Urology

Question 1

Where can prostate cancer metastasise to, what can it cause due to medication for prostate cancer and whats gold standard investigation?

Answer 1

This patient has spinal cord compression (new incontinence and leg weakness) following the administration of a GnRH analogue. It’s likely that this has caused a tumour flare in his bony metastasis, resulting in spinal cord compression.

Question 2

Raised CK after fall, and urine is red. What is it?

Answer 2

Myoglobinuria due to muscle damage and myoglobin has turned the urine red

Question 3

What is the mx for infected obstructive kidney stone?

Answer 3

Surgical decompression

Question 4

How should you mx a patient who has come in with >1L of retained urine?

Answer 4

Admit to hospital
-After catheter is inserted, he may have post catheter diuresis, which can lead to dehydration and ultimately may need fluids

Question 5

Mx for renal stones

Answer 5

-<5mm and unsymptomatic then wait and watch
-5-10mm then shockwave lithotripsy
-10-20mm then shockwave(efficacy may be reduced in obese patients) or ureteroscopy
-> 20 mm percutaneous nephrolithotomy(decompression)

Question 6

What’s the biggest risk factor for bladder cancer?

Answer 6

Smoking

Question 7

What is the most common causing bacteria of pyelonephritis and how does it look under a ms?

Answer 7

E.coli
Pink rod shaped

Question 8

mx for renal cancer

Answer 8

-Insensitive to chemo and radio
-If T1 or <7cm then partial nephrectomy
-If T2 or >7cm then radical nephrectomy

Question 9

What stones are you likely to get after chemotherapy?

Answer 9

Urate stones because chemo breaks increases turnover of cells which leads to release of large amounts of nucleic acid leading to uric acid. This hyperuricemia leads to urate stone formations

Question 10

What does positive transillumination on the testis mean?

Answer 10

Fluid so maybe hydrocele

Question 11

What is the composition of staghorn caliculi?

Answer 11

Struvite
-Under alkaline conditions can form staghorn caliculi

Question 12

What is the management of a patient who has had a transurethral resection of prostate and after lifting weights, had blood in urine and clots in the bladder?

Answer 12

This patient presents with clot retention after transurethral resection of prostate (TURP). It is a common complication following the procedure, hence most patients are advised to refrain from walking and lifting heavy weights for at least one week post-surgery. In the event of clot retention, an emergency clot evacuation and diathermy to the bleeding point is the definitive management.

Question 13

What is the most common site of metastasis for primary testicular cancer?

Answer 13

Para aortic lymph nodes