Urology

Question 1

Finasteride

MOA

Use

Adverse effects

Answer 1

Inhibitor of 5 alpha-reductase, an enzyme which metabolises testosterone into dihydrotestosterone.

Indications
benign prostatic hyperplasia
male-pattern baldness

Adverse effects
impotence
decrease libido
ejaculation disorders
gynaecomastia and breast tenderness

Finasteride causes decreased levels of serum prostate-specific antigen

Question 2

sildenafil

MOA

USe

Contraindications

Side effects

Answer 2

Phosphodiesterase type V (PDE5) inhibitors are used in the treatment of erectile dysfunction.
- also pulmonary HTN

PDE5 inhibitors cause vasodilation through an increase in cGMP leading to smooth muscle relaxation in blood vessels supplying the corpus cavernosum.

Contraindications
patients taking nitrates and related drugs such as nicorandil (angina meds)
hypotension
recent stroke or myocardial infarction (NICE recommend waiting 6 months)

Side-effects
Visual disturbances e.g. blue discolouration, non-arteritic anterior ischaemic neuropathy
nasal congestion
flushing
gastrointestinal side-effects
headache

Question 3

When to 2 week wait for prostate cancer

Answer 3

If it feels malignant on DRE

Can do a PSA in any LUTS, ED, Visible haematuria

If PSA is above age specific reference range

Question 4

When to 2 week wait for bladder cancer

Answer 4

Aged 45 or over AND

• Unexplained visible haematuria without UTI or
• Visible haematuria that persists/recurs after treating UTI

or

Aged 60 and over and have unexplained non-visible haematuria and either dysuria or a raised white cell count on a blood test

Question 5

When to 2 week wait for renal cancer

Answer 5

Aged 45 and over and have:

• Unexplained visible haematuria without urinary tract infection or
• Visible haematuria that persists or recurs after successful treatment of urinary tract infection

Question 6

When to 2 week wait for testicular cancer

Answer 6

If have non-painful enlargement or change in shape or texture of the testis

Consider US of testis for unexplained/persistent problems

Question 7

When to 2 week wait for penile cancer

Answer 7

• A penile mass or ulcerated lesion, where a sexually transmitted infection has been excluded as a cause, or
• A persistent penile lesion after treatment for a sexually transmitted infection has been completed

Question 8

Circumcision

Improves what

Contraindication

What type of anaesthetic

Answer 8

• Less risk of penile cancer
• Less risk of UTI
• Less risk of STI

Indications

• Phimosis
• Paraphimosis
• Recurrent balanitis
• Balatnitis xerotica obliterans

Contraindication
- Hypospadias

LA or GA

Question 9

What falsely raises PSA

How long to wait to do a PSA

Answer 9

Benign prostatic hyperplasia (BPH)

Prostatitis and urinary tract infection (NICE recommend to postpone the PSA test for at least 1 month after treatment)

Ejaculation (ideally not in the previous 48 hours)

Vigorous exercise (ideally not in the previous 48 hours)

Urinary retention

Instrumentation of the urinary tract

NICE advise that, as PSA levels may be increased, testing should not be done within at least:
6 weeks of a prostate biopsy
4 weeks following a proven urinary infection
1 week of digital rectal examination
48 hours of vigorous exercise
48 hours of ejaculation

Question 10

Drug causes of ED

Answer 10

BB

SSRIs