Urology(88) (NEW 2024) Flashcards
ANSWER C) undescended testes
EXPLANATION
In the aetiology of testicular tumors the only evidence-based risk factor is an undescended testis (in this case testicular tumors are 10-20 times more likely to occur). Trauma, torsion, genetic factors are not evidence-based predisposing factors.
ANSWER B) epididymitis
EXPLANATION
In case of epididymitis, the epididymis and the testicle are enlarged, and are painful to touch. In case of a testicular tumor, a non-tender nodule can be palpated, or the entire testicle could be non-tender, but enlarged. Varicocele causes a pulling-like pain, the distended veins can be palpated as a „bag of worms”, the testicles themselves are not painful to touch. A hydrocele can be transilluminated, it is not painful, a fluctuating fluid can be palpated within the scrotum.
ANSWER B) hard
EXPLANATION
Prostate cancer: hard, non-tender nodule in the prostate, or firm, irregular surface, of a non-tender prostate. Acute prostatitis presents with fever, extremely tender and enlarged prostate. BPH presents as nodular, glandular or muscle-like alteration of the enlarged prostate.
ANSWER B) contains many epithelial cells
EXPLANATION
In the female urine epithelial cells are often present, originating from the vagina
B) presents with sudden pain, which usually wakes the patient from his sleep
EXPLANATION
Usually, young men are predisposed to testicular torsion, which presents at night and the patient is awoken by a sudden, very intense scrotal pain radiating inguinally. It causes high fever only if it begins necrotizing. It presents equally commonly on either side.
D) tenderness on palpation of McBurney’s point
EXPLANATION
Typical signs of renal colic include intense flank pain, which radiates to the labia or scrotum of the same side and is often accompanied by nausea or vomiting. Tenderness of the McBurney’s point is characteristic in appendicitis.
ANSWER A) 5-α-reductase
EXPLANATIONIn the aetiology of BPH 5-α-reductase plays crucial role in converting testosterone to dihydrotestosterone within the prostate.
D) all of the above
EXPLANATION
Although in the aetiology of prostate cancer causal factors have not been determined, but older age, genetic- (positive family history) and hormonal factors (androgen-dependency) all contribute to the development of prostate cancer.
A) smoking
EXPLANATION
Smoking certainly plays a role as a risk factor for urothelial carcinoma. Other factors e.g. certain polycyclic chemicals also increase the risk of bladder tumors, but the connection is not as obvious as with smoking.
D) urinary dribbling following an increase in abdominal pressure (e.g. during exercise, coughing, sneezing etc.)EXPLANATIONIn case of stress urinary incontinence, the increased abdominal pressure leads to increased intravesical pressure without the contraction of the detrusor muscle, which exceeds the urinary tract’s pressure
B) send the patient to a urologist
EXPLANATION
The palpation of a nodule within a testicle is suspicious of a testicular tumor, which requires further examination by a urologist.
E) All of the answers are correct
EXPLANATION
Dysuria can be caused by BPH compressing the posterior wall of the urethra, prostate cancer, causing obstruction of the prostatic urethra, inflamed, enlarged prostate and extreme narrowing of the foreskin. In the latter case the patient first voids under the foreskin surrounding the glans.
E) All of the answers are correct
EXPLANATION
Bladder tumors near the internal urethral orifice can obstruct outflow as valves or can infiltrate the posterior urethra. Urethral narrowing can also compromise flow and can lead to complete obstruction. In case of acute prostatitis, the inflamed, enlarged prostate can completely compress the prostatic urethra. In case of hypo- or acontractile detrusor function, the contractile function of the detrusor decreases, or is insufficient, thus the urine cannot be emptied. The underlying cause can be myogenic or neurogenic.
ANSWERA) Answers 1, 2 and 3 are correct
EXPLANATION
Only parenchymal organs’ inflammations are accompanied by fever, thus NOT cystitis.
ANSWERA) Answers 1, 2 and 3 are correct
EXPLANATION
PSA (prostate-specific antigen) is prostate-specific, but not prostate cancer. Its normal range is 0-4 ng/ml, a grey zone is between 4-10 ng/ml, above 10 ng/ml a tumor is likely. Digital rectal examination (DRE) raises the suspicion of prostate cancer if an uneven surface or firm nodules are palpated, but only histology can confirm it. Therefore, for screening PSA and DRE are mandatory. (If DRE is performed first, at least 2 days should pass to have PSA tested as even palpation can increase PSA.) If prostate cancer is suspected based on either PSA or DRE, prostate biopsy is mandatory. The abdominal ultrasound has no use in the diagnosis of prostate cancer.
A) Answers 1, 2 and 3 are correct
EXPLANATION
Testosterone is the male sex hormone; LH is its trophic hormone and FSH enhances spermatogenesis (their levels are measured if hypogonadism is suspected). Parathyroid hormone is measured if hyperthyroidism is suspected.
ANSWERC) Answers 2 and 4 are correct
EXPLANATION
Infertility and azoospermia are complex andrological diagnoses, ultrasonography is insufficient on its own for the diagnoses. Semen analysis and the exploration of the underlying cause (via microbiological, diagnostic, surgical, radiological, biochemical genetic and endocrine tests) are inevitable. In case of orchidoepididymitis, the testicle is non-homogeneous, and in case a testicular tumor non-homogeneous region(s) or an entire non-homogeneous testicle can be observed.
ANSWERB) Answers 1 and 3 are correct
EXPLANATION
Bleomycin and Vincristin are used as systemic chemotherapeutic agents. Mitomycin C and BCG are used as intravesical agents in case of non-muscle invasive bladder tumors.
D) Only answer 4 is correct
EXPLANATION
Ureterocutaneostomy involves the anastomosis of ureters to the abdominal skin. Bilateral percutaneous nephrostomy involves urine diversion from both kidneys via puncturing the kidneys under ultrasound imaging and inserting percutaneous drains (catheters). The creation of a Bricker ileal conduit involves the anastomosis of the ureters into a short segment of the ileum, and the other end of the gut is anastomosed to the abdominal wall. The above three are non-continent diversions, thus urine outflow is continuous, patients wear stoma bags or urine collection bags. Creation of an orthotopic bladder involves the isolation of a section of a small intestine, which is connected to the original urethral stump, and both of the ureters are connected to the neobladder. Therefore, the route of the urine is as follows: upper urinary tract-orthotopic bladder-urethra. Emptying of the bladder can be voluntarily controlled via the outer sphincter of the urethra.
ANSWERC) Answers 2 and 4 are correct
EXPLANATION
Local chemotherapy can only be used in the treatment of non-muscle invasive bladder tumors to prevent recurrence. Patients with muscle-invasive bladder tumors can be cured via radical cystectomy, bladder wall resection (baldder dome) and TUR, on their own, or combined with radio- or chemotherapy (adjuvant, neoadjuvant therapy). For palliation, TUR can be performed, or chemo-, or radiation therapy can be administered, though in certain cases cystectomy may also be performed
D) Only answer 4 is correct
EXPLANATION
Pyelonephritis in pregnancy usually occurs during the second half of the pregnancy, affects the right side more frequently and if despite antibiotics and anti-inflammatory medications the fever or the pain don’t subside, a double J stent or nephrostomy should resolve the dilation and alleviate the symptoms.
ANSWERC) Answers 2 and 4 are correct
EXPLANATION
Internal urethrotomy is an endoscopic (transurethral) incision of the urethral stenoses with optic control. A ureteral catheter inserted using a special ureterocystoscope, also through the urethra. ESWL: Extracorporal shock wave lithotripsy does not need an endoscopic intervention. Epicystostomy is defined as percutaneous bladder punction.
ANSWERB) Answers 1 and 3 are correct
EXPLANATION
Diabetes mellitus causes impotency via vascular and neurogenic mechanisms. Beta-blockers may lead to erectile dysfunction due to reduced arterial inflow.
E) All of the answers are correct
EXPLANATION
the characteristic of labor changes of acute kidney failure: increased serum creatinine, potassium and carbamide levels, decreased GFR and acidosis.
C) Answers 2 and 4 are correct
EXPLANATION
The serum levels of β-hCG increase mainly in choriocarcinoma and AFP is higher in nonseminoma type testicular tumors. PSA is a tumor marker used in prostate cancer. Testosterone levels are utilized for the differential diagnosis of the subtypes of hypogonadism.
C) Answers 2 and 4 are correct
EXPLANATION
Anticholinergics block the effect of acetylcholine on the presynaptic nerve terminals, thus the whole nerve transmission is inhibited. This decreases the tone of the detrusor muscle and involuntary contractions. Therefore, it increases bladder capacity and decreases its excitability. They are recommended for the treatment of urge incontinence. Doxycycline is an antibiotic, hence it has no effect on urinary incontinence. The alpha-adrenoreceptor blockers relax the smooth elements of bladder neck to increase the urine outflow, hence they worsen urinary incontinence. Beta-3-adrenoreceptor agonists relax detrusor muscle to improve bladder continence issues, thus we utilize them in the treatment of urge incontinence.
E) All of the answers are correct
EXPLANATION
Antihypertensive drugs can cause erectile dysfunction through reduced arterial inflow. In plastic penile induration, the penile curvature may reach such a high level, that it leads to erectile dysfunction. The smoking doubles the risk of ED. Chronic alcoholism can also lead to erectile dysfunction.
A) 1st, 3rd and 5th answers are correct
EXPLANATION
US and CT can differentiate the solid surface from the fluid-containing cystic mass based on their echogenicity and density. Furthermore, CT and MR can differentiate based on morphological characteristics and contrast enhancement patterns. Retrograde pyelography and excretory urography only display the volume, and differential diagnosis is not feasible.
C) 2nd, 3rd and 4th answers are correct
EXPLANATION
Acute pyelonephritis usually develops due to the infection of the lower urinary tract. Characteristic symptoms are high fever with chills, pain due to the enlarged kidneys stretching the kidney capsules and pyuria (except the blocked kidney) refers to urinary infection. Macroscopic hematuria is not characteristic. Kidney pain related to movement refers to orthopedic conditions.
B) 1st, 4th and 5th answers are correct
EXPLANATION
Body movement related pain is mainly caused by conditions affecting the musculoskeletal system, e.g. rheumatoid arthritis or disc herniation. Renal ptosis can cause pain observed during standing (due to renal occlusion) and laying down relieves the pain. Kidney stones stucked in the urinary tract can cause continuous colic pain. Vesicoureteral reflux causes renal pain during urination.
B) 1st, 4th and 5th answers are correct
EXPLANATION
The most common symptom of bladder tumor is macroscopic, painless, so-called “silent” hematuria, often with clots. Renal tumors may also cause macroscopic bleeding when they break into the lumen of the urinary tract. In one type of acute cystitis, namely in hemorrhagic cystitis, macroscopic hematuria can be observed in addition to pyuria. Glomerulonephritis cause microhematuria. VUR does not lead to haematuria.
URO - 32 - It can be caused by varicocele - B)
The extended venous plexus increases the temperature of the testis impairing spermatogenesis (normally requires temperature below the body temperature. Following TURP the bladder neck is opened up. During ejaculation, the sperm launched towards the bladder (it travels towards lower resistance into the posterior urethra that is a shorter distance than towards the normal ejaculation route). These patients do not detect any ejaculation through their urethra during orgasm. Beta-blockers decreases arterial inflow resulting in erectile dysfunction. Drug treatment resistant erectile dysfunction can be further approached with vacuum therapy.
URO - 33 - It appears as a frequent complication after TUR (transurethral resection) surgery. - D)
The extended venous plexus increases the temperature of the testis impairing spermatogenesis (normally requires temperature below the body temperature. Following TURP the bladder neck is opened up. During ejaculation, the sperm launched towards the bladder (it travels towards lower resistance into the posterior urethra that is a shorter distance than towards the normal ejaculation route). These patients do not detect any ejaculation through their urethra during orgasm. Beta-blockers decreases arterial inflow resulting in erectile dysfunction. Drug treatment resistant erectile dysfunction can be further approached with vacuum therapy.
URO - 34 - It can be caused by beta-blockers. - A)
The extended venous plexus increases the temperature of the testis impairing spermatogenesis (normally requires temperature below the body temperature. Following TURP the bladder neck is opened up. During ejaculation, the sperm launched towards the bladder (it travels towards lower resistance into the posterior urethra that is a shorter distance than towards the normal ejaculation route). These patients do not detect any ejaculation through their urethra during orgasm. Beta-blockers decreases arterial inflow resulting in erectile dysfunction. Drug treatment resistant erectile dysfunction can be further approached with vacuum therapy.
URO - 35 - One way of the treatment can be a vacuum constriction device - A)
The extended venous plexus increases the temperature of the testis impairing spermatogenesis (normally requires temperature below the body temperature. Following TURP the bladder neck is opened up. During ejaculation, the sperm launched towards the bladder (it travels towards lower resistance into the posterior urethra that is a shorter distance than towards the normal ejaculation route). These patients do not detect any ejaculation through their urethra during orgasm. Beta-blockers decreases arterial inflow resulting in erectile dysfunction. Drug treatment resistant erectile dysfunction can be further approached with vacuum therapy.
E) both the statement and the explanation are false
EXPLANATIONRenal colic without fever, vomiting or unbearable pain can be treated at home with NSAID, tamsulosin and antispasmodics (eg No-Spa). If any of the three factors are present the patient should be hospitalised. In the hospital urinary diversion is present and stronger painkillers are available. However, in order to avoid masking the symptoms of any other acute abdominal complaints on the spot, narcotic analgesics are prohibited.
A) both the statement and the explanation are true and a causal relationship exists between themEXPLANATIONEarly detection of reoccuring bladder cancer is very important. The best way to diagnose the reoccuring tumor is to perform cystoscopy. It is suggeted to perform cystoscopy every three months in the first year after surgery and every 6 months afterwards.
E) both the statement and the explanation are false
EXPLANATION
In the case of superficial, non muscle invasive bladder tumors, the rate of recurrences are quite high. To prevent high recurrences it is suggested to perform intravesical instillation of chemotherapy. For high grade cancer it is suggested to use BCG and delay the instillationin a few weeks after the surgery. For low grade cancer it is suggested to use immediate instillation using epirubicin or mitomycin.
D) the statement is false, but the explanation itself is true
EXPLANATIONIn case of small bowel bladder replacement - if secondary superficial infection has not occurred - urine is not bacteriuretic. After bladder replacement with intestinal segregation, hyperchloraemic acidosis is always present. This is due to the fact that chloride and ammonium ion are reabsorbed from the bowels and as a result protons that are removed from the ammonium ion in the liver, will lower the pH level in the blood (shifting in the acidic direction).
B) both the statement and the explanation are true but there is no causal relationship between themEXPLANATIONIn case of intermediate and high risk prostate cancer lymphadenectomy is mandatory. In case of low risk disease lymphadenectomy is not neccessary. The neuro-vascular bundle is located on the lateral side of the prostate. Nerve sparing surgery usually results better erectile function. Lymphadenectomy doesn’t effect the nerve sparing technique.
A) DRE (digital rectal examination)EXPLANATIONWhen examining male patients with urinary complaints, the first test to be performed is the urinalysis and then the physical examination (which includes digital rectal examination). This examination is quite simple and cheap, and always mandatory in such cases.
A) Suspicion of prostate cancerEXPLANATIONThe hard, uneven prostate, the inhomogeneous prostate structure detected with elevated PSA level suggests the presence of prostate cancer. BPH: palpation found: glandular or muscle like prostate. Although the PSA may have elevated but is below 10ng/ml. Chronic prostatitis: sensitive, stuffed founds in the prostate, PSA may be moderately elevated. Acute prostatitis: patient has high fever, a very sensitive prostate, with softened palpation and enlarged prostate.
B) 1st, 3rd and 4th answers are correctEXPLANATIONTreatment for prostate cancer can only be started if histopathological diagnosis was made, threrfore prostate biopsy is mandatoryt to start any treatment. Curative tretment (radical prostatectomy or irradiation) should be performed in case the patient is free from metastasises, fit for surgery, his life expectancy exceeds 10 years, and he is not older than 75 years old.
C) intravesical epirubicin instillationEXPLANATIONThe first line treatment for urge urinary incontinence/overactive bladder is medical therapy (anticholinergic and beta 3 adrenoreceptor agonist). Second line treatment consist of botulinum toxin injection into the detrusor muscle or sacral neuromodulation. Intravesical epirubicin instillation is used to prevent the reoccurance of non-muscle invasive bladder cancer.
E) All of the answers are correctEXPLANATIONAnticholinergic medication decreases bowel movement, detrusor contractility and saliva excretion. It also influences eye movement. Therefore it causes parasympathetic symptoms such as obstipation, dry mouth, urinary retention, eye movement cordination problems.
C) BPH
EXPLANATIONThe most common cause of such symptoms in such age is prostate enlargement caused by prostate hyperplasia.
ANSWER B) Answers 1 and 3 are correct
EXPLANATIONUrine test is neccessary to rule out infection with such symptoms. It is important to rule out complete urinary retention with abdominal ultrasound for patients who have difficulty of urinating.
D) LHRH analoguesEXPLANATIONAlpha blockers can be used as first line treatment in BPH. This medication blocks the receptors at the bladder neck and in the prostate and thus causes muscle relaxation therefore alows better urine flow. 5 alpha reductase inhibitor blocks testosterone-dihydrotestosterone conversion and thus reduces prostate size. Phosphodiesterase 5 inhibitors also induce muscle relaxation in the prostate and the urethra and improve the erectile function. LHRH analogues are used in prostate cancer treatment.
A) Answers 1, 2 and 3 are correct
EXPLANATIONThe surgical solution for BPH depends on the size of the prostate. For volumes up to 70-80 ml, TURP is recommended, while for volumes above this, open adenomectomy or laser prostate enucleation may be suggested. Radical prostatectomy is performed not for BPH but for prostate cancer.
A transvesical prostatic adenomectomy is defined as an “open-sky” surgical procedure performed to remove a benign prostatic nodule that, growing up, could represent an obstacle to the normal emptying of the bladder.
C) Decreased maximum and average flow rate with a prolonged flowEXPLANATIONThe normal uroflowmetry curve is bell-shaped, while flat, plateau-like flow is typical for urethral stricture, not for BPH. The uroflowmetry of BPH is prolonged, but not plateau-like.
D) Renal function cannot deteriorateEXPLANATIONTUR syndrome typically develops during transurethral resection of the prostate (TURP) when a significant amount of hypotonic irrigation fluid enters the circulation during the surgery. This fluid can cause hemolysis, leading to hyperkalemia and potentially kidney failure
B) Complicated acute pyelonephritis due to upper urinary tract obstructionEXPLANATIONUpper urinary tract dilation developed due to ureteral stone and got infected, as confirmed by the fever and swelling of the parenchyma. The patient developed complicated pyelonephritis.
A) Answers 1, 2 and 3 are correctEXPLANATIONIn complicated pyelonephritis accompanied by fever, systemic broad-spectrum antibiotic therapy is necessary to treat bacteremia. In the presence of a large ureteral stone, spontaneous stone passage and resolution of the dilatation cannot be expected. Placement of a double-J catheter or nephrostomy tube is necessary for drainage of purulent fluid accumulation in the renal pelvis. Shock wave lithotripsy is contraindicated in a purulent environment.
D) Pyelonephritis with apostematous complications leading to urosepsisEXPLANATIONDespite antibiotic therapy and upper urinary tract diversion, persistent symptoms may indicate the formation of a renal abscess. One form of this is apostematous inflammation involving numerous small abscess formations affecting the renal parenchyma. In such cases, if other treatments fail, kidney removal may be unavoidable.
D) Only answer 4 is correctEXPLANATIONSilent, painless hematuria most commonly indicates bladder cancer. Upper urinary tract cancer may also present with silent hematuria, but in these patients, renal colic may occur, as well as passing of worm or thread-like clots. Painless bleeding may also occur from the dilated veins of enlarged prostate (benign prostatic hyperplasia -BPH), but patients with BPH typically report dysuric symptoms. Hematuria can also occur in acute prostatitis, but it is typically accompanied by pain, urinary difficulty, and fever.
C) Answers 2 and 4 are correctEXPLANATIONChronic liver disease can lead to a decreased level of factors necessary for hemostasis, resulting in an increased tendency for bleeding. The same risk applies to anticoagulant therapies widely used for various indications, including inhibition of platelet aggregation or the use of low molecular weight heparins.
B) Answers 1 and 3 are correctEXPLANATIONCystoscopy can confirm bleeding originating from prostate and bladder abnormalities, while detecting bleeding from the ureters can suggest upper urinary tract origins and their lateralization. Contrast-enhanced CT with a delayed phase can confirm the origin of bleeding throughout the entire urinary system. Urine sediment analysis is a nonspecific test that can confirm hematuria but does not provide information about its origin. Urodynamic testing provides information about bladder function but is not used in the diagnosis of bloody urine.
B) Abdominal and pelvic CT with contrast agentEXPLANATIONBlunt abdominal trauma with a full bladder predisposes to bladder rupture. It can be diagnosed by abdominal and pelvic CT with contrast agent. Attention should be drawn to the history, physical examination, and the absence of urination.
B) Bladder rupture
EXPLANATIONLeakage of contrast material from the bladder confirms suspicion of bladder injury.
D) Surgical exploration, bladder suturing and revision of the intestinal tractEXPLANATIONIn the case of intraperitoneal bladder injury, surgical intervention is necessary to remove the urine from the peritoneum, check the integrity of the intestines, and suture the bladder injury to prevent the development of severe peritonitis in the absence of these measures. Infraperitoneal bladder lesions can heal with the placement of a permanent urinary catheter, without the need for surgical exploration.
B) Acute pyelonephritisEXPLANATIONFever and pyuria indicate inflammation of the urinary parenchymal organs. Hematuria (but not hemato-pyuria) is mainly indicative of renal pelvis tumor, while kidney pain typically associated with pyelo-ureteral reflux is due to increased hydrostatic pressure in the bladder (e.g., during urination or bladder filling). Cystitis is not accompanied by fever.
ANSWERC) Answers 1, 2 and 3 are correctEXPLANATIONLaboratory tests, especially parameters indicating inflammation, are essential. They not only help assess the severity of the condition but also facilitate monitoring. Urine culture can assist in selecting targeted antibiotic therapy, particularly if empirical treatment fails. Ultrasound is the first step in evaluating the condition of the kidneys, allowing detection of urinary tract dilatation or abscesses. A CT scan of the abdomen and pelvis is not immediately recommended (not in the first line) but may be necessary if the cause is unclear or if the condition does not improve.
C) Answers 1 and 4 are correctEXPLANATIONBacterial origin requires administration of antibiotics, with antipyretics needed for fever, which also have analgesic effects. Bed rest is advisable for most patients who are unwell. In the case of pyelectasia, diversion of the infected urine is essential to prevent progression. In the case of a renal abscess, invasive methods such as drainage of the abscess, surgical exploration, or even nephrectomy may be necessary.
D) NitrofuranotinEXPLANATIONNitrofurantoin is used in the treatment of lower urinary tract infections but is not used in cases of acute pyelonephritis
D) FluoroquinoloneEXPLANATIONUncomplicated acute cystitis often resolves without the need for antibiotic therapy, alongside supportive treatment. If antibiotics are used, nitrofurantoin or fosfomycin are recommended due to their good resistance profiles and low side effects. Fluoroquinolones are not recommended as first-line treatment for lower urinary tract infections due to their decreased use caused by common side effects and high resistance rates. Symptomatic treatment with nonsteroidal anti-inflammatory drugs or bactericidal agents (such as D-mannose) alone is often sufficient.
E) broad-spectrum antibiotics, non-steroidal anti-inflammatory drugs, and epicystostomy in case of urinary retention
EXPLANATION
Acute prostatitis is a severe infectious disease requiring broad-spectrum antibiotic treatment. Massage of the prostate (previously used in the treatment of chronic prostatitis) to allow inflammatory secretions to enter the circulation is prohibited. In urinary retention, urethral catheter to prevent secretion is contraindicated, insertion of epicystostomy (suprapubic catheter) is an option. Local cooling of the prostate (Arzberger’s treatment) and non-steroidal anti-inflammatory drugs can complement antibiotic treatment but are not suitable for the treatment of prostatitis alone. The inflammatory process may cause a false-positive rise in PSA level and is not useful for therapeutic decisions in acute prostatitis.
B) Answers 2, 3, 4 are correctEXPLANATIONAcute epididymitis, like all bacterial infections, requires antibiotic treatment. To relieve symptoms, icing of the sensitive area (scrotum) and NSAIDs are recommended to speed healing. Removal of the epididymis (epididymectomy) is only an option in cases of abscess formation. Urinary diversion can be used in acute prostatitis and in cases complicated by urinary retention, in which a suprapubic catheter is inserted.
D) Answers 2 and 3 are correctEXPLANATIONFor urinary tract inflammation during pregnancy, penicillin derivatives are the first-line antibiotic treatment of choice. Fluoroquinolones are not recommended in pregnancy. Because of the risk of preterm delivery and fetal retardation, asymptomatic bacteriuria should be treated. Pyelectasia alone does not require intervention, but if it is accompanied by acute pyelonephritis that does not improve on antibiotic treatment, urinary diversion (double J catheter or percutaneous nephrostomy) is recommended.
D) all of the aboveEXPLANATIONNeedle biopsy can cause bleeding. Transrectal prostate biopsy can cause infection and prostatitis. Temporary swelling of the prostate after biopsy may cause difficulty in urination.
C) pelvic MRI scan, chest CT scan, bone isotopeEXPLANATIONLocoregional propagation can be excluded by pelvic MRI scan and typical distant metastases by bone isotope and chest CT scan.
A) radical prostatectomy, radiotherapyEXPLANATIONPossible curative treatment options for localized prostate cancer are radical prostatectomy and radiotherapy.
B) urethral stricture, incontinence, erectile dysfunctionEXPLANATIONthe typical complications after radical prostatectomy are stricture of the urethral anastomosis, incontinence due to weakness of the external sphincter and erectile dysfunction due to nerve damage.
A) PSA, chest and abdomen CT scan, bone scan, PSMA PET-CT scanEXPLANATIONPSA, chest CT scan and bone biopsy are standard methods for prostate cancer follow-up, PSMA PET-CT scan may be used in uncertain cases.
A) Answers 1, 2 and 3 are correctEXPLANATIONFor metastatic prostate cancer chemotherapy (docetaxel, cabazitaxel), androgen receptor pathway inhibitors (enzalutamide, apalutamide, abiraterone acetate), and for bone metastases alpha radiation radium isotope therapy can be offered. Radical prostatectomy is a treatment option for organ confined tumors.
B) Kidney biopsy and exploratory biopsy of the femurEXPLANATIONIf the diagnosis of renal tumor is confirmed by the imaging tests, sampling from the kidney and the femur is not necessary.
ANSWER D) The above answers A-B-C in that orderEXPLANATIONIf the patient has a solitary metastasis and life expectancy is more than one year: radical surgery should be applied. Radical surgery of the primary tumor should be done before the treatment of metastasis.
ANSWERC) Irradiation of lung metastasesEXPLANATIONThe above-mentioned medications can be expected to prolong survival and improve quality of life. Irradiation may be effective in relieving the symptoms of bone metastases but it is ineffective for lung metastases.
E) palpable inguinal lymph nodesEXPLANATIONA large renal tumor may be palpable and painful. It can also cause varicocele through occlusion of the renal vein and vena cava. If the tumor reaches the renal pelvis, it might lead to haematury. Renal tumors do not metastasize to the inguinal region.
B) intravenous urographyEXPLANATIONIn the investigation of renal tumors, in addition to the examination of the extent of the primary tumor, the screening of distant metastases is essential for treatment planning. Intravenous urography does not provide useful information on either the primary tumor or metastases.
A) Answers 1, 2 and 3 are correct
EXPLANATION
The treatment of kidney cancer is primarily surgical, radical nephrectomy or kidney-sparing excision of the tumor. In some cases (e.g. high surgical risk, multiple tumors, etc.) minimally invasive destructive techniques may be considered, and in the elderly, close follow-up for small tumors should be considered, as the risk of surgery may exceed the risk of tumor. Renal tumors are not radiosensitive and cannot be treated with classical chemotherapeutic drugs, only immunotherapy or biological therapy can be applied.
B) Inguinal lymph nodes
EXPLANATION
the lymphatic drainage of the penis is directed towards the lumbar lymph nodes, so this region is the primary site of metastasis.
C) Answers 2 and 4 are correct
EXPLANATION
Precancerous conditions can be classified into low- and high-risk groups according to the frequency of developing to penile cancer. Bowen’s disease and Lichen sclerosus belong to the high-risk group. Condyloma acuminatum and balanitis do not belong to the group of precancerous conditions.
B) Blood in urine
EXPLANATIONThe most common symptom of bladder cancer is asymptomatic haematuria. Microscopic haematuria is when microscopic examination of the urine confirms blood in the urine, or macroscopic is when the color of blood is visible to the patient. Fever and pain are less common symptoms, occurring when there is secondary inflammation, upper urinary tract obstruction or a large tumor. Weight loss is a late symptom of the tumor.
B) Answers 1 and 3 are correct
EXPLANATIONTo reduce recurrence, instillation of local chemotherapy within 6 hours after transurethral surgery is recommended for all endoscopically non-muscle-invasive looking tumors if there is no suspicion of bladder perforation or bleeding risk. If the patient has not received early local chemotherapy, intravesical chemotherapy is recommended once a week for 6 weeks after surgery. Chemotherapy should not be given before surgery. There is no proven benefit of local chemotherapy after partial resection or muscle infiltration.
A) Answers 1, 2 and 3 are correct
EXPLANATION
Ultrasonography of the pelvis and bladder ultrasonography play a major role in the diagnosis of bladder cancer. Urine cytology can be used to detect high-grade tumors and is important in the follow-up of these tumors and thus in the early detection of their recurrence. Tumor markers are not currently (2024) in routine clinical practice and cannot replace the diagnostic steps listed above.
C) Surgical (if possible microsurgical) sperm extraction can be performed, with a background of cryopreservation. After a successful intervention intracytoplasmic sperm injection (ICSI) can be performed.
EXPLANATION Non-obstructive azoospermia is a secretory dysfunction, a disorder of spermatogenesis. Approximately 50% of these patients have focal spermatogenesis. Finding these foci (testicular ducts) and isolating sperm from them can lead to pregnancy via ICSI. The intervention must be performed with cryopreservation background.
B) Cardiology consultation
EXPLANATIONThe risk factors of erectile dysfunction show significant similarities with the risk factors of cardiovascular diseases. Men between the ages of 40 and 50 with erectile dysfunction are 50 times more likely to have cardiovascular events within 10 years. The frequency between 50 and 60 years is 6.5 times more, above 60 years the difference is less. For this reason in the international guidelines the cardiology consultation is included at the level of the physical examination in the flowchart for the investigation of erectile dysfunction.
