Chapter 6 of 154% of exam

Genitourinary System

Genitourinary content covers the prostate, bladder, urethra, testes and penis, including infections, stones, congenital problems and cancers. Several items are time-critical emergencies disguised as common complaints.

Scrotal emergencies and masses

Acute scrotal pain is torsion until proven otherwise, because salvage falls quickly with time. Painless masses are separated by position, consistency and transillumination. Findings that change with standing or Valsalva point to venous causes.

Testicular torsion

Sudden pain, a high-riding horizontal testis and absent cremasteric reflex; detorsion and surgery without delay.

Merck Manual Professional Edition, Testicular Torsion

Varicocele

A bag of worms, usually on the left, that enlarges on standing or Valsalva.

Merck Manual Professional Edition, Painless Scrotal Mass

Hydrocele

A smooth cystic swelling that transilluminates.

Merck Manual Professional Edition, Painless Scrotal Mass

Prostate

Prostate questions contrast infection, hyperplasia and cancer by examination findings and by treatment timing. Systemic symptoms with a very tender gland suggest infection. Drug classes for hyperplasia differ in how fast they work and in whether they shrink the gland.

BPH drugs

Alpha-blockers relieve symptoms quickly; 5-alpha-reductase inhibitors shrink larger glands over months; combining them is more effective.

Merck Manual Professional Edition, Benign Prostatic Hyperplasia

Acute bacterial prostatitis

Fever, chills and urinary symptoms with an exquisitely tender, boggy prostate.

Merck Manual Professional Edition, Prostatitis

Prostate cancer

Suggested by digital rectal examination or PSA and confirmed by biopsy; screening involves shared decision-making.

Merck Manual Professional Edition, Prostate Cancer

Stones and infection

Stones present with colicky flank pain radiating to the groin and hematuria. Imaging choice and expulsive therapy are the core early decisions. Fever with flank pain signals upper-tract infection, which is more serious than cystitis.

Imaging stones

Noncontrast CT is the usual diagnostic test; ultrasound avoids radiation.

Merck Manual Professional Edition, Urinary Calculi

Medical expulsive therapy

Alpha-blockers such as tamsulosin can facilitate stone passage.

Merck Manual Professional Edition, Urinary Calculi

Pyelonephritis

Flank pain and systemic symptoms with urinary symptoms suggest kidney infection.

Merck Manual Professional Edition, Bacterial Urinary Tract Infections

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