Urology

Question 1

What are symptoms of BPH?

Answer 1

Presents with both storage symptoms (frequency, urgency, nocturia, and incontinence) and voiding symptoms (weak stream, dribbling, dysuria, straining).

Question 2

What is BPH?

Answer 2

Lower urinary tract symptoms (LUTS) caused by bladder outlet obstruction due to benign prostatic hyperplasia (BPH), also known as benign prostatic enlargement (BPE), are predominantly due to 2 components: a static component related to an increase in benign prostatic tissue narrowing the urethral lumen and a dynamic component related to an increase in prostatic smooth muscle tone mediated by alpha-adrenergic receptors.

Question 3

What are the first line investigation for suspected BPH?

Answer 3

urinalysis, PSA, international prostate symptom score, volume charting

Question 4

What is the international prostate symptom score (IPSS)?

Answer 4

The IPSS questionnaire allows your urologist to better understand
the severity of your water work symptoms. It is used for men who
are having problems that are likely to be related to an enlarged
prostate. It is helpful in determining which treatment option is best
for you and then monitoring any improvement.
There are 7 questions relating to different symptoms you might be
experiencing and one question relating to your overall quality of
life. Once you have scored each question the values are added
together to give an indication of the severity of your symptoms.

Question 5

What is 1st line treatment for BPH causing bothersome symptoms?

Answer 5

alpha blocker and behavioural management
OR
5-alpha-reductase inhibitors

Question 6

How do alpha receptor blockers work?

Answer 6

Alpha-blockers work through smooth muscle relaxation in the prostate and bladder neck. The predominant receptor type in the prostate and bladder is the alpha-1A receptor. Alpha-blockers are efficacious within a matter of a few days and are usually well tolerated.

5-alpha-reductase inhibitors work through reduction of serum dihydrotestosterone (DHT), via inhibition of DHT formation, reducing prostate volume by 20% to 25%.[8] They require several months of use to improve symptoms.

In patients with larger prostates over 30 grams, initial therapy with 5-alpha-reductase inhibitors should be considered as they are effective in larger prostates at reducing prostate size, decreasing the short-term risk for acute urinary retention and invasive surgery.

Question 7

What are some examples of alpha blockers used in BPH?

Answer 7

Long-acting alpha-1 blockers include terazosin and doxazosin. Terazosin and doxazosin are titrated to avoid first-dose hypotension and syncope from first-dose effect.

Question 8

What are complications of BPH?`

Answer 8

UTI, bladder stones, renal insuffiency, sexual dysfunction

Question 9

80% of renal stones are…

Answer 9

calcium oxalate

Question 10

What type of renal stone are not visible on an Xray?

Answer 10

uric acid

Question 11

What is the presentation of renal stones?

Answer 11

can be asymptomatic
loin to groin pain
renal colic (fluctuating in pain as the stone moves)
may have haematuria, nausea, vomiting and oliguria

Question 12

What is the gold standard test for diagnosing renal stones?

Answer 12

CT KUB - kidey urethra bladder

Question 13

What is usually the most effective analgesia for renal stones?

Answer 13

NSAIDs - PR diclofeac

Question 14

Explain the management of renal stones

Answer 14

Antiemetic if nausea and vomiting
Fluids
Antibiotics if infection is present
Stones less than 6mm have greater than 50% chance of passing without intervention
Spontaneous passage can take several weeks
Tamsulosin (an alpha-blocker) can be used to help aid spontaneous passage of stones
Surgical Interventions in large stones or stones that do not pass

Question 15

What are the 4 surgical interventions for renal stones?

Answer 15

1. Extracorporeal Shock Wave Lithotripsy
   An external machine generates shock waves and directs them at the stone under xray guidance.
   Breaks the stone to smaller parts to make them easier to pass.
2. Ureteroscopy and Laser Lithotripsy
   Camera inserted via urethra, bladder and ureter
   Stone identified
   The stone is broken up by targeted lasers
   The smaller parts are easier to pass
3. Percutaneous Nephrolithotomy
   Performed in theatres under anaesthetic
   A nephroscope (small camera on a stick) is inserted via a small incision at the patient’s back
   The scope is inserted through the kidney to assess the ureter
   Stones can either be removed or broken up to small stones
4. Open Surgery

Question 16

What does renal stones predispose the patient to?

Answer 16

further renal stones

Question 17

What is some advice that can be given to patients suffering from renal stones?

Answer 17

Increase oral fluids
Reduce dietary salt intake
Reduce intake of oxalate-rich foods for calcium stones (e.g. spinach, nuts, rhubarb, tea)
Reduce intake of urate- rich foods for uric acid stones (e.g. kidney, liver, sardines)
Limit dietary protein

Question 18

What is the area in the brain responsible for urination control?

Answer 18

pontine storage centre

Question 19

What is pyelonephritis?

Answer 19

Acute pyelonephritis is an infection of one or both kidneys usually caused by bacteria travelling up from the bladder – the most common causative pathogen is Escherichia coli, which is responsible for 60-80% of uncomplicated infections.

Question 20

What are some acute complications of pyelonephritis?

Answer 20

Sepsis.
Parenchyma renal scarring. 
Recurrent urinary tract infections.
Renal abscess formation.
Preterm labour in pregnancy.
Emphysematous pyelonephritis.

Question 21

When should a urine dipstick not be used to diagnosis UTI’s?

Answer 21

in people with an indwelling catheter, or aged over 65 years.

Question 22

What is the treatment on pyelonephritis?

Answer 22

eople with severe symptoms, or signs or symptoms which suggest a more serious illness or condition should be admitted to hospital.
All other people should be offered an antibiotic.
An antibiotic can be started once a midstream or catheter specimen of urine has been obtained for culture and sensitivity.
For women who are not pregnant, men, and people with an indwelling catheter – ciprofloxacin 500 mg twice a day for 7 days;

Question 23

Potential signs of prostate cancer include…

Answer 23

Any lower urinary tract symptoms, such as nocturia, urinary frequency, hesitancy, urgency or retention or
Erectile dysfunction or
Visible haematuria

Question 24

What is the main symptom of bladder cancer?

Answer 24

Haematuria

Question 25

In which demographic is pyelonephritis more common?

Answer 25

older women

Question 26

What is the difference between cystitis and pyelonephritis?

Answer 26

cystitis is a lower UTI

pyelonephritis is an upper UTI

Question 27

How may prostatitis present?

Answer 27

flu-like symptoms. with low backache, LUTS

Question 28

What is the treatment of acute prostatitis?

Answer 28

Men suspected of having acute bacterial prostatitis should be prescribed an oral antibiotic for 14 days: ciprofloxacin 500 mg twice daily

Question 29

How should I manage acute lower urinary tract infection without haematuria in a woman who is not pregnant or catheterized?

Answer 29

Consider the need for antibiotics depending on severity of symptoms, risk of complications, and previous urine culture results and antibiotic use.
If prescribing an immediate antibiotic — treat according to sensitivities from recent urine culture (if available), otherwise treat empirically taking account of local antimicrobial resistance patterns:
For first choice, consider prescribing:
Nitrofurantoin 100mg modified-release twice a day for 3 days (if eGFR ≥45ml/minute) or
Trimethoprim 200mg twice a day for 3 days (if low risk of resistance).

Question 30

What are some differential diagnoses for visible haematuria?

Answer 30

BPH, UTI, pyelonephritis, bladder cancer, urethra trauma

Question 31

Which demographic is the prevalence of non visible haematuria the highest?

Answer 31

men over 60 that smoke

Question 32

What are some differential diagnoses for non-visible haematuria?

Answer 32

menstruation, cystitis, pyelonephritis, Nephrolithiasis (kidney stones)

Question 33

What is the most common malignancy in young adult men (20 to 34 years of age), and highly curable when diagnosed early?

Answer 33

testicular cancer

Question 34

What is the 1st investigation to order for suspected testicular cancer?

Answer 34

ultrasound

Question 35

What is the treatment of balanitis?

Answer 35

For suspected non-specific dermatitis, application of topical hydrocortisone and imidazole.
For suspected or confirmed bacterial balanitis, oral flucloxacillin or clarithromycin (if there is penicillin allergy).

Question 36

What are associated symptoms of epididymo-orchitis?

Answer 36

Nausea or vomiting (common with torsion, may occur with epididymo-orchitis).
Symptoms of a lower urinary tract infection, or urethral discharge (suggesting epididymo-orchitis).
Parotid swelling (suggesting mumps orchitis).
Back pain, breathlessness, or weight loss (may occur in metastatic testicular cancer).

Question 37

What is the Prehn sign?

Answer 37

relief of pain with elevation of the testes — may suggest epididymitis, but does not rule out testicular torsion.

Question 38

How does a varicocele change when lying down?

Answer 38

it disappears and reappears when standing

Question 39

What can be described as a bag of worms consistency?

Answer 39

varicocele of the testes

Question 40

In which demographic are hydroceles most common?

Answer 40

neonatal ad usually disappears within 1-2 years

Question 41

What is a Valsalva-type manoeuvre used for?

Answer 41

to excentuate an inguinal hernia