Urology

Question 1

Predominant composition of urinary stones

Answer 1

Question 2

Presentation of Urinary Tract Stones

Answer 2

• acute onset severe 10/10 flank pain that
  radiates to the groin
• Waxes and wanes.
• Patients will struggle to sit comfortably and will pace/walk around.
• Can be associated with vomiting, nausea or haematuria.

Question 3

Risk Factors for Urinary Stones

Answer 3

Question 4

Complications of Urinary Stones

Answer 4

• Recurrent UTI
• Pain
• Urosepsis
• Renal Failure

Question 5

Investigations for Urinary Stone

Answer 5

Question 6

Treatment of obstructive ureteric stone + Sepsis?

Answer 6

Question 7

What is the Sepsis 6?

Answer 7

Give:

• Oxygen (>94%)
• Fluids (30mL/kg of isotonic crystalloid fluid)
• IV Antibiotics

Take:

• Lactate Levels
• Blood Culture
• Urine Output Monitoring

Question 8

Treatment of obstructive ureteric stone (NOT Spetic)

Answer 8

Question 9

Treatment of Non-Obstructing Stone (Usually in Kidney)

Answer 9

Question 10

Basics of Ureteric Stone Prevention

Answer 10

Fluid intake >3 Liters daily

Low Salt Diet

Question 11

Differential Diagnosis of Acute Urinary Retention?

• Males
• Females
• Both

Answer 11

Question 12

Complications of Benign Prostatic Hyperplasia (BPH)

Answer 12

Question 13

Investigations of Benign Prostatic Hyperplasia (BPH)

Answer 13

Question 14

Medical Treatment of Benign Prostatic Hyperplasia (BPH)

Answer 14

Question 15

Surgical Treatment of of Benign Prostatic Hyperplasia (BPH)

Answer 15

Question 16

Most Common metastasis of prostate cancer

Answer 16

Bone (Axial Skeleton)

Question 17

Investigations for Prostate Cancer

Answer 17

History/exam (DRE)

Labs: PSA blood test

Imaging:

• Multiparametric MRI of prostate: Most useful method to image prostate. Given PIRADS score, rated from 1-5 with 1 being low risk for malignancy with 5 a very high risk of malignancy
• Bone Scan/CT TAP to evaluate for metastatic disease

Question 18

Classification of Prostate Cancer?

Answer 18

Gleason score used for histological diagnosis and grading of prostate cancer, with the two most common tissue patterns present used to give an overall grade.
■ E.g. 3+4=7
■ However not the same as 4+3=7, which is considered more severe as 4 is the predominant tissue pattern type

Question 19

Conservative treatment of Prostates Cancer (young vs. Old Man)

Answer 19

Question 20

Indication for Surgical Treatment of Prostate Cancer?

Procedures?

Complications?

Answer 20

Question 20

Indication for Radiation Theraoy of Prostate Cancer?

Procedures?

Complications?

Answer 20

Question 20

Indication for Medical Treatment of Prostate Cancer?

Complications

Answer 20

Question 21

Rapid Access Prostate Clinics

• Ages Screened
• What is checked
• What are the thresholds for referral

Answer 21

Question 22

Risk factors for Renal Neoplasms

Answer 22

Question 23

Differential Diagnosis of Renal Tumors

Answer 23

Question 24

Paraneoplastic Syndromes Associated with Renal Neoplasm

Answer 24

Anemia Polycythemia (Ectopic EPO Secretion) Hypertension (Renin) Cushing's Syndrome (ACTH) Hypoglycemia (Insulin) Hypercalcemia (PTH-Like Substance)

Question 25

Complications of Renal Neoplasm

Answer 25

_Metastases:_ - lung metastases - bone metastases - venous involvement can cause lower limb edema _Paraneoplastic Syndromes_ - Anemia - Polycythemia (Ectopic EPO Secretion) - Hypertension (Renin) - Cushing's Syndrome (ACTH) - Hypoglycemia (Insulin) - Hypercalcemia (PTH-Like Substance)

Question 26

Investigations for Renal Neoplasm

Answer 26

Question 27

Treatment of Renal Neoplasm

Answer 27

Immunotherapy: **Interferon Alpha** Surgery: - **Partial Nephrectomy (Nephron-Sparing)** - **Radical Nephrectomy** - **Cryoablation and Radiofrequency Ablation**: Conservative: **Active surveillance can be considered in patients with a tumour <3cm**

Question 28

Risk factors for Urothelial Cell Carcinoma

Answer 28

Smoking Exposure to ionising radiation or arsenic Occupational exposure to amines or hydrocarbons (textile industry)

Question 29

Investigations for Urothelial Cell Carcinoma

Answer 29

Question 30

Treatment for Urothelial Cell Carcinoma

Answer 30

**Trans urethral resection of bladder tumour (TURBT)** - Needed initially for all for histological diagnosis/grading - Adequate for patients with non-muscle invasive disease - need surveillance flexible cystoscopies at regular intervals to ensure no recurrence. **Radical cystectomy and ileal conduit formation** - Used for muscle invasive disease - Usually open procedure under GA **Radiotherapy/Chemotherapy**: Palliative/ Metastatic setting

Question 31

Epidemiology of Testicular Tumors

Answer 31

Question 32

Types of Testicular Tumor

Answer 32

Question 33

Risk Factors for Testicular Tumor

Answer 33

History of Cryptorchidism (absence of at least one testicle from the scrotum) Family history Caucasian Maternal Estrogen Exposure HIV

Question 34

Investigations for Testicular Tumor

Answer 34

**Exam of external genitalia** - Exam contralateral testes first - Assess size, mass, painful or painless. Hard mass arising from testicle is suggestive of malignancy **Labs** - Tumour markers: alpha fetoprotein, HCG, LDH. **Imaging**: Urgent ultrasound testes – ~ 100% sensitivity for detection of testicular tumours

Question 35

Treatment of Testicular Tumor

Answer 35

Radical inguinal orchidectomy +/- insertion of testicular prosthesis

Question 36

Differential Diagnosis of Acute Testicular Pain

Answer 36

Question 37

Investigations for Acute Testicular Pain

Answer 37

US testes is best step to investigate pain or swelling of scrotum However, if suspicion of testicular torsion remember this is a clinical diagnosis – straight to surgical exploration!! Other investigations: urine culture and STI screen if considering epididymal-orchitis

Question 38

Treatment of Testicular Tortion

Answer 38

emergent scrotal exploration + orchidopexy (fixation of testicle)

Question 39

Treatment of Epididymitis/orchitis

Answer 39

antibiotics depending on local protocols and cause (UTI vs STI)

Question 40

Treatment of Hydrocele

Answer 40

managed conservatively or be offered surgical repair with Jaboulay or Lords procedure

Question 41

Treatment of Testicular Varicocele

Answer 41

managed conservatively or offered testicular vein embolization or ligation if bothersome.

Question 42

Treatment of Testicular Trauma

Answer 42

exploration if concerned about testicular rupture, otherwise conservatively managed with rest, elevation, and analgesia.