Urology

Question 1

Upper tract causes of macroscopic haematuria

Answer 1

Upper urinary tract:

• Infective: pyelonephritis
• Autoimmune: IgA nephropathy, glomerulonephritis, vasculitis
• Metabolic: Renal calculi
• Iatrogenic: systemic anticoagulation
• Neoplastic: Renal cell carcinoma
• Congenital: Polycystic kidney disease

Question 2

Lower tract causes of macroscopic haematuria

Answer 2

Infective: Cystitis, urethritis, non-infective cystitis

Iatrogenic: Recent procedure (e.g. TURP, radiation)

Neoplastic: Bladder cancer, BPH

Question 3

Investigations for haematuria

Answer 3

Bloods: FBC, U+Es, eGFR, glucose, PSA

O: MSU culture + sensitivity

X: CT urography if >40, USKUB if <40

S: Cystoscopy

Question 4

Persistent exercise-induced haematuria is a geature of which disease?

Answer 4

IgA nephropathy

Question 5

Common sites for renal calculi

Answer 5

Sites of urteric constriction

Pelvouereteric junction

Pelvic brim

Vesicoureteric junction

Question 6

Peak age of incidence of renal stones

Answer 6

20-40yo males

Question 7

Types of renal stones

Answer 7

Calcium oxalate (75%)

Magnesium (15%)

Urate (5%)

Question 8

Investigation of renal stones

Answer 8

B: FBC, U+E, Ca, PO4, Mg, glucose, HCO3, urate

O: urinalysis, MSU

X: XR KUB, non-contrast CT (latter is preferred, exclude AAA!)

S: 24hr urine for pH + biochemistry

Question 9

Symptoms of renal stones

Answer 9

• Pain
• Haematuria
• Proteinuria
• Sterile pyuria
• Urinary retention/anuria
  
  • Interrupted flow
  • strangury (desire to go but unable)
  • dysuria
• UTI, pyelonephritis, pyonephrosis

Question 10

Characteristics of renal stone pain

Answer 10

• Intermittent, excruciating, colicky (cannot sit still cf peritonism)
• Not tender/tender to percussion at renal angle
• Loin-to-groin pain
• Nausea + vomiting

Question 11

Predisposing factors for renal stones

Answer 11

Infective: Recurrent UTIs (esp proteus)

UT abnormalities: vesicoureteric reflux, hydronephrosis, pelvicoureteric j(x) obstruction

Metabolic abnormalities: High Ca, urate, RTA

Lifestyle: Dehydration, caffeine, spinach, nuts, chocolate

Medication: Aspirin, diuretics, theophylline, allopurinol, antacids, corticosteroids

Question 12

Clinical features of acute upper tract obstruction

Answer 12

Loin pain radiating to groin +/- loin tenderness

Superimposed infection

?Kidney enlargement

Question 13

Clinical features of chronic upper tract obstruction

Answer 13

Flank pain

Renal failure

Polyuria (impaired concentration)

Superimposed infx

Question 14

Clinical features of acute lower tract obstruction

Answer 14

May be acute on chronic!

Severe suprapubic pain

Confusion (esp elderly)

Dull + distended bladder

Question 15

Clinical features of chronic lower tract obstruction

Answer 15

Hesitancy, frequency

Terminal dribbling

Poor flow

Overflow incontinence

Distended + dull bladder

Question 16

Causes of urinary tract obstruction

Answer 16

Question 17

Pathophysiology of retroperitoneal fibrosis

Answer 17

Fibrinoid necrosis of vasa vasorum affecting aorta + retroperitoneal vessels

–> uretersembedded in fibrosis –> bilateral obstruction

Question 18

Causes of RPF

Answer 18

Primary

Inflammatory (2ry to AAA)

Lymphoma

Question 19

Risk factors for RPF

Answer 19

Beta-blockers, methyldopa

Asbestos

Smoking

SLE, thyroiditis, ANCA +ve vasculitis

Question 20

Presentation of RPF

Answer 20

Middle-aged man

Vague loin, back, abdominal pain

High BP

UT obstruction

Question 21

Risk factors for bladder cancer/TCC

Answer 21

Smoking

Pelvic irradiation

Aromatic amine exposure (rubber industry, dyes, paints)

Schistosomiasis

Chronic cystitis

Question 22

Differential for urinary incontinence

Answer 22

Infective: UTI, urethritis

Trauma: Pregnancy/post-partum (stress incontinence due to weak pelvic floor)

Metabolic: Diabetes

Iatrogenic: Diuretics

Neoplastic: BPH

Degenerative: Overactive detrusor, faecal impaction

Question 23

Differential of testicular lump that you cannot get above

Answer 23

Inguinoscrotal hernia

Proximal hydrocoele

Question 24

Differential of a lump that you can get above and is separate from the testis

Answer 24

Cystic: Epididymal cyst (spermatocoele)

Solid: Varicocoele, epididymitis

Question 25

Differential of a lump that you can get above but not separate from the testis

Answer 25

**Cystic:** Hydrocoele **Solid:** *Tumour!*, orchitis, haematocoele

Question 26

Causes of hydrocoeles

Answer 26

Fluid within tunica vaginalis ***Primary:*** More common, larger, younger men ***Secondary:*** Tumour, trauma, infection

Question 27

Presentation of epididymo-orchitis

Answer 27

Sudden onset swelling + tenderness Dysuria UTI features: Fever, rigors

Question 28

Clinical features of varicocoele

Answer 28

Visible dilation of scrotal veins Dull ache feels like 'bag of worms'

Question 29

Pathophysiology of varicocoele

Answer 29

Dilation of pampiniform plexus veins

Question 30

Presentation of testicular tumour

Answer 30

Painless lump Haemospermia Secondary hydrocoele Abdominal swelling (from nodes) Dyspnoea (from lung mets)

Question 31

Risk factors for testicular cancer

Answer 31

Undescended testes Infant hernia Infertility

Question 32

Investigation of testicular cancer

Answer 32

**B:** a-FP, b-HCG **X:** CXR, CT for staging **S:** Excisional biopsy

Question 33

Lateral to medial differential of groin lumps

Answer 33

**P**soas abscess **F**emoral neuroma **F**emoral aneurysm **S**aphena varix (venous dilatation) **F**emoral hernia **I**nguinal hernia **H**ydrocoele/variocoele **T**esticular tuour

Question 34

Clinical features of testicular torsion

Answer 34

Sudden onset pain in one testis, walking difficult Inflamed, swollen, tender Abdo pain N+V May be *intermittent* but if was severe treat anyway

Question 35

DDx for testicular torsion

Answer 35

Epididymo-orchitis (older patients, infective symptoms, more gradual onset)