Special Surgery
[URO OTHER]
1) Benign Prostatic Hypertrophy This causes urgency, frequency, dribbling, and trouble starting and trouble stopping the flow of urine. It’s a natural process of aging and and isn’t premalignant. DRE reveals a smooth, rubbery prostate and essentially rules out cancer. The next step is to rule out infection with a U/A and UCx. The most important thing to do is to rule out an obstructive uropathy with a CR (rule out renal failure). Then, it’s medical therapy – no biopsies ! Treat with α-blockers for immediate symptom relief and a 5-αreductase inhibitor for long term therapy. If there’s ever evidence of obstruction ( pain, ↑Cr, hydro-anything) do an inand-out-cath to decompress the bladder.
Erection Difficulty
Nighttime tumescence
Psychogenic Psychotherapy
Organic
Resection Pumps and Prosthesis
Atherosclerosis
2) Erectile Dysfunction When a man can’t achieve an erection begin by deciding if it’s psychogenic or organic . Do this with nighttime tumescence to determine if nocturnal erections occur. If he does have erections at night, it’s psychogenic and he needs psychotherapy. However, if the patient can’t achieve erections at night there’s an organic cause. Organic causes of atherosclerosis or diabetes are usually gradual onset and can be treated with phosphodiesteraseinhibitors. Other organic causes may include a spinal injury or an Arteriovenous malformation which will not be helped by PDE-i. Instead, he can try vacuum pumps, or as the last option, prosthetic devices .
Viagra Control Condition
3) Stones Kidney stones presents as colicky flank pain with hematuria . The workup involves U/A and Ucx looking for crystals, then a CT scan to find the size and location of the stone. Try hydration and analgesics to pass the stone, lithotripsy to break it up, and finally a nephrostomy (where urologists come in). See the medical renal section for more details. 4) Bacterial Prostatitis In a patient who has UTI symptoms but also fever, chills , and low back pain pyelo might be suspected. If the guy is old, check his tender prostate and get a U/A. Once the U/A shows bugs, give IV antibiotics. Do not do any more DREs: frequent massage can cause septic shock . There’s no need for a culture. Send him home on long term fluoroquinolones. On the other hand, a person with a tender prostate but no bacteria in the urine has a prostatitis (noninfectious) (noninfectious) and just needs NSAIDs. 5) Testicular Torsion In a kid who has a sudden onset testicular pain but without fever, pyuria, or mumps suspect torsion. The testis will be exquisitely tender with a horizontal lie. Ultrasound with Doppler will show decreased blood flow. This is a urologic emergency and requires surgical intervention followed by “tacking” aka orchipexy. If it happens to one it can happen to the other - tack that one too. 6) Acute Epididymitis It’s important to separate torsion (surgery ) from epididymitis (antibiotics); it’s also a testicular pain of acute onset. The testicle is in normal lie and the cord is tender (differentiating it from torsion). Because it’s so devastating to miss torsion, do a sonogram. However, if it’s a sexually active kid who has gone for days with the p ain it can’t be torsion. It’s usually E. Coli. Treat the bug with abx.
Sudden Onset Testicular Pain Horizontal Lie Nontender Cord Cord Physical Exam
Torsion Surgery
Normal Lie Tender Antibiotics
Epididymitis Poor Blood Flow Torsed Ovary Sonogram with Doppler
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