Urology

Question 1

Painful erection?

Answer 1

Prostatitis (or a penis fracture if injured during intercourse, but would have to be pretty aggressive - the force of 1 Mike Tyson punch to the penis)

Question 2

Hematspermia

Answer 2

Not concerning in young people. Over 50 concerning for cancer

Question 3

Treatment options for ED

Answer 3

Cialis or Viagra, try one then the other. After that Trimix (injections although drops might be coming on the market soon), there are rings and clamps but these are not for everyone and can be dangerous.

Question 4

Urge incontinence treatment

Answer 4

Mirbetriq - low dose then high, then anticholinergics then, both then botox injections

Question 5

Tx for prostatitis

Answer 5

Cipro

Question 6

Gross hematuria

Answer 6

Need a scope, and need a US/ or CT

Question 7

Microscopic hematuria

Answer 7

Repeat. If over 40 or if 35 with smoking hx, do cysto and US/CT

Question 8

Paediatric phimosis

Answer 8

Start young with intermittent betamethasone cream, and gentle stretching, hygiene. Usually resolves with age.

Question 9

Peyronie’s disease

Answer 9

Fibrous/ calcified plaques that leads to curved painful erections

Question 10

Tx for condyloma

Answer 10

Imiquimod (low dose is more tolerable), liquid nitrogen (penile block in place to make more tolerable), excision.

Question 11

Autonomic dysreflexia

Answer 11

Injury at T6 or above, get uncontrolled hypertension in response to lower body stimuli (full bladder, constipation).

Question 12

Tx Peyronie’s

Answer 12

Injection of verapamil and freezing, usually a course of 6 into the penile plaques

Question 13

Above cerebellar injury on the bladder, vs below

Answer 13

Upper = hyperactivity eventually leading to hypotonia 
Lower = loss of sensation leading to overflow incontinence

Question 14

Location of Transitional Cell Carcinoma

Answer 14

Primarily bladder, however 4% chance in the upper tract (this is why we don’t just do cystoscopes

Question 15

Pyridium

Answer 15

Can be used for dysuria, short term medication, OTC will turn pee orange

Question 16

Side effect of flowmax

Answer 16

Retrograde ejaculation (50% of people) 
(95% in rapaflo)

Question 17

Tx for BPH related LUTS

Answer 17

Flowmax, dutasteride, daily cialis (S/E low back pain and expensive - helps with the ED tho)

Question 18

Effect of myrbetriq

Answer 18

Slowly increases over 4 months then plateaus, some people are non-responders as they lack B3 receptors - then will have to trial on anticholinergics

Question 19

Times when it is appropriate to be on chronic abx

Answer 19

Post menopausal, recurrent - think of other risk factors, delirium, falls etc. Trial for 90-100 days to help bladder recover

Question 20

UTIVA

Answer 20

For UTI, has been shown to have some evidence, is a cranberry extract

Question 21

Complications undescended testicle

Answer 21

Testicular carcinoma, torsion, sub-fertility

Question 22

PSA screening

Answer 22

Not routine, but if risk factors 50-70, doesn’t have to be annual if <2-3, if >3 then annual. Stop screening if less than 1 and older than 60. Can add in Free:Total ratio for a mid range PSA (less than 11 more than 3).

Question 23

Free: Total ratio PSA

Answer 23

Will be lower in higher CA risk (atypical PSA secondary to CA is picked up more by proteins making it part of the ‘total’)

Question 24

Stone size

Answer 24

Less than 4mm is likely to pass on own, 4mm-10mm may get stuck, >10mm is unlikely to move

Question 25

Cranberry?

Answer 25

500mg daily, or UTIVA

Question 26

Total Testosterone

Answer 26

Can be used to screen for low testosterone, but then want to check a bioavailable testosterone if low/ low-normal

Question 27

Adult phimosis

Answer 27

Circumcise