DAVIS INTUBATED URETEROTOMY
DESCRIPTION Rarely used today, it was developed for surgical repair of lengthy or multiple ureteral strictures. An incision is carried out over the strictured area. A flap is then created attempting to maximally preserve its blood supply. Nephrostomy tube drainage is placed to avoid urinoma formation. A stenting catheter is passed through the cortex of the kidney, down the stenotic segment, and into the distal ureter/bladder. Apex of the flap is brought over the stent as far down as possible over the ureterotomy and closed with interrupted or running absorbable suture. The stenting catheter can be removed at 6 wk, after which an antegrade nephrostogram is done to ensure patency of the ureter. Nephrostomy catheter is removed afterward.
REFERENCE
Nakada SY, Thomas HH. Management of upper urinary tract obstruction. In: Wein AJ, et al., eds. Campbell-Walsh Urology. 10th ed. Philadelphia, PA: Saunders; 2012:1122–1168.
DAYTIME FREQUENCY SYNDROME (POLLAKIURIA)
DESCRIPTION The complaint of frequent daytime voiding or pollakiuria (from the Greek pollakis, meaning often) is a fairly common pediatric complaint. Other terms to describe the condition include extraordinary daytime urinary frequency, and in early literature, sham urinary tract infection. It is seen somewhat more often in boys usually between 4 and 10 yr. In children the differential includes UTI, diabetes mellitus, detrusor instability (DI), constipation, and bladder detrusor instability. If no cause can be determined simple behavioral regimen has demonstrated effectiveness including reassuring the parents and child and waiting for the condition to self-resolve. Reducing dietary intake of oxalate-rich beverages such as, tea and acidic juices such as apple in children who consume large amounts of them, along with liberal intake of water, have been proposed as ancillary approaches. The child needs to learn to ignore the urges and postpone voiding with some type of reward system.
REFERENCE
Farber JM. A strategy to treat pollakiuria. Contemporary Pediatrics. March 1, 2013.
DEEP VENOUS THROMBOEMBOLISM (DVT) PROPHYLAXIS: AUA GUIDELINES
DESCRIPTION Venous thromboembolism (DVT or PE) can occur in 1–5% of patients after major urologic surgery. Risk factors include advanced age, prior venous thromboembolism, cancer, hypercoagulable states, immobilization, obesity, smoking, pelvic dissection, lithotomy position, and many others. Bleeding risk must be weighed against the benefits of prophylaxis. Risk stratification:
• Low risk: Minor surgery, <40 yo, no additional risk factors
• Moderate risk: Minor surgery with additional risk factors or patients 40–60 yo with no additional risk factors
• High risk: Patients >60 yo OR patients 40–60 yo with additional risk factors
• Very high risk: Patients with multiple risk factors
RECOMMENDATIONS
• Transurethral or low-risk procedures: Early and frequent ambulation only
• Moderate Risk: Heparin 5,000 U SQ q12h start post op OR Enoxaparin 40 mg SQ/daily (if CrCL <30 mL/min 30 mg)
• High risk: Heparin 5,000 U SQ q8h start post op OR Enoxaparin 40 mg SQ/daily (if CrCL <30 mL/min 30 mg)
• Very high risk: Heparin 5,000 U SQ q8h start post op OR Enoxaparin 40 mg SQ/daily (if CrCL <30 mL/min 30 mg) AND adjuvant pneumatic compression device
• Active bleeding: Compression stockings and/or intermittent pneumatic compression
• Selected very high-risk patients: Consider postdischarge enoxaparin or warfarin
REFERENCE
Best Practice Statement 2008: Prevention of Deep Vein Thrombosis in Patients Undergoing Urologic Surgery. Available at www.auanet.org/content/guidelines-and-quality-care/clinical-guidelines.cfm, Accessed March 3, 2014.
DEHYDROEPIANDROSTERONE (DHEA) AND DHEA SULFATE (DHEA-S) BLOOD TEST
DESCRIPTION Because they are produced in the adrenal cortex, serum levels of DHEA and the sulfated form (DHEA-S) reflect adrenal gland function. Normal value ranges differ by age and sex. Common clinical reasons to measure these levels include female virilism, hirsutism, precocious puberty, CAH, and adrenal cancer. DHEA-S is the major form in serum. Generally, blood levels of both forms decrease in the aging male, and replacement has been linked with improved outcomes in Alzheimer disease and systemic lupus.
REFERENCE
Baulieu E, Thomas G, Legrain S, et al. Dehydroepiandrosterone (DHEA), DHEA sulfate, and aging: Contribution of the DHEAge Study to a sociobiomedical issue. Proc Natl Acad Sci U S A.2000;97(8):4279–4284.
DELAYED NEPHROGRAM
DESCRIPTION In most imaging studies, contrast is typically appreciated within a few minutes of injection. In a delayed nephrogram, contrast appearance in the kidney is delayed. The most common cause is obstruction of the collecting system or ureter by calculus, tumor, or clot. Other causes are:
• Extraluminal obstruction of the collecting system by extrinsic mass
• Intrarenal obstruction, usually by precipitated substances in the tubules, such as Tamm–Horsfall protein
• Azotemia
• Hypotension
• Renal vein thrombosis
• Rarely, acute kidney injury (AKI)
REFERENCE
Friedenberg RM. Excretory urography in the adult. In: Pollack HM, et al., eds. Clinical Urography. 1st ed. Philadelphia, PA: Saunders; 1990.
DEMENTIA AND VOIDING DYSFUNCTION
DESCRIPTION Dementia represents a debilitating neurologic cognitive disability, which can be associated with Alzheimer disease, Parkinson disease, and Lewy body disease. These patients typically develop lowerurinary tract symptoms (LUTS) of urgency, frequency, and urge incontinence. The incontinence may be a result of urgency and/or functional status. The more advanced the dementia and lack of mobility, the greater the role of functional incontinence. These patients are very difficult to manage successfully and require significant ancillary care. Incontinence in patients with a neurologic diagnosis is typically caused by DO. (See also Section I: “Neurogenic Bladder, General Considerations.”).
TREATMENT
• Anticholinergic medication
• α-Blocker medication
• Behavioral modifications
• Address underlying cause of dementia
REFERENCE
Ransmayr GN, Holliger S, Schletterer K, et al. Lower urinary tract symptoms in dementia with Lewy bodies, Parkinson disease, and Alzheimer disease. Neurology. 2008;70(4):299–303.
DENT DISEASE
DESCRIPTION Characterized by hypercalciuria, nephrocalcinosis, kidney stones, renal failure, and rickets. It is a disorder of the proximal tubules with X-linked recessive inheritance. Symptomatic disease is almost exclusively confined to males. Typical childhood presentation is polyuria, microscopic hematuria, asymptomatic proteinuria, or urolithiasis. Treatment is focused on reducing the hypercalciuria. (See Section II: “Hypercalciuria [Absorptive, Renal, and Resorptive].”)
REFERENCE
Stechman MJ, Loh NY, Thakker RV, et al. Genetic causes of hypercalciuric nephrolithiasis. Pediatr Nephrol. 2009;24(12):2321–2332.
DENYS-DRASH SYNDROME (DDS), UROLOGIC CONSIDERATIONS
DESCRIPTION Also called Drash syndrome, a rare disorder consisting of congenital nephropathy, Wilms tumor, and DSD (male pseudohermaphroditism) resulting from WT-1 gene mutations on chromosome 11p13. Patients develop hypertension, end stage renal disease (ESRD), and gonadoblastomas in their dysgenetic gonads.
TREATMENT
• Early prophylactic bilateral nephrectomy
• Gonadectomy
• Chemotherapy based on National Wilms Tumor protocol
• Renal transplantation after 2 yr of disease free on dialysis
REFERENCE
Shapiro O, Welch TR, Sheridan M, et al. Mixed gonadal dysgenesis and Denys-Drash syndrome: Urologists should screen for nephrotic syndrome. Can J Urol. 2007;14(6):3767–3769.
DERMATITIS HERPETIFORMIS
DESCRIPTION Dermatitis herpetiformis (also called Duhring disease) is an autoimmune blistering disorder associated with gluten sensitivity, and autoimmune and lymphoproliferative disorders. It is characterized by grouped excoriations, urticarial plaques, and papules with vesicles, and has been described on the external genitalia. It is extremely pruritic, and the vesicles are often excoriated to erosions by the time of physical exam. Diagnosis is made by the presence of IgA deposits in the upper papillary dermis seen on direct immunofluorescence of a skin biopsy specimen. The mainstays of treatment are dapsone and a gluten-free diet.
REFERENCE
Alonso-Llamazares J, Gibson LE, Rogers RS 3rd. Clinical, pathologic, and immunopathologic features of dermatitis herpetiformis: Review of the Mayo Clinic experience. Int J Dermatol. 2007;46(9):910–919.
DERMATOPHYTE, EXTERNAL GENITALIA
DESCRIPTION Dermatophytes are the most common type of fungi that cause skin and nail infections, and they can involve the external genitalia. The irritation is often caused by the dermatophyte, Trichophyton rubrum. They typically present in obese adults with excessive perspiration as a major risk factor. Skin manifestations include red, raised, sharply defined, itchy lesions in the groin that may extend to the buttocks, inner thighs, and external genitalia. Warm weather and tight clothing encourage fungus growth. Also consider treating tinea pedis (“athlete’s foot”), as this is often the original site of the offending organism.
SYNONYMS
• Tinea cruris
• Ringworm
• Jock itch
TREATMENT
• Weight loss; improved personal hygiene; talcum, cornstarch, or other desiccant powders to keep the area dry
• Topical antifungals (powders, creams, lotions, solutions) such as terbinafine (Lamisil), clotrimazole (Lotrimin), econazole (Spectazole), ciclopirox (Loprox)
REFERENCE
Nadalo D, Montoya C, Hunter-Smith D. What is the best way to treat tinea cruris? J Fam Pract. 2006;55(3):256–258.
DERMOID CYST, TESTICULAR
DESCRIPTION Dermoid cysts (epidermoid cyst) are benign intratesticular neoplasms and a variant of cystic teratomas that contain ectodermic derivatives. Patients present with a palpable, firm, nontender testicular mass. Case reports indicate occurrence over a wide range of ages, from 5–85 yr. Dermoid cysts are typically well-encapsulated and unilocular. They occur more often in the right testicle (upper/lower pole) and are usually treated with focal excision or enucleation.
REFERENCE
Viganò P, Picozzi SC, Manganini V, et al. 7-year history of an intratesticular mass: Patient description and review of the literature about dermoid cysts of the testis. Urol Int. 2006;77(3):281–283.
DESMOPLASTIC SMALL ROUND CELL TUMOR
DESCRIPTION Rare, usually very aggressive mesenchymal tumor that typically presents in the abdominal cavity but might involve the GU system. Those patients with GU involvement tend to be younger men. Histologically, irregular nests of small round cells surrounded by fibrous connective tissue are seen. Immunohistochemical studies reveal both epithelial and nonepithelial origins. Associated with a unique translocation between chromosomes 11 and 22, that involves EWSR1 and WT1 genes. Prognosis is particularly poor, largely due to majority of patients presenting with metastatic disease. Surgical resection and multidrug chemotherapy have been employed with poor success.
REFERENCE
Dufresne A, Cassier P, Couraud L, et al. Desmoplastic small round cell tumor: current management and recent findings. Sarcoma. 2012;2012:714986.
DE TONI-FANCONI-DEBRE SYNDROME
DESCRIPTION Syndrome of multiple defects of tubular function, characterized by aminoaciduria, phosphaturia, glycosuria, osteomalacia, and renal tubular acidosis. The proximal renal tubule is shortened and replaced by a thin tubular structure, constituting the swan-neck deformity.
TREATMENT
• Replacement of cation deficits (especially potassium)
• Correction of acidosis with bicarbonate or citrate
• Replacement of phosphate loss with isoionic neutral phosphate solution
• Encouragement of liberal calcium intake with added vitamin D
REFERENCE
Ogier H, Lombes A, Scholte HR, et al. De Toni-Fanconi-Debre syndrome with Leigh syndrome revealing severe muscle cytochrome C oxidase deficiency. J Pediatr. 1988;112(5):734–739.
DETRUSOR OVERACTIVITY
DESCRIPTION Involuntary or uninhibited contraction of the detrusor muscle (as seen with multichannel urodynamics) in the absence of a neurologic cause. According to the Incontinence Society definition: DO is a urodynamic observation characterized by involuntary detrusor contractions during the filling phase which may be spontaneous or provoked. Clinically, DO usually presents as urinary urgency, with or without urinary frequency urgency incontinence. (See also Section I: “Overactive Bladder.”) The etiology of DO can be either neurogenic or idiopathic.
SYNONYM
Overactive bladder
TREATMENT
• Behavior modification: Fluid restriction, avoidance of bladder irritant
• Pelvic floor exercises
• Anticholinergic/antimuscarinic therapy
• β3-Adrenergic receptor agonist therapy
• Botulinum toxin type A
• Sacral neuromodulation
• Posterior tibial nerve stimulation
• Surgical treatments: Ileovesicostomy, augmentation cystoplasty
REFERENCES
Abrams P, Cardozo L, Fall M, et al. The standardisation of terminology in lower urinary tract function: report from the standardisation sub-committee of the International Continence Society. Urology. 2003;61(1):37–49.
Ginsberg D, Cruz F, Herschorn S, et al. OnabotulinumtoxinA is effective in patients with urinary incontinence due to neurogenic detrusor activity regardless of concomitant anticholinergic use or neurologic etiology. Adv Ther. 2013;30(9):819–833.
DEXAMETHASONE SUPPRESSION TEST
DESCRIPTION The dexamethasone suppression test is designed to diagnose and differentiate among the various types of Cushing syndrome and other hypercortisolism states. Results indicative of Cushing disease involve no change in cortisol on low-dose dexamethasone but inhibition of cortisol on high-dose dexamethasone. If the cortisol levels are unchanged by both low- and high-dose dexamethasone, then a cortisol-secreting adrenocortical tumor is suspected or an ectopic ACTH source. Occasionally, other conditions (such as major depression, alcoholism, stress, obesity, kidney failure, pregnancy, or uncontrolled diabetes) may interfere with cortisol levels.
The low-dose test depends on the fact that only the correct dose of dexamethasone will suppress ACTH – and thus cortisol release in normal subjects – whereas patients with corticotrophic adenomas will not suppress below a specified cutoff. Traditionally, high-dose dexamethasone has been used to suppress pituitary sources of ACTH and thus serum cortisol levels to help distinguish Cushing disease from the ectopic ACTH syndrome. 2 mg of dexamethasone is given q6h for 48 hr, after which urinary cortisol is measured. Suppression of basal urinary cortisol levels (measured in the initial screening) by 90% is the commonly quoted cutoff for this test. It is advised that high-dose dexamethasone suppression be used more as a confirmatory test, if at all, for the diagnosis of Cushing disease.
REFERENCE
Gross BA, Mindea SA, Pick AJ, et al. Diagnostic approach to Cushing disease. Neurosurg Focus. 2007;23(3):E1.
DIABETES INSIPIDUS (DI), UROLOGIC CONSIDERATIONS
DESCRIPTION DI may cause polyuria. DI is further distinguished as neurogenic or nephrogenic in origin. Of urologic interest, the IVP can show marked hydronephrosis, dilated ureters, and megacystis secondary to the great increase in urine flow. Signs include hypernatremia and hyperosmolarity. The condition is diagnosed by the inability to concentrate urine despite water deprivation and administration of ADH. Neurogenic DI is caused by the loss of ADH secretion from trauma, tumor, or for iatrogenic reasons. Nephrogenic DI can be idiopathic, due to medications, or a result of obstructive uropathy.
TREATMENT
• Neurogenic: Replace ADH
• Nephrogenic:
– Remove the underlying cause
– Chlorothiazide with low sodium diet
REFERENCE
Garofeanu CG, Weir M, Rosas-Arellano MP, et al. Causes of reversible nephrogenic diabetes insipidus: A systematic review. Am J Kidney Dis. 2005;45(4):626–637.
DIETL CRISIS
DESCRIPTION The most severe manifestation of nephroptosis, originally described by Jozef Dietl in 1864. Classically described as colicky flank pain, nausea, chills, tachycardia, oliguria, and transient hematuria or proteinuria. Hydronephrosis secondary to vascular obstruction of the ureter is the postulated cause. Physical exam reveals an enlarged, tender kidney.
TREATMENT
• Manual reduction of the ptotic kidney was initially used
• Nephropexy has been used for nephroptosis and was 1 of the most commonly performed operations of the early 20th century; uncommon procedure today
REFERENCE
Moss S. Floating kidneys: A century of nephroptosis and nephropexy. J Urol. 1997;158:699–702.
DIMERCAPTOSUCCINIC ACID (DMSA) RENAL SCAN
DESCRIPTION DMSA allows the visualization of detailed renal cortical anatomy because it accumulates in the kidney at the proximal renal tubules and is slowly excreted in the urine. DMSA renal imaging is the most sensitive radiologic study used to detect pyelonephritic changes and scarring in the kidneys.
REFERENCE
Hardy R, Austin J. DMSA renal scans and the top-down approach to urinary tract infection. Pediatr Infect Dis J. 2008;27(5):476–477.
DIURETIC RENOGRAM
DESCRIPTION A noninvasive nuclear medicine study that provides functional information regarding upper urinary tract obstruction (sometimes referred to as “Lasix renogram”). This test is most commonly utilized to determine obstruction in the setting of hydronephrosis. A tubular agent is preferred, therefore MAG3 is widely used for its high extraction fraction, rapid parenchymal transit, low radiation absorbed dose, and excellent imaging properties. The recommended dose of furosemide (Lasix) in adults is 40 mg IV. In the standard protocol, Lasix is injected when the collecting system appears to be full (usually 15–20 min after tracer injection, called F + 20). In patients with equivocal results, a 2nd study with administration of Lasix 15 min before tracer injection (called F – 15) is performed to maximize the diuretic stress, which improves the sensitivity and specificity and reduces the chances of equivocal outcome. Quantitative parameters, such as time to peak (TTP), 20 min to peak activity ratio (20/MAX), pelvic T1/2 clearance time, and parenchymal transit time (PTT) are calculated (Image 
).
REFERENCE
Foda MM, Gatfield CT, Matzinger M, et al. A prospective randomized trial comparing 2 diuresis renography techniques for evaluation of suspected upper urinary tract obstruction in children. J Urol. 1998;159(5):1691–1693.
DOPPLER, PENILE
DESCRIPTION Currently, the most widely utilized method to measure arterial flow and prove arterial insufficiency as an etiology of impotence. It allows visualization of individual arteries and measurement of flow. Performed in the flaccid and erect states (after the intracavernosal injection of vasoactive agents). An increase in mean arterial diameter of >75% of the flaccid value and a mean peak flow velocity of >25 cm/s after vasoactive agent injection is used to determine adequate arterial capacity. A wide variability in some patients has been shown.
REFERENCE
Burnett AL. Evaluation and management of erectile dysfunction. In: Wein AJ, et al., eds. Campbell-Walsh Urology. 10th ed. Philadelphia, PA: Saunders; 2012:721–748.
DOWN SYNDROME, UROLOGIC CONSIDERATIONS
DESCRIPTION Also known as trisomy 21, the findings of this commonly seen trisomy include brachycephalic skull; congenital nasal hypoplasia; broad, short hands; and GU anomalies in the form of undescended testicles and a small penis. Males affected are hypogonadal with a smaller than average phallus. Approximately 25% will have cryptorchidism. Microscopic renal cysts, usually of the glomerular space, can also occur.
REFERENCE
Rabinowitz R. General consideration of congenital anomalies. In: Gillenwater JY, Grayhack JT, Howards SS, Duckett JW, eds. Adult and Pediatric Urology. 3rd ed. St. Louis, MO: Mosby; 1996.
DRIBBLING, POSTVOID
DESCRIPTION A complaint of loss of urine that occurs after completion of voiding, thought to be caused by retained urine in the urethra distal to the sphincter in men and retained urine in the vagina or urethral diverticulum in women. In men, it is a complaint associated clinically with BPH, following radical prostatectomy and stricture disease. Recent data suggests it may be a surrogate for median lobe hypertrophy in BPH.
REFERENCE
Ablove T. Post void dribbling: Incidence and risk factors. Neurourol Urodyn. 2010;29(3):432–436.
DROMEDARY HUMP
DESCRIPTION A normal anatomic variant of the left kidney consisting of a bulge of normal tissue that mimics a tumor. Dromedary humps arise from the superolateral aspect of the left kidney secondary to molding by the spleen. It is usually mistaken for tumors on IVP or kidney tomograms. Other imaging, such as CT, MRI, or renal US can be used to rule out a tumor. Appropriately named after the dromedary camel. (See also Section II: “Renal Pseudotumor.”)
REFERENCE
Dyer R, Chen MY, Zagoria RJ. Classic signs in uroradiology. Radiographics. 2004;24:S247–S280.
DROOPING LILY SIGN
DESCRIPTION Excretory urographic description for the lower pole moiety in a duplicated collecting system. The nonfunctioning upper pole produces a mass effect that pushes the lower pole downward. The lower pole ureter tends to be orthotopic, whereas the upper pole is typically ectopic.
REFERENCE
Amis ES, Newhouse JH. Essentials of Uroradiology. 1st ed. Boston, MA: Little Brown; 1991:263.
DROP METASTASES
DESCRIPTION Upper tract urothelial tumors can spread to urothelial structures that are either distal or proximal to the primary tumor called “drop metastases.” Upper urinary tract tumors frequently are multiple or can occur synchronously with bladder tumors. This may reflect the propensity of neoplastic cells to flow down from the renal pelvis or reflux from the bladder to the ureter, forming an invasive implant. However drop metastases may be difficult to differentiate from separate primary lesions. Recurrent bladder tumors tend to cluster around the ureteral orifice of an affected ureter. This suggests their origin as metastases from the original primary tumor.
REFERENCE
Ritchei, JP, Kantoff PW. Malignancies of the renal pelvis and ureter. UpToDate.com, Accessed March 8, 2014.
DRUG ERUPTION, FIXED
DESCRIPTION This sharply localized dermatitis characteristically recurs at the same site each time the offending drug is administered (penis is most common site), with an acute phase followed by desquamation and hyperpigmentation. Symptoms usually appear after 6 hr, although lesions can occur 24–48 hr later. A macrophage migration inhibition factor (MIF) assay is essential for diagnosis.
Common medications responsible include phenolphthalein, trimethoprim-sulfamethoxazole, antipyrine, quinine, tetracycline, salicylates/NSAIDS, and hydroxyzine hydrochloride. Discontinuation of the drug causing the reaction results in complete resolution of the fixed drug eruption. Supportive topical therapy (steroids) is used, as needed.
REFERENCE
Cohen HA, Barzilai A, Matalon A, et al. Fixed drug eruption of the penis due to hydroxyzine hydrochloride. Ann Pharmacother. 1997;31(3):327–329.
DYSFUNCTIONAL VOIDING
DESCRIPTION Dysfunctional voiding is characterized by an intermittent and/or fluctuating flow rate due to involuntary intermittent contractions of the periurethral striated muscle during voiding in neurologically normal individuals. Although dysfunctional voiding is not a very specific term, it is preferred to terms such as “nonneurogenic neurogenic bladder”. Other terms such as “ idiopathic detrusor sphincter dyssynergia,” or “sphincter overactivity voiding dysfunction,” may be preferable. However, the term dysfunctional voiding is very well established. The condition occurs most frequently in children. While it is felt that pelvic floor contractions are responsible, it is possible that the intraurethral striated muscle may be important. It was originally described by Hinman and Bauman in 1973 after a review of similar reported cases. Upper tract damage can occur. Diagnosis is through videourodynamics. (See also Section II: “Hinman Syndrome [Hinman–Allen Syndrome].”)
REFERENCE
Abrams P, Cardozo L, Fall M, et al. The standardisation of terminology in lower urinary tract function: report from the standardisation sub-committee of the International Continence Society. Urology.2003;61(1):37–49.
DYSGERMINOMA
DESCRIPTION Malignant tumor of the ovary, which is roughly the counterpart of seminoma of the testes, occurring in children and young women. It is occasionally seen in gonadal dysgenesis or testicular feminization syndrome. Patients may present with pelvic mass or abdominal pain. Pure dysgerminomas do not secrete tumor markers such as AFP or hCG.
TREATMENT
• Surgical resection for local disease
• Radiation therapy or chemotherapy for advanced disease
REFERENCE
Berek JS. Ovarian cancer. In: Hacker NF, et al., eds. Essentials of Obstetrics and Gynecology. 2nd ed. Philadelphia, PA: Saunders; 1992.
DYSORGASMIA
DESCRIPTION Pain with orgasm can affect both men and women and is not well described in the literature. In men, largely self-limited if experienced after radical prostatectomy (RP). Some reports that seminal vesiculectomy following RP can be therapeutic. In women often manifests as lower abdominal cramping pain.
REFERENCE
Matsushita K, Tal R, Mulhall JP. The evolution of orgasmic pain (dysorgasmia) following radical prostatectomy. J Sex Med. 2012;9(5):1454–1458.
DYSPAREUNIA, MALE (PARTNER DYSPAREUNIA, HISPAREUNIA)
DESCRIPTION The term dyspareunia means “bad or difficult mating.” Pain with intercourse is traditionally ascribed to female complaints. Recently cases of male dyspareunia and penile trauma have been reported due to the use of alloplastic materials in female pelvic floor surgery. This is often related to prominence or frank exposure of the sling material. Changes of male sexual function and particularly pain after sling insertion in their female partners may be due to sling exposure. Sexual interest and drive may be negatively influenced and can be treated effectively by correcting the sling exposure.
REFERENCE
Mohr S, Kuhn P, Mueller MD, et al. Painful love-”hispareunia” after sling erosion of the female partner. J Sex Med. 2011;8(6):1740–1746.
DYSRAPHISM, SPINAL
DESCRIPTION Most common cause of neurogenic bladder dysfunction in childhood, dysraphism is defined as failure of closure of the vertebral canal during embryonic development, leading to spinal cord dysfunction. The most common dysraphism, myelodysplasia, includes meningoceles, myelomeningoceles, and lipomeningoceles. Reflux, continence, sexuality, and bowel function are often important issues with these patients. Many rarer forms also exist, including tight filum terminale, dermoid cysts, and aberrant nerve roots with varying levels of resulting dysfunction. (See also Section II: “Myelodysplasia [Myelomeningocele], Urologic Considerations”; Section III: “Tethered Cord Syndrome.”)
REFERENCE
Bauer SB, MacLellan DL. Neuropathic dysfunction of the lower urinary tract In: Wein AJ, et al., Campbell-Walsh Urology. 10th ed. Philadelphia, PA: Saunders; 2012:3431–3456.
DYSTHYROIDISM (HYPO/HYPERTHYROIDISM) UROLOGIC CONSIDERATIONS
DESCRIPTION Thyroid disease (hyper/hypo) may occasionally be associated with male factor infertility and erectile dysfunction (ED). Hyperthyroidism is commonly associated with diminished libido (may be caused by increased circulating estrogen levels). In hypothyroidism, low testosterone secretion and elevated prolactin levels contribute to ED. Subclinical hypothyroidism does not impact semen parameters. In patients undergoing urologic surgery, they should be euthyroid prior to their intervention. Thyrotoxicosis or thyroid storm can present with fevers, tachycardia, confusion, and cardiovascular collapse. Hypothyroidism is generally associated with an increased sensitivity to medications such as anesthetic agents and narcotics; its severe form can be associated with myocardial dysfunction, coagulopathy, electrolyte imbalance, and decreased gastrointestinal motility.
REFERENCE
Vira MA, Steckel J. Core principles of perioperative care. In: Wein AJ, et al., eds. Campbell-Walsh Urology. 10th ed. Philadelphia, PA: Saunders; 2012:159–176.