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GU Labs

GU

QuestionAnswer
4-glass localization test for: chronic prostatitis vs UTI (avoid in acute prostatitis); detn nidus of infxn
infxn 2/2 retrograde organism spread thru vas deferens = epididymitis
urinary incontinence studies UA, PVR; cystometry (H2O into bladder), stress test, US, cystoscopy
prostate ca studies PSA. TR US (if PSA >4): hypoechoic lesions. Bx to dx adenocarcinoma & Gleason grading (2-10). PSA >10: radionuclide bone scan to r/o bony mets. CT unreliable to detect LN involvement
modalities for prostate ca staging: abd/pelvic CT or MRI, pelvic lymphadenectomy, bone scan
testicular ca studies scrotal US (intratesticular echogenic focus); CXR & chest/abd/ pelvic CT; high AFP & hCG (nonseminoma)
spermatocele dx studies FNA; scrotal U/S
PSA elevations can precede clinical dz by: 5-10 yrs
PSA index PSA density (PSA conc divided by PSA volume); higher may be assoc w/cancer
Acid phosphatase used for: Dx of prostatic ca; monitor tx w/ neoplastic drugs, esp in metastatic dz
Acid phosphatase elevated in prostate: Adenocarcinoma; Manipulation; Inflammation; Hypertrophy; do not assay immediately after DRE, TURP, or prostatic massage
Testicular U/S: utility Inflam scrotum; epididymitis; hydrocele; absent/ undescended testicle; torsion; abnormal blood vessels; lump or tumor; most scrotal masses
If testicular mass, first do: dx U/S
Use _____ to differentiate torsion from epididymitis Doppler US
Male infertility analysis: start with: semen analysis (if abnormal, look for exposure to toxins (environment, workplace, EtOH, drugs, hypogonadism)
Semen analysis: specimen reqs 0.5 mL, room temp, no sex 2-3 (2-5?) days prior, macro & micro analysis within 1 hr
Semen analysis: normal volume volume >2 ml
Semen analysis: normal liquefaction: liquefied within 1 hour
Semen analysis: normal pH: 7.2-7.8
Semen analysis: normal motility: ≥ 50%, >50% forward progression
Semen analysis: normal sperm concentration: ≥ 20 x 10(6)/ml
Semen analysis: normal morphology: ≥ 50%
Low sperm motility may be due to: antisperm Ab or infection
Abnormal sperm morphology: may be due to: varicocele, infection, exposure history
Low semen volume: may be due to: retrograde ejaculation or androgen insufficiency
Elevated LH in men: causes Testicular dysfn; primary testicular fail; CNS dysfn; precocious puberty; postviral orchitis
Decreased LH in men: causes Testicular tumors; secondary testicular fail; hypopituitarism; hypothalamic-pituitary dysfn
FSH normal range (M) 1.5-14.0 mIU/mL
Elevated FSH in men: causes primary gonadal failure, testicular agenesis, alcoholism, gonadotropin-secreting pituitary tumors
Decreased FSH in men: causes Anterior pituitary hypofunction, hypothalamic disorders
Limitation of FSH levels Pulsatile secretion throughout day (physiologic variation within reference range)
Primary testicular failure: labs increased LH/FSH, decreased testosterone
Secondary testicular failure (ie, pituitary dz): labs decreased LH, FSH, testosterone
Sims-Huhner test During female LH surge, examine cervical mucus 2-8 hrs post coitus to evaluate sperm & quality of mucus
Sims-Huhner test provides info about: number of sperm, progressive motility, morphology & interaction of spermatozoa with the cervical mucus
Seminal plasma fructose MOA Fructose is produced in seminal vesicles (energy source); if absent in ejaculate, implies absence or obstruction of ejaculatory ducts; exam on frozen seminal plasma specimen
Post-vasectomy testing: check sperm counts: After 20 ejaculations; 8-12 weeks post-vasectomy
Utility of free PSA helps distinguish prostate cancer from BPH in DRE-negative pts with borderline-high PSA
Most common formula for prostate volume ellipsoid formula
Prostate bx: eval men with azoospermia to: rule out ejaculatory duct cysts or seminal vesicular cysts
gold std test for testicular torsion radionucleotide scan
intratesticular echogenic focus on scrotal US = testicular ca
Positive urine cx = >10(5) bacteria/mL (or >100 CFUs) pure growth
If gram stain inconclusive for GU: Cx on Thayer-Martin plate
Decreased FSH, elevated LH & testosterone = Azoospermia &/or androgen resistance
Infertility despite normal FSH, LH, testosterone: ?obstruction of epididymis or vas deferens
Prostate cancer mgmt If neg bone scan & low PSA: local curative tx, radical prostatectomy, XRT. Advanced dz: androgen ablation (castration or LH for med alteration). Palliative bone pain tx
Created by: Abarnard