Urology

Question 1

Meds for BPH (5 classes and when to use)

Answer 1

Alpha blocker (tamsulosin)
- no effect on progression
5-a reductase inhibitor (finasteride, dutasteride)
- shrinks prostate; only use if enlarged
Antimuscarinic or B3 agonist (mirabegron)
- for storage symptoms (urgency, freq, incontinence)
Desmopressin
- for nocturia / nocturnal polyuria
PDE5 inhibitor (tadalafil)
- for pts with LUTS + ED

Question 2

4 most common types of kidney stones

Answer 2

calcium oxalate - 70%, radiopaque
calcium phosphate - 5-10%, radiopaque
struvite - 15-20%, poor opacity, associated with UTI’s
uric acid - 10%, radiolucent

Question 3

Diseases associated with nephrolithiasis

Answer 3

primary hyperPTH (high Ca)
Gout (high urate)
HyperT4
Bone disease (high Ca)
Bariatric surgery
Bowel/pancreatic disease
Obesity, HTN, DM (unclear why)

Question 4

How does size of ureteral stone change management?

Answer 4

> 5mm: refer to Urology, consider alpha blocker, consider shock wave lithotripsy or other intervention.

<5mm: 95% will pass, expectant management, follow-up imaging in 6 months.

Either way, have pt filter urine.

Question 5

Lifestyle changes to reduce occurence of calcium kidney stones

Answer 5

increase fluid intake
reduce salt
reduce animal protein
Ca intake:
High dietary Ca is associated with LESS stones
However, Ca supplements may increase stones.
moderate oxalate (spinach, nuts, chocolate, etc.)
increase citrate (e.g. orange juice)

Question 6

3 meds for recurrent kidney stones
(and how to choose them based on 24h urine collection)

Answer 6

potassium citrate (alkalinization):
- for hypercalciuria
- for hyperuricosuria
- for hypocitraturia
- for uric acid stone and pH <6

thiazide
- for hypercalciuria

allopurinol
- for hyperuricosuria + urate stone
- for hyperuricosuria + hyperuricemia