Urology

Question 1

What is the 2ww referral for haematuria? (2)

Answer 1

Aged 45 or more with visible haematuria without UTI or persists after treatment of UTI

Aged 60 or more with unexplained non-visible haematuria with either dysuria or raised WCC

Question 2

What are ureteric stones most commonly composed of?

Answer 2

Calcium oxalate due to hypercalciuria

Question 3

Which stone is radiolucent? In what group of people are they more common in ?

Answer 3

Urate stones

Children with inborn errors of metabolism

Question 4

What investigations should be ordered when diagnosing ureteric stones?

Answer 4

Bloods: FBC, CRP (infection), U&Es, eGFR (renal function), urate, bone profile (identify cause)
Imaging: CT KUB
Other: urine dipstick

Question 5

What are the options for managing ureteric stones?

1. Conservative
2. Medical
3. Surgical (4)

Answer 5

1. if <5mm and no complications, can watch and wait; advise drink plenty of fluids, use tea strainer to check for stones, can take up to 4 weeks
2. alpha blocker if <10mm
3. shockwaves, percutaneous nephrolithotomy, ureteroscopy, open surgery

Question 6

What is the painkiller of choice when managing ureteric stones?

Answer 6

NSAIDs e.g. diclofenac

Question 7

What is the most common type of:

1. Bladder cancer
2. Kidney cancer?

Answer 7

1. Transitional cell carcinoma

2. Renal cell carcinoma

Question 8

What imaging technique is used to investigate bladder cancer?

Answer 8

TURBT

Question 9

What is the classic triad of kidney cancer?

Answer 9

haematuria, loin pain, loin mass

Question 10

What are 3 paraneoplastic manifestations of kidney cancer?

Answer 10

1. Polycythaemia (EPO)
2. Hypercalcaemia (PTH)
3. Stauffer syndrome (cholestatic picture on LFTs without an obstruction)

Question 11

What are the 3 types of LUTS?

Can you give examples of each?

Answer 11

Voiding: hesitation, poor stream, straining
Storage: incontinence, nocturia, urgency, frequency
Post-micturition: dribbling, feel of incomplete emptying

Question 12

What are some causes of LUTS?

1. Voiding
2. Storage
3. Stress

Answer 12

1. BPH, cancer of bladder, prostate or rectum, diabetic neuropathy, urethral stricture (i.e. obstruction), antimuscarinics
2. Overactive bladder, BPH, neurological, infection, bladder stones, cancer
3. Injury to urethral sphincter e.g. surgery, overflow incontinence (e.g. antimuscarinics)

Question 13

What assessment would you do for someone presenting with LUTS?

Answer 13

Urine dipstick - infection, haematuria
DRE
PSA if indicated

Question 14

What are the management options for BPH?

Answer 14

Watch and wait, advice (avoid fizzy drinks and constipation)
Medication e.g. alpha blockers, 5-alpha reductase inhibitors
Surgery e.g. TURP

Question 15

What are the complications of a TURP? (5)

Answer 15

Failure to resolve symptoms
Incontinence
Retrograde ejaculation
Erectile dysfunction
Strictures

Question 16

What is the definitive test for diagnosing prostate cancer?

Answer 16

Prostate biopsy

Question 17

What are the options for treating prostate cancer? (5)

Answer 17

Watchful waiting if early 
Brachytherapy or directed radiotherapy 
Hormonal treatment (reduces testosterone)
Prosatectomy 
Chemotherapy if metastasised