Urology

Question 1

What are the most common organisms involved in epididymo-orchitis?

Answer 1

Youn and sexually active- Niseirria Gonorrhoea or Chlamydia

Old- E-coli

Question 2

What is the mx in epididymo-orchitis?

Answer 2

STI- treat
E-coli- MSU dependent/oral quinolone

Question 3

List the RFs for transitional cell carcinoma of the bladder?

Answer 3

SMOKING!!
Exposure to dyes
Rubber manufacture
Cyclophosphamide

Question 4

List the RFs for squamous cell carcinoma of the bladder?

Answer 4

Schistomiosis
Smoking

Question 5

What is the Ix indicated in renal stones?

Answer 5

FBC, CRP, U&Es
Coagulation studies
Urine dipstick and culture

Question 6

What is the most appropriate imaging for renal stones?

Answer 6

Non contrast CT KUB
In pregnancy and children- USS

Question 7

What is the most appropriate initial mx of renal stones?

Answer 7

Analgesia (NSAIDs)
+/- Alpha blocker if distal uteric stone <10mm

Question 8

What is the mx of renal stones?

Answer 8

<5mm- watchful waiting
5-10mm- Shockwave lithotripsy
10-20mm- Shockwave lithotripsy/Uteroscopy
>20mm- Percutaneous nephrolithotomy

Question 9

List the obstructive and storage sx of BPH?

Answer 9

Obstructive: (SHIP)
Straining
Hesitancy
Dribbling
Incomplete emptying
Poor flow

Storage- (FUN)
Frequency
Urgency
Nocturia

Question 10

What is the 1st line of mx for BPH?

Answer 10

Alpha 1 antagonist e.g. Tamsulosin
promotes smooth muscle relaxation

Question 11

What is the MOA of alpha 1 antagonist in BPH?

Answer 11

Decreases smooth muscle tone of bladder and prostate

Question 12

What is the 2nd line of mx in BPH?

Answer 12

5 alpha reductase Inhibitors
e.g. Finasteride

Question 13

How long does it take for finasteride to take effect?

Answer 13

6 months

Question 14

What is the MOA of Finasteride?

Answer 14

Blocks the conversion of testosterone to DHT, causing a decrease in prostate volume

Question 15

What is the SE of alpha 1 antagonists?

Answer 15

Dizziness
Postural Hypotension
Dry mouth
Depression

Question 16

List the causes of acute urinary retention (AUR)?

Answer 16

BPH**
Urethral obstruction- strictures, calculi, constipation
Medications- anticholinergics, TCAs, Opioids, Benzos
Neurological cause
UTI
Post operative

Question 17

List the sx of AUR?

Answer 17

Inability to pass urine
Lower abdominal discomfort
Considerable pain or distress
an acute confusional state may also be present in elderly patients

Question 18

What Ix are indicated in AUR?

Answer 18

Urine MCS
U&Es, FBC, CRP

Question 19

How should a diagnosis of AUR be confirmed?

Answer 19

Bladder USS- A volume of >300 cc confirms the diagnosis

Bladder scans have its inaccuracies

Question 20

What is the mx of AUR?

Answer 20

Decompressing the bladder via catheterisation- measure urine in bag in 15 mins

A volume of <200 confirms that a patient does not have acute urinary retention, and a volume over 400 cc means the catheter should be left in place. In between these volumes, it depends on the case.

Question 21

What is a complication of AUR?

Answer 21

Post-obstructive diuresis

The Kidneys may increase diuresis due to the loss of their medullary concentration gradient. This can take time re-equilibrate
this can lead to volume depletion and worsening of any acute kidney injury
some patients may therefore require IV fluids to correct this temporary over-diuresis

Question 22

List the causes of unilateral hydronephrosis?

Answer 22

PACT
Pelvic-ureteric obstruction
Aberrant renal vessels
Calculi
Tumours of the renal pelvis

Question 23

List the causes of BL hydronephrosis?

Answer 23

SUPER
Stenosis of the urethra
Urethral valve
Prostatic enlargement
Extensive bladder tumour
Retro-peritoneal fibrosis

Question 24

What is the 1st line Ix for hydronephrosis?

Answer 24

USS- Identifies presence of hydronephrosis and can assess the kidneys

Question 25

What other Ix can be conducted in hydronephrosis?

Answer 25

IVU- assess the position of the obstruction Antegrade or retrograde pyelography- allows treatment if suspect renal colic: CT scan

Question 26

What is the mx of hydronephrosis?

Answer 26

Remove the obstruction and drainage of urine Acute upper urinary tract obstruction: nephrostomy tube Chronic upper urinary tract obstruction: ureteric stent or a pyeloplasty

Question 27

List the classic triad of sx associated with renal cell cancer?

Answer 27

haematuria loin pain abdominal mass

Question 28

List the paraneoplastic syndrome associated with renal cell cancer?

Answer 28

Stauffer syndrome a paraneoplastic disorder associated with renal cell cancer typically presents as cholestasis/hepatosplenomegaly it is thought to be secondary to increased levels of IL-6

Question 29

What is the management of renal cell cancer?

Answer 29

For confined disease- partial or total nephrectomy Alpha-interferon and interleukin-2 have been used to reduce tumour size and also treat patients with metatases

Question 30

What are the complications associated with TURPs sx?

Answer 30

TURP Syndrome (Hyponatraemia, Fluid overload, Glycine toxicity) Urethral strictue/UTI Retrograde ejaculation Perforation of the prostate

Question 31

When is circumcision CI?

Answer 31

in Hypospadias

Question 32

What is the tell-tale sx of a epididymal cysts?

Answer 32

Separate from the body of the testicle found posterior to the testicle

Question 33

what are the Contraindications to urethral catheter?

Answer 33

Traumatic urethral injury/pelvic fracture History of urethral stricture Resistance to passage High riding prostate Blood at meatus