Urology

Question 1

Finasteride treatment of BPH, how long before results are seen?

Answer 1

6 months

Question 2

management of urge incontinence

Answer 2

1. bladder retraining (lasts for a minimum of 6 weeks, the idea is to gradually increase the intervals between voiding)
2. antimuscarinics
   oxybutynin (immediate release), tolterodine (immediate release) or darifenacin (once daily preparation)

mirabegron (a beta-3 agonist) – in elderly (to avoid constipation, dizziness, falls)

Question 3

management of stress incontinence

Answer 3

1. pelvic floor muscle training
   NICE recommend at least 8 contractions performed 3 times per day for a minimum of 3 months
2. surgical procedures: e.g. retropubic mid-urethral tape procedures
3. duloxetine may be offered to women if they decline surgical procedures
   a combined noradrenaline and serotonin reuptake inhibitor
   mechanism of action: increased synaptic concentration of noradrenaline and serotonin within the pudendal nerve → increased stimulation of urethral striated muscles within the sphincter → enhanced contraction

Question 4

Schistosomiasis is a risk factor for what cancer

Answer 4

Squamous cell bladder

Question 5

Gram positive cocci in clusters grown from the urine

Answer 5

Gram positive cocci in clusters grown from the urine is most likely to be S. saprophyticus. S. aureus is a common pathogen but is unusual in urinary infections.

Question 6

what female condition can also cause secondary polycythaemia because it can secrete EPO?

Answer 6

Uterine fibroids

Question 7

Finasteride effect on levels of serum prostate-specific antigen

Answer 7

decreased PSA

Question 8

Chlamydia trachomatis manifestations

Answer 8

Chlamydia trachomatis serovars D through K: urethritis and pelvic inflammatory disease

Chlamydia trachomatis serovars L1, L2 and L3* - Lymphogranuloma venereum (LGV)
genital chlamydia and bowel symptoms (proctocolitis)

Question 9

Finasteride treatment of BPH - how long before results are seen

Answer 9

6 months

Question 10

what is the first-line management for BPH with bothersome lower urinary tract symptoms?

Answer 10

alpha-1 antagonist such as tamsulosin or alfuzosin.