Urology

Question 1

What is 1st line to manage lower UTIs in Men?

Answer 1

7 days of nitro or trimethoprim

Question 2

What is Fournier’s Gangrene? Sx? RF?

Answer 2

Necrotising fasciitis of Scrotum.
Sx: extreme pain, fever, oedematous testicle(s), erythema, necrotising lesion.
RF: T2DM

Question 3

How can you classify Priapism?

Answer 3

> 2 hours since sexual stimulation:
- Ischaemic: obstruction means lack of venous drainage, usually due to haematological conditions such as sickle cell
- Non-ischaemic: unregulated cavernous arterial flow, often due to trauma

Question 4

How d you manage priaprism?

Answer 4

manual drainage of blood, saline drainage, and intracavernosal alpha antagonists (adrenaline/phenylephrine).

Question 5

What is Balanoposthitis?

Answer 5

Inflammation of glans penis and foreskin.
Redness, swelling, foul-smelling discharge.
It the foreskin is not involved it is called balanitis.

Question 6

How does prostatitis present? How is it managed?

Answer 6

Inflammation of the prostate gland: perineal/prostatic pain, LUTS, systemic features (fever).
Mx: oral quinolones (ciprofloxacin) 500mg BD 2/52

Question 7

By what route do you perform a prostatic biopsy?

Answer 7

Trans-peroneal.

Question 8

What is the most common type of tumour found in the prostate gland?

Answer 8

Adenocarcinoma

Question 9

How do we score prostate cancer?

Answer 9

Gleason scoring:
2 biopsies of tissue (the first is the most common type of tissue found).
These are graded /5 and added together.
Grades 3-5 are cancerous.
Added together, <7 is low risk, 7 is moderate, 8-10 is high risk.

Question 10

What are the management options for prostate cancer?

Answer 10

• Prostatectomy: for anyone without metastatic disease.
• Radiotherapy: adjuvant or radical
• Hormonal therapies: androgen analogues, GnRH analogues, GnRH antagonists

Question 11

How do the hormonal therapies used in prostate cancer work?

Answer 11

• Androgen analogues: downregulate testosterone
• GnRH analogues: decrease LH/FSH via -ve feedback
• GnRH antagonists: reducing GnRH means LH/FSH produced less

Question 12

What is the most common complication of a TURP procedure?

Answer 12

Clot retention: pt presents with urinary retention and frank haematuria. Clot needs evacuation with diathermy to bleeding points.
Tell pts to avoid heavy lifting and walking for 1 week after the procedure.

Question 13

What is a Bell Clapper deformity? What does it make you more at risk for?

Answer 13

Testes not fixed to the tunica vaginalis - more at risk for torsion as they can rotate more easily.

Question 14

What is a varicocele? How do you know what caused it?

Answer 14

Enlargement of the scrotal veins, causing an aching or heaviness and ‘bag of worms’ texture upon palpation.
Can be caused by different reasons, to find this out you do an USS abdo.

Question 15

Why may someone with a left sided renal cancer present with aching testes and a ‘bag of worms’ texture?

Answer 15

Venous congestion due to left sided renal cancer leads to varicocele.

Question 16

Why may a varicocele lead to cause infertility?

Answer 16

Increase in temperature due to pooling of blood makes it too hot for sperm production.

Question 17

What is a hydrocele?

Answer 17

Collection of fluid within the tunica vaginalis (surrounds testes and spermatic cord).

Question 18

How would you manage a 6 month old with a hydrocele?

Answer 18

Watch and wait- may resolve by 1-2 years.
If they don’t after this point, they must be surgically drained as it increases the risk of indirect inguinal hernias.

Question 19

What is the sensitivity of USS for detecting testicular torsions?

Answer 19

almost 100%

Question 20

How do you manage Epididymo-orchitis?

Answer 20

14 days ofloxacin or 10 days levofloxacin in low risk of sexual hx.
If it is in a higher risk man (<39 years) refer to sexual health for testing and manage based on result.

Question 21

What is high pressure chronic retention?

Answer 21

Residual volume >1L, abnormal renal profile, post-obstructive diuresis >200ml/hr.

Question 22

At what point can you TWOC a high pressure chronic retention pt?

Answer 22

After specialist input.

Question 23

How would manage anyone >45 with painless, visible haematuria?

Answer 23

2WW bladder cancer

Question 24

What are the signs of TCC/Urotheiomas?

Answer 24

Visible, painless haematuria, hydronephrosis, bladder outflow obstruction.

Question 25

Where do TCCs/Urotheliomas spread first?

Answer 25

Local lymph nodes

Question 26

What is gold standard for investigating TCC/Urotheliomas?

Answer 26

Cystoscopy.

Question 27

What is gold standard for diagnosis of renal stones?

Answer 27

CTKUB

Question 28

Are calcium stones radio opaque or radio lucent?

Answer 28

Radio-opaque

Question 29

Are Uric acid stones radio opaque or radio lucent? What pH of urine do they favour?

Answer 29

Radio lucent.
Low urinary pH (acidic) - and lower urine volumes.

Question 30

Are Struvite stones radio opaque or radio lucent? What pH do they favour? What is their classic shape?

Answer 30

Relatively radiolucent.
More common in higher pH urine, therefore are associated with proteus bacteria as these alkaline the urine.
Staghorn.

Question 31

Are Cystine stones radio opaque or radio lucent?

Answer 31

Relatively radiolucent.

Question 32

Which renal injury are Calcium-oxylate/phosphate stones associated with?

Answer 32

Renal tubular acidosis.

Question 33

How do you manage and obstructed kidney with hydronephrosis?

Answer 33

Stent or nephrostomy.
Commence sepsis 6 as these easily become infected.

Question 34

What is first line for ureteric colic pain?

Answer 34

PR diclofenac

Question 35

What is sued for medical expulsion of renal stones?

Answer 35

Tamsulosin (alpha blocker)

Question 36

How can we surgically manage renal stones >5mm but < 2cm?

Answer 36

Extracorporeal shock wave lithotripsy or ureteroscopy (pregnant women who cannot have ESWL).

Question 37

How do you manage renal stones which are >2cm or complicated (e.g., staghorn)?

Answer 37

Percutaneous nephrolithotomy.