Urology 5

Question 1

what is the significance of bacteruria

Answer 1

indicitive of UTI
however if there is ‘non sigificant’ growth this doesnt rule out UTI

Question 2

when do you treat asymptomatic bacteriuria

Answer 2

pregnant people (inc risk of preterm or miscarriage)

sometimes prior to urological surgery

Question 3

when would you start treatment for a UTI

Answer 3

typical symptoms with nitrates/leucocytes on dip

Question 4

how are uncomplicated UTIs in females treated

Answer 4

3 days of oral ABX
nitrofuratoin or trimethoprim

Question 5

what is considered an complicated UTI

Answer 5

male
abnormal urinary tract: renal calculi, hydronephrosis..
immunocompromised patients
atypical organism
recurrent despite treatment
during pregnancy

Question 6

what is the management for a complicated UTI

Answer 6

7-10 days
nitrofuratoin/ trimethoprim / co-amoxiclav
urine culture especially important

Question 7

why is nitrofuratoin only usefull in lower urinary infections

Answer 7

only active in urine
eg wouldn’t be able to treat pyelonephritis as its not in its active form as it reaches the kidneys

Question 8

what is the definition of recurrent UTIs

Answer 8

more than 2 in 6 months requires investigation

Question 9

how are recurrent UTIs managed conservatively

Answer 9

USS +/- flexible cystoscopy to rule out structural cause
advise fluids, avoid synthetic fabrics or scented soaps

Question 10

how are recurrent UTIs managed medically

Answer 10

topical oestrogen (post menopausal)
Methenamine hippurate - antiseptic almost
ABX: post coital, self start or low dose 6mnth
intravesica GAG layer instillation
intravesical gentamycin (last line)

Question 11

how can pyelonephritis be managed

Answer 11

if not too unwell in primary care:
oral ciprofloxacin or Augmentin

if unwell:
admission for exlusion of obstruction with USS and IV ABX

Question 12

what are some risk factors for prostatitis

Answer 12

strictures
obstruction
high levels of urine post void
generally men in their 40s/50s

Question 13

what is chronic prostatitis

Answer 13

syndrome of chronic pelvic pain +/- urinary or sexual dysfunction

Question 14

what are some causes of epididymo-orchitis

Answer 14

younger men: chalmydia, gonorrhoea
older: coliforms
mumps/ viral
drug induced - amiodarone

Question 15

what relieves the pain in patients with orchitis

Answer 15

lifting the testicle

Question 16

how is testicular torsion managed

Answer 16

if suspected take them straight to theatre
for emergency scrotal exploration

Question 17

what managment is available for orchitis

Answer 17

USS to confirm
PO doxycycline +/- IM cefriaxone or PO ciprofloxacin
need 10-14 days of ABX

swelling can take 6-8 weeks to settle