Urology

Question 1

Testicular torsion presentation

Answer 1

Acute excruciating pain
Testicle often moves superior
Can’t do full exam as so painful

Question 2

Testicular torsion Mx

Answer 2

If suspicious go straight to theatre and try and save testicle (6 hour rule)

Question 3

Varicocoele presentation

Answer 3

Bag of worms
Arises due to faulty valves
Can be elucidated by valsalva manouevre

Question 4

Testicular cancer investigations

Answer 4

USS
Bloods
- alpha fetoprotein
- beta HCG

Question 5

Renal calculi presentation

Answer 5

Excruciatingly painful
Colic pain, which comes and goes in waves and nothing you can do to appease it (whereas peritonitic pain subsides with lying perfectly still)

Question 6

Risks renal calculi

Answer 6

dehydration
increased incidence in summer
hot countries
high fat, salt and red meat diet

Question 7

Managing renal calculi

Answer 7

ALWAYS check for concomittent infection
- WBC, vitals, CRP

For pain give rectal diclofenac

<5mm nothing
medium = extracorporeal lithotripsy
large = cut open if stag horn (2+ calyces)

Managing infection

• IV fluids
• ABX
• Nephrostomy to drain pus

Question 8

Renal calculi investigations

Answer 8

Non contrast CT

Question 9

UTI presentation

Answer 9

dysuria, frequency and urgency
can have haematuria
usually women

Question 10

Common cause bacteria UTI

Answer 10

E.coli

Question 11

When to investigate UTI further

Answer 11

Post menopausal women
Men
Young women with recurrent UTI

This is because of increased risk of cancer

Question 12

UTI Ix

Answer 12

Urine culture
FBC
CRP

US KUB
Flexible cystoscopy

Question 13

PSA >20 usually indicates

Answer 13

Cancer

But could just be infection

Question 14

PSA cut off for further investigation

Answer 14

4

Question 15

Why is PSA not a routine screen

Answer 15

Low specificity and the diagnostic biopsy is dangerous due to 1-2% risk of septicaemia

MRI now becoming more widely used following PSA

Question 16

Causes of visible haematuria

Answer 16

Trauma
Infection
Stones
Cancer

visible haematuria is more worrying as 20% risk of cancer

Question 17

Causes of non-visible haematuria

Answer 17

Renal parenchymal disease

especially if proteinuria as well

1-5% risk of cancer
higher if symptomatic

Question 18

Hx questions for cause of haematuria

Answer 18

Infection - painful dysuria, frequency, urgency, fever

Stones - colic pain

Cancer- smoking, chemical exposure, cachexia

Trauma- any injuries even if a few weeks ago

Question 19

Exam for haematuria

Answer 19

Abdo
Genital
Rectal for male if suspect prostate problem

Question 20

Haematuria Ix

Answer 20

dipstick
Creatinine
urine culture
FBC
LFT
Ca2+

cystoscopy
USS
CT urogram (10-20 mins)

Question 21

Symptoms of outflow obstruction

Answer 21

hesitancy
weak stream
terminal dribbling

Question 22

Managing outflow obstruction

Answer 22

anti-cholinergics (oxybutynin)

• bad side effects so poorly tolerated
• CI in closed angle glaucoma

Alpha blockers (tamsulosin)
- smooth muscle relaxant

5alpha reductase inhibitors (finasteride)
- shrink prostate

Transurethral resection
- cores out prostate