Urology

Question 1

Bloods for testicular cancer

Answer 1

AFP, FBC, bHCG, LDH, U+E

Question 2

Tumour markers in each testicular cancer

Answer 2

AFP- non seminomas GC 60%
hCG- teratoma 40%, choriocarcinoma, seminoma 10%
LDH- seminomas 20%- so seminomas can essentially have normal markers

Question 3

Differential for lump in testicles

Answer 3

Skin- sebaceous cyst
Tunica vaginal- hydrocele, epidymitis, epi cyst
Testes- cancer, orchitis

Question 4

Initial investigations for lump

Answer 4

Bloods
USS

Question 5

USS highly suspicious of testicular cancer what do you do next

Answer 5

Orchidectomy - send of for histor
and maybe CT

Question 6

What approach are testicles removed

Answer 6

Inguinal approach- since tunica vaginalis surrounds (part of peritoneum)

Offer prosthesis

Question 7

After testicle removed what do you do next?

Answer 7

CT TAP
?Chemo

Question 8

Differentials for hameaturia

Answer 8

Renal, bladder, prostate cancer
GN
Trauma
Infection
Renal stone

Question 9

Ix for painless haematuria

Answer 9

CT urogram- visible haem, non- USKUV
MSU
Bloods
Urine dip
Flexible cystoscopy

Question 10

Tx of bladder cancer

Answer 10

Transurethral bladder tumour resection

Question 11

Stoma in RIF producing urine

Answer 11

If urine out of it- ileal conduit
Had cystostescemy

Question 12

What can’t you do before psa testing

Answer 12

 6 weeks of a prostate biopsy
4 weeks following a proven UTI / prostatitis
 1 week of DRE
48 hours of vigorous exercise AND/OR ejaculation

Question 13

Indications for circumcision

Answer 13

Phimosis
Recurrent balantitis

Question 14

Investigation for kidney stones

Answer 14

Non contrast CT KUB

Question 15

Mx for pain for kidney stones

Answer 15

PR/IM diclofenac- do not give in CVS

Question 16

Mx of kidney stones

Answer 16

<0.5cm- expectant
<2cm- lithotripsy
<2cm and pregnant- uteroscopy
Complicated/staghorn- nephrolithotomy
Hydronephrosis/infection- percutaneous nephrostomy + ABx

Question 17

Which size catheter for men and women

Answer 17

16-18 French for men
12-14 women

Question 18

Mx of BPH and their SE

Answer 18

A1 antagonist- if urinary sx -tamsulosin- dizziness, dry mouth, depression

5a reductase inhibitors- if prostate enlarged- fiansteride- ED, reduced libido, ejaculation problems, gyane

Question 19

Ix for prostate cancer

Answer 19

PSA testing
Multi parametric MRI
TRUS guided biopsy

Question 20

Mx of prostate cancer

Answer 20

Localised- T1/2- depends on life expectancy- active monitoring, prostatectomy
Advanced- T3/4- hormonal, radical prostateectomy- causes ED
Metastatic- GnRH agonist- Goserelin + 3w cover of anti androgen- flutamide

Question 21

How does acute urinary retention present

Answer 21

Suprapubic tenderness
Dull to percuss
Can present with acute confusional state in elderly

Question 22

What can cause acute urinary retention

Answer 22

Large prostate- in men usually due to BPH
Can also be due to urethral strictures, calculi, cystocele
Pelvic fracture- urethral trauma – suprapubic catheter s
Drugs- anticholinergics, TCA, antihistamines, opioids

Question 23

How renal tumours can present

Answer 23

Haematuria, loin pain, loin mass
Varcocele
Can also present with paraneoplastic syndrome- polycythaemia, bushings, high calcium
Cannon ball mets in lungs

Question 24

What one thing must you not do as in Ix for testicular cancer

Answer 24

Biopsy

Question 25

Ix for testicular torsion

Answer 25

-ve cremasteric reflex- stroke leg- raise Prehns test -ve- elevation relives pain

Question 26

RF for ED

Answer 26

CVD RF- metabolic syndrome ETOH Drugs- SSRI, BB, finasteride

Question 27

Mx of ED

Answer 27

PDE-4 inhibitors- sildenafil

Question 28

What occurs in a vasectomy

Answer 28

Local Cut the vas deferens

Question 29

Complications of vasectomy

Answer 29

Bruising Haematoma Infection Chronic pain Sperm granuloma Doesn't work immediately Failure-1/2000

Question 30

Interpretation of MC&S results

Answer 30

Single organism- >10^5 E coli or staph saprophytic - >10^3 White cells- inflammation Epithelial- failed

Question 31

Sterile pyuria MC&S results

Answer 31

Prior Abs Catheter TB STI

Question 32

Mx of UTI

Answer 32

Non pregnant- 3 days trimethoprim/nitro Pregnant- asymptomatic- 7 days- nitro but avoid at term Men- 7 days Cathererised- asymptomatic- none, symptoms- 7 days

Question 33

Sx of prostatitis

Answer 33

Referred pain- perineum, panic, rectum Voiding symtoms +- fever RF- recent UTI, catheterisation, biopsy

Question 34

Ix for prostatitis

Answer 34

DRE- tender, boggy prostate Screen for STI

Question 35

Mx of prostatitis

Answer 35

Quinilone 14d

Question 36

Incontinence Ix

Answer 36

Urine dipstick and MC&S to rule out DM and UTI Bladder diaries Urodynamic testing - 2nd

Question 37

Mx of incontinence

Answer 37

Stress- WL if BMI >30- pelvic floor 2nd- surgical or duloxetine Urge- bladder train for 6 weeks Anti muscarinic- oxybutinin- increases risk of falls so not to elderly

Question 38

Ix for varicocele

Answer 38

Doppler USS

Question 39

Mx of varicocele

Answer 39

Conservative Surgical

Question 40

What is bubbly urine a sign of

Answer 40

Enterovesiular fistula

Question 41

Complication of TURP

Answer 41

TURP syndrome Irrigation into system causing triad of hyponatraemia Fluid overload and glycine toxicity

Question 42

Why don't you remove catheter in someone who's hasn't moved bowels

Answer 42

Since constipation can cause urinary retention, especially in elder ladies

Question 43

Balantis Xerotica obliterans sx

Answer 43

Painful itchy white spots - lichen sclerosis Hyperkeratotic Associated with phimosis

Question 44

Ix of priapism

Answer 44

Cavernosal blood gas Shows ischaemic vs non ischaemic

Question 45

Types of urethral injury

Answer 45

Bulbar- straddle injury - most common Urinary retention, perineal haematoma Membranous Pelvic fracture Prostate displaced upwards, oedema

Question 46

CI to circumcision

Answer 46

Hypospadias

Question 47

When not to use nitro

Answer 47

GFR lower than <45 Near term of pregnancy Use amoxicillin instead

Question 48

Hydrocele vs inguinal hernia

Answer 48

Cant get above hernia

Question 49

When should you be allowed to have unprotected sex after vasectomy

Answer 49

Use additional contraception until semen analysis reveals azoospermia- 2x

Question 50

What should you measure after acute urinary retention

Answer 50

Serum creatinine

Question 51

If medical doesn't work for BPH what should you offer

Answer 51

TURP

Question 52

Deciding tx of prostate cancer

Answer 52

Gleason >7 is high grade Life expectancy Can- laparoscopic prostatectomy if Gleason is high and young

Question 53

How RCC can cause oedema

Answer 53

IVC obstruction

Question 54

Constant Incontinence after childbirth

Answer 54

Vesicovaginal fistula

Question 55

When is there irreversible necrosis in testicular torsion

Answer 55

4-6 hours after sx start

Question 56

What are patients who've received radiotherapy for prostate cancer at risk of

Answer 56

Colon cancer Bladder cancer Rectal cancer

Question 57

Biggest RF for testicular cancer

Answer 57

Infertility

Question 58

Types of renal stones

Answer 58

Calcium oxalate Calcium phosphate- most opaque- Uric- malignancy- high breakdown- radio Lucent Cystine- metabolic- Lucent Struvite- staghorn Stones may form after illness due to dehydration

Question 59

How Renal cell carcinoma may be seen on CT

Answer 59

A mass contains solid and liquid components, and is septated.

Question 60

Organism causing staghorn calculus

Answer 60

Proteus Miribalis

Question 61

Tx of torsion

Answer 61

Bilateral orchidopexy

Question 62

Ix of hydronephrosis

Answer 62

USS of renal tract

Question 63

Goserelin SE

Answer 63

Bone pain Urinary retention

Question 64

What medication can help with High calcium and stones formation

Answer 64

Thiazides

Question 65

If suspect hydrocele what should you do next

Answer 65

Urgent USS

Question 66

Signs of renal colic and high temperature tx

Answer 66

IV ABx and renal decompression

Question 67

Bilateral hydronephrosis tx

Answer 67

Catheter can be sufficient- for urethral problems

Question 68

Conditions associated with epididymal cysts

Answer 68

Von hippel Lindau CF PKD

Question 69

Test to assess whether suture in bladder has healed

Answer 69

Cystogram

Question 70

Tuberous sclerosis With renal mass

Answer 70

Angiomyolipoma

Question 71

Renal cancer associated with textiles

Answer 71

Renal transitional cell carcinoma