Metanephric adenoma is a rare, benign renal mass. Presenting laboratory findings may be polycythemia. These tumors are characterized by canonical BRAF V600E mutations and thought to arise from arrested embryonal rests. Histology is shown!

Thiazide diuretics can be used to reduce the rate of calcium stone recurrence by acting on the distal renal tubule to promoting calcium reabsorption. Potassium supplementation may be used to prevent thiazide-induced hypokalemia.

Varicocele grading can be done based on physical exam findings. Only palpable varicoceles have been shown to be associated with male infertility factor, so imaging/repair is not recommended for subclinical varicoceles. Grading is shown below:

Possible ways androgen deprivation therapy can enhance effects of radiation therapy in prostate cancer:
-Decrease number of viable clonogens --> decrease tumor volume
-Improve blood flow
-Eliminate small deposits outside radiation target
-Decrease DNA repair/enhance apoptosis

Pelvic lymphadenectomy in radical prostatectomy has not shown consistent evidence of therapeutic oncologic benefit. Node dissection helps with staging and future management, but frequency of complications such as vascular injuries and post-op lymphoceles can be increased.

Treating BPH:
-Most common initial therapy includes alpha 1 antagonist (terazosin, doxazosin, etc.)

How? Relaxes smooth muscle at the bladder neck and prostate, giving relief to an obstruction.

Most common side effects: hypotension, retrograde ejaculation, rhinitis

Non-surgical treatment of Peyronie's Disease:

FDA approved treatment is injectable collagenase clostridium histolyticum (CCH).

How? Degrades the collagen plaque causing the curvature.

Note: Use caution to avoid urethral injury when using for ventral plaque

Two methods of renal drainage for upper tract obstruction:

1. Percutaneous nephrostomy tube
2. Indwelling ureteral stent

Literature shows no difference in health-related quality of life when comparing the two; however, clinical context must be considered when choosing.

Trans-scrotal biopsies contraindicated for testicular neoplasms... why? Recall lymphatics!

Testicular lymph flow->retroperitoneal nodes
Scrotal lymph flow-> superficial inguinal nodes

Biopsies risk seeding the neoplasm in the scrotum, increasing chance of cancer spread.

Innervation of the bladder:
-Parasympathetic: from S2-S4 through the pelvic nerve
-Sympathetic: from T10-L2 through the hypogastric nerve
-Somatic: from mostly S2 through the pudendal (to external sphincter) and pelvic nerves

Bladder spasms are the most common cause of lower abdominal and pelvic pain after lower urinary tract surgery. Belladonna & Opium suppositories can be used in the immediate post op period. Oral oxybutynin or sublingual hyoscyamine are other management options.

When assessing hormonal secretion of an incidentally found adrenal mass, begin with one of the three first line tests to detect cortisol hypersecretion:
- overnight low dose dexamethasone suppression test
- late night salivary cortisol test
- 24hr urinary free cortisol eval

Azoospermia is the absence of sperm in the ejaculate, while aspermia is the absence of ejaculate.

When assessing male infertility, keep in mind that 70% of patients with bilateral absence of the vas deferens have a known CFTR mutation.

The outer diameter of a urethral stent is measured in French (F), where 3 F = 1 mm.

Pentosan polysulfate is a heparin like molecule that is FDA approved for the treatment of interstitial cystitis/ bladder pain syndrome. Current research shows that chronic use maybe associated with pigmentary maculopathy.

Steroid hormone binding globulin (SHBG) binds tightly to testosterone (T), inhibiting T from exerting a biological effect. Consider obtaining a SHBG level with free T when symptoms of hypogonadism (erectile dysfunction, low libido, fatigue etc.) occur with normal total T.

Testicular torsion is the most common cause of testis loss in the US. The salvage rate is 100% if detorsion occurs within 6 hours of the onset of pain. After 24 hours, there is pretty much no viability.

When using the intravesical chemotherapy agent mitomycin to reduce recurrence rate of bladder cancer, oral methods to alkalinize the urine can be given because mitomycin is more effective at a pH >6 (ex. Sodium Bicarbonate).

When performing cryotherapy on the prostate in treatment of prostate cancer, the prostate is frozen from anterior to posterior to permit optional visualization of the prostate during freezing.