Other urology

Question 1

Benign prostatic hyperplasia

Answer 1

• hesitancy, weak flow, frequency, urgency, intermittency, straining, terminal dribbling, incomplete emptying, nocturia
• DRE, abdo exam, urinary frequency chart, urine dip, PSA
• smooth and symmetrical prostate, central sulcus palpable
• Alpha blockers e.g. tamsulosin (postural hypotension), 5-alpha reductase inhibitors e.g. finasteride (sexual dysfunction)
• TURP

Question 2

Prostatitis

Answer 2

• either acute bacterial or chronic
• chronic - pelvic pain, LUTS, sexual dysfunction, bowel movement pain, tender enlarged prostate
• acute - fever, myalgia, nausea, fatigue, sepsis
• urine dip, MC&S, NAAT testing
• chronic management - alpha blockers, analgesia, psychological, laxatives
• acute - admission, antibiotics, analgesia, laxatives

Question 3

Testicular torsion

Answer 3

• twisting of spermatic cord + rotation of testicle
• rapid unilateral testicular pain, swollen and retracted testicle, no cremasteric reflex, abnormal position
• can USS (whirlpool sign) but don’t delay
• nil by mouth, analgesia, urgent urology review, surgical exploration of scrotum with orchidopexy/orchidectomy

Question 4

Pyelonephritis

Answer 4

• kidney inflammation due to infection
• risks: female, diabetes, structural abnormalities, vesico-ureteric reflux
• dysuria, suprapubic discomfort, frequency + triad - fever, loin pain, N&V
• urine dip, MC&S, FBC, inflammatory, imaging to exclude others e.g. USS
• in community give cefalexin or co-amoxiclav/trimethoprim if culture known
• beware renal abscess, kidney stone obstructing ureter
• can lead to CKD and renal failure

Question 5

Renal calculi

Answer 5

• stones in renal pelvis, may get stuck in ureters (vesico-ureteric junction)
• obstruction - AKI, infection - pyelonephritis
• types - calcium oxalate, calcium phosphate, struvite, uric acid (not Xray)
• unilateral loin-to-groin, colicky pain, haematuria, reduced urine output, N&V
• urine dip, FBC, U&Es, calcium, abdo XR, non-contrast CT KUB (USS if pregnant)
• NSAIDs - IM diclofenac, antiemetics, antibiotics
• watchful waiting if under 5 or 5-10mm
• ESWL, ureteroscopy + laser lithotripsy, percutaneous nephrolithotomy, open surgery (rarely)
• calcium stones – reduce oxalate-rich foods (spinach, beetroot, nuts, rhubarb)
• uric acid stones – reduce purine-rich foods (kidney, liver, anchovies, sardines and spinach)