Case Scenarios in Adult Urology

1
Case Scenarios in Adult Urology

• Noah S. Schenkman, M.D.
• Department of Urology

2
Case 1

• 62 y/o male presents with nocturia x 1 yr.
• What else do you want to know?

3
Case 1

• Physical exam?
• Labs?
• Imaging?
• Adjunctive tests?

4
Case 1 BPH

• Prevalence (2000) 6.5 million of 27 million
  Caucasian men age 50 to 79 in United States meet
  criteria for treatment options for BPH. 
• BPH prevalence estimates for different
  ages4049 24 percent5059 31 percent6079
  36 percent70up 44 percent 
• Doctor visits (2000) 4.5 million visits 
• Costs (2000) ) 1.1 billion /yr. in direct
  expenditures for medical services

5
(No Transcript)
6
Case 1

• Treatment decisions are patient/symptom driven
• Medical Therapy
• Alpha blocker
• 5 alpha reductase inhibitor
• Minimally Invasive Therapy
• Transurethral surgery
• Laser
• Electrocautery (TURP)

7
Case 1

• http//www.youtube.com/watch?vLPbyFe2FLrw

8
Case 2

• 36 y/o woman with one day history of left sided
  abdominal pain
• Pertinent questions?
• Physical exam?
• Labs?
• Imaging?

9
Case 2
10
Case 2
11
Case 2

• Immediate therapy?
• What to do after acute episode is over?

12
Case 2 Kidney Stones

• Prevalence (adults aged 2074 for 19881994) 
•  5.2 (6.3 men and 4.1 women) 
• Inpatient hospital stays hospital admissions
  among adults with "calculus of kidney and
  ureters" as a primary diagnosis (2000) 177,496
  hospital stays 
• Physician office and hospital outpatient visits
  combined (2000)
• 2.0 million visits
• Cost (2000) 2.07 billion

13
Kidney Stones

• Immediate treatment of renal colic
• Analgesia Toradol or opiates
• Hydration to euvolemia
• Strain urines
• Admit / intervene intractable vomiting,
  intractable pain, fever

14
Kidney Stones

• Observation /Medical Therapy
• ESWL Extracorporeal Shock Wave Lithotripsy
• Ureteroscopy
• Percutaneous Nephrolithotomy
• Laparoscopic Pyelolithotomy/Ureterolithotomy
• Open Stone surgery

15
Kidney Stones
16
ESWL
17
Case 3

• 60 y/o male presents with gross total painless
  hematuria
• History?
• Physical Exam?
• Labs?
• Imaging?

18
Case 3 Urine sample
19
Case 3

• Cystoscopy negative

20
Case 3
21
Case 3

• Further workup?
• Treatment options?

22
Treatment options Localized Renal Cell Ca

• Observation
• Approach Open vs. Laparoscopic
• Procedure Radical Nephrectomy vs. Partial
  Nephrectomy
• Ablative therapy percutaneous or laparoscopic

23
Laparoscopic Nephrectomy
http//www.youtube.com/watch?vGyV6Sc7-0KU
24
Other Options
25
Questions

• Contact
• Noah S. Schenkman
• nss2f_at_virginia.edu
• Or any urology resident or staff to set up 4th
  year rotation