Urology Basics

Urology Basics US Medical PG Question 1: A 97-year-old man visits the urology clinic 5 days after experiencing urinary retention at an emergency department visit. The patient has a history of hypertension, type II diabetes mellitus, stroke, dyslipidemia, a past myocardial infarction, and severe osteoarthritis in his right hip. He is not compliant with his medications and his multiple comorbidities are poorly managed. In the hospital, the patient’s urinary retention was treated with Foley catheterization. At clinic, the patient’s serum-specific prostate-specific antigen (PSA) is 6.0 ng/mL (normal is < 4 ng/mL). Digital rectal examination (DRE) demonstrates a nontender prostate with several rock hard nodules. The patient's Foley is removed and he is able to urinate on his own. Which is the most appropriate next step in management?

• A. Repeat PSA test
• B. CT abdomen and pelvis
• C. Cystourethroscopy
• D. Reassurance
• E. Transrectal prostate biopsy (Correct Answer)

Urology Basics Explanation: ***Transrectal prostate biopsy*** - The combination of an elevated **PSA** (6.0 ng/mL) and **palpable, rock-hard nodules** on digital rectal examination is highly suspicious for **prostate cancer**. - A definitive diagnosis requires a **tissue biopsy** to determine the presence of malignancy and its Gleason score. *Repeat PSA test* - While a repeat PSA can sometimes be useful to confirm a trend or rule out transient elevation, the presence of **palpable prostatic nodules** on DRE makes a repeat PSA insufficient given the high suspicion of malignancy. - Delaying definitive workup, such as a biopsy, could be detrimental if cancer is present. *CT abdomen and pelvis* - A CT scan would be more appropriate for **staging** if prostate cancer were confirmed, to assess for metastasis, rather than for initial diagnosis. - It would not provide the definitive **tissue diagnosis** needed to confirm prostate cancer. *Cystourethroscopy* - **Cystourethroscopy** is used to visualize the urethra and bladder, often for issues like hematuria, strictures, or bladder masses. - It is not the primary diagnostic tool for **prostate cancer** originating in the peripheral zone given the DRE findings. *Reassurance* - Given the patient's elevated **PSA** and **palpable rock-hard nodules** on DRE, providing reassurance is inappropriate and could lead to delayed diagnosis and treatment of potentially aggressive prostate cancer. - These findings are highly indicative of prostate pathology requiring further investigation.

Urology Basics US Medical PG Question 2: A previously healthy 22-year-old man presents to the university clinic with increasing scrotal pain and swelling over the past 5 days. He also has dysuria and urinary frequency. He has never felt this type of pain before. The young man considers himself generally healthy and takes no medications. He is sexually active with one partner and uses condoms inconsistently. At the clinic, his temperature is 36.7℃ (98.1℉), the blood pressure is 115/70 mm Hg, the pulse is 84/min, and the respirations are 14/min. On examination, he has swelling and tenderness of the right scrotum, especially over the posterior aspect of the right testicle. The Prehn sign is positive. The remainder of the physical exam is unremarkable. Doppler sonography shows increased blood flow to the testis. Which of the following is the most appropriate next step in management?

• A. Oral metronidazole for patient and sexual partner
• B. IV ceftriaxone and oral doxycycline (Correct Answer)
• C. Radical orchiectomy
• D. Surgical exploration
• E. Manual detorsion guided by Doppler sonography

Urology Basics Explanation: **IV ceftriaxone and oral doxycycline** - The patient's symptoms (scrotal pain, swelling, dysuria, urinary frequency), positive **Prehn's sign**, and **increased testicular blood flow** on Doppler sonography are highly suggestive of **epididymitis**, most likely caused by sexually transmitted infections (STIs) in a young, sexually active male. - **Empiric antibiotic treatment** for probable gonococcal and chlamydial infection (common causes of epididymitis in this age group) is the most appropriate next step, with **ceftriaxone** covering gonorrhea and **doxycycline** covering chlamydia. *Oral metronidazole for patient and sexual partner* - **Metronidazole** is primarily used to treat anaerobic bacterial infections and parasitic infections (e.g., *Trichomonas vaginalis*). - While *Trichomonas* can cause urethritis, it is not a common cause of epididymitis, and metronidazole would not cover the more likely bacterial etiologies of epididymitis such as *Neisseria gonorrhoeae* or *Chlamydia trachomatis*. *Radical orchiectomy* - **Radical orchiectomy** is the surgical removal of the testicle, typically reserved for confirmed cases of **testicular cancer**. - There are no indications of malignancy in this patient's presentation; the symptoms are inflammatory and infectious in nature. *Surgical exploration* - **Surgical exploration** is indicated if **testicular torsion** cannot be ruled out or if there are signs of **testicular abscess** or other surgical emergencies. - The positive **Prehn's sign** (relief of pain with scrotal elevation) and **increased blood flow** on Doppler argue against torsion and support epididymitis, making immediate surgical exploration unnecessary. *Manual detorsion guided by Doppler sonography* - **Manual detorsion** is a treatment for **testicular torsion**, a condition characterized by sudden, severe scrotal pain, an absent cremasteric reflex, a negative Prehn's sign, and **decreased or absent blood flow** on Doppler. - This patient's symptoms, especially the positive Prehn's sign and increased blood flow, are inconsistent with testicular torsion, making manual detorsion an inappropriate intervention.

Urology Basics US Medical PG Question 3: A 75-year-old woman presents to the physician with a complaint of a frequent need to void at nighttime, which has been disrupting her sleep. She notes embarrassingly that she is often unable to reach the bathroom in time, and experiences urinary leakage throughout the night as well as during the day. The patient undergoes urodynamic testing and a urinalysis is obtained which is normal. She is instructed by the physician to perform behavioral training to improve her bladder control. Which of the following is the most likely diagnosis contributing to this patient’s symptoms?

• A. Urinary tract infection
• B. Stress incontinence
• C. Urge incontinence (Correct Answer)
• D. Overflow incontinence
• E. Total incontinence

Urology Basics Explanation: ***Urge incontinence*** - The patient's symptoms of a **frequent need to void**, inability to reach the bathroom in time (urgency), and **nocturnal leakage** (nocturia with incontinence) are classic for urge incontinence. - This condition is characterized by **detrusor overactivity**, leading to sudden, strong urges to urinate that are difficult to defer. *Urinary tract infection* - While UTIs can cause urgency and frequency, the patient's **normal urinalysis** rules out an active infection as the cause of her symptoms. - UTIs typically present with dysuria, hematuria, or suprapubic pain, which are not mentioned. *Stress incontinence* - This type of incontinence is characterized by **involuntary urine leakage with increased intra-abdominal pressure**, such as coughing, sneezing, or laughing. - The patient's description of sudden urges and inability to reach the bathroom in time does not align with stress incontinence. *Overflow incontinence* - This condition is due to **incomplete bladder emptying**, leading to a constantly full bladder and continuous leakage. - It often presents with weak stream, hesitancy, and a feeling of incomplete voiding, which are not described here. *Total incontinence* - Total incontinence involves the **continuous and unpredictable leakage** of urine, day and night, without any discernible pattern. - While the patient experiences significant leakage, her symptoms point more specifically to the urge component rather than a complete absence of bladder control.

Urology Basics US Medical PG Question 4: A 75-year-old male presents to the emergency room complaining of severe lower abdominal pain and an inability to urinate. He reports that he last urinated approximately nine hours ago. When asked to urinate, only a few drops dribble from the tip of his penis. Further questioning reveals that the patient has experienced progressively worsening difficulty with urinating over the past two years. He has lived alone for five years since his wife passed away. He has not seen a doctor in that time. His temperature is 98.8°F (37.1°C), blood pressure is 145/90 mmHg, pulse is 115/min, and respirations are 22/min. He appears to be in severe pain. Physical examination reveals a distended bladder and significant tenderness to palpation over the inferior aspect of his abdomen. Which of the following sets of lab values would most likely be found in a urinalysis of this patient?

• A. Urine osmolality 550 mOsmol/kg H2O, Urine Na+ 15 mEq/L, FENa 0.9%, red blood cell casts
• B. Urine osmolality 400 mOsmol/kg H2O, Urine Na+ 25 mEq/L, FENa 1.5%, no casts
• C. Urine osmolality 300 mOsmol/kg H2O, Urine Na+ 45 mEq/L, FENa 5%, no casts (Correct Answer)
• D. Urine osmolality 200 mOsmol/kg H2O, Urine Na+ 35 mEq/L, FENa 3%, muddy brown casts
• E. Urine osmolality 600 mOsmol/kg H2O, Urine Na+ 15 mEq/L, FENa 0.8%, hyaline casts

Urology Basics Explanation: ***Urine osmolality 300 mOsmol/kg H2O, Urine Na+ 45 mEq/L, FENa 5%, no casts*** - The patient's presentation with acute urinary retention due to **benign prostatic hyperplasia (BPH)** and subsequent obstructive uropathy leads to **postrenal acute kidney injury (AKI)**. If the obstruction is prolonged, it can lead to kidney damage and an inability to concentrate urine effectively, resulting in an **isosthenuric** urine (osmolality near plasma, ~300 mOsmol/kg H2O) and a higher fractional excretion of sodium (**FENa > 2-3%**). - **No casts** are typically seen in pure postrenal AKI unless superimposed intrinsic renal damage has occurred. The increased urine Na+ and FENa reflect tubular dysfunction due to prolonged obstruction. *Urine osmolality 550 mOsmol/kg H2O, Urine Na+ 15 mEq/L, FENa 0.9%, red blood cell casts* - This profile suggests **prerenal azotemia** with a low FENa and concentrated urine, indicating appropriate kidney response to hypoperfusion, which is not the primary issue here. **Red blood cell casts** indicate glomerulonephritis, typically seen in intrinsic renal disease, which is not supported by the patient's presentation of obstructive uropathy. *Urine osmolality 400 mOsmol/kg H2O, Urine Na+ 25 mEq/L, FENa 1.5%, no casts* - This urine profile suggests an intermediate state, possibly early or resolving prerenal injury, but not classic for established postrenal AKI. The **FENa is still relatively low**, indicating some preserved tubular function, which would be compromised in prolonged obstruction leading to AKI. *Urine osmolality 200 mOsmol/kg H2O, Urine Na+ 35 mEq/L, FENa 3%, muddy brown casts* - **Muddy brown casts** are characteristic of **acute tubular necrosis (ATN)**, and while ATN can be a complication of prolonged postrenal obstruction, it is not the initial or most direct finding for postrenal AKI. Also, an osmolality of 200 mOsmol/kg H2O would suggest significant inability to concentrate urine, common in ATN, but the presence of muddy brown casts is the key differentiating feature. *Urine osmolality 600 mOsmol/kg H2O, Urine Na+ 15 mEq/L, FENa 0.8%, hyaline casts* - This profile is highly suggestive of **prerenal azotemia**, characterized by a **highly concentrated urine** (high osmolality) and **low urinary sodium and FENa**, indicating robust renal sodium and water reabsorption in response to perceived hypovolemia. While hyaline casts can be seen in prerenal states, the overall picture does not fit the obstructive cause of AKI described.

Urology Basics US Medical PG Question 5: A 37-year-old woman presents to the Emergency Department after 8 hours of left sided flank pain that radiates to her groin and pelvic pain while urinating. Her medical history is relevant for multiple episodes of urinary tract infections, some requiring hospitalization, and intravenous antibiotics. In the hospital, her blood pressure is 125/83 mm Hg, pulse of 88/min, a respiratory rate of 28/min, and a body temperature of 36.5°C (97.7°F). On physical examination, she has left costovertebral tenderness and lower abdominal pain. Laboratory studies include a negative pregnancy test, mild azotemia, and a urinary dipstick that is positive for blood. Which of the following initial tests would be most useful in the diagnosis of this case?

• A. Urine osmolality
• B. Fractional excretion of sodium (FeNa+)
• C. Renal ultrasonography (Correct Answer)
• D. Contrast abdominal computed tomography
• E. Blood urea nitrogen (BUN): serum creatinine (SCr) ratio

Urology Basics Explanation: ***Renal ultrasonography*** - This is the most appropriate initial imaging test to evaluate for **kidney stones** (given the flank pain radiating to groin and hematuria) and **hydronephrosis** (which can indicate obstruction) and assess for signs of **pyelonephritis** (given the history of recurrent UTIs and CVA tenderness). - It is **non-invasive**, readily available, and avoids radiation exposure, making it suitable as a first-line diagnostic tool in this setting. *Urine osmolality* - This test primarily assesses the kidney's ability to **concentrate urine**, which is more relevant for evaluating fluid balance, diabetes insipidus, or other renal tubular disorders. - It would not directly diagnose the cause of acute flank pain or urinary tract obstruction. *Fractional excretion of sodium (FeNa+)* - FeNa+ is used to differentiate between **prerenal azotemia** and **acute tubular necrosis**, indicating the kidney's response to hypoperfusion. - While the patient has mild azotemia, FeNa+ would not identify the underlying cause of the flank pain, hematuria, or potential obstruction. *Contrast abdominal computed tomography* - While highly sensitive for diagnosing kidney stones and other renal pathologies, **contrast CT** exposes the patient to **ionizing radiation** and risks associated with contrast agents (e.g., contrast-induced nephropathy), especially with pre-existing azotemia. - It is often reserved for cases where ultrasound is inconclusive or more detailed anatomical information is needed. *Blood urea nitrogen (BUN): serum creatinine (SCr) ratio* - This ratio is primarily used to differentiate between **prerenal** causes of acute kidney injury (high ratio, e.g., >20:1) and **intrinsic renal** causes (lower ratio, e.g., <15:1). - While it can provide insight into the etiology of azotemia, it does not directly identify the cause of the patient's acute flank pain or potential urinary tract obstruction.

Urology Basics US Medical PG Question 6: A 47-year-old man is brought to the emergency department 1 hour after injuring his genital area when he fell astride his backyard fence. He was trimming a tree from the fence when he lost his balance. His vital signs are within normal limits. Examination shows blood at the urethral meatus, perineal ecchymoses, and a scrotal hematoma. An x-ray of the pelvis shows swelling of the soft tissue but no other abnormalities. Which part of the urinary tract is most likely damaged in this patient?

• A. Penile urethra
• B. Bulbous urethra (Correct Answer)
• C. Anterior bladder wall
• D. Prostatic urethra
• E. Membranous urethra

Urology Basics Explanation: ***Bulbous urethra*** - Straddle injuries (falling astride an object) cause **direct compression of the bulbous urethra** against the inferior pubic ramus - Classic triad: **blood at urethral meatus, perineal ecchymoses, and scrotal/perineal hematoma** (butterfly pattern) - The bulbous urethra is part of the **anterior urethra** and is most vulnerable in blunt perineal trauma - This is a **Buck's fascia injury** with characteristic perineal and scrotal swelling *Penile urethra* - More distal portion of anterior urethra within the penis - Typically injured by **direct penile trauma** (penile fracture, penetrating injury, instrumentation) - Would not produce the perineal ecchymoses and scrotal hematoma seen in this case *Membranous urethra* - Part of **posterior urethra** located within the urogenital diaphragm - Typically injured with **pelvic fractures** (pubic rami fractures), which are absent in this case - Would present with high-riding prostate on rectal exam and inability to void *Prostatic urethra* - Most proximal portion of posterior urethra, well-protected within the prostate - Injured in **severe pelvic trauma** with disruption of puboprostatic ligaments - Also associated with pelvic fractures, not straddle injuries *Anterior bladder wall* - Requires **pelvic fracture** or penetrating trauma - Would present with **gross hematuria** and suprapubic pain/tenderness - Blood at meatus is not typical; more likely to have abdominal distension and peritoneal signs

Urology Basics US Medical PG Question 7: A 22-year-old man is brought to the emergency department because of progressive left-sided scrotal pain for 4 hours. He describes the pain as throbbing in nature and 6 out of 10 in intensity. He has vomited once on the way to the hospital. He has had pain during urination for the past 4 days. He has been sexually active with 2 female partners over the past year and uses condoms inconsistently. His father was diagnosed with testicular cancer at the age of 51 years. He appears anxious. His temperature is 36.9°C (98.42°F), pulse is 94/min, and blood pressure is 124/78 mm Hg. Cardiopulmonary examination shows no abnormalities. The abdomen is soft and nontender. Examination shows a tender, swollen left testicle and an erythematous left hemiscrotum. Urine dipstick shows leukocyte esterase; urinalysis shows WBCs. Which of the following is the most appropriate next step in management?

• A. Scrotal ultrasonography (Correct Answer)
• B. CT scan of the abdomen and pelvis
• C. Surgical exploration
• D. Measurement of serum mumps IgG titer
• E. Measurement of serum α-fetoprotein level

Urology Basics Explanation: ***Scrotal ultrasonography*** - A definitive diagnosis of **epididymitis**, **orchitis**, or **testicular torsion** requires imaging, which can confirm blood flow to the testis. - Given the symptoms of testicular pain, tenderness, and inflammation in a sexually active young man, **epididymitis** is highly suspected, but **testicular torsion** must be ruled out as it's a surgical emergency. *CT scan of the abdomen and pelvis* - This imaging modality is **not indicated** for the initial evaluation of acute scrotal pain. - While it can identify other intra-abdominal pathology, it does **not provide sufficient detail** of the scrotal contents or blood flow. *Surgical exploration* - **Surgical exploration** is the treatment for **testicular torsion**, but it should only be performed after a clinical or ultrasound diagnosis of testicular torsion is made. - Doing an immediate surgical exploration without imaging may result in unnecessary surgery if the patient has epididymitis. *Measurement of serum mumps IgG titer* - While **mumps orchitis** can cause testicular pain, this patient has symptoms more consistent with an infection related to sexual activity or a potential torsion. - Measuring mumps titers would **delay diagnosis** and management for more urgent conditions like testicular torsion. *Measurement of serum α-fetoprotein level* - **Alpha-fetoprotein (AFP)** is a tumor marker primarily used for the diagnosis and monitoring of **testicular cancer**. - This patient presents with acute pain and inflammatory signs, which are **not typical for testicular cancer**; AFP measurement is not indicated in the acute setting.

Urology Basics US Medical PG Question 8: A 59-year-old man comes to the physician because of a 3-month history of frequent urination. He has to urinate every 1–2 hours during the day and wakes up at least 2–3 times at night to urinate. He also reports that over the last 2 months, he has difficulty initiating micturition and the urinary stream is weak, with prolonged terminal dribbling. His pulse is 72/min, and blood pressure is 158/105 mm Hg. Rectal exam shows a smooth, symmetrically enlarged prostate without any tenderness or irregularities. Prostate-specific antigen is within the reference range and urinalysis shows no abnormalities. A postvoid ultrasound shows a residual bladder volume of 110 mL. Which of the following is the most appropriate next step in management?

• A. Transurethral resection of the prostate
• B. Terazosin therapy (Correct Answer)
• C. Bladder catheterization
• D. Finasteride therapy
• E. Cystoscopy

Urology Basics Explanation: ***Terazosin therapy*** - Terazosin is an **alpha-1 adrenergic antagonist** that blocks receptors in the prostate and bladder neck, causing relaxation of the smooth muscle and improving urinary flow. This is a first-line medical treatment for symptomatic **benign prostatic hyperplasia (BPH)**. - The patient presents with **obstructive and irritative lower urinary tract symptoms (LUTS)**, a symmetrically enlarged prostate, and a postvoid residual volume that indicates bladder outlet obstruction, all consistent with BPH. - Alpha-blockers provide **rapid symptom relief** (within days to weeks) and may also help with the patient's **elevated blood pressure** (158/105 mm Hg). *Transurethral resection of the prostate* - **Transurethral resection of the prostate (TURP)** is a surgical intervention reserved for patients with severe BPH symptoms refractory to medical therapy or those with complications like recurrent urinary retention or renal dysfunction. - Given that the patient has not yet tried medical therapy, and his symptoms are not immediately life-threatening, surgery is not the most appropriate first step. *Bladder catheterization* - **Bladder catheterization** is indicated for acute urinary retention or in cases of severe bladder obstruction leading to renal impairment. - While the patient has significant LUTS and a postvoid residual volume, he is not in acute urinary retention, so immediate catheterization is not necessary as a long-term management strategy. *Finasteride therapy* - **Finasteride** is a **5-alpha reductase inhibitor** that reduces prostate size by inhibiting the conversion of testosterone to dihydrotestosterone. It is more effective in patients with larger prostate volumes and takes several months to show its full effect. - Though a valid treatment for BPH, alpha-blockers like terazosin provide faster symptomatic relief by addressing dynamic obstruction and are generally preferred as initial therapy, often in combination with 5-alpha reductase inhibitors for larger prostates. *Cystoscopy* - **Cystoscopy** is an invasive procedure used to visualize the bladder and urethra directly. It is typically reserved for cases where there is suspicion of other pathologies like bladder stones, strictures, or bladder cancer, or for preoperative planning. - The patient's symptoms and examination findings are consistent with BPH, and his PSA is normal, so primary cystoscopy is not indicated as the next step in management.

Urology Basics US Medical PG Question 9: A 67-year-old man presents to his primary care physician complaining of frequent urination overnight. He states that for several years he has had trouble maintaining his urine stream along with the need for frequent urination, but the nighttime urination has only recently started. The patient also states that he has had 2 urinary tract infections in the last year, which he had never had previously. On exam, his temperature is 98.8°F (37.1°C), blood pressure is 124/68 mmHg, pulse is 58/min, and respirations are 13/min. On digital rectal exam, the prostate is enlarged but feels symmetric and smooth. Which of the following is a possible consequence of this condition?

• A. Increased serum creatinine (Correct Answer)
• B. Malignant transformation
• C. Increased serum AFP
• D. Increased serum hCG
• E. Increased serum ALP

Urology Basics Explanation: ***Increased serum creatinine*** - Chronic **urinary retention** due to benign prostatic hyperplasia (BPH) can lead to **hydronephrosis** and **renal parenchymal damage**, impairing kidney function and increasing serum creatinine. - The patient's symptoms of difficulty maintaining urine stream, frequent urination, and recurrent UTIs suggest BPH, which can progress to urinary obstruction and subsequent kidney dysfunction. *Malignant transformation* - **Benign prostatic hyperplasia (BPH)** is a non-malignant condition and does not directly undergo **malignant transformation** into prostate cancer. - While both BPH and prostate cancer can coexist, BPH itself is not considered a premalignant lesion. *Increased serum AFP* - **Alpha-fetoprotein (AFP)** is a tumor marker primarily associated with **hepatocellular carcinoma** and **germ cell tumors** (e.g., testicular cancer). - It is not associated with benign prostatic hyperplasia (BPH) or its complications. *Increased serum hCG* - **Human chorionic gonadotropin (hCG)** is a tumor marker most notably elevated in **choriocarcinoma** and some **germ cell tumors**. - It has no association with benign prostatic hyperplasia (BPH) or urinary obstruction. *Increased serum ALP* - **Alkaline phosphatase (ALP)** can be elevated in conditions affecting the **liver** (e.g., cholestasis) or **bones** (e.g., Paget's disease, osteoblastic metastases). - While significantly elevated ALP can indicate prostate cancer with **bone metastases**, it is not a direct consequence of uncomplicated benign prostatic hyperplasia (BPH).

Urology Basics US Medical PG Question 10: A 33-year-old man is brought to the emergency department 20 minutes after losing control over his bicycle and colliding with a parked car. The handlebar of the bicycle hit his lower abdomen. On arrival, he is alert and oriented. His pulse is 90/min, respirations are 17/min and blood pressure is 110/70 mm Hg. Pulse oximetry on room air shows an oxygen saturation of 97%. The pupils are equal and reactive to light. There are multiple bruises over his chest and lower extremities. The lungs are clear to auscultation. Cardiac examination shows no abnormalities. The abdomen is soft and nontender. There is no pelvic instability. Rectal examination is unremarkable. A complete blood count, prothrombin time, and serum concentrations of glucose, creatinine, and electrolytes are within the reference range. Urine dipstick is mildly positive for blood. Microscopic examination of the urine shows 20 RBCs/hpf. Which of the following is the most appropriate next step in management?

• A. Intravenous pyelography
• B. Laparotomy
• C. Observation and follow-up
• D. Suprapubic catheterization
• E. CT scan of the abdomen and pelvis (Correct Answer)

Urology Basics Explanation: ***CT scan of the abdomen and pelvis*** - This patient has suffered significant trauma to the lower abdomen, as indicated by colliding with a parked car and handlebar impact, along with **hematuria** (urine dipstick positive for blood, 20 RBCs/hpf). - A CT scan of the abdomen and pelvis is crucial to assess for potential **intra-abdominal organ injury**, particularly to the kidneys, bladder, or bowel, given the mechanism of injury and the presence of hematuria. *Intravenous pyelography* - While IVP can visualize the urinary tract, it is generally **less sensitive and specific** than CT scanning for detecting trauma-related urinary tract injuries and concurrent injuries to other abdominal organs. - Furthermore, modern trauma care primarily utilizes **CT scanning** due to its superior anatomical detail and ability to assess multiple organ systems simultaneously. *Laparotomy* - **Exploratory laparotomy** is a surgical procedure indicated for patients with signs of **hemodynamic instability**, peritonitis, or clear evidence of severe intra-abdominal injury, none of which are present in this hemodynamically stable patient. - Performing a laparotomy without further diagnostic imaging in a stable patient is premature and carries unnecessary risks. *Observation and follow-up* - While the patient is currently hemodynamically stable and the abdomen is soft and non-tender, the **mechanism of injury** (handlebar impact to the lower abdomen) combined with **hematuria** suggests a high likelihood of significant internal injury that requires further evaluation. - **Observation alone** without imaging could lead to delayed diagnosis and treatment of a potentially serious injury to the urinary tract or other abdominal organs. *Suprapubic catheterization* - **Suprapubic catheterization** is used to drain the bladder when urethral catheterization is not possible or contraindicated, for example in cases of suspected urethral injury. - There is no indication of urethral injury here (**unremarkable rectal exam**, no gross blood at the meatus), and the primary concern is evaluation of the organs, not bladder drainage.

Urology Basics Flashcard 1 of 6

Question: PSA can be used as a surveillance marker for recurrent disease after _____

Answer: prostatectomy

Urology Basics Flashcard 2 of 6

Question: Ischemia priapism may lead to permanent erectile dysfunction and _____

Answer: penile necrosis

Urology Basics Flashcard 3 of 6

Question: Abdominal trauma can result in superior bladder wall rupture, result in _____-peritoneal leakage of urine

Answer: intra

Urology Basics Flashcard 4 of 6

Question: Pelvic fractures can injure the anterior bladder wall, resulting in _____-peritoneal leakage of urine

Answer: extra

Urology Basics Flashcard 5 of 6

Question: Patients with a posterior urethral injury present with blood at urethral meatus and a _____

Answer: "high-riding" boggy prostate

Urology Basics Flashcard 6 of 6

Question: varicocele

Answer: increased venous pressure leads to dilated veins in pampiniform plaxus

Extra Information: scrotal enlargement, "bag of worms" appearancevaricocelectomy, embolizationinfertility