Urology and Transplant Surgery
Core Concepts
Understand the evaluation of hematuria, renal colic, and urinary tract infections. Know the management of urolithiasis (observation, medical expulsive therapy, lithotripsy, ureteroscopy). For transplant, focus on kidney transplantation: donor evaluation, immunosuppression, and complications (rejection, infection, surgical). Also, know the principles of organ procurement and allocation.
Traps in Questions
A common trap is the use of alpha-blockers for medical expulsive therapy: effective for distal ureteral stones >5 mm. Another trap is the evaluation of a renal mass: solid enhancing mass is presumed renal cell carcinoma until proven otherwise. For transplant patients, beware of the “fever in a transplant recipient” – consider both rejection and infection; CMV is a common culprit. Also, know that live donor nephrectomy has low morbidity and excellent outcomes.
Worked Example
A 40-year-old man with a 6 mm distal ureteral stone and severe pain. What is the best management? Answer: Trial of medical expulsive therapy with alpha-blocker and analgesia; if fails, ureteroscopy.
Rule of Thumb
In renal colic, if stone <5 mm, 80% pass spontaneously; if >10 mm, unlikely to pass and needs intervention.