Urology + Paediatric Urology

Question 1

How does bladder cancer typically present?

Answer 1

1) Painless gross haematuria
2) Lower urinary tract symptoms - frequency, urgency or dysuria
3) If locally advanced or metastatic cancer - tumour obstruction can cause flank, pelvic or suprapubic pain

Question 2

What is the criteria for a 2ww referral for suspected bladder or renal cancer?

Answer 2

Adults > 45 years old with unexplained visible haematuria without infection

Question 3

What is the treatment for acute prostatits?

Answer 3

Ciprofloxacin 500mg twice daily for 14 days

Question 4

What is a hydrocoele?

Answer 4

A collection of fluid around the testicle

Question 5

What causes a hydrocoele?

Answer 5

1) During normal development, the testes develop in the abdomen and descend into the scrotum, usually before birth
2) The testes descend along the path of the processus vaginalis, which should obliterate
3) If the processus vaginalis doesn’t completely close, fluid from the abdomen can gradually accumulate in the scrotum, causing a hydrocele

Question 6

What is a complication of a hydrocoele?

Answer 6

Inguinal hernia - if the processus vaginalis doesn’t close at all, the large gap means that intestine can protrude through processus vaginalis via the deep ring into the scrotum, causing an inguinal hernia

Question 7

How do you diagnostically confirm a hydrocoele and what would you find?

Answer 7

Scrotal ultrasound - would see simple fluid accumulated around the testicle

Question 8

How do you manage a hydrocoele?

Answer 8

1) Observation initially - most hydrocoeles will spontaneously resolve by 12 months
2) Surgical correction if they have not resolve by 1 year

Question 9

Why is surgical correction of a hydrocoele recommended if it has not resolved by 1 year?

Answer 9

Because there is a significantly increased risk of an indirect inguinal hernia

Question 10

What is a potentially cause of a hydrocoele in older age groups e.g. adolescents?

Answer 10

Teratoma or seminoma of the testes

Question 11

How would a hydrocoele due to teratoma or seminoma of the testes present in an adolescent boy?

Answer 11

1) Following trauma to the region they may present with swelling/discomfort (only notice the swelling for the first time when they experience trauma to the region)
2) On examination - swelling (e.g. 7cm), testis cannot be clearly palpated separately from the scrotal lump

Question 12

What investigation should anyone presenting with pain or swelling in the scrotum be referred for?

Answer 12

Ultrasound

Question 13

What investigation is contraindicated in testicular neoplasm and why?

Answer 13

Fine-needle aspiration cytology - bc it can spread the neoplasm to another region

Question 14

How does a varicocele present?

Answer 14

Bag of worms appearance - dilated tortuous veins

Question 15

What investigation can help distinguish hydrocoeles from varicoceles and testicular torsion?

Answer 15

Doppler ultrasound

Question 16

Which tumours secrete alpha-fetoprotein (AFP) and therefore what does an elevated AFP indicate?

Answer 16

Non-seminomatous germ-cell tumours that contain embryonal carcinoma, yolk sac tumour or teratoma

Question 17

Which testicular tumours do not secrete AFP?

Answer 17

Seminoma and choriocarcinoma

Question 18

What is a vesicoureteric reflux (VUR)?

Answer 18

Abnormal flow of urine from the bladder into the upper urinary tract

Question 19

How is vesicoureteric reflux diagnosed?

Answer 19

Micturating Cystourethrogram (MCUG) scan - MCUG is a diagnostic test to visualise the radio-opaque dye refluxing up into the ureters ± kidneys
- If radioactive dye is visualised refluxing back up into the ureters and/or kidneys during micturition then Vesicoureteric reflux can be diagnosed

Question 20

What are risk factors for vesicoureteric reflux?

Answer 20

1) Male
2) Neurogenic bladder
3) Posterior urethral valves

Question 21

What causes vesicoureteric reflux?

Answer 21

Urine refluxes back up the ureters as there is either a short or absent valve where the ureters enter the bladder

Question 22

How does vesicoureteric reflux present?

Answer 22

1) Recurrent UTIs (strong smelling urine)
2) Incomplete voiding

Question 23

How do you classify vesicoureteric reflux?

Answer 23

Grade 1 – into ureters only
Grade 2 – into pelvis causing no dilatation
Grade 3 – into pelvis causing mild dilatation
Grade 4 - into the pelvis causing moderate dilatation
Grade 5 – through to calyces

Question 24

How is vesicoureteric reflux managed?

Answer 24

1) Grades 1-3 often spontaneously resolve
2) If VUR persists, complications arise or grade 4/5 VUR - surgery may be required/is indicated
3) Abx prophylaxis - to reduce the risk of developing reflux nephropathy

Question 25

What are potential complications of vesicoureteric reflux?

Answer 25

1) Recurrent UTIs and subsequent complications (sepsis, scarring, abscesses)
2) Reflux nephropathy
3) CKD
If left untreated vesicoureteric reflux can cause renal scarring and the development of chronic renal failure in childhood

Question 26

When would you refer a child for a MCUG to rule out vesicoureteric reflux?

Answer 26

Any child < 6 months with recurrent UTIs - the MCUG determines the severity of reflux and therefore guides treatment options.

Question 27

What might be seen on ultrasound scan in vesicoureteric reflux?

Answer 27

Dilated ureters

Question 28

What is a varicocoele?

Answer 28

Enlargement of the scrotal veins

Question 29

How does a varicocoele present?

Answer 29

Asymptomatic OR
1) Ache/heavy feeling in scrotum
2) Dilated bag of worms appearance

Question 30

What is a complication of varicocoele?

Answer 30

Impaired fertility - thought to be the cause of 25-40% of male infertility

Question 31

What is an uncommon cause/association of a left sided varicocoele?

Answer 31

Compression of the gonadal vein e.g. from renal cell carcinoma

Question 32

How are varciocoeles managed?

Answer 32

1) Asymptomatic - no treatment
2) Pain or infertility - embolisation or surgery