Urology for Students

Histotripsy is an emerging treatment being investigated for renal cell carcinoma among other solid tumors This noninvasive ultrasound-based technology uses mechanical energy (rather than thermal) to break down the target tumor while sparing nearby structures (i.e. vasculature)

An artificial urinary sphincter (AUS) helps its user regain continence (typically following radiation or removal of the prostate). Most of the day the AUS prevents leakage, but squeezing a small pump in the scrotum deflates the cuff surrounding the urethra allowing urine to flow

@Axel_LAL Check ALT text for image

@UroStuds Hi do you have the reference please?

Ultrasound remains the most useful modality for diagnosis and monitoring of hydronephrosis, even able to identify prenatal cases. An example grading system is shown here. If intermediate or high risk on US, a voiding cystourethrogram (VCUG) can evaluate for vesicoureteral reflux

@DrSanjayPande10 @S3 Thanks for this follow up!

The initial placement of the Tinelead at 60 degrees @S3 foramen serves in modulating the pelvis -Bladder-Bowel complex towards finale of transforming in #sacralneuromodulation in Refractory urine Incontinence ,faecal incontinence, Refractory pelvic pain & Non-obstructive urine retention @KDAH #Mumbai

Symptoms of neurogenic bladder can range from overactivity with urge incontinence to interactivity with incomplete emptying. With an external control and the help of their urologist, each patient can fine-tune the pacemaker's programming to meet their unique symptom profile.

Described as a "bladder pacemaker," sacral neuromodulation (SNM) is traditionally performed for patients with neurogenic bladder. A subcutaneous pulse generator sends impulses via electrodes through the S3 sacral foramen to modulate nerve signaling and restore bladder function.

Workup of microhematuria depends on risk stratification (see AUA risk classification)! Low Risk: Repeat UA in <6mo or cystoscopy + renal US Intermediate risk: cystoscopy + renal US High Risk: cystoscopy + CT urogram

Helpful mnemonic when thinking of causes of hematuria! Pee Pee ON THIS (4 T's) Period (menses) Prostate Obstruction of urinary tract Nephritis Trauma of GU system Tumor or GU system Tuberculosis of GU system Thrombosis (renal vein) Hematologic Infection/inflammation Stones

Some treatment options for incontinence. Not all-inclusive, but some high-yield options! Stress: Lifestyle modification, pelvic floor exercises, pessary, pelvic floor surgery Overflow: cholinergic agonists Urge: Lifestyle modification, bladder training, antimuscarinics

Simplified etiologies for different types of incontinence! Stress: decreased urethral sphincter tone, hypermobile urethra Urge: detrusor muscle overactivity Overflow: impaired detrusor contraction, bladder outlet obstruction Stay tuned for treatment options!

High Yield STEP Tip! Circumcision is contraindicated in boys with hypospadias that includes the foreskin because the foreskin can potentially be used for a skin flap when performing urethroplasty.

Premature ejaculation (PE) diagnosed based on history provided by patient. Treating PE: - SSRIs used off-label, but first line for treatment - Topical penile anesthetics are another option. One study has reported that moderate physical activity can also lead to improvements.

USPSTF screening guidelines: -Prostate cancer: men 55-69, undergoing PSA-based screening should be an individual decision where risks/benefits are explained -Bladder cancer: insufficient evidence to assess if benefits outweigh harms for screening in asymptomatic adults

Ischemic priapism: Diagnosis can be made without imaging, and intervention should not be delayed. Goal of treatment is detumescence. Blood dyscrasias like sickle cell disease/trait, along with certain medications can predispose. Aspiration/irrigation is one form of treatment.

Arterial supply of the adrenal gland! Adrenals receive blood from 3 main vessels: 1. Superiorly, branches of the inferior phrenic artery 2. The middle adrenal artery stemming from the aorta 3. Inferiorly, from the inferior adrenal artery coming off the renal artery

Physical exam for testicular torsion: An absent cremasteric reflex is associated with torsion. A normal cremasteric reflex is strongly associated with normal testicular blood flow, however, it is important to note this finding alone is not enough to rule out torsion.

UTIs during pregnancy require tailored antibiotic treatment due to toxic effects of some drugs. Aminopenicillins and cephalosporins are commonly used and considered safe and effective. Nitrofurantoin should be avoided near term due to risk of hemolytic anemia to the newborn.

Metanephric adenoma is a rare, benign renal mass. Presenting laboratory findings may be polycythemia. These tumors are characterized by canonical BRAF V600E mutations and thought to arise from arrested embryonal rests. Histology is shown!

Thiazide diuretics can be used to reduce the rate of calcium stone recurrence by acting on the distal renal tubule to promoting calcium reabsorption. Potassium supplementation may be used to prevent thiazide-induced hypokalemia.