Urology

Question 1

What is the diagnosis of an acutely painful testis until proven otherwise?

Answer 1

A torsion.
Normally occurs in 10-20 yr old men.
Difficult to distinguish from epidiymo-orchitis, but there will be no fever, or leukocytosis (DO NOT WAIT FOR BLOODS TO GET BACK)

Question 2

What is the mechanism for testicular torsion?

Answer 2

The testi twists on the spermatic cord - no blood supply and a build up of venous blood causing irrevesible ischemia after 6hrs

Question 3

What are the different types of renal calculi?

Answer 3

Calcium oxalate (75%) - stones covered in sharp projections and cause bleeding. occur in alkaline urine.

Calcium magnesium ammonium phosphate (15%) - often associated with UTI. Grow very quickly and can cause stag horn calculi.

Urate (5%) - occur in acid urine.

Cystine (2%) Usually multiple, occur with renal tubular defects.

Question 4

What is the classic pain associated with renal colic?

Answer 4

Loin - groin

Question 5

What are the predisposing factors for renal calculi?

Answer 5

1. Food - tea, chocolate, rhubarb, strawberries (increased oxalate levels)
2. dehydration - job, summer,
3. drugs - loop diuretics, antacids, acetazolamide, steriods, theophylline, aspirin, thiazides, allopurinol, vit c and d
4. recurrent UTIs (in magniesium phosphate calciuli)
5. Metabolic abnormalities - hypercalcuria/aemia (hyper PTH, neoplasia, sarcoidosis, Addison’s, Cushing’s, lithium,) hyperuricosuria, hyperoxaluria, cystinuria, renal tubular acidosis
6. rental tract abnormalities - pelviureteric junction obstruction, hydronephrosis, calyceal diverticulum, horeshoe kidney, ureterocele, vesicoureteric reflux, uretheral stricture
7. foreign bodies - stents, catheters
8. family history

Question 6

What is the analgesia best used in renal colic?

Answer 6

PR diclofenac

Question 7

What are the indications for admission for renal calciuli?

Answer 7

Infection + stone
Obstruction 
Uncontrolled analgesia
AKI
Anuria

Question 8

How long on average does it take for a renal stone to pass?

Answer 8

Multiple size in mm by 4

>7mm unlikely to pass on its own

Question 9

What % of kidney stones are seen on xray?

Answer 9

90%

90% have haematuria

Question 10

What are the causes of a high PSA?

Answer 10

BPH, prostatitis, UTI, urinary retention, instrumentation, biopsy, TURP, prostate cancer

Question 11

How can lower urinary tract symptoms be devided?

Answer 11

Obstructive: weakness of stream, hesitancy, terminal dribbling, interittency, feeling of an incomplete bladder emptying

Irritative: urgency, frequency, nocturia, incontinence

Question 12

Which area of the prostate increased in BPH?

Answer 12

The inner (transitional) lobes

Question 13

What is the management of BPH causing outflow obstruction?

Answer 13

Self help: avoid caffeine and alcohol, relax when voiding, void twice in a row, control urgency by using distraction techniques, increase time between voiding to retrain bladder.

Transurethral rescetion of prostate (TURP) - <30g)

Drugs - alpha blockers: decrease smooth muscle tone, 5alpha reductase inhibitors: decreases testosterone conversion to dihydrotestosterone, helps reduce size of prostate

Question 14

What are the causes of chronic urinary retention?

Answer 14

Large prostate, pelvic malignancy, rectal surgery, DM, CNS disease,

Question 15

What are the causes of acute urinary retention?

Answer 15

large prostate, urethral stricture, anticholingerics, alcohol, constipation, post op, infection, neurological, carcinoma

Question 16

What volumes of urine can be in the bladder in acute and chronic retention?

Answer 16

600mL in acute

1500mL in chronic - can be painless

Question 17

What are the risks of a TURP?

Answer 17

Haematuria/ haemorrhage 
Haemtospermia 
Hypothermia
Urethral trauma/ stricture 
Infection 
Erectile dysfunction 
Incontinence 
Clot retention 
retrograde ejaculation 
Post TURP syndrome: low Na and low temp

Question 18

When reliving a patient of their acute retention what points need to be considered?

Answer 18

Hyperkalaemia
Metabolic acidosis
Post obstructive diuresis - need to match input/output
Sodium and bicarbonate loosing nephropathy - the kidney is injured by the retention, need to replace in for out. hold any nephrotoxic drugs
Infection

Question 19

What can cause urinary tract obstruction?

Answer 19

Outside the wall - pelviureter compression:
Tumours, diverituclitis, AAA, retroperitoneal fibrosis, accidental ligation of the ureter, retrocaval ureter, prostatic obstruction, phimosis

Within the wall:
Pelviuretic neuromuscular dysfunction, ureteric stricture, ureterovesical stricture, congential mega ureter, congenital bladder neck obstruction, neuropathic bladder, urethral stricture, congenital urethral valves, pinhole meatus

Question 20

What are the clinical features of the different levels of urinary obstruction?

Answer 20

Acute upper tract:
Loin to groin pain. may be superimposed infection +/- loin tenderness or an enlarged kidney

Chronic upper tract:
Flank pain, renal failure, superimposed infection. Polyuria may occur due to impaired urinary concentration

Acute lower tract:
Acute retention, severe suprapubic pain, distended bladder

Chronic lower tract:
urinary frequency, hesitencey, poor stream, terminal dribbling, overflow incontinence, distended bladder ++

Question 21

How do you differentiate between scrotal lumps?

Answer 21

Cannot get above it - inguinalscrotal hernia

Separate and cystic - epididymal cyst (>40yrs, painless, no treatment unless large)

Separate and solid - varicocele (dilated vein of pampiniform plexus, most common on L side. no treatment unless causing infertility)

Testicular and cystic - hydrocele ( collect of fluid in tunica vaginalis, if primary associated with a patent processus vaginalis but can be assocatied with trauma, infection, tumour)

Testicular and solid - tumour or orchitis (v painful)

Question 22

What are the causes of orchitis?

Answer 22

Chlamydia, Ecoil, mumps, gonorrhoea, TB

Question 23

Where is the growth felt in prostate cancer?

Answer 23

Peripherally

Question 24

What is the difference between phimosis and paraphimosis?

Answer 24

Phimosis is when thee foreskin cannot be retracted and it occuldes the meatus.

Paraphimosis is then the foreskin has been retracted but cannot be replaced. This prevents venous return and can cause oedema ad ischemia to the glans penis