GAMETE INTRAFALLOPIAN TRANSFER (GIFT)
DESCRIPTION GIFT is similar to IVF but is rarely performed currently with the improved pregnancy rates in IVF. Current indications for GIFT include patients who have ethical or religious objections to IVF and prefer fertilization in vivo rather than in vitro. Technique involves inducing superovulation, aspirating the ovarian follicles vaginally under US guidance, and identifying eggs. Sperm is collected and capacitated. During laparoscopy, sperm and eggs are mixed and transferred into 1 of the fallopian tubes, allowing in vivo fertilization. A 20–30% pregnancy rate per cycle is reported. Limitations of GIFT are that patients must have normal fallopian tubal function and the procedure requires general anesthesia and laparoscopy.
REFERENCE
DeUgarte CM, et al. Assisted reproductive technologies: In vitro fertilization & related techniques. In: DeCherney AH, Nathan L, eds. Current Diagnosis & Treatment Obstetrics & Gynecology. 10th ed. New York, NY: McGraw-Hill; 2006.
GANGLIONEUROBLASTOMA, ADRENAL
DESCRIPTION Extremely rare tumor originating from neural crest cells, this ganglioneuroblastoma exists on a spectrum of diseases between neuroblastoma and ganglioneuroma. It is varied in appearance and malignant potential, with prognosis and behavior depending on histology. The cause is unknown, but it has been reported to have a genetic predisposition. Treated by surgical resection.
REFERENCE
Koike K, Iihara M, Kanbe M, et al. Adult-type ganglioneuroblastoma in the adrenal gland treated by a laparoscopic resection: Report of a case. Surg Today. 2003;33(10):785–790.
GANGLIONEUROMA, ADRENAL
DESCRIPTION A tumor originating from neural crest cells, this is the benign counterpart of neuroblastoma. It does not metastasize, but can locally recur after resection and be locally aggressive. It most commonly presents as an abdominal mass. Histologically, the lesion is composed of ganglion cells with abundant cytoplasm and large nuclei. Treatment is by surgical resection.
REFERENCE
Gupta R, Dinda AK. Ganglioneuroma of the adrenal gland: A rare case. Indian J Pathol Microbiol. 2007;50(4):782–784.
GARTNER DUCT CYST
DESCRIPTION Gartner duct cyst is a rare congenital anomaly associated with urogenital maldevelopment, usually located posterior to the urinary bladder. It is caused by a failure of separation of the ureteric bud from the mesonephric duct that leads to persistence of the Gartner duct, often with cystic dilation. The Gartner duct is associated with müllerian duct developmental anomalies and with abnormal ureteric development, such as ureteric ectopia. Abnormal development of the ureter also results in the maldevelopment, ectopic kidney, or absence of the ipsilateral kidney. The usual presentation is an anterior vaginal wall mass with ipsilateral renal dysgenesis with or without urinary incontinence. Differential diagnoses include ectopic ureterocele, urethral diverticulum, urethral tumor, Skene gland cyst or abscess, and vaginal wall cysts or tumors. Diagnosis is by voiding cystourethrography, cystourethroscopy, and retrograde pyelography (maldevelopment of the bladder neck and hemitrigone; ureteric ectopia or ureteric dysgenesis) and renal and bladder US (a cystic lesion behind bladder is suggestive of Gartner duct cyst and ipsilateral renal agenesis or ectopic kidney). Treated surgically, depending on anatomic anomalies, including transvaginal or transabdominal excision of the Gartner duct and closure of any associated urinary fistula; reconstruction of bladder neck and urethra; reimplantation of ipsilateral and/or contralateral ureter; or removal of nonfunctioning renal unit and ectopic ureter.
REFERENCE
Dwyer PL, Rosamilia A. Congenital urogenital anomalies that are associated with the persistence of Gartner’s duct: A review. Am J Obstet Gynecol. 2006;195:354–359.
GENITAL AROUSAL DISORDER (PERSISTENT)
DESCRIPTION A condition of spontaneous, intrusive, and frequently unwanted genital arousal including throbbing, pulsating, and tingling. These feelings are usually unrelated to any sexual arousal. Physical arousal caused by this syndrome can persist for extended periods of time. Orgasm can sometimes provide temporary relief, but within hours the symptoms return suddenly. Can be debilitating and negatively impact quality of life.
TREATMENT
While not well-studied, treatment options include antidepressants, antiandrogens, psychotherapy, and local nerve blocks (pudendal nerve is most frequent)
REFERENCE
Basson R, Leiblum S, Brotto L, et al. Definitions of women’s sexual dysfunctions reconsidered: advocating expansion and revision. J Psychosom Obstet Gynaecol. 2003;24:221–229.
GENITAL PIERCING, UROLOGIC CONSIDERATIONS
DESCRIPTION Urologists must be familiar with complications from genital piercing. In males, piercings include the penile glans, shaft, urethra, scrotum, and combinations of these. Clitoral and labial piercings in females are also performed. Complications include:
• Transmission of infectious agent: HIV, Hepatitis B and C, or an STD
• Bleeding
• Cellulitis
• “Cutting-out” or erosion
• Priapism
• Paraphimosis
• Recurrence of condyloma acuminatum
• Urethral fistula
• Hypertrophic scarring, keloid
• Trauma during intercourse: To partner or self
REFERENCE
Anderson W, Summerton DJ, Sharma DM, et al. The urologist’s guide to genital piercing. BJU Int. 2003;91(3):245–251.
GENITAL SKIN LOSS
DESCRIPTION Genital skin loss is most commonly iatrogenic, as the result of skin debridement for necrotizing infection by polymicrobial infection—Fournier gangrene. Skin loss can less commonly occur as a result of trauma, usually blunt; however, penetrating trauma can also result in skin loss. Burns can also lead to genital skin loss.
TREATMENT
Reconstruction is the mainstay of treatment. In the case of skin loss to due to debridement for infection, the infection should be stable prior to reconstruction being performed. In the case of penile skin loss in an uncircumcised male, a flap using redundant foreskin may be harvested to address a proximal defect. Flaps may also be created using scrotal, abdominal, or thigh tissue. Split-thickness skin grafts can be used to address both penile and scrotal skin defects. Vacuum-assisted closure therapy has been effective in early management with skin grafts (see also Section I: “Scrotum and Testicle, Trauma.”)
REFERENCES
Czymek R, Schmidt A, Eckmann C, et al. Fournier’s gangrene: Vacuum-assisted closure versus conventional dressings. Am J Surg. 2009;197:168–176.
McAninch JW, Kahn RI, Jeffrey RB, et al. Major traumatic and septic genital injuries. J Trauma. 1984;24:291–298.
GENITAL ULCERS
DESCRIPTION Genital ulcers may be due to multiple causes: Infection, Behçet syndrome, erythema multiforme, Crohn disease, lichen planus, amebiasis, drug reaction, trauma, and carcinoma in situ are all possible causes. They are most commonly a manifestation of sexually transmitted infections, including chancroid, genital herpes, lymphogranuloma, and primary syphilis. Characteristics of the ulcers associated with sexually transmitted infections are as follows:
• Chancroid: Tender papule that turns painful which has a purulent ulcer underneath; may be single or multiple
• Genital herpes: Multiple painful vesicles
• Lymphogranuloma: A small painless papule or vesicle that ulcerates
• Primary syphilis: Painless, indurated ulcer; usually single
TREATMENT
If a sexually transmitted infection is suspected, empiric antibiotic therapy should be initiated even before confirmatory testing. Chancroid is treated with a single oral dose of azithromycin, or a single intramuscular dose of ceftriaxone, or oral erythromycin for 7 days. Genital herpes is treated with antiviral drugs such as Acyclovir. Lymphogranuloma is usually treated with tetracycline or erythromycin. Primary syphilis is treated with a single dose of intramuscular penicillin G or a single dose of oral azithromycin in a penicillin allergic patient. (See also Section I: “Sexually Transmitted Infections [STIs]; Sexually Transmitted Diseases [STDs], General.”)
REFERENCES
DiCarlo RP, Martin DH. The clinical diagnosis of genital ulcer disease in men. Clin Infect Dis. 1997;25:292–298.
Workowski KA, Berman S; Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines, 2010. MMWR Recomm Rep. 2010;59(No. RR-12)1–110.
GENITOURINARY PAIN INDEX (GUPI)
DESCRIPTION GUPI is a validated 9 question instrument to assess severity of symptoms, in men and women with urologic pain conditions. The GUPI can differentiate men with chronic prostatitis or interstitial cystitis, those with other symptomatic conditions (dysuria, frequency, chronic cystitis), and those with none of these diagnoses. It can discriminate between women with interstitial cystitis, those with incontinence, and those with none of these diagnoses.
REFERENCE
Clemens JQ, Calhoun EA, Litwin MS, et al.; Urologic Pelvic Pain Collaborative Research Network. Validation of a modified National Institutes of Health chronic prostatitis symptom index to assess genitourinary pain in both men and women. Urology. 2009;74(5):983–987.
GENOMIC TESTING, PROSTATE CANCER
DESCRIPTION A variety of genomic tests have been recently approved. The more common tests are shown in the table. All rely on either needle biopsy or radical prostatectomy tissue analysis. Their role in the definitive management of patients with prostate cancer is currently evolving.
REFERENCE
http://www.cancernetwork.com/oncology-journal/new-biomarkers-prostate-cancer/page/0/2, Accessed April 1, 2014.
GERM CELL APLASIA (SERTOLI CELL ONLY SYNDROME)
DESCRIPTION Total absence of germ cells within a normal interstitium. Patients present with infertility, and usually with small to normal testes and azoospermic semen specimens. Phenotypically, these patients are normally virilized males. Histologically, Sertoli cells line the seminiferous tubules with a complete absence of germ cells and normal interstitium. Plasma FSH is usually elevated due to the absence of germ cells. Plasma testosterone and LH are normal. Diagnosis is based on an elevated FSH and FNA of the testis. Aplasia may represent the endpoint of various etiologies, resulting in this histologic appearance. Adoption or use of donor sperm is necessary if children are desired.
REFERENCE
Odabas O, Ugras S, Aydin S, et al. Assessment of the testicular cytology by fine-needle aspiration and the imprint technique: Are they reliable diagnostic modalities? Br J Urol. 1997;79(3):445–448.
GESTATIONAL AGE ASSESSMENT, UROLOGIC CONSIDERATIONS
DESCRIPTION Gestational age assessment can be derived from 3 clinical methods: (1) physical exam, (2) ultrasound, and (3) history, using the date of the last menstrual period (LMP) to calculate the estimated date of delivery (“due date” or EDD). The clinical assessment of gestational age or duration of pregnancy reflects the “menstrual age.” Studies have shown ultrasound to be superior to physical exam or history. Rapid determination of gestational age in the delivery room includes assessment of soles of the feet, breast nodules, earlobe, hair, and the external genitalia of males. Babies born 36 wk and earlier the testes are usually partially descended, the scrotum is small with very few rugae. Term infants (39 wk and beyond) should have the testes fully descended, the scrotum should appear normal sized with prominent rugae.
REFERENCE
Gomella, TL ed. Assessment of Gestational Age in Neonatology. 7th ed. New York, NY: McGraw Hill, 2013.
GIBBON CLASSIFICATION OF VOIDING DYSFUNCTION
DESCRIPTION Historic classification based in large part on the system proposed by Bors-Comarr. 5 categories are proposed to be important: (1) Full general and neurologic diagnosis, (2) state of the bulbocavernosus and anal reflexes in cord injuries, (3) presence or absence of reflex detrusor contractions, (4) urodynamic findings, and (5) failure of storage, emptying, or control when dealing with incontinence.
REFERENCE
Gibbon NOK. Nomenclature of neurogenic bladder. Urology. 1976;8:423–431.
GIBSON INCISION
DESCRIPTION A curvilinear incision is made starting 2–3 cm medial to the anterior superior iliac spine, running parallel to the inguinal ligament down to 2–3 cm superior and just lateral to the pubic tubercle. The external and internal obliques and the transversalis muscle are bluntly opened along their fibers. After transecting the transversalis fascia, the peritoneum is swept medially to expose the ureter at its midsection. Useful for distal ureteral stones, distal ureterectomy and renal transplant.
REFERENCE
Yang WH, Ou CH. A muscle sparing modified Gibson incision for hand-assisted retroperitoneoscopic nephroureterectomy and bladder cuff excision–an approach through a window behind the rectus abdominus muscle. Urology.2012;79(2):470–474.
GIGGLE INCONTINENCE (ENURESIS RISORIA)
DESCRIPTION Giggle incontinence, also referred to as enuresis risoria, is urinary leakage that occurs only with laughter in children with rare exception exclusively occurs in girls. It is characterized by large-volume voids. These children have normal bladder function when the child is not laughing. The disorder is thought to be mediated by the central nervous system and has similarities to detrusor instability.
TREATMENT
• Treatment of this condition is not well studied
• Anticholinergics (eg, oxybutynin)
• Methylphenidate
• Biofeedback was effective in 1 series in patients refractory to medical management
REFERENCE
Nevéus T, von Gontard A, Hoebeke P, et al. The standardization of terminology of lower urinary tract function in children and adolescents: Report from the Standardisation Committee of the International Children’s Continence Society. J Urol. 2006;176(1):314–324.
GIL-VERNET EXTENDED PYELOLITHOTOMY
DESCRIPTION An open approach to remove a large renal calculi, such as a staghorn calculi. Using a flank incision, the kidney is exposed and freed at the upper pole, lower pole and posteriorly. The ureter is identified and traced to the renal pelvis. The renal pelvis is incised and the incision can be continued to include the calices to allow for removal of more significant calculi.
REFERENCE
Gil-Vernet J. New surgical concepts in removing renal calculi. Urol Int. 1965;20:255–288.
GIL-VERNET ORTHOTOPIC URINARY DIVERSION
DESCRIPTION A continuous segment of terminal ileum, cecum, and ascending colon are isolated. The unit is rotated 180° to allow anastomosis of the reduced end of the ascending colon to the urethra and the ureters to the terminal ileum.
REFERENCE
Benson MC, Olsson CA. Continent urinary diversion. In: Walsh PC, Retik AB, Vaughan ED, et al., eds. Campbell’s Urology, 7th ed. Philadelphia, PA: Saunders; 1998:3190–3245.
GIL-VERNET URETERAL REIMPLANTATION
DESCRIPTION Through a transvesical approach, the ureters are dissected free from their hiatus. The principle involves advancing the ureters across the trigone to the midline such that both ureteral orifices are juxtaposed. A single incision is made in the trigone mucosa, which will serve to join traction sutures from each ureter that are anchored in the midline.
REFERENCE
Khoury AE, Bagli DJ. Vesicoureteral reflux. In: Wein AJ, et al., eds. Campbell-Walsh Urology. 10th ed. Philadelphia, PA: Saunders; 2012:3267–3309.
GITELMAN SYNDROME
DESCRIPTION Gitelman syndrome is an autosomal recessive disorder characterized by hypokalemia, hypocalciuria, and hypomagnesemia with metabolic alkalosis. It is caused by loss of function mutations of a thiazide sensitive sodium-chloride symporter found in the distal convoluted tubule of the kidney.
TREATMENT
Replacement of respective electrolytes.
REFERENCE
Nakhoul F, Nakhoul N, Dorman E, et al. Gitelman’s syndrome: A pathophysiological and clinical update. Endocrine. 2012;41(1):53–57.
GITTES NEEDLE URETHROPEXY
DESCRIPTION Historically used to treat female stress incontinence. A Stamey needle is delivered through a stab incision at the upper border of the pubis, then transferred under digital guidance through the anterior vaginal wall at the level of the bladder neck. A No. 2 proline suture is used to suspend the bladder neck on both sides, and the vaginal sutures eventually cut through the wall and become buried in the scar.
REFERENCE
Benson JT, Agosta A, McClellan E. Evaluation of a minimal-incision pubovaginal suspension as an adjunct to other pelvic-floor surgery. Obstet Gynecol. 1990;75(5):844–847.
GLEASON GRADE, TERTIARY PATTERN
DESCRIPTION The standard Gleason grading system reports the primary and secondary Gleason pattern. The tertiary pattern (3rd most prevalent) is noted if it is high grade. Retrospective data suggest that a high-grade tertiary component after RP, even when present in a small percentage of total tumor volume, has prognostic significance. Its presence is associated with biochemical recurrence and adverse pathologic features such as seminal vesicle invasion, extraprostatic extension, and positive surgical margins.
REFERENCES
Harnden P, Shelley MD, Coles B, et al. Should the Gleason grading system for prostate cancer be modified to account for high-grade tertiary components? A systematic review and meta-analysis. Lancet Oncol. 2007;8(5):411–419.
Sim HG, Telesca D, Culp SH, et al. Tertiary Gleason pattern 5 in Gleason 7 prostate cancer predicts pathological stage and biochemical recurrence. J Urol. 2008;179:1775–1779.
GLEASON GRADING/SCORING SYSTEM
DESCRIPTION A widely accepted system to describe the aggressiveness of prostatic adenocarcinoma was developed by Dr. Donald Gleason between 1969 and 1974, in which prostate cancer mortality data were correlated to low-magnification architectural patterns of prostate carcinoma. 5 grades are described, ranging from well differentiated to undifferentiated. To account for variations within tumors, 2 grades are recorded: The predominant, or primary, grade and the less extensive, or secondary, grade. These are summated to give the Gleason score (or Gleason sum). Gleason system, the most prevalent and the 2nd most prevalent pattern (if at least 5% of the tumor) are added together to obtain a Gleason score (eg, Gleason grade 3 + 4 = 7). The Gleason score is a strong independent predictor of cancer behavior and treatment outcome for prostate cancer patients. Pattern 3 is separated from pattern 4 because this separation usually distinguishes Gleason score 6 from Gleason score 7 tumors, with the latter having a significantly worse prognosis.
• Gleason pattern 1: Very well-circumscribed nodule of single, separate, closely packed, back-to-back glands. There is no infiltration into adjacent benign prostatic tissue. The glands are fairly large, round or oval, and are approximately equal in size and shape. Gleason pattern 1 is usually found in transition zone cancers and is rare. When present, it is usually associated with a pattern 2 tumor. Distinction from pattern 2 is not critical, as they have a similar prognosis.
• Gleason pattern 2: Usually, but not always, seen in transition zone carcinomas. Well-circumscribed nodule of single, separate glands with the glands more loosely arranged and not as uniform as in pattern 1. Minimal invasion by neoplastic glands into the surrounding benign prostatic tissue. The cells are smoothly rounded or oval with open lumens and are not angular, as seen in pattern 3. The cytoplasm is more abundant and pale staining than intermediate-grade tumors.
• Gleason pattern 3: Infiltrative with extension into adjacent benign prostatic tissue. The glands vary in size and shape and are often elongated or angular. These small glands are often called microglands and are usually smaller than Gleason pattern 1 or 2 glands. However, some of the glands of pattern 3 may be moderate to large sized. The small glands of pattern 3, in contrast to small poorly defined glands of pattern 4, are distinct glandular units and 1 should be able to draw an imaginary circle around each of them. Cribriform glands may also be Gleason pattern 3, with these glands being slightly larger than benign glands and having regular outer contours. They resemble intraductal cribriform carcinoma of the breast. Cribriform pattern 3 must be separated from cribriform pattern 4, intraductal cribriform proliferations, and prostatic duct adenocarcinoma.
• Gleason pattern 4: The glands are no longer single and separate as seen in pattern 1–3. They are fused, poorly defined with only occasional lumen formation, or cribriform. Fused glands are chains, nests, or masses of glands that are no longer completely separated by intervening stroma. Fused glands contain rare strands of residual stroma that may give the appearance of partial separation of the glands. Consequently, fused glands may have a scalloped appearance peripherally. The “hypernephromatoid” pattern described by Gleason is an uncommon variant of fused glands and resembles RCC. Cribriform glands of pattern 4 are either large cribriform glands (cribriform sheets) or small cribriform glands with irregular infiltrating borders. The small cribriform glands with irregular infiltrating borders of pattern 4 must be distinguished from cribriform pattern 3, in which the small cribriform glands have regular borders. Fragments of cribriform carcinoma in needle biopsies of the prostate imply a cribriform cancer and are designated pattern 4.
• Gleason pattern 5: The tumor has virtually no glandular differentiation. It is composed of solid sheets, solid cords, or single cells. Nests of tumor with central comedonecrosis are also classified as pattern 5. It is controversial whether cribriform glands of cancer that otherwise would be considered Gleason pattern 4 should be considered Gleason pattern 5 if comedonecrosis is present. Separating poorly defined pattern 4 glands from cords and nests of tumor with virtually no glandular differentiation or with only vacuoles is a problem, but usually not critical because any combination of the 2 patterns will lead to a Gleason score of 8–10, all of which are poorly differentiated (Image 
).
REFERENCE
Egevad L, et al. Gleason Grading of prostate carcinoma. Available at http://web.archive.org/web/20051016170005/pathology2.jhu.edu/gleason/patterns.cfm (archive accessed March 2, 2014).
GLEASON GRADING SYSTEM, MODIFIED
DESCRIPTION The International Society of Urologic Pathology held a consensus conference in 2005 at which the “old Gleason grading system” for prostatic carcinoma from 1966 underwent its 1st major revision. With this modified grading system, a shift of the most frequent Gleason scores from 6–7a (3 + 4) in biopsy specimens and an increased degree of agreement between specimens of biopsies and radical prostatectomies with carcinoma of the prostate could be demonstrated. After modified grading of GS 3 + 4 = 7a tumors, 95% were stage pT2, whereas 79% of GS 4 + 3 = 7b tumors were stage pT3–4. In cases with PSA <10 ng/mL and tumor extent <20%, the most frequent Gleason scores were 6 and 7a. Cases with serum PSA >10 ng/mL or tumor extent of >20% had higher scores (7b or higher). Cancers with tumor infiltration of <1 mm in 1 of 12 cores and PSA <10 ng/mL were mainly low grade (Gleason scores 6 and 7a) and may correspond to so-called insignificant carcinoma of the prostate. Using the modified Gleason system, grade, stage, tumor extent, and serum PSA show good correlations and characterize the difference between low- and high-grade malignancy of the prostate.
REFERENCE
Helpap B, Egevad L. Modified Gleason grading. An updated review. Histol Histopathol. 2009;24(5):661–666.
GLENN-ANDERSON URETERONEOCYSTOSTOMY
DESCRIPTION Through a transvesical approach, the ureter is mobilized from its hiatus and advanced toward the bladder neck through a submucosal tunnel, where it is reimplanted. Used to treat vesicoureteral reflux or resection of a ureteral orifice.
REFERENCE
Kay R. Reimplantation of the ureter. In: Novick AC, Streem SB, Pontes JE, eds. Stewart’s Operative Urology. Baltimore, MD: Williams & Wilkins; 1989: 526–538.
GLOMERULOCYSTIC KIDNEY DISEASE (CORTICAL MICROCYSTIC DISEASE)
DESCRIPTION Rare, bilateral cystic kidney disease that can be inherited (autosomal dominant) or sporadic. Presents most commonly in childhood with bilateral flank masses, which are large kidneys with many cysts. Seen rarely in adults with hypertension, hematuria, and end stage renal disease (ESRD). Cysts are confined to the cortex and arise from the Bowman space. Renal biopsy may be necessary to confirm diagnosis. Radiologically, the lesions are similar to autosomal-dominant polycystic kidney disease (ADPKD). Treatment is supportive, with renal replacement therapy if renal failure occurs.
REFERENCE
Gusmano R, Caridi G, Marini M, et al. Glomerulocystic kidney disease. Nephrol Dial Transplant. 2002;17:813–818.
GLOMERULOSCLEROSIS
DESCRIPTION An accumulation of homogeneous eosinophilic material in the glomerulus, made up of plasma proteins that have exuded from the plasma into glomerular structure; this is a light microscopic feature known as hyalinization. This change contributes to obliteration of capillary lumina of the glomerular tuft, a feature of glomerulosclerosis. Hyalinization and glomerulosclerosis are a consequence of endothelial or capillary wall injury and the end result of various forms of glomerular damage.
REFERENCE
Alpers CE. The kidney. In: Kumar V, Abbas AK, Fausto N, eds. Robbins and Cotran: Pathologic Basis of Disease. 7th ed. Philadelphia, PA: Elsevier Saunders; 2005.
GLUCAGON STIMULATION TEST
DESCRIPTION Indicated when the diagnosis of pheochromocytoma is highly suspected by history and clinical findings but blood pressure is normal and diagnostic biochemical tests are equivocal (catecholamines only modestly elevated). The mode of action is the stimulation of glucagon-sensitive adenylate cyclase receptors expressed on the tumor, which can lead to dangerous rises in blood pressure; thus, this test is rarely used. A physician must be present throughout the test, and it should only be performed in patients whose blood pressure is well controlled. A rise in plasma norepinephrine to >3-fold or >2,000 pg/mL is diagnostic of pheochromocytoma.
REFERENCE
Guber HA, Farag AF, Lo J, et al. Evaluation of endocrine function. In: McPherson RA, Pincus MR, eds. Henry’s Clinical Diagnosis and Management by Laboratory Methods. 21st ed. China: Saunders Elsevier; 2007.
GLYCOSURIA, RENAL
DESCRIPTION Normal urine contains small amounts of glucose. Increased amounts represent either inefficient handling by the tubule or hyperglycemia. Diabetes is the most common cause of glycosuria. Causes of primary glycosuria are either intestinal glucose–galactose malabsorption or benign familial renal glycosuria. Some substances are known to cause false-positive glucose readings on dipstick, such as ascorbic acid and salicylates. Medications such as ACE inhibitors may also have a direct effect on the kidney and cause glycosuria. Pregnancy can be causative. Glycosuria may also be part of Fanconi syndrome or RTA.
SYNONYM
Glucosuria
REFERENCE
Bakris GL, Fonseca VA, Sharma K, et al. Renal sodium-glucose transport: Role in diabetes mellitus and potential clinical implications. Kidney Int. 2009;75(12):1272–1277.
GOLDSTEIN TEST
DESCRIPTION Intraoperative diagnostic pneumoperitoneum, also known as Goldstein test, is done in the a setting of pediatric open inguinal hernia repair. To prevent unnecessary contralateral inguinal exploration, the test is performed by introducing a soft rubber catheter through the ipsilateral hernia sac. Air is insufflated into the peritoneal cavity, distending it, and the contralateral groin is palpated for crepitus. The presence of crepitus constitutes a positive test and necessitates repair of a metachronous hernia. Currently, this practice has been largely supplanted by the use of laparoscopy.
REFERENCE
Haynes JH. Inguinal and scrotal disorders. Surg Clin North Am. 2006;86(2):371–381.
GOLDSTON SYNDROME
DESCRIPTION Rare syndrome with principal features of kidney, liver, and brain abnormalities. The kidneys are cystic and large bilaterally. Histologic lesions of the liver are triads with a double band of fibrous tissue without bile ducts. The brain shows the Dandy–Walker malformation, which is the cystic dilation of the 4th ventricle, secondary to obstruction of the foramina of Luschka and Magendie. Renal replacement therapy, as indicated, and hydrocephalus requiring a shunt are standard treatments.
REFERENCE
Gloeb DJ, Valdes-Dapena M, Salman F, et al. The Goldston syndrome: Report of a case. Pediatr Pathol 1989;9(3):337–343.
GONADAL DYSGENESIS, MIXED
DESCRIPTION Gonadal dysgenesis syndromes include Turner syndrome (45, XO), 46, XX “pure” gonadal dysgenesis, mixed gonadal dysgenesis (45, XO/46, XY), partial gonadal dysgenesis (aka, dysgenetic male pseudohermaphroditism), and bilateral vanishing testis syndrome. It is the 2nd most common cause of ambiguous genitalia in the newborn after CAH. Mixed gonadal dysgenesis is characterized by unilateral testis, often intra-abdominal; contralateral streaked gonads; and persistent müllerian structures with varying degrees of inadequate masculinization (“testis plus streak gonad”). A streak gonad is dysgenetic and resembles ovarian stromal tissue, but no germ cells are present. Usual karyotype is 45, XO/46, XY mosaicism. Phenotype is variable, ranging from a female with Turner syndrome, to ambiguous genitalia, to (rarely) normal-appearing males. Almost all have a uterus, vagina, and fallopian tubes, but with varying degrees of phallic development, labioscrotal fusion, and undescended testis. Increased risk exists of gonadoblastoma (incidence 20%) in either dysgenetic testis or streak gonad (more frequently testis), as well as an increased risk of Wilms tumor. Clinical diagnosis is at birth and with confirmatory karyotyping. (See also Section I: “Disorders of Sexual Development [DSD]”; Section II: “Gonadal Dysgenesis, Pure.”)
TREATMENT
• Determine gender assignment, based upon potential for normal function of external genitalia and gonads
• Perform appropriate gonadectomy (if male, consider prophylactic gonadectomy versus bringing testis down to scrotum for purpose of screening of gonadoblastoma)
• Screen for Wilms tumor
• Initiate appropriate sex and growth hormone replacement
REFERENCE
Kolon TF. Disorders of sexual development. Curr Urol Rep. 2008;9(2):172–177.
GONADAL DYSGENESIS, PURE
DESCRIPTION 46, XX “pure” gonadal dysgenesis (“bilateral streak gonads”) is closely related to Turner syndrome, except that it lacks the somatic stigmata associated with Turner syndrome. Patients present with amenorrhea and lack of pubertal development. Evaluation reveals normal female external genitalia and müllerian ducts, absent wolffian ducts, normal height, sexual infantilism, bilateral streaked gonads, and 46, XX karyotype. A streak gonad is dysgenetic and resembles ovarian stromal tissue, but no germ cells are present. This is an autosomal recessive trait with no increased risk of gonadoblastoma (unlike in mixed gonadal dysgenesis). It is treated with cyclic estrogen and progesterone replacement. (See also Section I: “Disorders of Sexual Development [DSD]”; Section II: “Gonadal Dysgenesis, Mixed.”)
REFERENCE
Kolon TF. Disorders of sexual development. Curr Urol Rep. 2008;9(2):172–177.
GONADOBLASTOMA
DESCRIPTION Rare tumor comprising 0.5% of all testes tumors that occurs almost always in gonadal dysgenesis (intersex disorders). This is a benign tumor that has the potential for malignant transformation. Patients present either with a palpable mass or virilization secondary to androgen production. It has 2 distinct cell types: Large germ cells (similar to dysgerminoma and seminoma) and small cells resembling immature Sertoli or granulosa cells. Tubules microscopically contain PAS-positive staining Call–Exner bodies. Upregulation of the TSPY gene is implicated in this tumor. (See also Section I: “Testis Cancer, Adult General Considerations” and “Testis Cancer, Pediatric, General Considerations”; Section II: “Turner Syndrome.”)
SYNONYMS
• Tumors of dysgenetic gonads
• Mixed germ-cell tumor
• Gonadocytoma
TREATMENT
• With an intersex disorder or Turner syndrome: Prophylactic removal of the dysgenic gonad before developing gonadoblastoma
• Radical orchiectomy with possible contralateral orchiectomy secondary to high incidence of bilaterality
REFERENCE
Brant WO, Rajimwale A, Lovell MA, et al. Gonadoblastoma and Turner syndrome. J Urol. 2006;175(5):1858–1860.
GOODPASTURE SYNDROME
DESCRIPTION Characterized by a triad of pulmonary hemorrhage, iron deficiency anemia, and glomerulonephritis (GN), representing <1% of all cases of GN. Anti-GBM antibody deposition in the lungs and kidneys is the cause. Antibody production appears to be self-limited. Histologically, it shows focal proliferative and necrotizing glomerular lesions that progress rapidly to diffuse proliferation with crescents. Immunohistochemical studies show diffuse linear deposition of IgG along the GBM. Primarily a disease of young white males (Male > Female, 6:1) with a mean age of 21. About 1/3 of patients die of pulmonary involvement. Renal involvement is usually severe and progressive, with rapid development of oliguria and renal failure.
TREATMENT
• Steroid pulse therapy with prednisone
• Plasma exchange therapy to remove circulating anti-GBM antibody
• Cyclophosphamide to inhibit further antibody production
• Renal replacement therapy for ESRD
REFERENCE
Shah MK, Hugghins SY. Characteristics and outcomes of patients with Goodpasture’s syndrome. South Med J. 2002;95(12):1411–1418.
GOODWIN URETERAL ANASTOMOSIS
DESCRIPTION Through a transcolonic approach, a nonrefluxing anastomosis is performed by raising a tunnel of mucosa with a mosquito hemostat for a 3–4-cm distance, then exiting the bowel wall. The ureter is grasped and pulled through the tunnel. The spatulated ureter is anastomosed to the colonic mucosa while incorporating some muscularis for security.
REFERENCE
Dahl DM, McDougal WS. Use of intestinal segments in Urinary Diversion. In: Wein AJ, et al., eds. Campbell-Walsh Urology, 10th ed. Philadelphia, PA: Saunders; 2012:2411–2449.
GORLIN SYNDROME
DESCRIPTION Autosomal dominant cancer condition characterized by an increased risk of multiple basal cell carcinomas. Features include disorders of the skin, skelet al, eye, nervous system, and endocrine glands. The lesions are sensitive to ionizing radiation.
SYNONYMS
• Nevoid basal cell carcinoma syndrome
• Basal cell nevus syndrome
REFERENCE
Mitchell G, Farndon PA, Brayden P, et al. Genetic predisposition to cancer: The consequences of a delayed diagnosis of Gorlin syndrome. Clin Oncol (R Coll Radiol). 2005;17(8):650–654.
GOUT, UROLOGIC CONSIDERATIONS
DESCRIPTION An inherited disorder of purine metabolism characterized by elevated serum urate levels and severe recurrent arthritis, gout leads to an increased risk of urate urolithiasis and uric acid nephropathy. Most patients with uric acid stones, however, do not have gout. About 20% of patients with gout will develop a stone. Gout may also produce a type IV RTA, resulting in hyperkalemia and a mild metabolic acidosis. (See Section I: “Renal Tubular Acidosis”; Section I: “Urolithiasis, Uric Acid.”)
TREATMENT
• Alkalinization of urine and increasing urine output help prevent stones.
• Allopurinol or following a low-purine diet will decrease serum urate levels.
REFERENCE
Liebman SE, Taylor JG, Bushinsky DA. Uric acid nephrolithiasis [review]. Curr Rheumatol Rep. 2007;9(3):251–257.
GOUVERNEUR SYNDROME
DESCRIPTION Classic presentation of vesicoenteric fistula, with suprapubic pain, urinary frequency, dysuria, and tenesmus.
REFERENCE
Vidal Sans J, Pradell Teigell J, Palou Redorta J, et al. Review of 31 vesicointestinal fistulas: Diagnosis and management. Eur Urol. 1986;12(1):21–27.
GRANULOMA INGUINALE (DONOVANOSIS)
DESCRIPTION Ulcerative disease of the genitals with significant locoregional lymphadenopathy, caused by Klebsiella granulomatis (formerly known as Calymmatobacterium granulomatis). The disease occurs rarely in the United States and is endemic in some tropical and developing areas (India; Papua, New Guinea; the Caribbean; central Australia; and southern Africa). Clinically, the disease is commonly characterized as painless, slowly progressive ulcerative lesions on the genitals or perineum without regional lymphadenopathy; subcutaneous granulomas (pseudoboboes) might also occur. The lesions are highly vascular (ie, beefy red appearance) and bleed easily on contact. Ulceration at site inoculation may be on the genitals or extragenital sites, and prominent lymphadenopathy often results in further skin ulceration over the nodes. Untreated, it results in lymphedema and genital mutilation. (See also Section I: “Sexually Transmitted Infections [STIs]; Sexually Transmitted Diseases [STDs], General.”)
Diagnosis is based on rapid Giemsa stained-smear of ulcer (RapiDiff), to look for Donovan bodies. For smear-negative cases, biopsy of the ulcer is necessary. Culture and PCR are available only in specialized centers.
TREATMENT
• Doxycycline 100 mg orally twice a day for at least 3 wk and until all lesions have completely healed
• Alternative regimens (treat until all lesions healed): Azithromycin 1 g orally once per week for at least 3 wk OR ciprofloxacin 750 mg orally twice a day for at least 3 wk OR erythromycin base 500 mg orally 4 times a day for at least 3 wk OR trimethoprim-sulfamethoxazole 1 double-strength (160 mg/800 mg) tablet orally twice a day for at least 3 wk
REFERENCES
O’Farrell N. Donovanosis. Sex Transm Infect. 2002;78:452–457.
Workowski KA, Berman S; Centers for Disease Control and Prevention. Sexually Transmitted Diseases Treatment Guidelines, 2010. MMWR Recomm Rep. 2010;59(No. RR-12):1–110.
GRANULOSA CELL TUMORS
DESCRIPTION The most common ovarian neoplasm. Usually small, cystic, unilateral, and secretes estrogens. Often presents in childhood as precocious puberty or as postmenopausal bleeding in older women. During the reproductive years, prolonged and irregular bleeding and a pelvic mass are most common. These tumors can also present with urinary symptoms, and they can rarely be present in the testes.
TREATMENT
• Surgical excision is usually curative.
• Close follow-up of the contralateral ovary is necessary.
REFERENCE
Chan YF, Restall P, Kimble R. Juvenile granulosa cell tumor of the testis: Report of 2 cases in newborns. J Pediatr Surg. 1997;32(5):752–753.
GRAPEFRUIT AND GRAPEFRUIT JUICE, INTERACTION WITH UROLOGIC MEDICATIONS
DESCRIPTION Grapefruit or grapefruit juice can affect the metabolism of many medications, increasing the risk of toxicity and adverse events. These oral medications tend to be metabolized through the intestinal cytochrome P450 3A4 (CYP3A4) system and can also inhibit the drug concentration for up to 72 hr. The following mediations are used in urologic practice and do not represent an exhaustive listing. Typically there is increased drug levels by grapefruit interaction.
• Immunosuppressive agents:
– Cyclosporine everolimus, sirolimus, tacrolimus, temsirolimus
• Phosphodiesterase Type 5 inhibitors (PDE-5I)
– Tadalafil, vardenafil
• Tyrosine kinase inhibitors (TKI)
– Axitinib, everolimus, pazopanib, sunitinib, temsirolimus
REFERENCE
Stump AL, Mayo T, Blum A. Management of grapefruit-drug interactions. Am Fam Physician. 2006;74(4):605–608.
GRATIFICATION DISORDER
DESCRIPTION Also known as infantile masturbation, usually peaks at 4 yo but can be seen as early as 3 mo of age. The disorder may occur in the absence of genital manipulation and can consist of vocalizations with quiet grunting, diaphoresis, and pressure on the perineum with characteristic posturing of the lower extremities. The patient is commonly referred for seizures or a movement disorder because of the recurrent paroxysmal movements.
REFERENCE
Yang ML, Fullwood E, Goldstein J, et al. Masturbation in infancy and early childhood presenting as a movement disorder: 12 cases and review of the literature. Pediatrics. 2005;116:1427–1432.
GRIESS TEST
DESCRIPTION Detects the presence of nitrite in urine, which is formed when bacteria reduce the normally present nitrate. With a lower sensitivity and specificity than microscopy and culture, this test in combination with leukocyte esterase has been used to screen asymptomatic patients. Microscopy is indicated for the higher-risk population for UTI.
REFERENCE
Schaeffer AJ. Urinary tract infections. In: Gillenwater JY, Grayhack JT, Howards SS, et al., eds. Adult and Pediatric Urology. 3rd ed. St. Louis, MO: Mosby; 1996.
GRISS SEX FUNCTION INDEX (GOLOMBOK–RUST INVENTORY OF SEXUAL SATISFACTION)
DESCRIPTION Golombok–Rust Inventory of Sexual Satisfcation (GRISS) is a validated psychometric instrument intended for heterosexual couples or individuals. The questionnaire is based on a 28-item scale, with separate forms for men and women. It contains subscales of ED, orgasmic disorders, vaginismus, and male and female nonsensuality. It may be used in individuals undergoing marital or sex therapy.
REFERENCE
Wiegel M, Wincze JP, Barlow DH. Sexual dysfunction. In: Barlow D, ed. Assessment and Treatment Planning for Psychological Disorders. New York, NY: Guilford Press; 2002.
GROIN HERNIA, PEDIATRIC
DESCRIPTION The most common surgery in the pediatric age group. Most hernias in this population are indirect and congenital. The incidence is higher in preterm births, with a male to female ratio of 6:1. The hernia is formed from the persistence of the processus vaginalis and can present as a communicating hydrocele, hydrocele of the cord, simple hydrocele, or incarceration and strangulation of intraperitoneal contents. Surgical repair is usually indicated.
REFERENCE
Warner BW. Pediatric surgery. In: Townsend CM, Sabiston DC, eds. Sabiston Textbook of Surgery. 18th ed. Philadelphia, PA: Saunders; 2008.
GROWING TERATOMA SYNDROME
DESCRIPTION Refers to an enlarging mature teratoma arising during or after chemotherapy for a nonseminomatous germ-cell tumor. The AFP and β-HCG serum levels are normal. The preferred treatment is complete surgical resection as teratomas are chemotherapy and radiation therapy resistant.
REFERENCE
Vaughn DJ, Flaherty K, Lal P, et al. Treatment of growing teratoma syndrome. N Engl J Med. 2009;360:423–424.
GUILLAIN–BARRé (TRANSVERSE MYELITIS) SYNDROME: UROLOGIC CONSIDERATIONS
DESCRIPTION Also known as acute inflammatory demyelinating polyneuropathy, an inflammatory demyelinating disorder of the autonomic and peripheral nervous system. It is thought to be triggered by a bacterial or viral antigen, causing the immune system to cross-react and attack neural tissue. Symptoms may include muscle weakness, respiratory difficulties, autonomic neuropathy, and cardiac, bowel, bladder, and sexual dysfunction. Lower urinary tract dysfunction can range from urgency and stress incontinence to urinary retention.
TREATMENT
• Manage lower urinary tract dysfunction (Clean intermittent catherization (CIC), anticholinergics, etc.)
• Plasmapheresis
• IV immunoglobulin
REFERENCE
Ganesan V, Borzyskowski M. Characteristics and course of urinary tract dysfunction after acute transverse myelitis. Dev Med Child Neurol. 2001;43(7):473–475.
GUN SHOT WOUND, EXTERNAL GENITALIA
DESCRIPTION The genitalia have several characteristics that are somewhat protective against sustained injury. Characteristics such as the laxity of skin, flaccidity, and multiple sources of blood supply assist with dampening the blow of trauma and help with reconstruction efforts. Nevertheless, the location of major vasculature and visceral organs make these injuries potentially life-threatening. Greater than 50% of injuries to the penis have urethral injuries and 75% have other significant associated injuries. A majority of these injuries require exploration with copious irrigation, excision of foreign material, antibiotics, and primary closure. In injuries to the urethra, imaging such as retrograde urethrogram should be implemented and, if warranted, abdominal/pelvic imaging should be obtained. (See also Section I: “Penis, Trauma”; Section I: “Scrotum and Testicle, Trauma.”)
REFERENCE
Phonsombat S, Master VA, McAninch JW. Penetrating external genital trauma: A 30-year single institution experience. J Urol. 2008;180(1):192–195.
GUN SHOT WOUND, KIDNEY
DESCRIPTION The kidney is subject to the majority of external injuries in the GU system. Hematuria is a good indicator of injury but its amount or absence does not eliminate renal injury nor does it dictate the degree of injury. Any degree of hematuria in penetrating trauma should prompt imaging. Kidney injury is graded from I–V in accordance with the American Association for Surgery of Trauma Organ Injury Severity Scale for the Kidney. In carefully selected patients, management can be nonoperative, with careful observation or segmental embolization used. Absolute indications for surgical exploration include expanding perirenal hematoma, evidence of persistent renal bleeding, and pulsatile perirenal hematoma. Relative indications include urinary extravasation, nonviable tissue, delayed diagnosis of arterial injury, segmental arterial injury, and incomplete staging. (See also Section I: “Renal Trauma, Adult”; Section I: “Renal Trauma, Pediatric”; Section II: “American Association for Surgery of Trauma Organ Injury Severity Scale.”)
REFERENCE
Voelzke BB, McAninch JW. Renal gunshot wounds: Clinical management and outcome. J Trauma. 2009;66(3):593–600.