#Urology ⏳⏱⬇️

🛑Key symptoms of urology:

1.Obstructive +irratation symptoms➡️ bladder outFlow obstruction as prostate (mc) in male & urethral stricture

2. Pain +hematuria ➡️stone

3. Painless +hematuria ➡️cancer

4. Dysurea +offensive +Dark urine +(FUN) ➡️ UTI

5. H/o trauma +pain +hematuria ➡️ trauma

⛔ Normal urine out put for adult/ day:

20-30 ml/hr or 0.5ml/kg/hr

⭕️ Undescended testis :

Def = arrest in normal pathway of descent , more in Rt side

Etiology = H3S = ¹ ⏬ HCG
                              ² short gabernaculm
                           ³ short spermatic cord
                  ⁴ strictures of inguinal canal

Cp = empty scrotum

Inx = Hormonal assay , US , Ct , laparoscopy

Ttt = orchedopexy & according to the age, or hormonal ttt.

Comp = 3T 2S 2I = ¹ torsion testis
                                 ² tumer
                                ³ truma
                                ⁴ sterility
                               ⁵ psychiatry
                              ⁶ infection
                           ⁷ indiret inguinal hernia

⭕️ Ectopic testis :

¹ Def = arrest testis outside normal pathway

² Ectopic site = superficial inguinal pouch commenst site

³ Ttt = orchedopexy or orchedoctomy no hormonal ttt

⭕️ Retractile testis :

Def = occure in young children due to exaggerated creamastric reflex

Note : cremastric ms not well developed in first 3 months so no retractile testis under 3 months

Type : ¹ low retractile = by melking test stay there
² high retractile = milking test dosen't stay

Ttt = orchedopexy

⭕️ Hydrocele :

Def = collection of serous fluid inside tunics vaginalis

Type : ¹ congenital / due to persistent of tunica vaginalis , reducible,  testis palpable

² aquired / idiopathic  , irreducible,  testis impalpaple

CP = scrotal swelling ,  +ve transllumination test , +ve fluctuation test 

Inx = scrotal US

Ttt = Jaboly operation = نفتح ونربط للخلف
Or Lords operation = نفتح ونربط ع الجناب

Complications =  ¹ pyocele
                              ² hematocele
                    ³ herniation through dartos
                    ⁴ buried penis

⭕️ varicocele :

Def = elongation or dilatation of pumpiniform plexus of veins

Site = unilateral lt side 95%

Type = ¹ primary ( reflux )
            ² secondary ( obstructive )

CP = dragging sensation or aching pain

Inx = doppler or duplex us

Ttt = ¹ secondary treat underlying cause

² Primary __ do varicelectomy by ( open , laparoscopic )
or sclerotherapy

Open ___ do  high ligation = ligation of testicular veins
or low ligation = ligation of pumpiniform plexus

Laparoscopic ___ do ligation of testicular veins

If reccurent do embolization

Complications = ¹ subfitility
        ² 2nd hydrocele & thromboplebitis

⭕️ Torsion testis :

Def = twisting of testis and epididymis around axis of spinal cord,  it's surgical emergency & more in Rt side

CP = sudden sever pain

D.d = ¹ torsion testis
          ² epidymo orchitis
نفرق عن طريق prehis signs
نرفع scrotum فوق ، لو الألم زاد يعني testis
ولو نقص يعني epidymo orchitis

Inx = urgent doppler & douplex

Ttt =  urgent exploration of scrotum
Do detorsion & orchedopexy

⭕️ penis disorder :

¹ hypospadias = opening of external urethral meatus on ventral side of penis , ttt early surgical correction before 2yr , CI circumcision

² epispadias = on dorsum

³ phimosis = foreskin can't be retracted over glans penis

⁴ para phimosis = inability to reduce fore skin , ttt by circumcision

⁵ circumcision = remove foreskin

Indication : Religion , social , phimosis , para phimosis

CI in : hypospadias,  bleeding disorder,
Unstable or sick infant

Complications : MC bleeding then infection

⁶ priapism = prolonged unwanted erection lasting > 4 hr

⭕️ testicular tumers :

2 type :

¹ Teratoma = هذا يمثل طلبة الطب 😁

العمر ديمه في العشرينات من 20 _ 30 سنة
سريع في كل شي 🥲

و Radio resistance مقاوم لكل الظروف✔️🌚

دمهم حامي ابسط كلمة عراكات طول 🙂 = blood metastasis
Poor prognosis.

Tumer marker = B-HCG , LDH, alpha FP🚨 (MCQ).

ttt: excission + chemo only

² seminoma = هذا يمثل فترة مابعد التخرج

العمر بعد 30 سنة 🌚

بطيء هلبا يعني ماعندا شي امتي ماينوض ويدير حاجته عادي لاعنده شيت ماقراشي لاعنده هم يخمم فيه 🙅🏻‍♀

ويكون radiosensetive يعني ابسط كلمة يفتح منها نقاش ويكسد عليها 🫢🫣

Lymphatic spread
Good prognosis

Tumer marker B-HCG, LDH

ttt: Excision + Radio + chemo.

🚨Most commen تجميعة

🍃Mc cancer in infant neuro blastoma.
🍃Commen benign cyst kidney is simple cyst.
🍃Commen benign mass kidney  is adenoma.
🍃Commen maligenint primary   kidney in adult is Rcc.
🍃Commen maligenint primary kidney in children is willems.

🍃Mc presention of Rcc is  total pian Less hematourea.
🍃Mc presention of wilms is mass.
🍃Mc presention of Urinary bladder cancer is pianless, hematourea.
🍃Mc presention of testicular cancer is palpable pianless solid mass in testis.

⭕️ D.d of scrotal swelling :

🔻Painless
¹ hydrocele
² varicocele
³ indirect inguinal hernia

🔻Painful
¹ torsion testis
² epidymo orchitis
³ strangulation indirect inguinal hernia

⭕️ D.d of empty scrotum :

¹ undescended testis
² retractile testis
³ ectopic testis
⁴ agenesis
⁵ orchidectomy

Prostate zones anatomy

Trigone is the commenest site of CA.

Bladder cancer