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Trans-scrotal biopsies contraindicated for testicular neoplasms... why? Recall lymphatics! Testicular lymph flow->retroperitoneal nodes Scrotal lymph flow-> superficial inguinal nodes Biopsies risk seeding the neoplasm in the scrotum, increasing chance of cancer spread.

Two methods of renal drainage for upper tract obstruction: 1. Percutaneous nephrostomy tube 2. Indwelling ureteral stent Literature shows no difference in health-related quality of life when comparing the two; however, clinical context must be considered when choosing.

Non-surgical treatment of Peyronie's Disease: FDA approved treatment is injectable collagenase clostridium histolyticum (CCH). How? Degrades the collagen plaque causing the curvature. Note: Use caution to avoid urethral injury when using for ventral plaque

Treating BPH: -Most common initial therapy includes alpha 1 antagonist (terazosin, doxazosin, etc.) How? Relaxes smooth muscle at the bladder neck and prostate, giving relief to an obstruction. Most common side effects: hypotension, retrograde ejaculation, rhinitis

Pelvic lymphadenectomy in radical prostatectomy has not shown consistent evidence of therapeutic oncologic benefit. Node dissection helps with staging and future management, but frequency of complications such as vascular injuries and post-op lymphoceles can be increased.

Possible ways androgen deprivation therapy can enhance effects of radiation therapy in prostate cancer: -Decrease number of viable clonogens --> decrease tumor volume -Improve blood flow -Eliminate small deposits outside radiation target -Decrease DNA repair/enhance apoptosis

Varicocele grading can be done based on physical exam findings. Only palpable varicoceles have been shown to be associated with male infertility factor, so imaging/repair is not recommended for subclinical varicoceles. Grading is shown below:

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.

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!

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.

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.

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

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.

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

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.

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.

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!

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

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

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