Urology

Question 1

What is chronic retention

Answer 1

urinary retention usually caused by prostatic hyperplasia

Question 2

management of chronic retention

Answer 2

trans urethral resection of the prostate - keep catheter until procedure carried out as retention will recur

Question 3

Investigation of Renal Calculi

Answer 3

CTKUB in all suspected cases
- hydronephrosis + infection = surgical emergency
nephrostomy, stent or ureteric catheter.

Question 4

Mx of Prostate Cancer

Answer 4

T1-T2: watch and wait or radical prostatectomy or radiotherapy
T3-T4: Radical prostatectomy or radiotherapy or hormone therapy
Metastatic: hormone therapy

Question 5

Hormone therapy for Prostate Cancer

Answer 5

synthetic GnRH agonist e.g. goserelin
- negative feedback on anterior pituitary
- need an initial cover with antiandrogen to prevent an
the initial increase in testosterone
Anti-androgen e.g. cyproterone acetate
Orchidectomy

Question 6

Types of renal stones

Answer 6

Radio-opaque 
 - Calcium oxalate (most common)
 - mixed calcium oxalate/phosphate 
 - calcium phosphate
 - triple phsophate
Radio Lucent
 - urate stones
 - xanthine stones (rare)
 Semi-Opaque
 - Cystine stones - rare

Question 7

Management of renal stones

Answer 7

Stone burden of less than 2cm in aggregate - Lithotripsy
Stone burden of less than 2cm in pregnant females -Ureteroscopy
Complex renal calculi and staghorn calculi - Percutaneous nephrolithotomy
Ureteric calculi less than 5mm Manage expectantly

Question 8

Risk factors for erectile dysfunction

Answer 8

cardiovascular disease risk factors
alcohol use
drugs: SSRIs, beta-blockers

Question 9

Differentials for pain in the testicle (2)

Answer 9

torsion

epididymo-orchitis

Question 10

Differentials for swelling or lumps in the testicles(3)

Answer 10

hydrocoele
inguinal hernia
testicular cancer

Question 11

Associations and composition of ‘Stag Horn’ Calculi

Answer 11

Occur due to alkalinisation of urine as a result of bacterial infection with Proteus mirablis.
Calculi contain ammonia, phosphate and magnesium (struvite)

Question 12

Medical benefits of Male Circumcision

Answer 12

reduces the risk of penile cancer
reduces the risk of UTI
reduces the risk of acquiring sexually transmitted infections including HIV

Question 13

Medical Indications for male circumcision

Answer 13

phimosis
recurrent balanitis
balanitis xerotica obliterans
paraphimosis

Question 14

Causes of urethral stricture (4)

Answer 14

Iatrogenic e.g. traumatic placement of indwelling urinary catheters
sexually transmitted infections
hypospadias
lichen sclerosus

Question 15

What is TURP syndrome?

Answer 15

Rare, life-threatening complication on trans-urethral resection of the prostate
caused by irrigation with glycine
CNS - headache, visual disturbance, respiratory symptoms and systemic symptoms.

Question 16

Risk factors for TURP syndrome (7)

Answer 16

surgical time > 1 hr
height of bag > 70cm
resected > 60g
large blood loss
perforation
large amount of fluid used
poorly controlled CHF