urology

Question 1

What are some medications that cause erectile dysfunction?

Answer 1

SSRIs, beta-blockers

Question 2

How does the prostate feel in prostatitis?

Answer 2

tender, boggy prostate gland

Question 3

What is the management of prostatitis?

Answer 3

14 days of quinolone

Question 4

What are the risk factors for testicular cancer?

Answer 4

• Cryptorchidism
• Infertility
• Family history
• Klinefelter’s syndrome
• Mumps orchitis

Question 5

A 4-week-old boy is brought to GP. concerned about a ‘swelling’ in the right side of his scrotum that has appeared over the past week. He does not appear to be in any pain, has been feeding well and has not had any diarrhoea or coryzal symptoms.

On examination, a scrotal swelling is palpable on the right side. It is possible to get above the swelling. The right testicle is difficult to palpate as a result of the swelling, but the left testicle is easily palpable. On transillumination, the right hemiscrotum lights up.

What is the appropriate management?

Answer 5

Reassure that it is not sinister and will resolve in the 1st year of life

This 4-week-old boy presents with what is likely a hydrocele that was not noticed at birth. As fluid accumulates hydroceles grow to become more visible. Given this clinical diagnosis, aspiration is inappropriately invasive and has no role.

Similarly, as hydroceles often are self-resolving, specialist input is not required unless it persists beyond 18 months to 2 years of age.

Question 6

what are the medical indications of circumcision?

Answer 6

1. phimosis
2. reccurent balanitis
3. balanitis xerotica obliterans
4. paraphimosis

Question 7

what medications are responsible for acute urinary retention?

Answer 7

anticholinergics
TCAs
antihistamines
opioids
benzodiazepines

Question 8

what bloods are required in a suspected case of acute urinary retention?

Answer 8

1. Serum U&Es and creatinine - should be checked to assess for AKI
2. FBC and CRP - to look for infection
   - NOt PSA - is typically elevated anyway

Question 9

when do you leave the catheter in place for acute urinary retention?

Answer 9

Urinary catheterisation can be performed in patients with suspected acute urinary retention, and the volume of urine drained in 15 minutes measured. A volume of <200 confirms that a patient does not have acute urinary retention, and a volume over 400 cc means the catheter should be left in place. In between these volumes, it depends on the case.

Question 10

what is the complication of acute urinary retention?

Answer 10

post obstructive diuresis
Kidneys may increase diuresis due to the loss of their medullary concentration gradient

this can lead to volume depletion and worsening of any acute kidney injury

Question 11

when is a partial nephrectomy indicated in renal cell carcinoma?

Answer 11

If the renal cell carcinoma is <7cm - partial nephrectomy is indicated

If bigger - alpha inferferon and interleukin 2 can be used to reduce tumour size

Question 12

what are the aetiology of renal cell cancer?

Answer 12

1. smoking
2. von hippel-lindau syndorme
3. tuberous sclerosis

Question 13

how do you differentiate between inguinal hernia and hydrocele?

Answer 13

hydrocele - you can get above the swelling

inguinal hernia - cannot get above the swelling

Question 14

what is the important investigation in priapism?

Answer 14

cavernosal blood gas analysis - differentiate between ischaemic and non-ischaemic

doppler or duplex US - alternative to blood gas analysis to assess for blood flow within the penis

Question 15

what are the risk factors for developing teratomas and seminomas?

Answer 15

1. infertility
2. cryptorchidism
3. family history
4. klienfelter’s syndrome
5. mumps orchitis

Question 16

what are the features of testicular carcinomas?

Answer 16

1. painless lump
2. pain may also be present
3. hydrocele
4. gynaecomastia - increased oestrogen: androgen ratio
   germ cell tumours - hCG - leydig cell - increases in both oestradiol and testosteorne production

leydig cell tumours - directly secrete more oestradiol and convert additonal androgen precursor to oestrogens

Question 17

what is the first line investigation for in suspected prostate cancer?

Answer 17

multiparametric MRI - for people with suspected clinically localised prostate cancer

Question 18

what is the blind treatment for epididymo-orchitis?

Answer 18

ceftriaxone 500mg intramuscularly single dose, plus doxycycline 100mg by mouth twice daily for 10-14 days

Question 19

what is TURP syndrome

Answer 19

caused due to irrigation with large volumes of glycine- hypo-osmolar and is systemically absorbed when prostatic venous sinuses are opened up - hyponatraemia

glycine is broken down by the liver into ammonia, hyper-ammonia and visual disturbances

Question 20

what are the risk factors for bladder cancer?

Answer 20

1. smoking
2. exposure to analine dyes
3. rubber manufacturing
4. cyclophosphamide