urology

Question 1

presentation BPH

Answer 1

• weak/ intermittent flow
• straining
• hesistancy
• terminal dribbling
• incomplete empying
• urgency
• frequency
• incontinence
• nocturia
• acute urinary retention

Question 2

BPH- investigations?

Answer 2

Digital rectal exam!

+/- PSA or urinalysis

Question 3

BPH management?

Answer 3

First line= Alpha-1- antagonists (TAMSULOSIN)

2nd- 5- alpha reductase inhibitor (e.g. finasteride)

Surgical- TURP (transurethral resection of prostate)

Question 4

alpha-1- antagonist (tamsulosin) SE

Answer 4

• postural hypotension
• dry mouth
• retrograde ejaculation
• depression

Question 5

5- alpha reductase inhibitors (e.g. finasteride) SE

Answer 5

• erectile dysfunction

- gynaecomastia

Question 6

presentation of acute urinary retention?

Answer 6

• subacute onset of anuria
• suprapubic pain/discomfort
• palpable distended bladder

Question 7

investigations acute urinary retention?

Answer 7

-prompt decompression with catheterisation

UROLOGICAL EMERGENCY

Question 8

most common cancer in adult men?

Answer 8

-prostate cancer

Question 9

what type of cancer is prostate cancer?

Answer 9

95% adenocarcinoma

Question 10

presentation of prostate cancer?

Answer 10

DRE- asymmetrical, hard, nodular enlargement

Raised PSA

• largely asymptomatic
• LUTS
• haematuria
• haematospermia
• pain in back, perineum or testes
• ED
• weight loss
• bone pain

Question 11

investigations for prostate cancer?

Answer 11

DRE- asymmetrical, hard, nodular enlargement

PSA- raised

First line investigation= multi parametric MRI (compared to traditional method of TRUS)

Multiple biopsy’s (at least 10 required)

Question 12

what grading system is used for prostate cancer?

Answer 12

Gleason’s grading (used for prognosis)

Question 13

treatment for localised prostate cancer (T1/T2)

Answer 13

Conservative:
-active monitoring and observation appropriate if low Gleason’s or elderly with significant co morbidities

• radical prostatectomy
• radical radiotherapy

Question 14

treatment for localised advanced prostate cancer (T3/T4)

Answer 14

• hormonal therapy if not fit for radical therapy
• radical prostatectomy
• radical radiotherapy

Question 15

Presentation of metastatic prostate cancer?

Answer 15

Suspect metastatic disease if anorexia, weight loss and bone pain

• classically osteosclerotic bone lesions (haematological spread)
• local invasion to seminal vescles
• lymphatic spread occurs first

Question 16

investigations- metastatic prostate cancer

Answer 16

• isotope bone scan +/- Xray

- CT/ MRI for staging

Question 17

treatment of metastatic prostate cancer?

Answer 17

Hormonal therapy:

• synthetic GnRG agonist (GOSERLIN)
• Anti androgen (CYPROTERONE ACETATE)
• bilateral orchidectomy

radiotherapy can also be used in palliative setting

anti androgen is given to prevent testosterone rise from synthetic GnRH agonist

Question 18

bladder cancer associated with smoking and >50 years

Answer 18

transitional cell cancer (90%)

Question 19

bladder cancer associated with chronic schistosomiasis infection

Answer 19

squamous cell carcinoma

Question 20

presentation of bladder cancer?

Answer 20

-painless macroscopic haematuria +/- LUTS

Question 21

investigations bladder cancer?

Answer 21

• flexible cytoscopy with biopsy
• pelvic MRI for local invasion
• CT for metastasis +/- PET

Question 22

bladder cancer treatment

Answer 22

T2: radical cystectomy

T4: palliative

Question 23

investigation for >50 with macroscopic haematuria

Answer 23

CT urography + flexible cytoscopy

Question 24

investigation macroscopic haematuria <50

Answer 24

-renal/bladder USS + flexible cytoscopy

+/- CT urography if no cause found

Question 25

investigation macroscopic haematuria in pregnant woman

Answer 25

MR urography