ABU URPS cheat sheet

Normal adult urine output is roughly 0.5-1.0 mL/kg/h; oliguria is <0.5 mL/kg/h or <400 mL/24h.

PSA thresholds: >4 ng/mL historically prompts workup; age-adjusted upper limits are ~2.5 (40-49), 3.5 (50-59), 4.5 (60-69), 6.5 (70-79) ng/mL.

Serum creatinine rises measurably only after substantial GFR loss; Cockcroft-Gault and MDRD/CKD-EPI are the standard eGFR estimators.

Asymptomatic bacteriuria is treated only in pregnancy and before urologic instrumentation; otherwise treatment is not indicated.

First-line uncomplicated cystitis agents include nitrofurantoin 5 days, TMP-SMX 3 days (if local resistance <20%), fosfomycin single dose, pivmecillinam.

Microscopic hematuria: ≥3 RBC/hpf on 2 of 3 specimens; risk-stratified evaluation with cystoscopy and upper tract imaging.

Testosterone deficiency requires symptoms plus two morning total testosterone values <300 ng/dL.

AUA-SI/IPSS is scored 0-35: 0-7 mild, 8-19 moderate, 20-35 severe.

Renal cell carcinoma subtypes: clear cell (~75%), papillary (10-15%), chromophobe (~5%); clear cell is linked to VHL inactivation on 3p.

TNM bladder cancer: T1 invades lamina propria, T2 muscularis propria, T3 perivesical fat, T4 adjacent organs; CIS is flat high-grade Tis.

BCG is indicated for high-risk NMIBC and CIS; maintenance BCG reduces recurrence and progression.

Prostate cancer Gleason/Grade Group: GG1 = 3+3, GG2 = 3+4, GG3 = 4+3, GG4 = 8, GG5 = 9-10.

Testicular germ cell tumors: pure seminoma is radiosensitive; nonseminoma often uses BEP; tumor markers are AFP, hCG, LDH.

Renal mass biopsy is most useful for small masses and for distinguishing RCC from lymphoma, metastasis, or oncocytoma.

Partial nephrectomy is preferred for T1 renal tumors when technically feasible; radical nephrectomy for larger or centrally invasive tumors.

Upper tract urothelial carcinoma is associated with Balkan endemic nephropathy and aristolochic acid exposure; radical nephroureterectomy is standard for high-risk disease.

Stone composition: calcium oxalate (~70-80%), calcium phosphate, uric acid (~5-10%), struvite (infection), cystine.

Struvite stones form with urease-producing organisms (Proteus, Klebsiella, Ureaplasma); treatment is complete stone clearance plus eradication.

Acute ureteral colic: NSAIDs are first-line analgesia; stones <5 mm often pass spontaneously, 5-10 mm observation is reasonable.

Ureteral stones >10 mm or failing observation: ureteroscopy or SWL; proximal stones favor flexible URS or SWL depending on size and anatomy.

Uric acid stones are radiolucent on plain film and dissolve with urinary alkalinization (target pH 6.5-7.0) plus allopurinol if hyperuricemic.

Cystine stones: hexagonal crystals, positive nitroprusside test; target urine pH >7.0 and high fluid intake.

24-hour urine metabolic evaluation is indicated for recurrent, bilateral, or high-risk stone formers.

Percutaneous nephrolithotomy is first-line for staghorn or large (>20 mm) renal stones.

Stress urinary incontinence is urine loss with increased intra-abdominal pressure; urgency incontinence is preceded by urgency.

Midurethral sling (retropubic or transobturator) is standard surgical treatment for stress incontinence; bulking agents are an option for poor surgical candidates.

Overactive bladder first-line: behavioral therapy plus bladder training; second-line: antimuscarinics or beta-3 agonist (mirabegron).

Pelvic organ prolapse quantification uses POP-Q stages 0-IV; stage II is leading edge -1 to -2 cm relative to hymen.

Post-void residual >150-200 mL suggests incomplete emptying; retention is often defined as PVR >300 mL.

Urethral diverticulum presents with postvoid dribbling, dyspareunia, and a tender anterior vaginal wall mass.

Vesicovaginal fistula most often follows hysterectomy; diagnosis with dye test or cystoscopy.

Recurrent UTI in women: ≥2 infections in 6 months or ≥3 in 12 months.

Antenatal hydronephrosis grading: anterior-posterior renal pelvis diameter ≥10 mm in third trimester is significant; ≥15 mm is high risk.

Vesicoureteral reflux grading I-V: grade V shows gross dilation with loss of papillary impressions and tortuous ureter.

UPJ obstruction: delayed drainage on diuretic renography with preserved differential function; pyeloplasty for declining function or symptoms.

Posterior urethral valves present with bilateral hydronephrosis, thick-walled bladder, and keyhole sign; treat with catheter drainage then valve ablation.

Undescended testis: orchidopexy recommended by 6-18 months of age; risk of malignancy and infertility increases with delayed treatment.

Hypospadias: avoid circumcision; repair typically between 6-18 months; meatal location and chordee guide technique.

Cryptorchidism and disorders of sex development require karyotype and hormonal evaluation before surgical decisions.

Vesicoureteral reflux management: antibiotic prophylaxis for higher grades; ureteral reimplantation for breakthrough infections or persistent high-grade reflux.

Renal transplant recipients require lifelong immunosuppression; calcineurin inhibitors (tacrolimus, cyclosporine) are cornerstone agents.

Acute rejection types: hyperacute (preformed antibodies), acute cellular, and antibody-mediated; biopsy with C4d staining helps diagnose antibody-mediated rejection.

Delayed graft function is dialysis requirement in the first week post-transplant; common in deceased-donor kidneys.

Renal artery stenosis after transplant can cause hypertension and graft dysfunction; Doppler ultrasound is first-line imaging.

Renal artery aneurysm >2 cm or rapidly enlarging is generally an indication for repair.

Renal cell carcinoma with tumor thrombus: level I in renal vein, level II in IVC below hepatic veins, level III above hepatic veins, level IV above diaphragm.

Varicocele is more common on the left due to the left gonadal vein draining into the left renal vein.

Nephrectomy for living donation: left kidney is often preferred for longer renal vein and easier laparoscopic access.

Renal trauma: most blunt injuries are managed nonoperatively; hemodynamic instability or expanding hematoma may require exploration.

Urethral injury: retrograde urethrogram is the diagnostic study; suprapubic catheter is preferred when urethral catheterization is unsafe.

Bladder rupture: intraperitoneal rupture requires surgical repair; extraperitoneal may be managed with catheter drainage in selected cases.

Testicular trauma: ultrasound is first-line; suspected rupture requires scrotal exploration.

Ureteral injury: often iatrogenic during pelvic surgery; management depends on location and timing, with stenting or reconstruction.

Urethral stricture: anterior strictures may be treated with dilation or urethrotomy; recurrent or long strictures often need urethroplasty.

Peyronie's disease: plaque and curvature; stable disease may be treated with collagenase or surgery (plication or graft).

Fournier gangrene: necrotizing fasciitis of perineum; urgent debridement and broad-spectrum antibiotics.

Semen analysis reference: volume ≥1.5 mL, concentration ≥15 million/mL, total motility ≥40%, progressive motility ≥32%, normal morphology ≥4% (strict criteria).

Male infertility evaluation includes history, exam, semen analysis, and hormonal testing (FSH, LH, testosterone) when indicated.

Azoospermia: obstructive vs nonobstructive; FSH and testicular volume help distinguish; micro-TESE may retrieve sperm in nonobstructive cases.

Erectile dysfunction: PDE5 inhibitors are first-line; contraindicated with nitrates.

Priapism: ischemic (low-flow) is a urologic emergency; aspiration and irrigation, then intracavernosal phenylephrine.

Peyronie's disease: curvature, plaque, and pain; collagenase Clostridium histolyticum is an option for stable disease with curvature.

Hypogonadism treatment with testosterone suppresses spermatogenesis and is contraindicated in men seeking fertility.

Premature ejaculation: behavioral therapy, topical anesthetics, or SSRIs/dapoxetine.

Urodynamic study phases: filling cystometry, pressure-flow study, and sometimes urethral pressure profilometry.

Detrusor overactivity is involuntary detrusor contractions during filling; it may be neurogenic or idiopathic.

Detrusor sphincter dyssynergia: detrusor contraction with simultaneous sphincter contraction; common in spinal cord injury above the sacral cord.

Compliance is calculated as change in volume divided by change in detrusor pressure; low compliance (<20 mL/cm H2O) risks upper tract damage.

Neurogenic bladder management: clean intermittent catheterization is preferred for incomplete emptying; antimuscarinics for overactivity.

Sacral neuromodulation is an option for refractory overactive bladder and nonobstructive retention.

Spinal shock after spinal cord injury may cause areflexic bladder initially; later patterns depend on lesion level.

Valsalva leak point pressure and detrusor leak point pressure help assess sphincter deficiency and risk of upper tract injury.

CT urography is the preferred study for painless gross hematuria and upper tract urothelial carcinoma evaluation.

Noncontrast CT is the study of choice for suspected renal colic; it detects stones, obstruction, and alternative diagnoses.

Ultrasound is first-line for scrotal pain to differentiate torsion from epididymitis; Doppler assesses blood flow.

MRI is useful for staging prostate cancer and renal masses; multiparametric MRI improves detection of clinically significant prostate cancer.

DMSA scan assesses renal cortical scarring and differential function; MAG3 is used for obstruction and drainage.

Renal mass imaging: Bosniak classification for cystic renal masses (I-IV); higher categories warrant surgical evaluation.

Retrograde urethrogram evaluates anterior urethral integrity; voiding cystourethrogram evaluates bladder and urethral anatomy.

Bone scan is used for staging prostate cancer when PSA is high or symptoms suggest bone metastasis.

Urothelium is transitional epithelium; umbrella cells line the surface and express uroplakins.

Prostate cancer most commonly arises in the peripheral zone; BPH arises in the transition zone.

Gleason grading is based on architectural patterns; higher grade indicates less differentiation and worse prognosis.

Renal cell carcinoma clear cell type is associated with VHL gene inactivation and abundant clear cytoplasm due to glycogen and lipid.

Testicular germ cell tumors: seminoma vs nonseminoma; intratubular germ cell neoplasia is a precursor.

Bladder cancer risk factors include smoking, aromatic amines, cyclophosphamide, and pelvic radiation.

Prostate-specific antigen is a serine protease produced by prostatic epithelium; it is organ-specific but not cancer-specific.

Immunohistochemistry: prostate cancer is typically NKX3.1 and PSA positive; urothelial carcinoma is GATA3 and p63 positive.