General Urology and Office Practice
Core concepts
Office urology rewards pattern recognition: hematuria evaluation, UTI stratification (uncomplicated vs complicated vs recurrent), BPH/BPH mimics, scrotal pain, and appropriate use of urinalysis, urine culture, PSA, and imaging. Know when to image (gross hematuria, persistent microscopic hematuria after negative UA, risk-stratified CT urography) and when not to. Understand antibiotic stewardship and the difference between asymptomatic bacteriuria (treat only in pregnancy and before urologic instrumentation) and symptomatic infection.
Traps
Questions often test the next best step rather than the diagnosis. A patient with dysuria and a negative culture may have urethritis, interstitial cystitis, or a vaginal/atrophic cause. Do not reflexively image every microscopic hematuria. Remember that recurrent UTI in women is a clinical diagnosis; culture is for failure or atypical features. BPH medications (alpha-blockers vs 5-alpha reductase inhibitors) have distinct onset and PSA effects - finasteride halves PSA, so double it when interpreting.
Worked rule of thumb
Microscopic hematuria: repeat UA to exclude transient causes; if persistent, risk-stratify. Low-risk (age <40, no risk factors) may get cystoscopy + renal ultrasound; high-risk gets CT urography + cystoscopy. For a 65-year-old smoker with painless gross hematuria, the answer is CT urography plus cystoscopy - not antibiotics and recheck.
Exam strategy
Read the stem for red flags: smoking, age, gross blood, flank pain, fever, obstruction. These drive escalation.