abnormal DRE: TRUS + biopsy, bone scan to r/o mets for PSA > 10
  1. prostate cancer screening: - USPSTF: none (55-69 individual decision)
  • ACS: PSA and DRE for >50yr men with a life expectancy >10yrs or 40-45yr at high risk
  1. prostate cancer gleason score: 1. small, uniform glands
  2. more stroma between glands
  3. distinctly infiltrative margins
  4. irregular masses of neoplastic glands
  5. only occasional gland formation
  1. testicular cancer CM: - firm, painless, non-tender testicular mass
  • heavy feeling in the scrotum
  • common mets to belly, brain, and lungs
  1. testicular cancer dx: - Scrotal US
  • Seminoma: ‘B-HCG, LDH
  • Nonseminoma: ‘AFP, B-HCG, LDH
  • Radical inguinal orchiectomy is definitive
  • Screening NOT recommended
  1. testicular cancer tx: - Orchiectomy + radiation ± chemo
  • Seminomatous are radiosensitive
  • Nonseminomatous are radioresistent
  • AFP will increase risk of recurrence
  1. renal cell carcinoma (RCC): - Tumor of proximal convoluted renal tubule cells
  • MC type of renal cancer
  • RF: smoking, obesity, HTN, dialysis, men
  1. RCC CM: - Triad: hematuria, flank pain, palpable abd/flank mass
  • HTN and hypercalcemia
  • Left-sided varicocele
  • Mets MC to the lung
  1. RCC dx: - Abd CT: initial test
  • Biopsy is gold standard
  • Anemia
  • scans to assess for metastasis
  1. RCC tx: - Radical nephrectomy (usually curative)
  • Advanced: Molecularly targeted agents and debulking nephrectomy
  1. Wilms tumor: nephroblastoma
  • asymptomatic abdominal mass that does not cross midline in child (avg 3.5 years)
  • no other signs
  • HTN, fever, hematuria, anemia dx: U/S, CT --> confirmed by biopsy tx: surgical resection and chemo, most curable
  1. perioperative renal risk assessment: pre-existing conditions like CKD, DM, HTN, increase risk of postoperative complications like AKI
  • assess Cr/GFR preoperatively
  • advanced age, HF, nephrotoxic medications increase risk of injury
  1. perioperative GU RF: urinary retention, patients with BPH
  • prostate cancer, UTI, hx neurogenic bladder are RF for GU complications
  • pelvic surgery can Increase risk of ureteral injury or neurogenic bladder dysfunction
  1. Renal/GU complications: Acute kidney injury (AKI)
  • rise in serum Cr, hypoperfusion, nephrotoxic drugs, or sepsis
  • ensure adequate hydration, avoid toxins, monitor closely Urinary retention
  • anesthesia, analgesics, bladder outlet obstruction
  • early mobilization, cautious use of catheters, monitor bladder volumes UTIs
  • minimize catheter use, aseptic technique, early catheter removal Electrolyte imbalances (hyperK, hypoN)
  • surgery, fluid shifts, renal impairment
  • regular monitor of electrolytes and adjust fluid accordingly
  1. lithotripsy: - breaks down kidney or urethral stones that are too large to pass spontaneously (>5-10mm) or cause significant sx
  • 2 types: extracorporeal shock wave or laser
  1. extracorporeal shock wave lithotripsy: - non-invasive shock waves fragment stones from outside the body
  • uses US or fluoroscopic guidance
  • best for smaller stones in the kidney or upper ureter
  1. laser lithotripsy: - inserts a scope through the urethra to directly visualize and fragment stones with a laser
  • best for larger stones in the kidney or lower ureter
  1. lithotripsy management: - ‘oral hydration to promote passage
  • risk of hematuria, pain, UTI, ureteral injury, stricture
  • fragments can cause steinstrasse (column of residual fragments causing obstruction)
  1. urinary catheter: - drains urine during acute or chronic retention
  • monitors urine output
  1. urinary cath types: - Indwelling (Foley): long-term drainage
  • Intermittent: short-term or self cath
  1. urinary cath procedure: - catheter is lubricated and inserted through the urethra into the bladder
  • catheter sizes vary based on pts size and indication (often 14-18 French for adults)
  1. urinary cath management: - Prompt removal when no longer indicated to “CAUTI

- GFR <

  • Fluid overload unresponsive to diuresis
  • Refractory hypERkalemia
  1. dialysis procedure: - requires a vein >5mm close to the skin for 2 e 0 c m
  • often uses an AV fistula between cephalic vein and radial artery
  • prosthetic graft used if no vein available
  1. hemodialysis: - acquired through AV fistula or prosthetic graft
  • 3x/week treatment for 3-5hr per session
  1. peritoneal dialysis: - Dialyzer instilled into peritoneal cavity through indwelling catheter
  • Water/solutes move across capillary bed between visceral/parietal layers and into dialysate, which is then drained
  • Fresh dialysate is instilled, creating an exchange
  • Can be done overnight at home
  • Risk of peritonitis