urology

Question 1

LUTS

Answer 1

obstructive (voiding): WHISE
- weak stream
- hesitancy
- intermittency
- straining to void
- emptying incomplete

irritative (storage) : FUN
- frequency
- urgency
- nocturia (waking up more than once at night)

Question 2

where does BPH develop

Answer 2

in peri- urethral transitional zone

Question 3

how to evaluate BPH

Answer 3

o Objective: Prostate size, urine flow rate, Post-void residual volume
o Subjective: International Prostatic Symptom Score (IPSS)

Question 4

medical management of BPH

Answer 4

o Alpha-blocker: relax smooth muscles of bladder and prostate
—> Tamsulosin (omnic) – alphazosin (xatral)

o 5 alpha reductase inhibitors: decrease production of DHT (needed for acinar cell growth)
—-> Finasteride (proscar)

o Combination of both drugs is most effective

Question 5

what is SE of alpha blocker drugs

Answer 5

retrograde ejaculation– omnic
orthostatic hypotension–xatral

Question 6

when do we use both medications in BPH

Answer 6

when prostate size is >40 cc and pt didnt benefit from alpha 1 alone

Question 7

what are the indications to go for surgical management in BPH

Answer 7

o Indications:
-retention (only if recurrent not from first time)
-gross hematuria
-bladder stones
-recurrent UTIs
-renal insufficiency

Question 8

surgical approaches for BPH

Answer 8

1) transurethral resection of prostate (TURP)
2) open prostectomy
3) HoLEP

Question 9

what is a complication of TURP

Answer 9

Complicated by TURP syndrome (hyponatremic hypochloremic metabolic acidosis due
to absorption of irrigation fluid)

▪ Other complications: retrograde ejaculation, incontinence, urethral stricture

Question 10

TURP syndrome occurs in what type

Answer 10

occurs in monopolar TURP bcz we use glycine as irrigation fluid ( which if absorbed causes a shift of Na free fluid from intracellular to extracellular compartment - Dilutional hyponatremia)

Question 11

how to prevent TURP syndrome

Answer 11

monopolar turp is limited to 90min only to prevent irrigation fluid absorption

Question 12

what is firet symptoms patient would feel in TURP syndrome

Answer 12

visual hallucinations in dilutional hyponatremia

Question 13

why would on ebe careful when correcting Na lvls in TURP syndrome

Answer 13

bcs fast inc in Na can cause pontine myelinolysis

Question 14

when is HoLEP used

Answer 14

used to tx pts with very large prostates = upper limit for TURP prostate size is 80 cc is larger use HoLEP

Question 15

types of renal stones

Answer 15

• Calcium oxalate (most common)
• Uric acid
• Struvite (from infections)
• Cystine (genetic disorder)

Question 16

what are radio- opaque stones that can be seen in xray

Answer 16

ca oxalate
struvite
cysteine

Question 17

radiolucent stones not clear cant be seen in xray

Answer 17

uric acid stones

Question 18

calcium oxalate causes

Answer 18

hypercalciuria
hyperoxaluria
hyper PTH
Vit D toxicity

is v hard and sharp

Question 19

struvite (staghorn)

Answer 19

-infectious calculi
-triple phosphate : (Mg , ammonium, phosphate)
-caused by infection w urea splitting bacteria (proteus , kleibsella)
- urine is alkaline bcs of urease splitting bacteria forming ammoina (alkaline )

Question 20

how is cysteine stone genetic cause

Answer 20

Autosomal recessive defect in small bowel mucosal absorption and renal tubular absorption of dibasic amino acids results in “COL A” in urine (cystine, ornithine, lysine, arginine)

Question 21

cysteine forms what type of stone shape

Answer 21

hexagonal

Question 22

why out of COLA cystine is the one causes stone

Answer 22

bcs all are soluble in urine except cystine is insoluble bcs autosomal recessive

Question 23

mostly cystine in who

Answer 23

Aggressive stone disease seen in children and young adults

Recurrent stone formation

FMHx

Question 24

uric acid stones

Answer 24

-acidic urine
-causes: ASA, thiazides, gout, leukemia (inc cell turnover)
-tx: alkalization of urine (allopurinol)

Question 25

what is an imp stome that is absent in imaging using both xray KUB and CT kub without contrast

Answer 25

indinavir stones indinavir is ans antiretroviral drug used for HIV - viewed using CT with contrast give shadow like appearance

Question 26

symptoms of renal stones

Answer 26

Asymptomatic o Severe, sharp pain in the side and back, radiates to lower abdomen and groin, comes in waves and fluctuates in intensity o Pain or burning sensation with urination (Dysuria) o Pink, red or brown urine o N/V o Fever and chills if infection present

Question 27

investigations of renal stones

Answer 27

o Initial: plain X ray KUB o Gold standard: non-contrast CT KUB (and with contrast) we only do contrast if HIV pt on tx o Ultrasound is used to detect hydronephrosis and obstruction

Question 28

management of renal stones

Answer 28

o Start with fluid rehydration (Administering IV fluids, analgesics, anti-emetics) o Expectant management (if stone<5 mm): conservative (analgesics, hydration, alpha-blocker to relax lower ureter)

Question 29

kidney stones based on size to tx

Answer 29

<1cm: ESWL + retrograde flexible uretroscopy >1-2: flexible uretroscopy+ percutaneous nephrolithotomy >2 cm: PCNL (lap or open surgery) Percutaneous Nephrolithotomy

Question 30

uretric stone tx

Answer 30

>0.5 cm: SWL +/- DJ Failed: flexible (upper & mid part) or semi-rigid (lower part) URS (Uretroscopy/ uretrorenoscopy)

Question 31

If immediate intervention is required -in case of sepsis, renal failure, or intractable pain-:

Answer 31

Internal drainage with DJ stent External drainage with percutaneous US guided nephrostomy tube

Question 32

contraindications of SWL

Answer 32

pregnancy, bleeding tendency, morbidly obsess ▪ Complications: bleeding

Question 33

dj stent indications

Answer 33

obstruction, infection, before SWL (fragments), after operative intervention (edema)