1. How would you manage a patient who has a prostate-specific antigen (PSA) of 200 and a positive bone scan with a biopsy proving Gleason 8 adenocarcinoma of the prostate?
2. How would you explain to a GP as to how to start LHRH analogue treatment?
3. When can you give the first luteinizing hormone-releasing hormone (LHRH) injection?
4. How would you manage bone pain in metastatic prostate cancer?
5. What are the 2-week guidelines for referral of suspected malignancy?
6. How would you investigate a 50-year-old male with painless haematuria?
7. How would you investigate a 3 cm mass in the kidney detected on renal ultrasound scan (USS)?
8. How would you manage a newly diagnosed pT1G3 tumour in the bladder?
9. What if the patient with a pT1G3 bladder tumour also has carcinoma in situ (CIS)?
10. What is the TNM classification for bladder cancer?
11. Draw the transverse appearance of the prostate as it would appear on transrectal ultrasound scan (TRUSS).
12. Discuss the role of interferon-a in the treatment of renal cell cancer (RCC).
13. What are the complications of radical prostatectomy?
14. What are the complications of radiotherapy for carcinoma of the prostate?
15. What are the risks of ureterolysis?
16. What is the role of finasteride in prostate cancer prevention?
17. How would you investigate a female patient with painless haematuria who is on methotrexate treatment?
18. How do you administer Mitomycin C?
19. Tell me about the Bosniak classification.
20. Describe the technique of TRUSS and prostate biopsy.
21. What are Partin’s tables?
22. Tell me about prostate brachytherapy.
23. What happens to PSA levels after radiotherapy treatment?
24. What is the aetiology of carcinoma of the bladder?
25. What is an acceptable glomerular filtration rate (GFR) prior to undergoing chemotherapy?
26. What is accelerated MVAC?
27. How common is cord compression in advanced carcinoma of the prostate?
28. What is the half-life of PSA?
29. What is the significance of a high PSA nadir following LHRH analogue treatment?
30. What chemotherapy can be used in advanced prostate cancer?
31. Tell me about von Hippel-Lindau (VHL).
32. What is the incidence of upper tract transitional cell carcinoma (TCC)? How often would you image the upper tracts in a patient with a history of bladder cancer?
33. How would you manage a T3b RCC? What is the prognosis?
34. A 37-week pregnant woman presents with haematuria. What would be the investigation and treatment?
35. A male patient aged 73 presents with lower urinary tract symptoms (LUTS) and is noted to have a PSA of 140 and an obvious prostate cancer on digital rectal examination (DRE). How would you discuss the findings with the patient? How would you manage this patient?
36. When would you start hormone treatment in the patient in the previous question? Why does a flare response occur? What are the side effects of LHRH analogues? How do you avoid osteoporosis?
37. How many cores should you take on a TRUSS biopsy of the prostate? What is the benefit of increasing the number of cores?
38. What is PSA density, PSA velocity, Free:total PSA?
39. Classify PIN. What is the incidence of CaP and PIN. What would you do if PIN was found on a prostate biopsy?
40. What are the different types of testicular tumour?
41. How would you counsel a patient regarding orchidectomy?
42. How many cycles of chemotherapy are used in seminoma and teratoma?
43. A 40-year-old man has renal mass diagnosed. What are the indications for partial and radical nephrectomy?
44. What are the surgical approaches to the kidney?
45. What are the indications for nephron-sparing surgery?
46. How would you investigate a caval thrombus?
47. A patient presents with a testicular tumour, does it make any difference performing orchidectomy through the scrotum or inguinal region?
48. How would you follow up a patient with a T1b renal cell carcinoma post-operatively?
49. What is the role of neoadjuvant chemotherapy in carcinoma of the bladder?
50. Which investigations would you perform before giving cisplatin therapy?
51. What are the autocrine mechanisms of carcinogenesis?
52. What is the management of a male aged 65 with a PSA of 5?
53. What do you understand by the term age-related PSA?
54. How would you counsel a patient for biopsy of the prostate?
55. Discuss the significance of a negative prostate biopsy in a patient with a PSA of 5.
56. What is a tumour suppressor gene?
57. What is the impact on the management of prostate cancer with seminal vesicle involvement?
58. What are the indications for adjuvant treatment post radical prostatectomy?
59. What do you know about anti-angiogenic therapy for cancer and monoclonal antibodies for cancer?
60. What are the British Association of Urological Surgeons (BAUS) guidelines for metastatic prostate cancer?
61. What is the PRO7 trial?
62. What do you know about zoledronic acid? What is the evidence for the use of zoledronic acid and what are the complications?
63. How would you manage adenocarcinoma at the dome of the bladder?
64. What is the management of urachal carcinoma? The margins are positive, what further treatment is required?
65. What do you know about familial prostate cancer? What is the relevance of breast cancer?
66. How does the androgen receptor work?
67. What is the management of keratinizing squamous cell metaplasia? What is the risk of progressing to SCC?
68. What is malakoplakia of the bladder?
69. What is the management of a 6 cm angiomyolipoma?
70. What is the evidence for performing an extended lymphadenectomy for invasive bladder cancer?
71. What is the role of neoadjuvant chemotherapy for invasive bladder cancer?
72. What is an oncogene? How does ras oncogene cause a malignant phenotype?
73. What is a mutation?
74. What are the indications for a partial nephrectomy? How do you perform a partial nephrectomy? What is the warm ischaemia time?
75. What is the management of metastatic renal cancer?
76. What is the literature for adjuvant treatment of renal cancer?
77. What is the management of classical seminoma?
78. What is the toxicity of bleomycin, etoposide and cisplatin (BEP)?
79. What is a tumour suppressor gene?
80. What is the evidence for post-operative intravesical Mitomycin C?
81. What percentage of people with a normal PSA has underlying prostate cancer?
82. What is the pickup rate of prostate biopsy?
83. Tell me about the European screening program for prostate cancer.
84. What are the predisposing conditions for carcinoma of the penis? What are the metastatic sites?
1. What is the classification of vesico-ureteric reflux (VUR)?
2. What associated abnormalities are found with VUR?
3. How would you manage grade III VUR?
4. How do you measure GFR?
5. How do you do a renogram?
6. Describe how you would perform an orchidopexy.
7. What is the management of an undescended testicle?
8. How do you do a Whitaker test?
9. What are the indications and how would you do a pyeloplasty?
10. How does isotope renography work?
11. What are the phases in a renogram? How long do you wait before scanning?
12. What are the symptoms of pelviureteric junction (PUJ) obstruction? Which renogram would you perform? What are the treatment options?
13. What is the incidence of undescended testes?
14. Describe the Fowler-Stephens procedure.
15. What is the differential diagnosis of the acute scrotum?
16. What is the management of a 2-year-old with cryptorchidism?
17. Describe the descent of the testes.
18. What is the natural history of cryptorchidism?
19. What is the fate of undescended testes?
20. What about bilateral undescended testes?
21. A 3-year-old girl with a first urinary tract infection (UTI) has been treated and completely recovers. When would you organise the DMSA? If photopenic areas are found what would you do?
22. What prophylactic antibiotic would you use in the above case?
23. Define reflux and what classification is used.
24. Draw me the glomerulus. What happens to the GFR when the efferent and afferent arterioles constrict?
25. What is the presentation of ureteroceles? What are the treatment and complications?
26. How do you do a laparoscopic pyeloplasty?
27. What other methods of pyeloplasty do you know?
1. What are the side effects of sildenafil?
2. What are the contraindications for sildenafil?
3. Draw the nitric oxide/cyclic guanosine monophosphate (NO/cGMP) pathway.
4. What are the differences between high- and low-flow priapism?
5. How would you manage a penile fracture which presents within 24 hours?
6. A man wants to undergo a vasectomy. How would you counsel him?
7. What would you do if persistent sperm are seen following a vasectomy?
8. How do you assess a man with erectile dysfunction (ED)? What tests would you ask for?
9. What are the side effects of a PDE-5 inhibitor?
10. What is the incidence of chronic scrotal pain post vasectomy?
11. Tell me about haemospermia.
12. What are the indications of varicocele repair in adolescent males?
13. What is the evidence that varicocele repair improves semen parameters?
14. What are the approaches available for varicocele repair?
15. Who would you scan the upper tracts in when presented with a varicocele?
16. What is the risk of ED in a patient presenting with a fractured penis?
17. How would you treat high-flow priapism?
18. Tell me about Peyronie’s disease.
19. Tell me about the testosterone pathway.
20. How is testosterone released from the adrenals?
21. What is testosterone bound to?
22. What happens to testosterone during the day?
23. When should a testosterone assay be performed?
24. How is testosterone converted to dihydrotestosterone (DHT)?
25. What is the rate of infection of a penile prosthesis?
26. What is the risk of priapism for someone using intracavernosal prostaglandin?
27. Classify priapism. What are the investigations and treatment?
28. What precautions would you take in order to minimise the risk of infection when inserting a penile prosthesis?
29. Describe the Lue procedure for the management of Peyronie’s disease.
30. Anatomically describe a hydrocele.
1. How would you manage a 1.5 cm lower pole calyx stone?
2. What are the contraindications for extracorporeal shock wave lithotripsy (ESWL)?
3. What is the management of a 6 mm stone in the upper third of the ureter?
4. Draw an obstructed renogram curve.
5. What is Homsy’s sign?
6. What is the incidence of asymptomatic bacteriuria in pregnancy?
7. What is the incidence of pyelonephritis in pregnancy?
8. Which antibiotics are contraindicated in pregnancy?
9. How do you define urinary tract infection?
10. Describe the concept of bacterial adherence.
11. Where did the 105 CFU definition arise from?
12. What is the epidemiology of urinary tract calculi?
13. What is the composition of stones and their frequency?
14. What is the management of a 3 mm distal ureteric stone?
15. What is the role of a-blockers in ureteric stones?
16. What is the management of first-time stone formers?
17. How would you do a 24 urine analysis in a recurrent stone former?
18. What is the effect of calcium restriction on stone disease?
19. What are the causes of stone formation? How would you treat hypercalcaemia?
20. What is the management of a child with a large distal ureteric stone?
21. What analgesia would you use for ESWL? What sort of machine do you use in your department?
22. How do you locate the stone?
23. Which energy level do you start at?
24. What are the contraindications to performing an intravenous urography (IVU)?
25. What conditions cause calcified cysts in the kidney?
26. What are virulence factors?
27. What is the dosing regime for gentamicin?
28. How does gentamicin work?
29. Describe the various lithotriptors and how they work.
30. What sort of antibiotic is trimethoprim?
31. Define recurrent UTI.
32. What are the risk factors for UTI? What investigations would you do?
33. How would urine dipstick help in UTI?
34. What defences against Escherichia coli are there?
35. What is the role of Lactobacillus in preventing E. coli colonisation?
36. What does P-fimbriae attach to?
37. What is the Stamey test?
38. What is the classification of prostatitis?
39. How do you treat prostatitis medically?
40. What are the risks of percutaneous nephrolithotomy (PCNL)?
41. What is the management of post-PCNL bleeding via the nephrostomy?
42. What is the prevalence of UTI before and after starting sexual activity?
1. How would you treat interstitial cystitis?
2. How would you investigate a female with incontinence?
3. How would you manage a 20-year-old female with urgency and frequency?
4. How does tolterodine XL work as extended release?
5. What are the problems associated with ileocystoplasty?
6. How would you manage chronic pelvic pain syndrome?
7. A 55-year-old female with multiple sclerosis is bed bound with a problematic catheter. What is the investigation and management?
8. How do you do a bladder neck closure?
9. What is Ulmstein’s integral theory of continence?
10. What is Delancy’s hammock theory?
11. What are the complications of tension-free vaginal tape (TVT) and transobturator tape (TOT)?
12. What do you understand by types I and III incontinence?
13. How does BOTOX work in the bladder and what are the risks?
14. What changes occur in the urinary tract during pregnancy?
15. How would you manage loin pain and hydronephrosis in a 35/40 pregnant woman?
16. What is Fowler’s syndrome?
17. Draw the neurophysiology of micturition.
18. What are the complications of an ileal conduit?
19. What are the principles of reservoir reconstruction?
20. What is Laplace’s law?
21. How do you perform a video cystogram?
22. What are the causes of painful urinary retention in a 25-year-old woman?
23. What are the urodynamic findings in a patient with multiple sclerosis?
24. What are the risk factors for upper tract deterioration in a neurogenic bladder?
25. What is the management of overactive bladder (OAB) in MS?
26. How do you do a Boari flap and Psoas hitch?
27. What are the causes of a urethral stricture?
28. What are the narrowest parts of the urethra?
29. How do you deal with a post-transurethral resection (TUR) bulbar stricture?
30. What is the value of urethrography in stricture disease?
31. What do you understand about interstitial cystitis?
32. How do you diagnose interstitial cystitis?
33. What is a Koch pouch?
34. What is a Mainz 2 pouch?
35. What are the provocative manoeuvres during urodynamics?
36. What is the stop test?
37. What is PSA? What causes PSA elevation?
38. How do you consent for TRUSS and what are the side effects?
39. What is the definition of detrusor instability? What is the medical and surgical treatment?
40. How many times should a patient cough during urodynamic evaluation?
41. Which types of neobladder do you know using small bowel?
42. How does trospium chloride work?
43. What types of BOTOX are there?
44. How many types of detrusor sphincter dyssynergia (DSD) are there?
45. How do you diagnose a urethral diverticulum?
46. Why does a urethral stricture give a flat curve?
47. What is the evidence for intermittent self-catheterisation (ISC) in urethral stricture management?
48. What is the significance of mast cells in a biopsy from a patient with interstitial cystitis?
49. How is interstitial cystitis classified? What are the disadvantages for this classification?
50. How would you do a colposuspension?
51. Which antibiotic prophylaxis would you use in a colposuspension?
52. How would you manage a pelvic haematoma post colposuspension?
53. What are the risks of nephrostomy insertion in a pregnant female?
54. Why do you detubularise the ileum in pouch formation?
55. What end fill pressure on urodynamics would be significant for a neuropath with reduced compliance?
56. What is the Mitrofanoff principle?
57. What are the metabolic consequences of a continent pouch? What happens to serum calcium?
58. What is the risk of UTI in clean intermittent self-catheterisation (CISC)?
59. How common is bacteruria in patients with an ileal conduit?
60. What is the most common urethral stricture?
61. Where are strictures most commonly located post transurethral resection of the prostate (TURP) and why?
62. What is the calibre of the urethra?
63. Draw a picture of the bulbar urethra and corpus spongiosum.
64. What makes bladder muscle contract?
65. Where is the sacral micturition centre?
66. How do sympathetic fibres get to the bladder?
67. What is the nerve supply and structure of the urethral sphincter?
68. How do the sphincter arrangements differ in females?
69. What sensations can you feel in the bladder?
70. What is DSD? Where is the site of the lesion?
71. Which sensory neurotransmitters are in the bladder?
72. What injuries would you get with an open book pelvic fracture?
73. Explain a urethral distraction defect.
74. Draw a picture of the micturition pathway.
75. Who described the pontine micturition center?
76. Where is the social control of voiding?
77. What happens to micturition with lesions above pons and below the pons?
1. How would you take your SHO through insertion of a suprapubic catheter?
2. What are the advantages of a suprapubic catheter over a urethral catheter?
3. You are called to the gynaecology ward to see a patient who is 3 days post-hysterectomy and has clear fluid draining vaginally. What would you do?
4. What would you do with a 12-year-old boy with an acutely painful scrotum?
5. How would you classify acute scrotum diagnosis according to age groups?
6. How would you diagnose idiopathic scrotal oedema?
7. How would you manage a ureteric injury which occurs during aneurysm repair?
8. A patient arrives having been involved in a road traffic accident and presents with haematuria. What is the subsequent management?
9. How would you perform a urethrogram in a patient with a fractured pelvis?
10. What is the management of a patient with pelvic fracture and urethral and bladder trauma?
11. Classify renal trauma.
12. What is shock?
13. What is the relationship between the uterine artery and ureter?
14. What is the definition of systemic inflammatory response syndrome (SIRS)? What is septic shock? What are the clinical features of shock?
1. What types of contrast media do you know?
2. What do we worry about with contrast media?
3. What are the components of a cystoscope?
4. How is a cystoscope constructed?
5. What is the physics behind the Hopkins’ lens system?
6. What does ‘LASER’ stand for?
7. What are the settings for your diathermy machine when performing a TURP?
8. Draw the circuit diagram for diathermy.
9. Show the waveform for diathermy.
10. Tell me about green light laser.
11. What are the advantages and disadvantages of laser?
12. How do you perform sphincter electromyography (EMG)?
13. How would you do a flexible cystoscopy?
14. Which local anaesthetic agent would you use?
15. What angle lens is used in a flexible cystoscope?
16. What is a dual energy x-ray absorptiometry (DEXA) scan?
1. What is the meaning of F (in terms of catheter size)?
2. What is the role of urodynamics in men?
3. How would you set up a LUTS clinic?
4. How many uroflows would you do in each patient in a LUTS clinic?
5. What do you understand by a frequency-volume chart?
6. How can you improve patient compliance with a frequency-volume chart?
7. Draw a uroflow showing normal male flow and one showing a male with BPH.
8. What are the indications for TURP?
9. How would you manage a diabetic patient undergoing TURP post-operatively?
10. What are the pharmacotherapies used in BPH?
11. How would you manage a patient who has been on combination treatment and presents with retention?
12. How would you design a trial of laser prostate versus standard TURP?
13. What are the complication rates for TURP?
14. What do you know about warfarin?
15. A patient presents with haematuria and is on warfarin and has bleeding secondary to BPH. What would you do?
16. What are the surgical treatments for BPH?
17. What is on the International Prostate Symptom Score (IPSS) sheet?
18. What is the disadvantage of the IPSS?
19. Tell me about the concept of uroselectivity in a-blockers.
20. Tell me about MTOPS. What are your recommendations for combination therapy?
21. How do 5-a-reductase inhibitors work? What is the benefit of dutasteride?
22. Regarding BPH, what are the messages from MTOPS?
23. What is the difference between dutasteride and finasteride?
24. What are the absolute indications for surgery?
25. What is IPSS? How is it used?
26. What are the complications of bladder outflow obstruction?
27. What types of flowmeter are there?
28. How do you interpret a flow rate?
29. How do you work out the voided volume on a flow rate?
30. What is the mortality from TURP?
31. Tell me about laser prostatectomy.
32. What is the bladder outflow obstruction index?
33. What irrigation fluid do you use during a TURP?
34. Why use 1.5% glycine and not 3%?
35. Tell me about TUR syndrome.
36. How can you monitor for TUR syndrome during surgery?
37. What are the risk factors for acute urinary retention?
38. What are the treatment options for men with LUTS?
39. Tell me about the BAUS guidelines for LUTS.
40. How do you manage patients with acute urinary retention (AUR)?
41. What is the efficacy of a-blockers prior to undergoing a trial without catheter?
42. What is the significance of a residual volume during AUR?
43. Tell me about chronic retention.
44. What is the physiological basis of post-obstructive diuresis. Distinguish between pathological and physiological diuresis.
45. Draw the zones of the prostate gland.
46. Where does BPH originate?
47. Describe the embryology of the prostate.
48. How would you consent for a TURP?
49. Tell me about the national prostatectomy audit.
50. What is nocturnal polyuria?