Urology

Question 1

Discuss the presentation and management of benign prostatic hyperplasia

Answer 1

- hyperplasia of stroma and epithelium in periurethral transition zone
Presentation (FUNDSHED)
- frequency
- urgency
- incontinence
- stream interuption
- hesitancy
- incomplete emptying
- DRE for size, symmetry and nodularity
Investigations
- PSA (<4 normal, 4-10 consider free/total PSA, >10 cancer more likely)
Management
- urology referral
- fluid restriction
- pelvic floor exercises
- bladder training
- alpha-receptor antagonist tamsulosin (Flomax) to relax smooth muscle around prostate
- 5-alpha reductase inhibitor finasteride to reduce growth
- TURP

Question 2

Discuss the presentation and management of erectile dysfunction

Answer 2

- consistent and recurrent inability to attain and/or maintain penile erection sufficient for sexual performance for >=3 months
Etiology
- vascular (90%)
- endocrine
- anatomic
- neurologic
- medications
- psychogenic (10%)
Presentation
- discuss time course
- presence of spontaneous erections and stiffness during sex
- discuss partner or situation specific events
Investigations
- testosterone (free and total)
- prolactin
- TSH
- fasting glucose, HbA1C, lipid profile
Management
- lifestyle changes
- medications
      - sildanefil (Viagra) 25-100mg/dose taken 0.5-4h before erection
      - tadalafil (Cialis) 5-10mg/daily

Question 3

Discuss the presentation, investigation, treatment and complications for gonococcal STI

Answer 3

Presentation - Male
- urethral discharge
- dysuria
- testicular swelling
Presentation - Female
- mucopurulent endocervical discharge
- dysuria
- pelvic pain
- dyspaurenia
Investigations
- urethral swab for gram stain and culture in males
- urine PCR, endocervical swab and vaginal swab for females
Treatment
- Ceftriaxone 250mg IM single dose
- culture 4-days post treatment to assess for cure
Complications - Male
- urethral stricture
- epididymitis
Complications - Female
- PID
- infertility
- ectopic pregnancy
- perinatal infection
Complications - Both
- Arthritis
- increase risk of HIV

Question 4

Discuss the presentation and management of non-gonococcal urethritis (chlamydia)

Answer 4

Presentation
- 70% asymptomatic
- present 2-6 weeks following contact
- similar presentation and investigation as gonorrhea
Treatment
- azithromycin 1g PO single dose

Question 5

Discuss the presentation, investigation, treatment and complications of HPV

Answer 5

Presentation
- cauliflower lesion (condylomata acuminata)
Investigation
- female screening Pap
Treatment
- Cyrotherapy
- electrocautery
- topical therapy
Complications
- anal cancer
- female cervical, vaginal or vulvar cancer

Question 6

Discuss the presentation, investigations, management of genital herpes (HSV-1&-2)

Answer 6

Presentation
- first episode have painful vesiculoulcerative genital lesions with possible fever and tender lymphadenopathy
- recurrance are less extensive and have triggers
Investigations
- swab vesicular content
Treatment
- Acyclovir 200mg PO 5x/d for 5-10 days
- Famciclovir 250mg PO TID x5days
- Valacyclovir 1000mg PO BID x10d
- second presentation cut dosing in half for all but acyclovir

Question 7

Discuss the presentation, investigations, treatment and complications of syphilis

Answer 7

Presentation
- primary have chancre and regional lymphadenopathy
- secondary have rash and flu-like symptoms
- meningitis
- uveitis
- mucous lesions
- latent, asymptomatic phase
- tertiary have neurologic, cardiovascular and tissue complications
Investigations
- serologic VDRL testing
Treatment
- Penicillin G IM
Complications
- chronic neurologic and cardiovascular sequelae