Urology

Question 1

How do you investigate urge incontinence?

Answer 1

Urodynamic studies

Question 2

How do you treat urge incontinence conservatively?

Answer 2

Behavioural advice - avoid stimulants such as caffeine and alcohol
Acupuncture may work

Question 3

How do you treat urge incontinence medically?

Answer 3

• anticholinergics = oxybutinin (reduces the para - causing detrusor relaxation)
• B3 agonists = mirabegron
• botulin toxin injections

Question 4

How do you treat urge incontinence surgically?

Answer 4

Augmentation enterocystoplasty (makes the bladder bigger using bowel - reduces the pressure)

Question 5

How can you treat stress incontinence conservatively?

Answer 5

Pelvic floor m exercises

Lifestyle modifications

Question 6

How can you treat stress incontinence medically?

Answer 6

Duloxetine 20-40mg BD

increases the sympathetic stimulation to increase sphincter muscle tone

Question 7

How can you treat stress incontinence surgically?

Answer 7

• Sling/tape TVT/ TOT
• Retropubic suspension
• Artificial sphincters
  (these all prevent the hyper mobility of the uretra by acting as a hammock thus preventing leakage)
  + urethral bulking agents

Question 8

You have a patient with complaints about their bladder. What is the basic bladder work up?

Answer 8

• Bladder diaries
• Urinalysis +/- culture
• Urodynamics (flow rate or bladder scan)

Question 9

What are the 3 most important investigations for BPH?

Answer 9

1) DRE (+clinical dx)
2) PSA
3) TRUSS (trans-rectal USS)

Question 10

Give the c, m and s treatments for BPH

Answer 10

C = avoid caffeine, bladder training // watch and wait

M = aB (tamsulosin), 5a reductase inhibitor (finesteride)

S = TURP// TUVP // open prostectomy

Question 11

What are the SE of tamsulosin?

Answer 11

Postural hypotension
Headache
Dry mouth

Question 12

What type of cancer is prostate cancer usually?

Answer 12

Adenocarcinoma

Question 13

What are the SE when brachytherapy is used to treat prostatic cancer?

Answer 13

Urinary symptoms, bowel and sexual problems

Question 14

With metastatic prostatic cancer, aside from the usual surgery/chemo/radio, what additional treatment option is there?

Answer 14

80% are androgen sensitive thus hormone therapy/chemical castration can be of benefit

• Goserelin (GnRH analogue)
• Tamoxifen (oestrogen blocker)

Question 15

Which LN does prostatic ca spread to?

Answer 15

Pelvic

Question 16

Which LN does bladder ca spread to?

Answer 16

Iliac + parailiac

Question 17

A 75 yr old smoker presents with LUTS and mild haematuria. What work up do you do if you suspect malignancy?

Answer 17

Urine - dip (confirm the haematuria) + MC+S
Imagining - KUB USS, KUB CT
ST - cystoscopy +/- cytology

Question 18

What are the treatment options for someone with nocturia?

Answer 18

• fluid restrict (in pm and evening)
• Diuretics
• Desmopressin

Question 19

What situations constitute as significant haematuria?

Answer 19

• 1 episode of macro
• 1 episode of symptomatic micro
• persistent micro 2/3 +ve dips

Question 20

Give some urological differentials for haematuria

Answer 20

Infection 
Trauma - stones 
Inflam - interstitial cystitis , HSP 
N - bladder, renal, prostate 
Renal - renal cystic disease, IgA nephropathy

Question 21

What are the most common organisms that cause a UTI?

Answer 21

E. coli
Staph saprophyticus
Enterobacteria (klebsiella)

Question 22

How do you treat acute prostatitis?

Answer 22

A fluroquinolone 2-4 weeks

(ciprofloxacin)

Question 23

How can you treat interstitial cystitis?

Answer 23

c - Lifestyle modifications

m - analgesics, anti-histamines + amytriptyline