Common Urological Presentations

Question 1

What are the most common urological presentations?

Which require urgent intervention?

Answer 1

• BPH (benign prostatic hyperplasia)
  
  • Must be treated urgently to prevent urinary retention.
• UTIs
• Renal / ureteric calculi
  
  • Hydronephrosis - small kidney stone can travel down the ureter and cause the kidney to balloon up. Must be treated urgently.
• Cancer of the kidneys, prostate, urinary bladder, adrenal glands or testis.
• Testicular swelling + pain
  
  • Torsion

Question 2

Describe the features of benign prostatic hyperplasia (early, moderate and advanced).

What are the presenting symptoms?

Answer 2

• Pain
• Haematuria
• Prostatic symptoms:
  
  • Nocturia
  • Increased frequency
  • Hesitation
  • Poor stream

Question 3

What is the difference between phimosis and paraphimosis?

Answer 3

• Phimosis
  
  • Condition where the foreskin is too tight to be pulled back over the head of the penis (glans).
• Paraphimosis
  
  • ​The foreskin is pulled back behind the tip of the penis and becomes stuck there. The retracted foreskin and the penis become swollen, fluid can build up, and the foreskin is unable to return to its original position.

Question 4

What are the differentials for a swelling in the scrotum?

Answer 4

• Testicular tumour
• Testicular torsion
• Left renal tumour
• Any patient who presents with a painless swelling in the testes - index of suspicion for malignancy is very high.
• The cause is much more likely infective if the swelling is painful.

Question 5

What investigations would you do in a patient with pain and haematuria +/- scrotal swelling?

Answer 5

• Urine dipstick
• USS renal
• CT KUB

Question 6

What are the manaement options for BPH?

Answer 6

• Alpha blockers - Tamsulosin / Finasteride
• TURP (trans-urethral resection of the prostate)

Question 7

What are the management options for renal / ureteric calculi?

Answer 7

• Extracorporeal shocl wave lithotripsy
• Percutaneous nephrolithotomy
• Ureteroscopy

Question 8

What are the treatment options for phimosis and paraphimosis?

Answer 8

• Cicumcision
  
  • ​Dorsal slit method

Question 9

What is the treatment for a varicocele?

Answer 9

Embolisation

Question 10

What is the treatment for pyelonephritis / cystitis / prostatitis?

Answer 10

Urinary Tract Infections!

ANTIBIOTICS

Question 11

What are the treatment options for cancer of the kidneys, prostate, urinary bladder, adrenal glands or testis?

Answer 11

• Surgery
• Chemotherapy
• Radiotherapy

Question 12

What is painless haematuria a red flag for?

Answer 12

Renal cell carcinoma (50-60% of cases of painless haematuria).