ABU Urology cheat sheet

ISUP grade group 1 = Gleason 3+3=6; group 2 = 3+4=7; group 3 = 4+3=7; group 4 = Gleason 8; group 5 = Gleason 9-10.

Serum PSA >4 ng/mL is the traditional biopsy threshold; PSA density >0.15 ng/mL/cc and free:total PSA <10% raise the suspicion of prostate cancer.

Clear cell renal cell carcinoma accounts for about 75% of RCC and is linked to VHL inactivation on chromosome 3p; papillary is 10-15% and chromophobe about 5%.

Non-muscle-invasive bladder cancer includes Ta, T1 and CIS; high-risk disease receives intravesical BCG, while T2 or higher disease is managed with neoadjuvant cisplatin-based chemotherapy plus radical cystectomy.

Pure seminoma never elevates AFP; nonseminomatous germ cell tumors may elevate AFP, hCG and LDH. Radical inguinal orchiectomy is the diagnostic and therapeutic first step.

Upper tract urothelial carcinoma is treated by nephroureterectomy with bladder cuff excision; selected low-grade distal ureteral tumors may be managed by distal ureterectomy.

High-risk prostate cancer (PSA >20 ng/mL, Gleason 8-10, or cT3) warrants staging with PSMA PET or bone scan plus cross-sectional imaging.

A renal mass with macroscopic fat density on CT is an angiomyolipoma; biopsy is reserved for indeterminate masses or suspected metastasis or lymphoma.

Calcium oxalate stones account for 70-80% of urinary calculi; struvite (magnesium ammonium phosphate) stones form with urease-producing infection and often branch into staghorn calculi.

Uric acid stones are radiolucent and form at urine pH below 5.5; they dissolve with alkalinization to pH 6.5-7.0 using potassium citrate, with allopurinol added for hyperuricemia.

Spontaneous passage of distal ureteral stones is about 80% for stones under 5 mm, about 50% for 5-10 mm, and rare above 10 mm; alpha-blockers may aid passage of 5-10 mm distal stones.

SWL is first-line for renal stones under 2 cm; PCNL is preferred for stones over 2 cm, staghorn calculi, and lower-pole stones with unfavorable anatomy; ureteroscopy suits mid and distal ureteral stones.

SWL is contraindicated in pregnancy, uncorrected coagulopathy and untreated urinary infection; obesity and high stone Hounsfield units lower success.

Cystine stones are faintly radiopaque and form at urine pH below 7; management includes high fluid intake, alkalinization above pH 7, and chelating agents such as penicillamine or tiopronin.

A 24-hour urine metabolic evaluation is indicated for recurrent stones, young age at onset, bilateral or staghorn stones, and stones in a solitary kidney.

An infected obstructed stone requires urgent decompression by ureteral stent or percutaneous nephrostomy plus antibiotics; definitive stone treatment is delayed until infection resolves.

Overactive bladder is urgency, frequency and nocturia with or without urgency incontinence; first-line therapy is behavioral treatment plus an antimuscarinic or beta-3 agonist.

Stress urinary incontinence is leakage with increased intra-abdominal pressure; the midurethral sling is standard surgical treatment, with bulking agents reserved for selected patients.

Detrusor overactivity on urodynamics is defined by involuntary detrusor contractions during filling; it correlates with urgency but not perfectly with symptoms.

Upper motor neuron lesions above the sacral cord cause detrusor overactivity and detrusor-sphincter dyssynergia; lower motor neuron lesions cause an areflexic detrusor.

Clean intermittent catheterization is the standard treatment for incomplete bladder emptying; a post-void residual above 200-300 mL suggests clinically significant retention.

POP-Q staging: stage 0 no prolapse, stage 1 leading point more than 1 cm above the hymen, stage 2 between 1 cm above and 1 cm below, stage 3 more than 1 cm beyond but not complete, stage 4 complete vaginal eversion.

Bladder pain syndrome/interstitial cystitis is a clinical diagnosis of pain with urgency and frequency without infection; Hunner lesions are found in only a minority at cystoscopy.

Hypogonadism is symptoms plus total testosterone below 300 ng/dL on two morning fasting samples; low LH and FSH indicate secondary hypogonadism, elevated gonadotropins indicate primary.

WHO 2010 semen reference limits: volume at least 1.5 mL, concentration at least 15 million/mL, total motility at least 40%, progressive motility at least 32%, normal morphology at least 4%.

PDE5 inhibitors are first-line for erectile dysfunction and are contraindicated with nitrates; testosterone therapy alone is not a treatment for erectile dysfunction.

Priapism lasting more than 4 hours is a compartment syndrome; treatment begins with corporal aspiration and intracavernosal phenylephrine, not with PDE5 inhibitors.

Varicocele is most common on the left, described as a bag of worms, and is repaired when associated with infertility, testicular atrophy or abnormal semen parameters.

Azoospermia with low FSH and small testes suggests nonobstructive azoospermia; normal FSH and testicular volume with low ejaculate volume suggests obstruction.

Vasectomy is not immediately effective; a post-vasectomy semen analysis confirming azoospermia or rare nonmotile sperm is required before stopping contraception.

Peyronie disease is a tunica albuginea plaque causing curvature; stable disease lasting more than 12 months may be treated surgically with plication or grafting.

Hypospadias is a ventral meatus with a dorsal hood and chordee; circumcision is deferred so the foreskin can be used for reconstruction.

Orchidopexy for an undescended testis is recommended between 6 and 18 months of age to reduce infertility and malignancy risk.

Vesicoureteral reflux is graded I-V by VCUG; grade I involves the ureter only, and grade V shows gross dilation and tortuosity with loss of papillary impressions.

Posterior urethral valves present in male infants with bilateral hydronephrosis and a thick-walled bladder; VCUG confirms the diagnosis and endoscopic valve ablation relieves obstruction.

Testicular torsion is a surgical emergency; salvage is highest within 6 hours, and bilateral orchiopexy is performed because of the underlying bell-clapper anomaly.

Wilms tumor (nephroblastoma) presents at age 2-5 years as an abdominal mass; treatment is nephrectomy plus chemotherapy, with radiation for advanced stages.

Antenatal hydronephrosis is graded by the SFU system; an anteroposterior renal pelvic diameter above 10 mm in the third trimester warrants postnatal evaluation.

Febrile urinary tract infection in a child warrants urine culture and renal/bladder ultrasound; VCUG is reserved for abnormal ultrasound, recurrent febrile infection, or suspected reflux.

GFR is estimated with CKD-EPI or MDRD; Cockcroft-Gault estimates creatinine clearance and is used for drug dose adjustment.

Maintenance immunosuppression typically combines a calcineurin inhibitor (tacrolimus), an antimetabolite (mycophenolate), and corticosteroids.

Hyperacute rejection is antibody-mediated and occurs minutes to hours after reperfusion; it is prevented by pretransplant crossmatching and is not reversible once established.

Acute cellular rejection presents with a rising creatinine and is confirmed by biopsy; treatment is high-dose corticosteroids, with antithymocyte globulin for severe cases.

BK virus nephropathy causes rising creatinine with decoy cells and BK viremia; management is reduction of immunosuppression, not intensification.

Early post-transplant complications include renal artery thrombosis, ureteral leak or stenosis, and lymphocele; Doppler ultrasound is the first imaging test.

Tacrolimus causes hypomagnesemia and hyperkalemia through altered distal tubular handling; hyperkalemia may also reflect trimethoprim or ACE inhibitor use.

Renal autoregulation maintains GFR through afferent dilation and efferent constriction; ACE inhibitors dilate the efferent arteriole and can sharply reduce GFR in renal artery stenosis.

Renal trauma is graded I-V; hemodynamically stable grade I-IV injuries are managed nonoperatively, while grade V injury or hemodynamic instability prompts angiography or surgery.

Posterior urethral injury follows pelvic fracture and presents with blood at the meatus and a high-riding prostate; retrograde urethrogram confirms the injury before catheterization.

Intraperitoneal bladder rupture requires surgical repair; extraperitoneal rupture is usually managed with catheter drainage alone.

Penile fracture is a tear of the tunica albuginea with sudden detumescence and hematoma; immediate surgical repair reduces long-term curvature and erectile dysfunction.

Testicular rupture with a disrupted tunica albuginea requires scrotal exploration and repair; an intact tunica with hematoma may be managed conservatively.

Ileal conduit is the most common urinary diversion; orthotopic neobladder preserves urethral voiding but requires a negative urethral margin and adequate renal and hepatic function.

Buccal mucosa graft urethroplasty is preferred for long or recurrent anterior urethral strictures; excision and primary anastomosis suits short bulbar strictures.

Escherichia coli causes about 80% of uncomplicated urinary tract infections; dipstick nitrite has high specificity and leukocyte esterase has high sensitivity.

Asymptomatic bacteriuria is treated only in pregnancy and before urologic procedures with mucosal trauma; treatment in other groups promotes antimicrobial resistance.

Acute pyelonephritis with obstruction requires urgent decompression by stent or nephrostomy because antibiotics alone are insufficient.

Acute bacterial prostatitis presents with fever, dysuria and a tender prostate; treatment is parenteral antibiotics, and prostate massage is avoided.

Chronic bacterial prostatitis is localized with the four-glass test or the two-glass pretest/post-massage test; fluoroquinolones are first-line therapy.

Intravesical BCG induces a local immune response against urothelial carcinoma in situ and high-grade Ta/T1 tumors; maintenance therapy improves recurrence-free survival.

The urothelial glycosaminoglycan layer is a permeability barrier; its disruption is implicated in interstitial cystitis and chemical cystitis.

Urease-producing organisms such as Proteus and Klebsiella alkalinize urine and promote struvite stones; complete stone clearance is required to eradicate the infection.