Urology

Question 1

BPH

Answer 1

LUTS symptoms, mainly voiding problems (poor stream, terminal dribbling…), also frequency
First line: finasteride(5alpha reductase inhibitor) if high risk of progression, tamsulosin(alpha 1 antagonist)
Minimally invasive: TUNA, TUMT
Surgical: TURP

Question 2

UTI organisms

Answer 2

Commonest: E. coli
Sexually active young women: staphylococci saprophyticus
Urinary tract abnormalities: pseudomonas, staphyl epidermidis

Question 3

Renal stone

Answer 3

Male to female 3:1, age 30-50
Calcium oxalate(most common), magnesium ammonium sulphate(struvite, in recurrent UTI people), urate

Young people with unilateral flank pain, loin to groin pain, and microscopic haematuria on urine dip

Ix Gold standard: CT KUB
Not all stone visible on X-ray
Ultrasound can show hydronephrosis

Tx: small stone not obstructive: pass by itself
Lifestyle: reduce tea, coffee, nuts, strawberry, beetroots,spinach and beans
Medical: tamsulosin
Surgical: ESWL(shockwave), ureteroscopy + laser(camera), PCNL(skin puncture and laser)

Question 4

Prostate cancer

Answer 4

Second lethal male cancer in UK( lung cancer wins cause smoking why not)
Adenocarcinoma in the peripheral zone
DRE: asymmetrical, nodular, irregular (unlike smooth, symmetrical in BPH)

Elderly men with LUTS symptoms and maybe haematuria

Ix: PSA (Don’t if UTI/prostatitis < 1 month, ejaculation/exercises <48 hours, urinary retention, something in the tract(like a stent))
First line is now Multiparametric MRI prostate(5 point likert scale)
If >3— TRUS biopsy(Gleason histology score, 3+4=7, 4+3=7 etc)
If <3— can choose not biopsy

Mx: active surveillance(regular follow up until there is a concern, different from watchful waiting which is patient monitor until symptoms change)
Radical prostatectomy 
HIFU(ultrasound)
Radiotherapy
Chemotherapy
Hormonal therapy( GNRH agonist)

Question 5

Testicular tumour

Answer 5

Seminoma(50% of germ cell tumour): beta HCG +
Teratoma: AFP+, beta HCG +
Risk factors: undecended testis( cryptochidism), klinefelter’s syndrome, mumps orchitis, infertility(*3 risk)

Young guy with painless scrotal lump+/- gynaecomastia

Dx: ultrasound

Tx: orchitectomy, chemo, radio