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Professionalism

1 What is a profession? The professions are the means by which the complex services needed by society are organized. A profession has been defined by the American College of Surgeons as: …an occupation whose core element is work that is based upon the mastery of a complex body of knowledge and skills. It is a vocation in which knowledge of some department of science or…

Medical Ethics

1 Are there any principles of medical ethics? Yes, there are four: a. Beneficence: The intent of doing good and offering net benefit by therapeutic intervention. This principle requires maintenance of professional knowledge and skill by ongoing education throughout one’s career. b. Nonmaleficence: The intent of not causing harm. To exercise this principle, one must know probability of harm from a proposed intervention. c. Autonomy: Deliberated…

Can Healthcare Be Reformed?

1 Is healthcare reform an oxymoron? Yes. 2 What is fee for service? The doctor establishes the price, and the patient agrees to pay it. This traditional system of exchange has great merit if both parties understand the value of the service provided. If either party (usually the patient) cannot estimate the service value, it is possible (even likely) that the doctor will honestly escalate the…

Pediatric Urology

1 How should we evaluate a patient with febrile urinary tract infection (UTI)? After treatment of the infection, the patient should undergo a urinary tract evaluation with a renal-bladder sonogram and ± voiding cystourethrogram (VCUG). Approximately 50% of children under the age of 12 presenting with a UTI are found to have abnormalities of the genitourinary (GU) tract. The most common abnormalities identified are vesicoureteral reflux…

Urodynamics and Voiding Dysfunction

1 What is an urodynamic study? Urodynamic studies assess the functional aspects of the storage and emptying ability of the lower urinary tract (LUT). The principles of urodynamic studies originated from hydrodynamics. The components of urodynamic studies are cystometrogram, leak point pressures, urethral profile pressures, pressure-flow studies, uroflowmetry, and electromyography. These studies have evolved into videourodynamics with the addition of fluoroscopy (i.e., video). 2 What is…

Prostate Cancer

1 What is the prevalence of prostate cancer in the United States? Prostate cancer is the most common cancer among men, except for skin cancer. In 2016 an estimated 180,890 men in the United States will be diagnosed with prostate cancer. Prostate cancer is the second leading cause of cancer death in men in the United States. It is estimated that 26,120 deaths from this disease…

Bladder Cancer

1 What is the incidence of transitional cell carcinoma (TCC) of the bladder? Bladder cancer accounts for about 5% of all new cancers in the United States. The American Cancer Society’s estimates for bladder cancer in the United States are 79,030 new cases (60,490 in men and 18,540 in women) and 16,870 deaths for 2017. Recently, the overall rates of new bladder cancers and of cancer…

Renal Cancer

1 How common is renal cell carcinoma (RCC)? All solid renal masses and cystic lesions with solid components are suspicious for RCC, which affects approximately 65,000 new patients each year and has a 5-year mortality rate of 35%. 2 What is the etiology of RCC? The etiology is unknown, but cigarette smoking is a well-known risk factor. Recurrent RCC is a common manifestation in patients with…

Urolithiasis

1 What is the likelihood that someone in the United States will have a kidney stone in their lifetime? Approximately 1 in 11 people will have at least one kidney stone in their lifetime. 2 Are people with kidney stones likely to have stone recurrence? At least 50% of first-time kidney stone patients will have another kidney stone episode within 10 years. 3 What are the…

Penile and Scrotal Urologic Emergencies

1 What is priapism? A prolonged erection lasting for more than 4 hours, beyond or unrelated to sexual activity or stimulation. 2 Why is priapism an emergency? Prolonged ischemia to the penis results in corporal body fibrosis and future erectile dysfunction. 3 What are the three types of priapism? Ischemic (low flow), nonischemic (high flow), and stuttering (intermittent). In ischemic priapism the corpora cavernosa are typically…

Lung Transplantation

1 Which human organ transplant was performed first, the heart or the lung? Although heart transplantation has progressed more rapidly, the first human lung transplant preceded the first heart transplant. 2 Who performed the first human lung transplant? When? James Hardy performed the first human lung transplant in 1963; however, more than 20 years passed before lung transplantation was performed routinely in clinical practice (during that…

Mechanical Circulatory Support

1 What are the indications for ventricular assist device (VAD)? Bridge to transplant: Patients are in need of and are eligible for transplant, but their clinical course is such that they will not survive until a donor organ is available. Thus, mechanical circulatory support (MCS) is required to “bridge” the gap until an organ is available. The ultimate goal for these patients is heart transplantation, and…

Heart Transplantation

1 What is the gold standard therapy for end-stage heart disease? Heart transplantation remains the gold standard therapy for end-stage heart failure. The most common technique is to place the heart in its anatomical or orthotopic position. Ventricular assist devices (VADs) have become more popular either as a bridge-to-transplant or as a destination-therapy for those who are not transplant candidates, with promising results. 2 Who were…

Kidney Transplantation

1 When was the first successful kidney transplant performed? In 1954, Dr. Joseph Murray successfully transplanted a kidney between identical twins at the Brigham Hospital in Boston. 2 What are the most common causes for end-stage renal disease (ESRD) in the United States? In adults, hypertension and diabetes are now the most common cause of ESRD, whereas glomerular disease, which used to be the most prevalent,…

Liver Transplantation

1 When and where was the first liver transplant performed? Dr. Thomas Starzl performed the first liver transplant at the University of Colorado in Denver in March of 1963. Early results were dismal but laid the foundation for the future of transplantation. 2 Is liver transplantation a safe and effective operation? Liver transplant is still a relatively new procedure. As recently as 30 years ago, it…

Congenital Cysts and Sinuses of the Neck

1 What are branchial cleft anomalies? They can occur as cysts, sinuses, and fistulas found in the head and neck related to incomplete obliteration of the first, second, third, or fourth (extremely rare) branchial clefts during early fetal development. Cysts have mucosal or epithelial lining but no external openings. Sinuses may communicate either externally with the skin or internally with the pharynx. Fistulae, however, connect to…

Abdominal Tumors

1 What are the most common malignant solid abdominal tumors in children? a. Neuroblastomas are derived from neural crest tissue. In the abdomen, they originate from the adrenal glands and parasympathetic ganglia. b. Wilms’ tumors, nephroblastomas, are derived from the kidney. The classic Wilms’ tumor consists of three elements—blastemal, stromal, and epithelial. c. Hepatoblastomas originate in the liver. 2 How does the presentation of neuroblastoma differ…

Congenital Diaphragmatic Hernia

1 What is the most common type of congenital diaphragmatic hernia (CDH)? Congenital abnormalities of the diaphragm include a posterolateral defect (Bochdalek hernia), an anteromedial defect (Morgagni hernia), or the eventration (central weakening) of the diaphragm. The Bochdalek hernia is the most common variant and accounts for approximately 80% of CDH cases. This defect is most common on the left (80%), 20% are right-sided lesions, and…

Tracheoesophageal Malformations

1 What are tracheoesophageal fistula and esophageal atresia? The pathogenesis for the development of esophageal atresia, with and without fistula, is still unknown. Theories include imperfect separation of the tracheoesophageal septum or defective pharyngeal arch development. More than 50% of cases of esophageal atresia with tracheoesophageal atresia are associated with other anomalies; 10% are found in specific chromosomal or single gene disorders. 2 Describe the three…