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GU Labs
GU
| Question | Answer |
|---|---|
| 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
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