What is the “Marshall test”?

What is the treatment of the following disorders:

Stress incontinence?

Urge incontinence?

Overflow incontinence?

Chapter 76 / Urology 763

Woman with urinary stress incontinence placed in the lithotomy position with a full bladder leaks urine when asked to cough

Bladder neck suspension

Pharmacotherapy (anticholinergics,-agonists)

Self-catheterization, surgical relief of obstruction, -blockers

URINARY TRACT INFECTION (UTI)

What is the etiology?	Ascending infection, instrumentation,
	coitus in females
What are the three common	1. E. coli (90%)
organisms?	2.	Proteus
	3.	Klebsiella, Pseudomonas
What are the predisposing	Stones, obstruction, reflux, diabetes
factors?	mellitus, pregnancy, indwelling catheter/
	stent
What are the symptoms?	Lower UTI—frequency, urgency, dysuria,
		nocturia
	Upper UTI—back/flank pain, fever, chills
How is the diagnosis made?	Symptoms, urinalysis ( 10 WBCs/HPF,
	105 CFU)
When should workup be	After first infection in male patients
performed?		(unless Foley is in place)
	After first pyelonephritis in prepubescent
		female patients
What is the treatment?	Lower: 1 to 4 days of oral antibiotics
	Upper: 3 to 7 days of IV antibiotics

764 Section III / Subspecialty Surgery

MISCELLANEOUS UROLOGY QUESTIONS

Why should orchiopexy be	T the susceptibility to blunt trauma
performed?	c the ease of follow-up examinations
In which area of the	Periurethral
prostate does BPH arise?
In which area of the	Periphery
prostate does prostate
cancer arise?
What type of bony lesions is	Osteoblastic (radiopaque)
seen in metastatic prostate
cancer?
What percentage of renal	33%
cell carcinoma show
evidence of metastatic
disease at presentation?
What is the most common	Lung
site of distant metastasis in
renal cell carcinoma?
What is the most common	Wilms’ tumor
solid renal tumor of
childhood?

What type of renal stone is radiolucent?

What are posterior urethral valves?

What is the most common intraoperative bladder tumor?

What provides drainage of the left gonadal (e.g., testicular) vein?

Uric acid (Think: Uric Unseen)

Most common obstructive urethral lesion in infants and newborns; occurs only in males; found at the distal prostatic urethra

Foley catheter—don’t fall victim!

Left renal vein

What provides drainage of the right gonadal vein?

What are the signs of urethral injury in the trauma patient?

What is the evaluation for urethral injury in the trauma patient?

Chapter 76 / Urology 765

IVC

“High-riding, ballottable” prostate, blood at the urethral meatus, severe pelvic fracture, ecchymosis of scrotum

RUG (Retrograde UrethroGram)

What is the evaluation for a transected ureter intraoperatively?

What aid is used to help identify the ureters in a previously radiated retroperitoneum?

IV indigo carmine and then look for leak of blue urine in the operative field

Ureteral stents

How can a small traumatic	Foley catheter
EXTRAperitoneal bladder
rupture be treated?
How should a traumatic	Operative repair
INTRAperitoneal bladder
rupture be treated?
What percentage of patients	33%
with an injured ureter will
have no blood on urinalysis?
What is the classic history	Patient with diabetes taking NSAIDs or
for papillary necrosis?	patient with sickle cell trait
What is Fournier’s gangrene?	Necrotizing fasciitis of perineum,
	polymicrobial, diabetes major risk
	factor
What unique bleeding	Release of TPA and urokinase (treat with
problem can be seen with	-aminocaproic acid)
prostate surgery?
What is the scrotal “blue	Torsed appendix testis
dot” sign?

766 Section III / Subspecialty Surgery
What is Peyronie’s disease?	Curved penile orientation with erection
	due to fibrosis of corpora cavernosa
What is a ureterocele?	Dilation of the ureter—treat with
	endoscopic incision or operative excision
What is a “three-way”	Foley catheter that irrigates and then
irrigating Foley catheter?	drains

Container of irrigation fluid

Irrigation

inlet

3-way Foley catheter

Irrigant outlet