Urology

Question 1

In who are kidney stones most common in?

Answer 1

Caucasian men

Question 2

How are kidney stones diagnosed?

Answer 2

History
Examination
Bloods (U+Es, calcium and urate)
Urine dip (RBC, WBC, Nitrites, pH)
MSU
Imaging: CT KUB (no contrast)

Question 3

What are the main features of urinary colic?

Answer 3

Common but lots of differentials
Usually dipstick haematuria
Beware AAA

Question 4

What is the treatment for renal colic?

Answer 4

Analgesia (NSAIDs, Opiates)

Question 5

When would you admit a patient with renal colic?

Answer 5

Single kidney
Pyrexia
Continuing pain
Renal impairment
Pregnancy
Large stone/severe obstruction on CT

Question 6

What is the treatment for stone?

Answer 6

Conservative/Medical - Tamsulosin

If stone is greater than 5mm consider:
ESWL - oupatient
Ureteroscopy
PCNL

Question 7

What is the conservative managment of kidney stones?

Answer 7

High fluid intake
Do not cut down on dairy
Less salt

Question 8

What is ESWL?

Answer 8

Pt. awake
Shockwave therapy at stone to break stone up
Given oral analgesia
For stones up to 1cm

Question 9

What is Ureteroscopy?

Answer 9

Surgical
Camera and laser fed up into the kidney
Down under GA
Day case procedure

Question 10

What is PCNL?

Answer 10

Keyhole surgery
Through back
For big stones

Question 11

What are the two types of haematuria?

Answer 11

Visible and Non-visible

Question 12

What are some causes of haematuria?

Answer 12

Consider malignancy until proven otherwise
Infection
Trauma
Drugs

Question 13

How do you manage haematuria?

Answer 13

Encourage oral fluids
Treat any UTI
Admit?

Question 14

When do you admit patients with haematuria?

Answer 14

Clots/retention
Anemia
Renal impairment
Tachy/Hypotension
Prolonged bleeding
Eldery/frail

Question 15

What imaging is used when considering urological cancers?

Answer 15

CTUrogram

Cystoscopy

Question 16

What are RFs for bladder cancer?

Answer 16

Smoking
Aniline dyes
Rubber
Textiles 
Printing

Question 17

How are bladder cancers classified?

Answer 17

TNM

How deep into the bladder wall

Question 18

What is the management for bladder cancer?

Answer 18

Trans-urethreal resection of bladder tumour (TURBT)

Flexible cystoscopy surveillance

Intravesical chemo/immuni

Radical cystectomy

Radiotherapy

Question 19

What is BPH?

Answer 19

Benign Prostatic Hypertrophy
Narrows down urethra
Histological diagnosis

Question 20

What are the two categories for LUTS?

Answer 20

Storage

Voiding

Question 21

What are some storage LUTS?

Answer 21

Frequency
Urgency
Nocturia

Question 22

What are some voiding LUTS?

Answer 22

Poor flow
Hesitancy
Intermittency
Straining to void
Sensation of incomplete emptying

Question 23

What is BPE?

Answer 23

Benign prostate enlargement

Clinical diagnosis based on DRE

Question 24

What are LUTS?

Answer 24

Lower urinary tract infections

Not age nor gender nor organ specific

Question 25

How do assess patients with LUTS?

Answer 25

``` History and Examination DRE IPSS Questionnaire Urine dip Freq/Volume chart PSA ``` In 2ry care Flow rate and PVR UDS/VUDS Flexi cystoscopy

Question 26

What are some mediations used to treat BPH?

Answer 26

Alpha-blocker (Tamsulosin) - relaxes smooth muscle of prostate 5-alpha reductase enzyme inhibitor (Finasteride) Antocholinergics (Solifinacen) Beta 3 agonist (Mirabegron) PDE5 inhibitors

Question 27

What are the surgical managements for BPH?

Answer 27

``` TURP (Trans-urethral resection of the prostate HoLEP Urolift Rezum PAE ```

Question 28

How do you assess urinary retention?

Answer 28

Palpable bladder Dull to percuss Bladder scan Consider CISC

Question 29

What can be done if usual catheterisation fails?

Answer 29

Failed urethral catherisation: Catheter introducer Suprapubic Flexi guided catheterisation