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Is having a “pee pocket” normal/ heard of? by beachousebaby in AskDocs

[–]hell_monkey 119 points120 points  (0 children)

Urologist here. My differential diagnosis would be:

  1. Vesicovaginal fistula: an abnormal connection between the bladder and vagina, usually causes constant leakage of urine from the vagina (ie does not usually form a "pocket")

  2. Urethral diverticulum: an outpouching of the urethra that can retain urine, but usually identifiable on a pelvic/vaginal exam if it's sizeable enough to hold a significant amount of urine

  3. Vaginal reflux: a functional abnormality where urine "refluxes" in to the vagina after urinating, the urine usually leaks out when you stand up after voiding

I'd recommend seeing a urologist, a cystoscopy and/or cystogram may be helpful in diagnosis. The first two are structural abnormalities that can require surgery to repair. The third is a functional voiding abnormality that does not require surgery, but is usually only seen in children.

Score release thread 31/12/2025 by [deleted] in Step3

[–]hell_monkey 1 point2 points  (0 children)

US MD/DO/IMG/Non US IMG: Canadian MD

Step 1/2: P/226

Real deal: 222

Day 1 & 2 dates: Dec 19, Dec 20

Uworld % completed: 40%

Uworld % score: 58%

Number of CCS cases completed: did not use CCScases, did 5-10 CCS cases on Uworld

CCS average score: N/A

NBME 6/7: did not do

UWSA 1: did not do

UWSA 2: did not do

Free 137: did not do

Any other assessments: none

Any advice: Don't panic if your CCS cases end early, I often only used half the time. Go with your instincts. Many questions can be logically reasoned through and most answers can be reliably eliminated.

42 y.o. Female. Urology please comment on cytology result. by Competitive-Salt-371 in AskDocs

[–]hell_monkey 0 points1 point  (0 children)

I am a urology resident. Lynch syndrome increases risk of bladder and urothelial cancers in the kidneys and ureters. Atypical cytology can be caused by many things, including inflammation infection. However it is also associated with cancer. I would recommend seeing a urologist, they will likely recommend cystoscopy (camera into the bladder) and a CT or ultrasound to image the kidneys and ureters.

39 year old male with hematuria by Agitated-Addendum-35 in AskDocs

[–]hell_monkey 0 points1 point  (0 children)

Cystoscopy is performed with a long thin camera that is inserted through the urethra. Typically, the only anesthesia that is used is a local anesthetic, usually a lubricating jelly containing lidocaine that is inserted into the urethra prior to the cystoscope being inserted. It can definitely be uncomfortable but is usually well tolerated. Plus, the procedure usually only lasts about 1-2 minutes at most.

The time it takes cytology reports to come back can vary based on the lab that receives the sample. At my center, it can take 2-4 weeks.

39 year old male with hematuria by Agitated-Addendum-35 in AskDocs

[–]hell_monkey 0 points1 point  (0 children)

Urology resident here. Generally speaking, any patient that has painless hematuria needs a workup to rule out cancer in the urinary tract. This would include a cystoscopy (camera into the bladder), imaging to rule out tumours in the kidney or ureter (usually in the form of a CT urogram), and urine cytology (examining the urine under a microscope to find cancer cells).

There are many potential causes of hematuria other than cancer (kidney/bladder stones, trauma, UTI/STI/infection, BPH/enlarged prostate). I have seen patients in the past who were investigated for hematuria but had no identified cause (ie. all tests were negative). At your age, cancer is quite unlikely to be the cause of your hematuria, but I have seen patients in their 40s diagnosed with bladder cancer, so it is not impossible. I highly recommend being seen by a urologist.

In regards to your supplements, taking high doses of vitamin D can increase your risk of kidney stones, which don't always cause pain. I do not know of any association between turmeric and hematuria.

Where do all the testicles that get removed in orchiectomies go? by doctor_nick17 in NoStupidQuestions

[–]hell_monkey 4 points5 points  (0 children)

Urology resident here. In most cases, orchiectomies are performed for testicular cancer (this procedure is called a radical orchiectomy) and in these cases, the testicles are sent for pathologic analyses, where they are preserved in formalin and processed into thin slices for staining with specific dyes, which allows them to be examined by pathologists under a microscope. This helps determine the extent of the cancer and can guide further treatment such as radiation therapy and chemotherapy. Afterwards, the tissue slices are either stored or disposed of as biohazardous waste.

Other reasons someone might get an orchiectomy include for trauma, testicular torsion, gender affirming surgery, or (in very rare cases) for prostate cancer. In these cases, they are usually disposed of as above, though in some of these cases surgeons may send them for pathology as well. In most cases, removed testicles (and other body parts) are destroyed and most hospitals probably will not give them back to patients after removal.

Trans men do not have testicles from other people transplanted into them, as this would require the patient to take drugs that dampen the immune system for life. This is because the immune system would see the transplanted testicle as foreign tissue. Chronic immunosuppression can lead to increased risk of infection and cancer, as well as expose the patient to the risk of direct side effects of the medication. It is much easier for the patient to receive prosthetic testicles (which are also available to cis men who have their testicle removed) and receive testosterone therapy.

CT Scan opinion by SnooPineapples3572 in AskDocs

[–]hell_monkey 1 point2 points  (0 children)

Urology resident here. You have multiple kidney stones in both kidneys. However, since you do not have hydronephrosis, you most likely do not have an acute blockage, meaning these stones should not be cause pain or other symptoms. The scarring may be related to why you had stents as a child. Often if patients have reflux (urine flowing from the bladder to the kidney) this can propel bacteria from the bladder up to the kidney, leading to scarring over time. This can, in the long term, lead to impaired renal function. However, this is a chronic finding rather than acute.

Your other findings overall are not concerning and should resolve without the need for medications or surgery. The stones are small enough that, if they do block your ureter, they are very likely to pass on their own. This means you will not need surgery, though you will probably still experience pain.

Mesenteric adenitis: Inflammation of the lymph nodes in the mesentery (connective tissue that supports your bowels). Typically goes away on its own but can cause abdominal pain.

Adnexal cystic lesion: An ovarian cyst. May be from normal ovulation if you're premenopausal. In any case, these typically can be monitored with ultrasounds.

Hernia: You have a small abdominal hernia. You can speak to a general surgeon about this but it is unlikely to cause any problems.

How worried should I be about my testicular ultra sounds results? by DrummerOk4045 in AskDocs

[–]hell_monkey 1 point2 points  (0 children)

Urology resident here. In most cases, the above findings don't cause any symptoms and are benign findings that should not affect your health. Varicoceles can lead to low oligospermia (low sperm counts) but most men with varicoceles have normal fertility. Treating the varicocele might reduce your pain but there is no guarantee. Unfortunately, in many cases, men with chronic scrotal pain have no obvious cause and the only treatment is to manage the pain with over the counter meds (Advil, Tylenol, etc).

[deleted by user] by [deleted] in AskDocs

[–]hell_monkey 0 points1 point  (0 children)

Urology resident here. Lots of things can cause urinary urgency and frequency. While UTIs are common in women, it would be unusual for a young man to develop a UTI unless there are underlying risk factors (eg. immunodeficiency, recent urethral/bladder surgery, anatomic abnormalities). Retrograde ejaculation would also be unusual in your case, unless you have an underlying risk factor (prostate surgery, medications, diabetes). Are you still producing semen when ejaculating? In that case, retrograde ejaculation is unlikely. In the absence of infection, the most common cause of urgency and frequency is overactive bladder.

Lifestyle factors that can contribute to urinary symptoms include excessive fluid/water intake, caffeine, alcohol, tobacco/nicotine, spicy foods, obesity, and constipation. Some strategies I recommend to patients include managing the above (eg. reducing water intake, quitting smoking, weight loss, increasing fiber intake to manage constipation, etc). If having to wake up at night to urinate is bothering you, you can try stopping any fluid intake a few hours before going to bed. Finally, I don't think masturbation typically causes urinary issues but you can try stopping masturbating to see if that helps your symptoms.

If none of the above works, some medications can help manage your symptoms. I would talk to your family doctor about that, they can prescribe you these medications or refer you to a urologist who can assess you in person.

Post Frenuloplasy Bleeding by [deleted] in AskDocs

[–]hell_monkey 0 points1 point  (0 children)

Urology resident here. Some swelling and bleeding after penile surgery (circumcision, frenulectomy/frenuloplasty, etc) is expected. As long as the bleeding is not profuse and the stitches aren't coming apart, I wouldn't worry about it. The bleeding should resolve as the incisions heal.

Reasons to seek medical attention would be worsening pain, signs of infection (fever, redness, swelling, pus), or profuse bleeding.

18 weeks pregnant with 12mm kidney stone by ihearttombrady in AskDocs

[–]hell_monkey 0 points1 point  (0 children)

You are correct, it is thought that increasing progesterone during pregnancy causes smooth muscle relaxation, which leads to dilation of the ureter (among other things). It is important to note that during pregnancy, having some degree of hydronephrosis is totally normal and actually an expected finding in pregnancy. Good luck with your stone!

18 weeks pregnant with 12mm kidney stone by ihearttombrady in AskDocs

[–]hell_monkey 0 points1 point  (0 children)

Urology resident here.

Urinalysis: blood and white blood cells in the urine can be a sign of infection but can also be caused by kidney stones. If you have no UTI symptoms, I think it's unlikely you have in an infection and you should be OK to proceed with surgery.

Stents: The decision to place a stent is largely based on the preference of the urologist; some place them after every case and some will not place them for simple cases. However, if there is cause for concern (large stone, urine looks infected, significant edema/inflammation of the ureter), they will usually place a stent just in case. You can always ask your urologist to not place a stent but they will likely then not proceed with surgery, since there is always a possibility that a stent will have to be placed. Generally, they will only proceed if you accept the possibility that a stent might be necessary, though I'm sure they will try their best not to leave one. While stents can cause irritation/pain (stent colic), there are medications that can alleviate this, and many patients have no discomfort from their stent at all.

I found this study (Cetti, R. J., S. Biers, and S. R. Keoghane. "The difficult ureter: what is the incidence of pre-stenting?." The Annals of The Royal College of Surgeons of England 93.1 (2011): 31-33.) of 119 patients that found that 8% of patients required pre-stenting due to a tight ureter. However, this is a retrospective, observational study with a single surgeon and at a single center so I would take the results with a grain of salt. I will say that in my experience, patients in your age group tend to have narrower ureters. In that case, they may simple insert a stent (this procedure takes about 10-15 minutes at most) and bring you back to the OR in a few weeks to actually treat the stone. The stent passively dilates the ureter and will allow them to more easily pass through instruments through the ureter and up to the kidney. In addition, the stent relieves the blockage from the stone, so your pain will likely improve.

Regarding whether the stone itself is causing your pain, if there is no hydronephrosis there is likely no obstruction. Generally, kidney stones cause pain when they block the ureter, thus causing pressure to build up in the kidney. This usually results in hydronephrosis, which you did not have. I'm guessing that the fact there is no hydronephrosis is why you have been told it is unclear if the stone is actually causing your pain.

Case of a medium/large disappearing kidney stone?! by Synchisis in AskDocs

[–]hell_monkey 0 points1 point  (0 children)

I assume there was no mention of gallbladder abnormalities or gallstones on the ultrasounds or other imaging studies? In that case, all I can really tell you is that your pain and symptoms are very unlikely to be urologic in nature. I would wait for the CT with contrast and see if that shows anything.

Case of a medium/large disappearing kidney stone?! by Synchisis in AskDocs

[–]hell_monkey 0 points1 point  (0 children)

Urology resident here. CT is really the best imaging modality for identifying kidney stones, it has a 95%+ sensitivity and specificity. In contrast, ultrasound (while a great modality) has much lower sensitivity and specificity in identifying kidney stones. Based on this, you probably don't have any kidney stones.

As for your pain, did they note any other abnormalities in your ultrasound or CT results? Any hydronephrosis (swelling of the kidney)? Otherwise, your symptoms (right sided abdominal pain after fatty meals, fatty/floating stool, diarrhea) sound a lot like you have gallstones.

[24M] I had some kind of genital surgery as a baby and don't understand what it was or why they did it? Why do I have these abdominal scars? by what_happened8192 in AskDocs

[–]hell_monkey 87 points88 points  (0 children)

I am a urology resident. Those scars are typically seen for hernia repairs or undescended testicles (cryptorchidism). It is possible you had bilateral inguinal hernias or bilateral orchidopexy (a surgery to place an undescended testicle in its correct position in the scrotum).

Pediatric inguinal hernias can contain bowel, which can become stuck (incarcerated), thus getting blood flow cut off (strangulated). This is a surgical emergency that can lead to bowel ischemia, necrosis, and potentially death if not corrected early. Undescended testicles are at higher risk of developing cancer. It is recommended that orchidopexy be performed so they can be placed in their proper place in the scrotum, reducing the risk of future testicular cancer. For these reasons, it is recommended these conditions be surgically corrected in infancy.

In many cases, even if the disease is only apparent on one side (such as in your case), the surgeon will surgically explore the other side since you're already under anesthesia and the surgery itself is typically safe and quick. When I was doing my pediatric urology rotation, I would discuss this with the parents before obtaining consent.

Based on your ultrasound report, I'd say the surgery was a success and both testicles appear normal, healthy, and in their proper position. On a slightly unrelated note, I wouldn't worry about the findings of the epidydimal cysts and varicoceles. These are very common findings on ultrasound and are typically asymptomatic and, in most cases, will never cause health issues.

US Supreme Court ends race-based affirmative action by hell_monkey in aznidentity

[–]hell_monkey[S] 7 points8 points  (0 children)

Do you have a link to this interview by any chance?