Urology

Question 1

Testicular disease - sudden onset testicular pain + abdominal radiation DD

Answer 1

• Torsion
- RF: bell clapper testies

Any suspicion → urological surgeon (<8 hours can save testicle)

• Hydatid of morgagni torsion
• hydrocele - filling with peritoneal fluid - transilluminates
• epididymal cyst
• Varicocele - L side drain into renal vein - exclude renal cancer

Question 2

Stone disease symptoms

Answer 2

renal colic - loin to groin

haemturia

Question 3

Locations

Answer 3

PUJ - pelvic uteric junction
Pelvic brim - transverse process of spine
VUJ

Question 4

RF

Answer 4

Dehydration 
high calcium 
gout 
anatomical variant 
hyperparathyroidism 
Prv Hx
HTN
metabolic acidosis

Question 5

Inv

Answer 5

CT-KUB → not young women/men (radiation risk)

Not all visible on plain XR

Question 6

Complications

Answer 6

Infective obstructive tract
Bilateral stones
Solitary kidney

Question 7

mgmt

Answer 7

Let them pass
Diclofenac
>5cm - give 40 days if well 
Lithotripsy if in kidney 
Fit and healthy - transurethral surgery

Question 8

Mgmt infective obstructive tract

Answer 8

Nephrostomy

Question 9

Haematuria Hx and causes

Answer 9

Bleeding in part of uriary tract
Visible or non-visible
Pain (infection, lower tract) or painless
Systemic symptoms

Trauma, infection, malignancy, consider drugs anticoagulation, cyclophosphamide, operations TURP

Question 10

Urinary retention

Answer 10

Actue → painful high pressure, obstructive, inflammatory drug, neurogenic, TURP

Chronic → Low pressure, painless - cancer, prostate disease

Question 11

Fourniers gangrene

Answer 11

Black testicle, lots of bacterial causes
Need surgery → debridement

RISK: DM, alcohols, immunosuppressed
TX: antibiotics - cut back to clean boarder
High mortality

Question 12

BPH

Symptoms

Answer 12

Common 90% > 80 years
Causes
- Storage and voiding symptoms

Rule out - cancer
DR - nodular or smooth

Tx depends on patent factors such as fitness for surgery, patient preference and is based on national guidelines these include conservative, medical or surgical
Medical
Tamsulosin/finasteride
Surgical - TURP, catheters

Question 13

Priapisim

Answer 13

Erection lasting more then 4/5 hours
Ischaemic - sickle, antipsychotics, viagra,
Arterial - post traumatic
Suttering - sickle cell

Find out cause
• ABG on penis and see PCO2, O2 and PH - ischaemic need to Tx immediately

Conservative
Medical - phenylephrinine
Surgical - shunts

Arterial - not emergency

Question 14

Catheters
Blocks
Blood
Suprapubic catheter

Answer 14

Flush the catheter - 50 mls - suck in and out
3 way catheter - constant irrigation
Instilala gel replace with catheter