Management

Question 1

What is the treatment for acute urinary retention?

Answer 1

Catheterise patient - note volume of fluid (>1 1/2L > chronic retention)
Dip to look for UTI, PSA

Question 2

What is the medical management for stones?

Answer 2

• Increase fluid intake
• Dietary modification e.g. decreased Na, sugar
• Treat infection
• Alkalinise urine (urate stones)
• Specific medical therapies

Question 3

What are the specific medical therapies for stones?

Answer 3

• Bendroflumethazide (hypercalciuria)
• Allopurinol (hyperuricosuria)
• Penicillamine (cystinuria)

Question 4

What is the surgical management for large stones?

Answer 4

• Extracoporeal shock wave lithotripsy (ESWL)
• Ureteroscopic
• Percutaneous
• Laparoscopic
• Open operation

Question 5

What is the management for ADPKD?

Answer 5

• Monitoring renal function
• Family screening
• High morbidity secondary to CVD
• BP control from childhood is essential
• No surgery

Question 6

What is the classic history for glomerular haematuria?

Answer 6

• Known HTN, proteinuria
• Recent URTI
• Systemic symptoms e.g. rash, joint pains, weight loss

Question 7

What is the treatment for UTIs?

Answer 7

Simple lower UTIs usually respond to a 3-day course of an antibiotic such as trimethoprim, cephalexin or nitrofurantoin.

Question 8

What is the treatment for pyelonephritis?

Answer 8

24-48 hrs of IV gentamicin or temocillin followed by a 10 day course of oral antibiotics.

Question 9

What is the treatment for bladder cancer?

Answer 9

• T1: Transurethral resection of bladder tumour (TURBT)
  Consider BCG therapy into bladder for multiple small tumours or high-grade tumours.
• T2-3: radical cystectomy gold standard. Radiotherapy (worse survival rate) or salvage cystectomy.
• T4: palliative chemo/radiotherapy. Chronic catheterisation and urinary diversions may help to relieve pain.

Question 10

What is the treatment for BPH?

Answer 10

1. alpha blockers e.g. tamsulosin, alfuzosin, doxazosin, terazosin (reduce smooth muscle tone)
2. 5 alpha-reductase inhibitors: add or used alone e.g. finasteride (conversion of testosterone to dihydrotestosterone)

Question 11

What is the treatment for someone low risk on gleason score?

Answer 11

Active surveillance

Treatment options come with risk of ED and long-term debilitating bowel disturbance.

Question 12

What surgery can be done for prostate cancer?

Answer 12

• TURP
• TUIP
• Retropubic prostatectomy
• Robotic prostatectomy

Question 13

What chemotherapy agents can be used for bladder cancer?

Answer 13

Mitomycin, epirubicin, gemcitabine

Question 14

What is the criteria for a urological 2 week referral?

Answer 14

• Any patient aged over 45 with unexplained visible haematuria without UTI or haematuria recurs after treatment of UTI
• Any patient over 60 with unexplained microscopic haematuria
• Any man with raised PSA or abnormal feeling prostate
• Any man with testicular mass or possible penile cancer