urology

Question 1

urge incontinence

Answer 1

caused by overactivity of the detrusor muscle of the bladder

suddenly feeling the urge, rushing to bathroom + not making it

Question 2

management of urge incontinence

Answer 2

bladder retraining - increasing time between voiding

anticholinergic med = oxybutynin (dry mouth/eye)
beta-3 agonist = mirabegron

invasive - sacral nerve stimulation, cytoplast (enlarge bowel), urinary diversion (stoma)

Question 3

stress incontinence

Answer 3

urine leaks at times of increased bladder pressure due to weakness of pelvic floor + sphincter muscle - laughing, coughing or surprised

Question 4

management of stress incontinence

Answer 4

pelvic exercises, avoid diuretics, caffiene

duloxetine

vaginal tape/sling, colsuspension, intral urethral bulking

Question 5

pharmacological management of stress incontinence

Answer 5

duloxetine

–> SNRI antidepressant, second line where surgery is preferred

Question 6

surgical management of stress incontinence

Answer 6

vaginal tape - sling arounf urethra
colsuspension - stitching anterior wall to pubic symphysis
intramural urethral bulking - injection to reduce diameter

artifical urinary sphincter - pump to deflate cuff around urethra

Question 7

commonest cause of pyelonephritis

Answer 7

E. coli
klebsiella

both gram neg anaerobic rods

Question 8

management of pyelonephritis

Answer 8

co-trimaxazole 7-10days

Question 9

management of benign prostatic hyperplasia

Answer 9

immediate = alpha-blockers - tamsulosin (postural hypotension)

gradual = 5-alpha reductase inhbitors - finasteride

Question 10

treatment of small ureteric stones

Answer 10

alpha blocker = tamsulosin

Question 11

testicular torsion vs torsion of appendix testes

Answer 11

testicular torsion = absent cremasteric reflex

appendix = cremasteric reflex present, super young, blue dot, resolve without surgery

Question 12

bell clapper deformity

Answer 12

testicular torsion

–> fixation between testicle + tunica vaginalis is absent, hangs horizontally

Question 13

management testicular torsion

Answer 13

surgical exploration, >6hr pretty irretrievable

Question 14

acute epididymitis cause

Answer 14

bacterial infection - gonorrhoea or chlamydia
amiodarone
history of UTI, catheter

Question 15

commonest bacterial cuse of epididymo-orchitis

Answer 15

gonorrhea or chlamydia

Question 16

epididymo-orchitis presentation

Answer 16

tenderness confined to epididymis
cremasteric reflex present
dysuria

Question 17

management of epididymo-orchitis

Answer 17

analgesia, bed rst

ofloxacin

Question 18

epididymo-orchitis investigation

Answer 18

us - swollen epidudymis, increased blood flow

urine culture
chlamydia PCR

Question 19

hydrocele

Answer 19

fluid around testes - between tunica vaginalis + mesothelial lining
transilluminates, can “get above it”

Question 20

variocele

Answer 20

bag of worms

Ix = US with doppler

Question 21

can’t get above testicular lump

Answer 21

hernia

Question 22

paraphimosis

Answer 22

Painful swelling of foreskin distal to phimotic ring
Often after foreskin retracted for catheter or cystoscopy + staff forget to put it back
–> Impairs venous return resulting in oedema

Management = reduce oedema, apply pressure while – if fails dorsal slit to cut foreskin

Question 23

balanitis xerotic obliterans/lichen sclerosis

Answer 23

progressive inflammatory dermatosis glans penis + foreskin
common
young, present with phimosis/paraphimosis

histology = band of collagen + band of lymphocytes

Question 24

what causes genital warts?

Answer 24

HPV 6 + 11

Question 25

high risk HPV strains

Answer 25

16 + 18

Question 26

priapism and treatment

Answer 26

prolonged unwanted erection (>4hrs)

aspiration of blood within corpus cavernosa + irrigation with salin
–> adrenaline may also be used, US to check for damage

Question 27

fourniers gangrene

Answer 27

type of necrotising faciitis affecting perineum (male genitalia)
starts as cellulitis
mortality high in diabetics + alcoholics

Ix = xray/US - gas in tissue
Mx = antibiotics + surgical debridement

Question 28

commonest causative organism of emphysematous pyelonephritis

Answer 28

E. coli

Question 29

emphysematous pyelonephritis

Answer 29

acute necrotising + perirenal infection caused by GAS-forming uropathogens
–> E.coli

common in diabetics, assoc with ureteric obstruction

Question 30

emphysematous pyelonephritis presentation, investigation + management

Answer 30

px = fever, vomiting, flank pain
ix = CT - gas in kidney

Mx = ITU, not settling then nephrectomy

Question 31

perinephric abscess

Answer 31

flank mass, high WBC, high serum creatinine, pyuria

ix = CT

Mx = antibiotics + percutaneous surgical drainage

Question 32

what is posterior urethral injury assoc with? investigation + management

Answer 32

fracture of pubic rami

ix = retrograde urethrogram
mx = suprapubic catheter, delayed construction after at least 3 months

Question 33

bladder injury presentation

Answer 33

assoc pelvic fracture

pain, tender, bruising
inability to void
guarding/rigidity
diminished bowels sounds

Question 34

bladder injury investigation

Answer 34

CT cystography

extraperitoneal injury = flame-shaped collection of contrast in pelvis

Question 35

bladder injury management

Answer 35

large bre catheter, antibiotic

repeat cystogram in 14days

Question 36

penile fracture

Answer 36

typically happens during intercourse
cracking/popping sound followed pain, rapid detumenscence, discolouration + swelling

mx = prompt exploration + repair

Question 37

benign prostatic hyperplasia, which lobe is most likely affected?

Answer 37

median lobe of prostate

Question 38

hyposapadias

Answer 38

Hypospadias is a birth defect in boys in which the opening of the urethra is not located at the tip of the penis.

Question 39

hy