Renal/uro

Question 1

Urinary tract obstruction - imaging

Answer 1

• Ultrasound is first line (sensitivity 45%)
• If this fails to pick it up but you still think it’s there, do non-contrast CT (99% sensitive) – note
  that using contrast is bad because it obscures the view of the radio-opaque stone
• INITIAL = USS
• BEST = non-contrast CT KUB

Question 2

stones - <5mm

Answer 2

Medical management
- IM/oral diclofenac
- Alpha adrenergic blockers to aid passage of stone out the bladder neck (tamsulosin)
- Nifedipine can help in small stone as it relaxes the ureters.
- This solves most stones <5mm and they pass within 4 weeks. More treatment is required is
there is they are bigger, if there is obstruction, or if there is a horseshoe kidney or previous
transplant

Question 3

stones - 5mm to 2cm

Answer 3

ECSL

Question 4

stones >2cm/complex e.g. staghorn

Answer 4

percutaneous nephrolithotomy

Question 5

Complicated stone (with hydronephrosis or pyrexia)

Answer 5

decompression with percutaneous

nephrostomy. Worry about stone later.

Question 6

stone recurrence prevention -

Answer 6

calcium - thiazides
urate - allopurinol/ bicarb for urine alkalisation
oxalate - cholestyramine/pyridoxine

Question 7

lower uti

Answer 7

Trimethoprim/nitrofurantoin

Question 8

lower uti and preg

Answer 8

Trimethoprim/nitrofurantoin/cefalexin

Question 9

upper uti

Answer 9

Ciprofloxacin/co-amoxiclav

Question 10

upper uti and preg

Answer 10

Cefalexin

Question 11

BPH

Answer 11

Conservative – Avoid caffeine + alcohol, void x2, bladder training

Medical

1st line = α blockers (tamsulosin)

2nd line = 5-α reductase inhibitor (finasteride)

3rd line = BOTH 🡪 LUTS + >30g prostates or PSA >1.4ng/ml

Surgical – TURP, TUIP, TULIP, open prostatectomy

Question 12

PSA cut off values

Answer 12

40-49

≥ 2

50-59

≥ 3

60-69

≥ 4

≥70

≥ 5

Question 13

Prostate cancer

Answer 13

Confined to the prostate:
Watchful waiting
Radical prostatectomy
Radical radiotherapy – External beam or brachytherapy

Hormone therapy
LHRH agonists (Goserelin) – Result in a flare
LHRH antagonists (Degarelix) – Effective for advanced cancer
Anti-androgens (Cyproterone acetate)
Orchidectomy

If metastatic - Hormone therap

Question 14

bladder cancer

Answer 14

Mx

Tis/Ta/T1 – Diathermy via TURBT + chemo

T2-3 – Radical cystectomy

T4 – Palliative chemo/radiotherapy

Question 15

varicocele

Answer 15

Surgical ligation, embolisation

Question 16

hydrocele

Answer 16

Mx

Ligation of PPV

Aspiration +/- sclerosing agent

Jaboulay – Inversion of sac

Lord’s – Plication of sac

Question 17

epidydimal cyst

Answer 17

Often not indicated, surgical excision if symptomatic

Question 18

epidydimo orchitis

Answer 18

<35y/o Doxycycline (chlamydia) or ceftriaxone (gonorrhoea)

> 35y/o Ciprofloxacin (UTI)

Question 19

testicular tumours

Answer 19

Radical inguinal orchiectomy

Radiotherapy (seminomas)

Chemotherapy (NSGCT)

Question 20

aki definition

Answer 20

Rise in creatinine >26μmol/L in 48hrs

Rise in creatinine >1.5 x baseline

Urine output <0.5ml/kg/h for >6h

Question 21

aki

Answer 21

Treat fatal consequences of AKI (↑K+ and pulmonary
oedema-morphine, o2, cpap, nitrates, diuretics)

Treat underlying cause!!

Stop nephrotoxic drugs e.g. metformin/nsaids/vanc/gent/acei

Supportive care

Fluid balance

Electrolyte balance

Acid-base balance

Nutritional support

> > Dialysis

Question 22

ckd def

Answer 22

GFR <60 mL/min/1.73 m2

for >3months

Question 23

obstruction

Answer 23

Treat underlying cause!

Upper – Nephrostomy or ureteric stent

Lower – Urethral or suprapubic catheter

Question 24

retention

Answer 24

Mx

Voiding tricks – Running water, analgesia, privacy

Catheterise!

Tamsulosin

Treat underlying cause