Urology

Question 1

oscopy

octopy

meaning

Answer 1

exam

remove

Question 2

Important Hx Quesitons

Answer 2

Haematuria, flow, dysuria, incontinence
Smoker
Medications

Question 3

Haematuria - frank painless

Answer 3

cancer

Question 4

causes of Haematuria

Answer 4

Cancer
UTI
Stones
Prostitis
Kidney Disease
Cyclophosphamide
Beetroot
Strenuous Exercise (dehydrated, bladder wall friction)

Question 5

when is 2 week referral used for haematuria?

Answer 5

all frank
persistant + dysuria
Micro/Macrohaematuria + LUT symptoms
Female retention with pain and haematuria

Question 6

CT urogram

when do image relative to contrast

Answer 6

before and after

Question 7

Aim of CT urogram

thickness of slices

Answer 7

see urothelial filling defects

ureters shouldn’t be seen unless there is a problem

4mm

Question 8

CT KUB

thickness and aim

Answer 8

diagnose stones as bright white

2.5mm

Question 9

Triple phase CT

Answer 9

1. No contrast - look for fat in angiolipoma
2. Contrast enhancement - arterial phase
3. Venous phase - look for invasion of renal vein

Question 10

In reporting CTs what to comment on

Answer 10

Location
Size
Vein involvement
Lymph node and mets
State of other kidney (very important)

Question 11

DMSA

Answer 11

Nuclear scan in order to differentiate function of R and L

Question 12

When to perform a Cystoscopy?

Answer 12

Smokers
Occupational exposure
Persistent dysuria
Pelvic radiotherapy
cyclophosphamide
Phenacitin abuse

Question 13

TCC incidence

Answer 13

12700 new/year
4th commonest cancer in males in Uk
Peak incidence 6th 7th decade (younger in easter europeans)

Question 14

Aetiology of TCC

Answer 14

Smoking and Anilin dyes
rubber, textiles, leather
petroleum

Question 15

Mx of TCC

Answer 15

Transurethral Resection

Question 16

What is Hexfix cytoscopy

Answer 16

add chemical into bladder with blue and red light from camera - shows up abnormal cells better

Question 17

Staging of TCC

Answer 17

C in situ
Ta - into mucosa
T1 - lamina propria
T2 - musculoris propria
T3 - perivascular fat

Question 18

Radical cystectomy

Answer 18

30 d mortality of 1-2% or 4.5% if elderly.

Question 19

Upper tract division

Answer 19

Men - everything in pelvis

Woman - bladder, uterus, ovaries, tubes, top of vagina and lymph nodes.

Question 20

How is renal caner normally found?

Answer 20

Incidental finding on US

Question 21

If symptomatic in renal cancer - what triad cna you expect?

Answer 21

Haematuria, loin pain, palpable mass

Question 22

With renal cancer - what is the significance of haematuria?

Answer 22

Shows invasion to collecting system

Question 23

Urinary Tract Stones - types

Answer 23

85% calcium oxolate
15% Uric acid - radiolucent
and Struvite stones from infected urine

Question 24

Finding regarding pain in stones

Answer 24

Loin to groin and pain out of proportion to clinical findings

Question 25

Pain in tip of penis

Answer 25

Stone may be in LUT

Question 26

Rx of stones

Answer 26

Cystoscopy + JJ stent Uretoscopy and laser of stone (if smaller) Shock wave lithotripsy Percutaneous Nephrolithotomy - if stone in collecting duct over 2cm

Question 27

at what size would you expect stones to pass?

Answer 27

80% smaller than 5mm will pass naturally.

Question 28

Bladder outflow obstruction in BPH - does size affect voiding?

Answer 28

No

Question 29

Why might you get hypertrophied detrussor muscle in BPH?

Answer 29

Works harder to overcome the pressure

Question 30

Storage problems - complain of

Answer 30

Weak stream, straining and hesitancy

Question 31

Voiding problems - complain of

Answer 31

Urgency, frequency, nocturia, incontinence, dribbles

Question 32

Rx of BPH

Answer 32

Alpha blocker - tamsulosin | 5 alpha reductase inhibitor

Question 33

Action of Tamsulosin

Answer 33

Alpha blocker - binds to bladder neck and relaxes

Question 34

Action of 5A reductase inhibitor

Answer 34

Shrink prostate over 6-8 months

Question 35

if medical therapy fails in BPH

Answer 35

Surgery - transurethral resection of prostate (TURP) - Enucleation of prostate - Urolift staples

Question 36

Complication of TURP

Answer 36

Retrograde ejaculation

Question 37

How long does the bladder take to heal?

Answer 37

10 days

Question 38

In DRE - what relation is the finger width to weight

Answer 38

one finger width is 10g.

Question 39

How is the flow rate different in BPH

Answer 39

peak stream will be much lower and for a greater duration. men may have to sit down to void

Question 40

If Prostate enlarged what tests would be appropriate

Answer 40

``` PSA Flow rate US prostate MRI if suspected cancer Bone scan for mets ```

Question 41

Normal PSA level

Answer 41

less than 4

Question 42

Staging of prostate cancer

Answer 42

1 and 2 - can't feel but in one side or both respectively 3 - feel nodule 4 - contiguous and mets

Question 43

Post surgery follow up

Answer 43

GP setting - surveillance Anti- androgens (suppress adrenals) Radiotherapy Brachytherapy - radioactive seeds inserted

Question 44

Testicular cancer presentation

Answer 44

painless lump in testes

Question 45

double time of testicular cancer

Answer 45

10 days

Question 46

Markers for testicular cancer in blood

Answer 46

AFP, bHCG and LDH

Question 47

If testicular cancer present what scan should be done

Answer 47

CT thorax, abdo and pelvis

Question 48

Operation for testicular cancer

Answer 48

Inguinal orchidectomy

Question 49

When are three way catheters used

Answer 49

Irrigation often after surgery to prevent clots

Question 50

Who might use a self intermittent urinary catheter

Answer 50

MS - detrussor failure, neuropathic failure | Spinal injuries

Question 51

indication for nephrostomy tube vs JJ stent

Answer 51

Based on expertise available to perform. JJ stent harder more equipement.

Question 52

What will you see coming out of an ileal conduit?

Answer 52

Clear fluid

Question 53

Complications of stoma?

Answer 53

``` Ischaemic Stricture Retract or prolapse Skin reactions Parastomal hernia ```