Genital Pathology

• Phimosis / Paraphimosis • Balanitis • Squamous cell lesion • Erectile dysfunction Genital Pathology • Herpes • Hypospadius • Stricture • Peyronies’ Disease • Priapism

Erectile dysfunction • 65% of men over age of 65 have ED • DM, PVD, HTN, smoking, EtOH • Medications • Hypogonadism • Psychological Management of Erectile Dysfunction

• Oral medications • Urethral • tadalafil • Testosterone • sildenafil • Topical • vardenafil • Injectable • Avanafil • Implant • Injectable • Transdermal • Tri-mix • Adverse side effects • Caverject

Bladder Disorders •Cancer •Chronic cystitis •Overactive Bladder •Incontinence •Reflux •Hematuria •UTI

Bladder cancer – risks, work up, rx

•Tobacco •CT Urogram, Cytology, Cystoscopy •Paint (w/wo contrast of abd & pelvis) •Dye •Biopsy, surveillance q 3 months •Chemicals •BCG, 6 weeks once a week •Cystectomy – ostomy, pouch, diversion. Bladder Cancer • Staging determines treatment • Periodic biopsies or TURBT • BCG treatment • Cystectomy

https://commons.wikimedia.org/w/index.php?curid=34334316">Link Chronic cystitis

• Vesicoureteral reflux • Tumors • Neurogenic bladder • Foreign Bodies • Obstruction • Indwelling catheters • Congenital Abnormalities • Other • Pelvic-ureteric obstruction • Diabetes mellitus • Ureteric and urethral strictures • Renal failure • Urolithiasis • Urinary diversions • Bladder diverticuli • Urinary instrumentation

Overactive Bladder

• Rule out retention, infection • Trial of behavior modification • Diet • Weight Loss • Manage constipation • Irritants • Anticholinergics • mirbegron

Incontinence • Stress incontinence • Lack of sphincter support • Overflow incontinence • Obstruction • Atony of the bladder • Urge incontinence • Gush of urine • Excess contractions • Mixed incontinence Renal Pathology

• Pyelonephritis • Nephro/ureterolithiasis • Hydronephrosis • Renal cell carcinoma • Transitional cell carcinoma • Wilm’s Tumor Renal Pathology-Pyelonephritis

• Pain – dull, throbbing • Chills & Fever • Fatigue, malaise • Urgency & frequency • Nausea, abdominal pressure • Jaundice, bile brown/dark yellow • CVA tenderness • Flank pain

Renal Pathology - N e p h r o / ureteronephrolithiasis

• Calcium • Uric acid • Struvite • Cysteine Renal Pathology -Ureteronephrolithiasis Renal Pathology -Ureteronephrolithiasis

• Diagnosis • Definitive treatment • PE and UA • Spontaneous passage < 0.5-0.7 • KUB • Ureteroscopy/stent obstruction • Non-contrast CT • ESWL .5 – 1.5 cm, location • Treatment • Percutaneous (PCNL) large > 1 • Size does matter • Pathologic evaluation • Fluids • Prevention • Alpha blocker • Diet • Tamsulosin 0.4mg daily • Caffeine • Others • Animal protein • Analgesia • Gastric Bypass • Memetic

Renal Carcinoma • Wilm’s Tumor • Renal Cell Carcinoma • Symptoms • Abdominal swelling • Palpable abdominal mass • Abdominal pain • Fever • Blood in the urine • Etiology/epidemiology • Genetic • Black increased/Asian lower • Syndromes • WAGR • Denys-Drash • Beckwith-Wiedemann

• Renal cell carcinoma • Clear cell RCC Renal Cancer • Papillary RCC • Classic triad of symptoms in 10% • Chromophobe RCC • Flank mass • Pseudotumors • Hematuria • Oncocytomas • Pain • Benign or malignant • Approximately 2/3 of patients • Sarcoma have metastasis at presentation • Hypovascular • Only 1-3% will have a solitary metastasis • Benign cysts • Most common benign renal mass

Renal Pathology-Renal Carcinoma • Clear cell papillary renal cell • Hereditary leiomyomatosis & • Clear cell papillary AND clear RCCa cell RCCa w/ smooth muscle • Thyroid-like follicular RCCa stroma • Acquired cystic disease • Tubulocystic RCCa associated • Mucinous tubular & spindle cell • RCCa with translocation • Multilocular cystic clear cell • Hybrid oncocytoma, RCCa chromophobe RCCa

Hematuria

• Painless vs Painful • Clots • Amorphous • Veriform • Differential Diagnosis • Diagnosis • CT urogram • Cystoscopy • cytology Hematuria

• P – period, pseudo heme • T – tuberculosis • P - prostate • T – thrombosis • O - obstruction • H - hemotologic • N – nephritis • I – infection/inflammation • T - trauma • S - stones • T - tumor

Hematuria • Period, pseudo hematuria • Prostate PeePee on T4his • Obstruction • Nephritis • Trauma • Tumor • TB • Thrombosis • Hematologic • Infection/Inflammation • Stone

Urinary Tract Infection • Short antibiotic therapy • Urinalysis w/ C & S • Nitrofurantoin 100mg PO BID 5-7 • Bacteria, pyuria, RBC • SMX/TMP DS PO BID 5-7 days • Assess microscopic • Monurol, fluoroquinolones, • Counts, WBC • Extended antibiotic • Symptomatic treatment • Complicated UTI • Increase fluids • Men, pregnant, DM • phenazopyridine • Immunocompromised • • Stones, stents, catheters Treat to culture • Neurogenic bladder w/ catheters

Chronic Cystitis

• Radiation cystitis • Interstitial cystitis • Suprapubic catheters • Neobladder • Pelvic pain syndrom Congenital Disorders

• Vesicoureteral reflux • • • Cryptorchidism • Polycystic The END…… [email protected]