The Urology Guy @TheUrologyGuy Twitter profile | Pikagi

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The Urology Guy

@TheUrologyGuy

1,680

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We will be your one stop shop for exam and boards prep - no more trawling through Campbell's or wondering how much detail you need to know

Organ of Zuckerkandl

https://t.co/a9lF139xp7

Joined April 2023

Don't wanna be here? Send us removal request.

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@TheUrologyGuy

The Urology Guy

1 year

URETER SURGICAL RELATIONS Anterior to psoas, lumbar TPs Crossed by gonadal v. Crosses anterior to iliac bifurcation ♂️ vas is anterior, crossing from lat - med ♀️ureter post. to ovary, thru base of broad lig, post. to uterine a. (💦👇🌉) then crosses ant. vaginal fornix

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@TheUrologyGuy

The Urology Guy

11 months

💣❗🚩 TESTICULAR TORSION - BELL CLAPPER DEFORMITY Best photo explaining bell clapper deformity - anatomical variant predisposing to testicular torsion. Torsion = time critical emergency. What suture will you use for orchiopexy? Paper by @uro_nima @DrAsanad (link 👇)

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@TheUrologyGuy

The Urology Guy

8 months

PRINCIPLES OF URINARY ANASTOMOSES: Spatulated (⬆️ mucosal surface) Watertight (🚫 leak) Absorbable suture (nidus for stones) Stented and drained (🚫 leak) Tension free (🚫 ischemia) Well vascularised, healthy tissue (🚫ischemia) Mucosa to mucosa What suture do you use?

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@TheUrologyGuy

The Urology Guy

9 months

You WILL be asked over & over - arterial supply of the testis? 1️⃣ testicular a 2️⃣a. to vas 3️⃣cremasteric Important for: - Fowler-Stephens procedure - Vasectomy risk might be higher in someone with previous inguinal surgery - Laparoscopic varicocele ligation - Epididymectomy

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@TheUrologyGuy

The Urology Guy

8 months

BRICKER VS WALLACE ureteroileal anastomosis for ileal conduit: - Bricker - end to side - two separate anastomoses to side of conduit - Wallace - end to end - ureters joined together and placed on end of conduit Surgeon preference dictates the choice

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@TheUrologyGuy

The Urology Guy

11 months

Do you know the Mayo classification for IVC thrombus in RCC? We used to use a 2 cm cutoff above the renal vein as the differentiator between level 1 and 2. Did you know an updated classification was published in 2020? We should now use the caudate lobe as differentiator.

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@TheUrologyGuy

The Urology Guy

10 months

BLOOD SUPPLY OF THE URETER Multiple vessels forming longitudinal anastomosis Prox ureter from renal artery- from MEDIAL Distal from internal iliac, inf vesical, sup vesical- from LATERAL Mid from aorta/gonadal- from POSTERIOR Important to preserve adventitia when dissecting

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@TheUrologyGuy

The Urology Guy

1 year

🩸AAST GRADING RENAL TRAUMA 1️⃣ non expanding subcapsular haematoma or normal imaging w hematuria 2️⃣ parenchymal lac < 1 cm 3️⃣parenchymal lac > 1 cm 4️⃣collecting system injury OR contained injury to artery/vein 5️⃣shattered kidney or avulsion of hilum/devascularisation

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@TheUrologyGuy

The Urology Guy

1 year

ANATOMY OF ADRENAL Right - 🔺triangular, sup to R kidney Left - 🌙 crescent, medial to upper L kidney 🩸Arteries x 3 Superior (from inf phrenic) Middle (from aorta) Inferior (from renal a.) 🔵Single vein Right adrenal vein - short, directly to IVC ☠️☠️ Left - enters renal v.

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@TheUrologyGuy

The Urology Guy

10 months

ANATOMY OF THE PERINEUM 🦋 Colles' fascia is continuous with Scarpa's, and superficial dartos Urine/blood extravasation limited to 'butterfly' pattern But may track up abdo wall to clavicles. Classic exam q's..Confused? This video is a must 👇

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@TheUrologyGuy

The Urology Guy

10 months

PROSTATITIS Classic questions you will be asked: How do you categorise or classify prostatitis? What antibiotics will you use to treat? How do you do a Stamey test? When might you see granulomatous prostatitis? 🧵

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@TheUrologyGuy

The Urology Guy

11 months

RENAL CYSTS 🔵 Extremely common incidental finding on imaging. Do they need follow up? Could it be cancer? Use the BOSNIAK criteria to guide decision making Note Bosniak criteria is based off CT imaging with contrast. more info re: small renal mass -

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@TheUrologyGuy

The Urology Guy

11 months

How long do you stop anticoagulation prior to a procedure? Guidelines in the image - but many surgeons prefer to wait longer. Our page on anticoagulants has: - mechanisms - VTE risk stratification - reversal for NOACs

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@TheUrologyGuy

The Urology Guy

1 year

VARICOCELE 🪱🪱 15% adult men - mostly asymptomatic 30-45% men undergoing fertility workup >90% left sided (If right sided 🚩?retroperitoneal mass) Anatomy - left gonadal vein longer, 90 deg into renal vein Grading: 1️⃣palpable w Valsalva 2️⃣palpable w/o Valsalva 3️⃣visible

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@TheUrologyGuy

The Urology Guy

1 year

🚩🚩🩸🩸 Anatomy of the CAVA Knowledge of the tributaries of the IVC is ESSENTIAL for safe surgery in the retroperitoneum. Torn gonadal vein can be a bad day Torn lumbar vein can be an absolute disaster Managing avulsed lumbar? - pack - oversew - consider opening if lap

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@TheUrologyGuy

The Urology Guy

1 year

PENILE FRACTURE 🍆 3 key features Pop/crack sound 🎉 Immediate loss of erection 📉 Bruising ++ like an 🍆 10-20% assoc urethral injury - hematuria 🩸 USS or MRI can help localise injury prior to OT 🔪 Surgical exploration/repair good outcomes (vs observation - ED, curvature)

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@TheUrologyGuy

The Urology Guy

1 year

😴 NOCTURIA is not always the prostate! Independent risk factor for increased mortality ☠️ Bladder diary most important investigation: > 33 % of total daily urine output at night = nocturnal polyuria Important to assess for all causes (before TURP!)

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@TheUrologyGuy

The Urology Guy

9 months

MEDICAL MANAGEMENT OF KIDNEY STONES I've just published this page which summarises all of the guideline and algorithms for medical management and prevention of stones, based on metabolic workup. Bookmark this tweet or visit the page:

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@TheUrologyGuy

The Urology Guy

1 year

Knowledge of anatomy is mandatory in surgery. 🫁 Flank incision = risk of pleural injury ❗ Incision further posterior = more pleural attachments Medial half of the 12th rib, and medial 3/4 of the 11th rib have pleural attachments. I like supra-11 incision for partial - you?

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@TheUrologyGuy

The Urology Guy

10 months

BLADDER TRAUMA INTRAPERITONEAL injury: manage operatively -> repair EXTRAPERITONEAL injury: can manage non-op with Foley drainage Indications to repair extraP: - rectal/vaginal injury - open pelvic # / placement of metal - bladder neck inj - foreign body (bullet/shrap/bone)

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@TheUrologyGuy

The Urology Guy

9 months

❗CALYCEAL DIVERTICULUM Cystic cavity within the kidney, lined by non-secretory urothelium, communicating with a calyx or renal pelvis by a narrow isthmus. Calyceal diverticular do not have papillae and fill with urine passively. Management of stones:

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@TheUrologyGuy

The Urology Guy

10 months

RISK FACTORS FOR RENAL STONES For exams, you need a way to classify risk factors for stones that will stay in your mind. This table is how I remembered - even if you just remember the categories, you can get most. Full page here:

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@TheUrologyGuy

The Urology Guy

10 months

FOURNIER'S GANGRENE: Necrotising fasciitis of male genitals/perineum. Risk factors - diabetes, immunosuppression, malnutrition, instrumentation, obesity Exam - febrile, shock, pain ++, crepitus, rapidly progressing edema, erythema, tenderness Rx = surgical debridement ASAP!🔪

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@TheUrologyGuy

The Urology Guy

11 months

PDE5 inhibitors are the mainstay of medical management of #erectiledysfunction . However, many times they are prescribed without appropriate counselling. Key tips: - avoid having at same time as food - still require sexual stimulation to work - don't work immediately

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@TheUrologyGuy

The Urology Guy

9 months

💎💎Renal stone analysis should prompt an immediate thought about what can be done to prevent future stones. e.g.: struvite stone = UTIs calcium phosphate stone = ?could this be renal tubular acidosis uric acid stone = acidic urine, ?hyperuricemia

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@TheUrologyGuy

The Urology Guy

9 months

Blood in the semen is an alarming thing for patients, but usually no sinister cause is found. Do you have an approach you use? I tend to think about MRI prostate & cystoscopy in those over 40-50...but appreciate it is usually low yield. What do you do?

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@TheUrologyGuy

The Urology Guy

1 year

🍆 Management of the inguinal nodes in penile cancer can become very complicated, especially for those trying to understand the topic for exams. This is my simple way to approach it based on guidelines, not only for exams, but real life. Any doubt ➡️ refer hi-volume centre.

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@TheUrologyGuy

The Urology Guy

10 months

🚩🚩 Blood at urethral meatus is a RED FLAG in trauma for urethral injury - need urethrogram prior to placing catheter. But how to do urethrogram?

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@TheUrologyGuy

The Urology Guy

9 months

What factors determine how you manage kidney stones? 🧓Patient factors 🥔Kidney factors 💎Stone factors 🏥Technical factors

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@TheUrologyGuy

The Urology Guy

1 year

👀 'ONE SHOT IVP' in trauma? To confirm presence of contralateral kidney, prior to exploration/trauma nephrectomy (assume no CT prior) ‼️ 2mg/kg IV contrast, then xray in OR after 10 min Alternatives? -direct palpation -ultrasound See old @JUrology article

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@TheUrologyGuy

The Urology Guy

1 year

ENDOMETRIOSIS - may involve the bladder or ureter Bladder - may present with cyclic hematuria, bladder pain, urinary symptoms, incidental on imaging Ureter - often causes silent obstruction (❗❗) and hydronephrosis, or symptoms renal obstruction Rx - often surgical

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@TheUrologyGuy

The Urology Guy

8 months

What are your options for managing ureteric stones?? This will vary depending on your location and what resources you have. Here is our table regarding the pros and cons of all the options. What do you think?

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@TheUrologyGuy

The Urology Guy

11 months

AUTONOMIC DYSREFLEXIA ❗❗ Severe hypertension in response to noxious stimulus - usually distended or irritated bladder. Seen in those with spinal cord injury T6 or higher. Potential life threatening emergency - must treat promptly. for more notes

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@TheUrologyGuy

The Urology Guy

10 months

Upper tract urothelial cancer: Best oncological treatment is radical nephroureterectomy. BUT - this may often be overkill, and often these patients have threatened renal function anyway. Use @Uroweb guidelines to stratify low risk - may be amenable to kidney sparing surgery.

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@TheUrologyGuy

The Urology Guy

10 months

STRUVITE STONES (Infection stones) form in alkaline urine Usually in presence of urease producing bacteria (urea splitting organisms): - > 50 % proteus - klebsiella - serratia - enterobacter - NOT normally E.coli, pseudomonas, enterococcus

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@TheUrologyGuy

The Urology Guy

1 year

DUTASTERIDE/FINASTERIDE AND PROSTATE CANCER PCPT: 25% reduction in CaP - mostly Gleason 6 Higher prevalence Gl 8-10 w finasteride ?Reduced prostate size = more ca found 15 yr f/u - no survival difference REDUCE: 23% reduction in CaP Small incr risk Gl 8-10 EAU guideline:

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@TheUrologyGuy

The Urology Guy

1 year

🧠🧠TURP SYNDROME💧💧 Acute dilutional hyponatraemia, secondary to excess intravascular absorption of irrigation fluid (glycine) Symptoms: Confusion/nausea/vision change HTN, bradycardia, tachypnea Facial warmth/flushing Seizures/coma Risks- big prostate, long resection, bleed

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@TheUrologyGuy

The Urology Guy

9 months

POST OBSTRUCTIVE DIUESIS All emergency department practitioners, urologists, renal physicians and inpatient doctors should have an appreciation for those at risk of POD I've seen patients lose 10+ litres in 24 hours. Can you share your preferred management strategy?

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@TheUrologyGuy

The Urology Guy

11 months

URETHRAL DIVERTICULUM Classic presentation is "3 x Ds" - dysuria, dyspareunia & (postvoid) dribbling Reality=rare to have all 3 Other sx- palpable mass, storage LUTS, hematuria, UTIs, discharge. Best scan=MRI Cysto may identify ostium - use 0 degree MRI image from Campbell:

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@TheUrologyGuy

The Urology Guy

11 months

DIETL'S CRISIS Refers to episodic severe flank pain associated with nausea/vomiting, classically after an intake of alcohol or other diuretic. Usually associated with PUJ obstruction (or UPJ obstruction depending which country you are in!) DDx - renal colic

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@TheUrologyGuy

The Urology Guy

1 year

Who are the best candidates for a SLING for post-prostatectomy incontinence? - mild-moderate incontinence - non obese - no XRT - dry overnight 50-60% cure 20-30% better Mechanism - repositioning and support prox urethra, ⬆️functional urethral length (NOT compression)

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@TheUrologyGuy

The Urology Guy

9 months

FEMALE UROLOGY is often neglected during study because of a lack of understanding and exposure. Can you articulate the relationship between pelvic organ prolapse and stress incontinence? Further info on POP for exams and practice here

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@TheUrologyGuy

The Urology Guy

9 months

MARTIUS FLAP (labial fat pad) You may have heard about this but never seen it. The principles are straightforward and you never know when it may be useful. It's also common to get asked about in exams. Check my page but also the article below 👇

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@TheUrologyGuy

The Urology Guy

1 year

PROSTATITIS Classic questions you will be asked: How do you categorise or classify prostatitis? What antibiotics will you use to treat? How do you do a Stamey test? When might you see granulomatous prostatitis?

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@TheUrologyGuy

The Urology Guy

10 months

LYNCH SYNDROME Upper tract urothelial cancer is 3rd most common cancer in these patients. Germline mutation in one of 4 mismatch repair (MMR) genes -> "microsatellite instabiity" Cumulative lifetime risk of 2.9 % for UTUC in Lynch patients (14 x relative risk) How to screen?

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@TheUrologyGuy

The Urology Guy

9 months

❗❗Consent process for vasectomy ... sounds straightforward but really really important in both practice and exams... Check my page for lots of detail -

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@TheUrologyGuy

The Urology Guy

10 months

Autosomal dominant polycystic kidney disease - indications for nephrectomy: 1. Uncontrolled pain 2. Refractory bleeding or infection 3. Troublesome stone burden not amenable to usual treatment 4. To make room for transplant 5. Solid enhancing suspicious renal mass

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@TheUrologyGuy

The Urology Guy

1 year

Urological manifestations of METABOLIC SYNDROME? Defn - 3/4 of -obesity -T2DM -lipids -HTN Renal - ⬆️CKD, ⬆️stones, ⬆️RCC Lower tract - ⬆️OAB, ⬆️BPH/LUTS Andrological - ⬆️ED, ⬆️hypogonadism

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@TheUrologyGuy

The Urology Guy

1 year

❗❗Tip for commonly examined hereditary syndromes in urology: It is usually a safe bet to guess AUTOSOMAL DOMINANT for the mode of transmission. This works for vHL, Birt Hogg Dube, tuberous sclerosis, adult polycystic kidney disease. the main exception - cystinuria!!

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@TheUrologyGuy

The Urology Guy

1 year

XGP KIDNEY (Xanthogranulomatous pyelonephritis) Rare, severe, chronic kidney infection characterised by destruction of renal parenchyma. Also - a favourite scan to be shown to residents and trainees to be grilled on. Pathophys? Histo? Presentation? Imaging? Management? (1/9)

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@TheUrologyGuy

The Urology Guy

11 months

🚩🚩 UTI & PREGNANCY 4-7% pregnant women have asymptomatic bacteriuria. Normally we don't treat asymptomatic bacteriuria. But in pregnancy - 20 - 40% may progress to pyelonephritis - which can lead to adverse fetal outcomes. Which ABx are safe? Penicillins, cephalosporins

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@TheUrologyGuy

The Urology Guy

10 months

@AaronGoodman33 Most importantly - often cause false positive bladder scan, and result in urology getting called for 'urinary retention despite Foley'

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@TheUrologyGuy

The Urology Guy

7 months

14 ▶️ 16 ▶️ 18 can be remembered like traffic lights 🚦

@LisaTUroMD

Lisa Teixeira, MD MS

7 months

A quick little project to help memorize the foley colors 🌈

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@TheUrologyGuy

The Urology Guy

11 months

@uro_nima @DrAsanad Nassiri et al, Urology 2021 Our notes on torsion and acute scrotum -

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Testicular torsion & acute scrotum

Aetiology and incidence Peak incidence between 12 – 16 years, but can occur at any age younger or older. Prevalence 1 in 4000 Extra-vaginal torsion only seen antenatally or in neonates. All other...

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@TheUrologyGuy

The Urology Guy

10 months

TUBEROUS SCLEROSIS key facts: - autosomal dominant - mutation TSC1 (chr 9) or TSC2 (chr 16) -> unopposed mTOR activation - renal cysts - AMLs - more prone to rupture/bleed, often bilateral/multifocal - intellectual impairment and seizures - cerebral tubers - lung LAMs

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@TheUrologyGuy

The Urology Guy

1 year

VON HIPPEL LINDAU (vHL) What are the urological manifestations of vHL? What are the non urological manifestations? What is the genetics and how does it relate to RCC? Don't they just need a nephrectomy?

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@TheUrologyGuy

The Urology Guy

10 months

I have a page on Malacoplakia which comes from 'soft plaque' in Greek abnormal macrophage function & inflammatory reaction in response to infection - often history of repeated E.coli infections. Michaelis-Gutmann bodies are classic Histo 👇👇

From the Greek word meaning “soft plaque”. Rare chronic granulomatous inflammatory disease most commonly affecting bladder but can affect many other organ systems. Females 4:1 affected in urinary...

theurologyguy.com

@drmehrarohit

ROHIT MEHRA

6 years

Malakoplakia of the urinary bladder with histiocytic infiltrate and MG bodies (concentric basophilic inclusions)- one of the highest number of MG bodies I have seen in any case! #bladder #Pathology @UMichPath

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@TheUrologyGuy

The Urology Guy

10 months

SHOCK Definition - acute circulatory failure, with inadequate tissue perfusion causing cellular hypoxia 4 types of shock: 1. Hypovolemic 2. Cardiogenic 3. Obstructive 4. Vasodilatory (distributive) Can be multiple in same patient - e.g. septic patient also dehydrated

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@TheUrologyGuy

The Urology Guy

9 months

Circumcision is contraindicated if patient (especially infant) has hypospadias - foreskin may be used during reconstruction/hypospadias repair

@Uroweb

European Association of Urology (EAU)

9 months

Do not perform simple circumcision if phimosis is associated with other penile anomalies such as buried penis, congenital penile curvature, epispadias or hypospadias. #PedsUro #EAUguidelines

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@TheUrologyGuy

The Urology Guy

8 months

My notes on ileal conduit & complications:

Principles of bowel surgery: Proper exposure and mobilisation Preserve vascular supply Avoid spillage, use clean instruments, packs Serosa to serosa anastomoses Clean off mesentery from working...

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@TheUrologyGuy

The Urology Guy

9 months

Congratulations and welcome to all those matching to urology in USA. Look forward to helping you all over the coming years! #UroMatch2024 #UroSoMe #AUAMatch2024

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@TheUrologyGuy

The Urology Guy

10 months

Differential diagnoses for renal masses based on imaging characteristics 👇 See our page for everything you need to know about renal masses -

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@TheUrologyGuy

The Urology Guy

1 year

🔍🖥️CT SCANS Med students keen on surgery - must know what phase CT you are reading and why 🪨Non-con - stones, ⬇️eGFR 🩸Arterial - bleeding, vascular anatomy 🦀Portal venous - inflammation, abdo organs, staging 🍹Oral - GIT pathology 🚰Delayed - hematuria, urine leak

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@TheUrologyGuy

The Urology Guy

9 months

Further info: Fowler-Stephens/cryptorchidism - Vasectomy - Varicocele - Epididymectomy -

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Epididymis is one big long tightly coiled tubule. Rich blood supply with vascular anastomoses – head supplied by testicular artery, tail by artery to vas, some collaterals from cremasteric. The tail...

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@TheUrologyGuy

The Urology Guy

1 year

NOVEL ANTI-ANDROGENS Enzalutamide -inhibits binding of DHT/T to androgen receptor -💊160mg daily -side effects - fatigue -C/I: - seziures/neuro disease🧠 Abiraterone -inhibits 17a-hydroxylase -💊1g daily + 5mg pred -side effects - oedema,hypoK,htn,steroids -C/I: liver disease

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@TheUrologyGuy

The Urology Guy

8 months

Images are from this paper and meta-analysis suggesting no difference in long term stricture risk -

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@TheUrologyGuy

The Urology Guy

9 months

This article is outstanding and gives you everything you need to know including a visual guide. Credit - @drsamantha_p @TamsinGreenwel1

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@TheUrologyGuy

The Urology Guy

1 year

Medical students and interns: Do you know the difference between detrusor overactivity (DO) and overactive bladder (OAB)? 👇

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@TheUrologyGuy

The Urology Guy

10 months

Thanks for reading. Here's a link to my page on prostatitis:

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Commonly used label or diagnosis which can refer to broad spectrum of conditions. Only 10 % of cases labelled as prostatitis have demonstrable bacterial infection. NIH/NIDDK classification: 1 Acute...

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@TheUrologyGuy

The Urology Guy

10 months

Fluoroquinolones have the most favourable pharmacokinetic properties for penetrating the alkaline prostatic fluid. (ciprofloxacin, norfloxacin) Trimethoprim is the next best alternative.

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@TheUrologyGuy

The Urology Guy

11 months

Excellent pictorial here. My notes are here - similar content but I need to make some graphics like this to present it cleaner.

BPH - surgical management

Indications for BPH surgery: Urinary retention Renal impairment or upper tract dilation Recurrent UTI (Recurrent) bladder stones Haematuria due to BPH Bothersome LUTS which are refractory or unsuited...

theurologyguy.com

@NicholasZaorsky

Nicholas Zaorsky, MD MS

@NicholasZaorsky

11 months

Treatment options for benign prostatic hyperplasia (BPH) and lower urinary tract symptoms (LUTS) #prostate #MensHealth #urology

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@TheUrologyGuy

The Urology Guy

1 year

PARKINSON'S DISEASE - NEUROLOGY OR UROLOGY? 35 - 70 % of patients with Parkinson's may have urological dysfunction. What are the common urinary symptoms? What is seen on urodynamics? How can we treat these patients? Should I do a TURP? WTF is MSA?

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@TheUrologyGuy

The Urology Guy

9 months

Further info on my page:

Post obstructive diuresis

Serious condition which can arise after relief of bilateral renal obstruction or solitary kidney obstruction with potential for severe dehydration and electrolyte disturbances (hypo and hyperkalaem...

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@TheUrologyGuy

The Urology Guy

10 months

@Uroweb 'Sir, your PET scan shows an L1 vertebral met, avid pelvic nodes and a pre sacral node. But because the CT and Bone Scan are OK, we will perform radical prostatectomy'

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@TheUrologyGuy

The Urology Guy

1 year

A 30 year old lady is referred to your clinic with an incidental finding of a dilated ureter on ultrasound. What is your definition of megaureter? How do you classify it to help guide your management?

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@TheUrologyGuy

The Urology Guy

1 year

PRIAPISM How many causes of priapism can you list? Bonus question - where does the name 'priapism' come from?

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@TheUrologyGuy

The Urology Guy

10 months

Here's our page with all the exam notes you need on Fournier's:

Fournier's gangrene

Life threatening necrotising fasciitis of the perineum and male genitalia. Usually polymicrobial and requires urgent debridement with concurrent resuscitation. Mortality rate has historically been...

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@TheUrologyGuy

The Urology Guy

1 year

SEPSIS Were you taught about SIRS? Definitions of sepsis vs severe sepsis? These are now historic and not recommended. New guidelines suggest the use of SOFA, or more commonly, qSOFA 👇

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@TheUrologyGuy

The Urology Guy

1 year

BALANITIS XEROTICA OBLITERANS (BXO) Now correctly known lichen sclerosis et atrophicus Incidence - about 1 in 300 Appearance - white patches, skin thickening, cracking and bleeding of foreskin Management - topical steroids or surgery (circumcision) HIGH YIELD POINTS: (1/2)

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@TheUrologyGuy

The Urology Guy

9 months

My page on hematospermia here:

Common presentation which is usually benign and self-limiting, but may cause patients considerable anxiety. In most cases, an exact cause is never found. It is important to exclude sinister causes...

theurologyguy.com

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@TheUrologyGuy

The Urology Guy

1 year

🍌PEYRONIE'S DISEASE🌶️ Fibrous plaque ➡️ penile curvature, pain, shortening Most common location dorsal Pathophysiology ?repetitive microtrauma / abnormal healing ACUTE PHASE approx 6 months - symptomatic RX / NSAIDs STABLE PHASE (no progression) - surgery (if needed) 🔪

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@TheUrologyGuy

The Urology Guy

1 year

RENAL ARTERY ANATOMY R renal a. longer than left Artery is posterior vein Renal a. -> 5️⃣x segmental arteries -4️⃣x anterior (apical, upper, middle,lower) -1️⃣x posterior (functional end arteries -> infarcts) ↘️lobar ↘️interlobar ↘️arcuate ↘️interlobular ↘️afferent arteriole

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@TheUrologyGuy

The Urology Guy

9 months

@Yasseruro Looking forward to hearing the answer. My guesses are TB or hydatid.

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@TheUrologyGuy

The Urology Guy

1 year

for full notes on nocturia workup and management 😊

Waking to void once or more during sleep Primary nocturia – waking from sleep exclusive because of the need to void Secondary nocturia – voiding at night whilst awake for other reasons (or ‘conveni...

theurologyguy.com

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@TheUrologyGuy

The Urology Guy

11 months

💦 A 38 year old man presents with urinary symptoms - poor flow and hesitancy. Don't always blame the prostate!! The differential diagnosis for LUTS are wide, and one must be aware of all possible contributors - potentially in younger men.

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@TheUrologyGuy

The Urology Guy

10 months

STAMEY TEST (4 glass test): 1 - 1st catch urine (VB1 urethral) 2 - mid stream urine (VB2 bladder) 3 - prostate massage + secretions (EPS) 4 - first catch urine (VB3 prostate) 2 glass test similar sens/spec 1 - mid stream urine (VB2) (prost massage) 2 - first catch urine (VB3)

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@TheUrologyGuy

The Urology Guy

1 year

There are many options for treatment for chronic pelvic pain syndrome - current guidelines suggesting using the UPOINTS framework to help guide management based on patients symptoms + phenotype There is no silver bullet - but we can help these patients improve quality of life!

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@TheUrologyGuy

The Urology Guy

1 year

Causes of priapism: 1. Hematological - sickle cell disease, myeloma, leukemia 2. Drugs - intracavernosal injections, illicit stimulants, ritalin, lipid-rich TPN 3. Cancer - penile, prostate, pelvic 4. Neurological - SCI, cauda equina 5. Trauma - pelvic/perineal, iatrogenic

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@TheUrologyGuy

The Urology Guy

1 year

- good article, and where the initial images are from

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@TheUrologyGuy

The Urology Guy

10 months

@drphil_urology @Uro_BarashiMD @ZacharySmithMD @WashU_Uro @JoeIppolitoLab @MIRimaging Do you have any thoughts on when to consider pre-operative immunotherapy? (in someone with venous/caval thrombus otherwise suitable for upfront nephrectomy) Even if no metastatic disease?

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@TheUrologyGuy

The Urology Guy

11 months

I've updated my page on locally advanced RCC here

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@TheUrologyGuy

The Urology Guy

1 year

Vermiculation or peristalsis?

@Tom_Marcelissen

Tom Marcelissen

@Tom_Marcelissen

1 year

The Kelly clamp was named after Howard Kelly, an American gynaecologist. Did you know that he discovered a way to identify the ureters during surgery by gently squeezing them, inducing peristalsis? This is also known as “Kelly’s sign”.

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@TheUrologyGuy

The Urology Guy

10 months

I've never done a four glass Stamey test.... but your attendings and professors may ask!

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@TheUrologyGuy

The Urology Guy

1 year

All of this content and high yield exam revision notes will be available on our free website at :)

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@TheUrologyGuy

The Urology Guy

10 months

NIH/NIDDK classification: 1 - acute bacterial prostatitis 2 - chronic bacterial prostatitis 3 - chronic non bacterial prostatitis (or chronic pelvic pain syndrome) *3a - inflammatory CPPS (white cells in semen/EPS) *3b - non inflammatory CPPS 4 - asymptomatic/histological

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@TheUrologyGuy

The Urology Guy

11 months

Here's my page on medical management of ED - further pages on surgical management, workup etc. available as well.

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Medical management of ED

Principles of management: Lifestyle modification Medical adjuncts / reversible causes PDE5 inhibitors Contra-indications for PDE5i: Side effects of PDE5i: Optimal use: Regular use of PDE5 inhibit...

theurologyguy.com

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@TheUrologyGuy

The Urology Guy

9 months

More notes on calyceal diverticulum, and everything else:

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Calyceal diverticulum

Cystic cavity within the kidney, lined by non-secretory urothelium, communicating with a calyx or renal pelvis by a narrow isthmus. Calyceal diverticular do not have papillae and fill with urine...

theurologyguy.com

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@TheUrologyGuy

The Urology Guy

10 months

ABx for prostatitis: Prostate capillary bed lacks active transport – penetration dependent on passive transport 3 factors determine ability to penetrate – lipid solubility; pKa and protein binding B-lactams - low pKa / poor lipid solubility Antibiotic with best properties?

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@TheUrologyGuy

The Urology Guy

1 year

Mural calcification of the bladder wall is the hallmark characteristic of schistosomiasis on imaging. Other organs – prostate, SVs, distal ureters, colon and gynae organs may also show calcification. Ureteric dilation may also be apparent.

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@TheUrologyGuy

The Urology Guy

1 year

PRIAPUS is the Greek God of fertility and farming. What a combination. We will keep posting useful information every day. Check out our website for further notes on priapism or all things urological, available anytime

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