Arab Board Urology Clinical Exam cheat sheet

Normal adult GFR is approximately 125 mL/min; creatinine clearance is estimated by Cockcroft-Gault: CrCl = [(140 − age) × weight(kg)] / [72 × serum creatinine(mg/dL)], × 0.85 for females.

Renal blood flow is about 20–25% of cardiac output (~1.1 L/min); the kidney extracts only ~10% of delivered oxygen, so it is vulnerable to hypoxia but tolerates brief ischemia.

The ureter has three anatomic narrowings where stones lodge: ureteropelvic junction, crossing of the iliac vessels, and ureterovesical junction.

Detrusor muscle is smooth muscle with parasympathetic (S2–S4) motor supply via pelvic splanchnic nerves; sympathetic (T10–L2) fibers relax the detrusor via beta-3 receptors.

The prostatic urethra is lined by transitional epithelium proximally and by prostatic glandular epithelium; the external urethral sphincter is skeletal muscle under pudendal (S2–S4) control.

Serum PSA is organ-specific but not cancer-specific; it rises with BPH, prostatitis, instrumentation, and ejaculation, and is reduced by 5-alpha-reductase inhibitors by roughly 50% after 6 months.

Normal bladder capacity in adults is 400–600 mL; the first desire to void occurs at about 150–250 mL.

Acid-base handling: the kidney reabsorbs ~99% of filtered bicarbonate in the proximal tubule and secretes H+ in the distal nephron; type 1 (distal) RTA causes hypokalemia and stones, type 2 (proximal) does not.

Renal cell carcinoma subtypes: clear cell (~75%, VHL pathway), papillary (type 1/2), chromophobe; clear cell is the most vascular and most responsive to VEGF-targeted therapy.

Small renal masses <4 cm in a frail patient may be managed by active surveillance; partial nephrectomy is preferred when technically feasible for T1 tumors.

Bladder cancer: ~75% present as non-muscle-invasive (Ta, T1, CIS); T1 and CIS carry high progression risk and warrant intravesical BCG. Muscle-invasive disease (T2+) is managed with radical cystectomy or trimodality therapy.

Prostate cancer risk stratification uses PSA, Gleason/ISUP grade group, and clinical T stage; grade group 1 = Gleason 3+3, group 5 = Gleason 9–10.

Testicular germ cell tumors: seminoma vs nonseminoma; pure seminoma is radiosensitive, while nonseminoma (embryonal, yolk sac, choriocarcinoma, teratoma) is managed with platinum-based chemotherapy and RPLND in selected cases.

Cryptorchidism increases germ cell tumor risk 4–10 fold; orchiopexy before puberty reduces but does not eliminate the risk.

Penile squamous cell carcinoma is associated with HPV (especially 16/18) in a subset and with lichen sclerosus/phimosis; inguinal lymph node staging is the strongest prognostic factor.

Adrenal incidentalomas >4 cm or with suspicious imaging features warrant evaluation for malignancy; pheochromocytoma must be excluded biochemically (metanephrines) before any biopsy or surgery.

Stone composition: calcium oxalate (~75%), calcium phosphate, uric acid (~10%), struvite (infection, struvite = magnesium ammonium phosphate), cystine.

Acute renal colic imaging: non-contrast CT has sensitivity >95% for stones; ultrasound is preferred in pregnancy and children.

Ureteral stones <5 mm pass spontaneously in ~80%; stones >10 mm rarely pass and warrant intervention.

Medical expulsive therapy with an alpha-blocker is most useful for distal ureteral stones 5–10 mm.

Shockwave lithotripsy is best for stones <2 cm in the renal pelvis/upper ureter with normal renal function; it is less effective for hard (calcium oxalate monohydrate, cystine) stones and for lower-pole stones with a steep infundibulopelvic angle.

PCNL is first-line for stones >2 cm and for staghorn calculi; ureteroscopy with laser lithotripsy is preferred for mid/distal ureteral stones and for stones up to 2 cm.

Struvite stones require complete stone clearance plus eradication of urease-producing infection (Proteus, Klebsiella) to prevent recurrence.

Uric acid stones may be dissolved by urinary alkalinization to pH 6.5–7.0; allopurinol is used when hyperuricemia or hyperuricosuria is present.

Stress urinary incontinence is treated first-line with pelvic floor muscle training; midurethral sling or Burch colposuspension are surgical options for intrinsic sphincter deficiency or failed conservative therapy.

Overactive bladder is a clinical diagnosis of urgency with or without urge incontinence; first-line is behavioral therapy plus bladder training, then antimuscarinics or beta-3 agonists.

Pelvic organ prolapse quantification uses the POP-Q system with points Aa, Ba, C, D, Ap, Bp, and gh, pb, tvl; stage 0 = no prolapse, stage IV = complete eversion.

Vesicovaginal fistula most often follows hysterectomy; presentation is continuous urinary leakage; diagnosis by dye test or cystoscopy.

Interstitial cystitis/bladder pain syndrome is diagnosed clinically after excluding other causes; Hunner lesions are found in a minority and respond to fulguration.

Urethral diverticulum presents with postvoid dribbling, dyspareunia, and a suburethral mass; MRI is the imaging of choice.

Female urethral syndrome with sterile pyuria warrants evaluation for urethral diverticulum, fistula, or tuberculosis.

Recurrent UTI in women is defined as ≥2 infections in 6 months or ≥3 in 12 months; behavioral measures and vaginal estrogen in postmenopausal women reduce recurrence.

Detrusor overactivity is involuntary detrusor contractions during filling; it is a urodynamic finding, not a clinical diagnosis.

Detrusor sphincter dyssynergia occurs in suprasacral spinal cord lesions; it causes high detrusor pressure with sphincter contraction and risks upper tract damage.

Areflexic bladder (lower motor neuron lesion, e.g., cauda equina) is managed with clean intermittent catheterization; the Crede maneuver is avoided because of high pressure.

Urodynamic study components: uroflowmetry, filling cystometry, pressure-flow study, and EMG; detrusor pressure = intravesical pressure − abdominal pressure.

Bladder outlet obstruction on pressure-flow study shows high detrusor pressure with low flow; the Bladder Outlet Obstruction Index (BOOI) = detrusor pressure at Qmax − 2 × Qmax.

Postvoid residual >200 mL suggests incomplete emptying; elevated PVR with high detrusor pressure warrants intervention to protect the upper tracts.

Sacral neuromodulation is indicated for refractory urgency-frequency, urge incontinence, and non-obstructive retention after failed conservative therapy.

Anticholinergics can precipitate urinary retention in men with BPH; beta-3 agonists (mirabegron) avoid anticholinergic burden but can raise blood pressure.

Urethral stricture length and location guide repair: short bulbar strictures (<2 cm) may be treated with excision and primary anastomosis; longer or penile strictures require graft augmentation.

Buccal mucosal graft is the preferred graft for urethroplasty because of its thick epithelium, thin lamina propria, and rich vascularity.

Anterior urethral strictures are most commonly bulbar and idiopathic or traumatic; posterior (membranous) strictures are usually traumatic (pelvic fracture).

Pelvic fracture urethral injury is best managed with suprapubic catheter and delayed posterior urethroplasty; early realignment is an alternative in selected patients.

Urethral stricture recurrence after dilation or internal urethrotomy is common; repeated endoscopic treatment of long strictures is discouraged because it worsens the field for later repair.

Hypospadias repair complications include urethrocutaneous fistula, meatal stenosis, and diverticulum; repair is typically done at 6–18 months of age.

Vesicovaginal and rectourethral fistulas require adequate tissue interposition (Martius flap, gracilis) at repair.

Urinary diversion: ileal conduit is the most common; orthotopic neobladder requires a competent sphincter and negative urethral margins.

Erectile dysfunction first-line therapy is a PDE5 inhibitor; contraindicated with nitrates. Second-line options include vacuum devices and intracavernosal alprostadil; third-line is penile prosthesis.

Priapism lasting >4 hours is a urologic emergency; initial treatment is aspiration and irrigation of the corpora with or without intracavernosal phenylephrine.

Ischemic (low-flow) priapism shows dark, hypoxic blood on aspiration; non-ischemic (high-flow) priapism is usually post-traumatic and may be observed.

Peyronie disease is characterized by penile plaque and curvature; stable disease >3 months with bothersome curvature may be treated surgically (plication or grafting).

Male infertility evaluation: two semen analyses, FSH, LH, testosterone, and karyotype/Y-microdeletion testing when severe oligospermia or azoospermia is present.

Azoospermia with elevated FSH and small testes suggests primary testicular failure; normal FSH with low volume suggests obstructive etiology (e.g., CBAVD, ejaculatory duct obstruction).

Varicocele is the most common correctable cause of male infertility; repair is considered for palpable varicocele with abnormal semen parameters.

Testosterone replacement suppresses spermatogenesis and is contraindicated in men seeking fertility; alternatives include hCG or clomiphene.

Vesicoureteral reflux is graded I–V by the international system; grade I–III often resolve spontaneously; grade IV–V may require ureteral reimplantation or endoscopic injection.

Posterior urethral valves present with bilateral hydronephrosis, thick-walled bladder, and a dilated posterior urethra on voiding cystourethrogram; treatment is catheter drainage and valve ablation.

Undescended testis should be corrected by orchiopexy by 6–18 months of age to reduce infertility and tumor risk.

Hypospadias: do not circumcise before repair; the meatus is ventral, and chordee may coexist.

Antenatal hydronephrosis with a ureteropelvic junction obstruction and split function <35–40% on renography suggests the need for pyeloplasty.

Cryptorchidism, hypospadias, and inguinal hernia are associated with disorders of sex development when bilateral or atypical; karyotype and endocrine evaluation are warranted.

Neurogenic bladder in myelomeningocele is managed with clean intermittent catheterization and anticholinergics to protect the upper tracts.

Testicular torsion is a surgical emergency; salvage is highest when detorsion occurs within 6 hours.

Living donor kidney transplantation offers superior graft survival compared with deceased donor transplantation; preemptive transplantation before dialysis improves outcomes.

Crossmatching: ABO compatibility and HLA compatibility; a positive T-cell complement-dependent cytotoxicity crossmatch is a contraindication to transplantation.

Delayed graft function is defined as need for dialysis within the first week after transplantation; it is more common with deceased donor and prolonged cold ischemia time.

Immunosuppression typically includes a calcineurin inhibitor (tacrolimus), an antimetabolite (mycophenolate), and corticosteroids.

BK virus nephropathy presents with rising creatinine and decoy cells in urine or positive BK PCR; treatment is reduction of immunosuppression.

Arteriovenous fistula is the preferred vascular access for hemodialysis; the radiocephalic (Brescia-Cimino) fistula is first choice, followed by brachiocephalic.

Aneurysm, stenosis, and thrombosis are complications of AV access; failing access with rising venous pressure warrants fistulography and angioplasty.

Renal artery stenosis after transplantation presents with hypertension and rising creatinine; Doppler ultrasound is the initial imaging test.

Renal trauma: most blunt injuries are managed nonoperatively; hemodynamic instability or a pulsatile expanding hematoma is an indication for exploration.

Urethral injury: blood at the meatus, high-riding prostate, and perineal hematoma suggest urethral disruption; perform retrograde urethrogram before catheterization.

Bladder rupture: extraperitoneal rupture is managed with catheter drainage; intraperitoneal rupture requires surgical repair.

Testicular rupture with hematocele and disrupted tunica albuginea requires surgical exploration and repair.

Fournier gangrene is a necrotizing fasciitis of the perineum; treatment is urgent debridement and broad-spectrum antibiotics.

Traumatic priapism and penile fracture (tunica tear with audible pop) require prompt surgical repair.

Ureteral injury most often occurs iatrogenically during pelvic surgery; management depends on location and time of recognition (stent, primary repair, or reimplantation).

Hematuria after trauma warrants CT cystography for suspected bladder injury and CT with delayed phases for renal injury.

Non-contrast CT is the imaging test of choice for suspected urolithiasis; CT urography is used for hematuria evaluation and upper tract urothelial carcinoma.

Multiparametric MRI (PI-RADS) is used for prostate cancer detection; PI-RADS 1–2 = clinically significant cancer unlikely, PI-RADS 4–5 = likely.

Renal ultrasound is the first-line test for hydronephrosis and for distinguishing cystic from solid renal masses.

Bone scan is indicated for prostate cancer with high-risk features or symptoms; PSMA PET is increasingly used for staging and biochemical recurrence.

Preoperative evaluation: assess renal function, correct coagulopathy, and stop anticoagulants per protocol; antibiotic prophylaxis is given for endoscopic procedures with mucosal breach.

Venous thromboembolism prophylaxis after major pelvic surgery reduces symptomatic VTE; extended prophylaxis is considered after radical cystectomy.

Contrast-induced nephropathy risk is reduced by hydration and by minimizing contrast volume; metformin is held per institutional protocol in patients with renal impairment.

PSA screening shared decision-making applies to men 55–69 years; PSA velocity and free/total ratio refine risk when total PSA is borderline.