Arab Board Urology Final Written cheat sheet

Renal cell carcinoma subtypes: clear cell (75-80%, VHL mutation), papillary (10-15%, MET mutation), chromophobe (5%, multiple chromosomes loss), collecting duct (aggressive).

Prostate cancer Gleason grading: pattern 3 = well-formed glands, 4 = fused/poorly formed glands or cribriform, 5 = single cells or cords; Grade Group 1 = Gleason 3+3, Group 5 = 9-10.

Bladder cancer risk factors: smoking (most important), aromatic amines, cyclophosphamide, pelvic radiation; non-muscle invasive (Ta, T1, CIS) treated with TURBT ± intravesical BCG.

Testicular germ cell tumors: seminoma (painless mass, AFP normal, hCG elevated in 10-20%), non-seminoma (embryonal, yolk sac, choriocarcinoma, teratoma; AFP elevated in yolk sac).

Penile cancer: squamous cell carcinoma, HPV 16/18 associated; inguinal lymphadenectomy indicated for palpable nodes or high-risk primary (≥T1b, grade 3, lymphovascular invasion).

Adrenal incidentaloma: >4 cm or heterogeneous → resection; workup includes plasma metanephrines, dexamethasone suppression test, aldosterone/renin.

Kidney tumor biopsy: indicated for small renal masses when diagnosis uncertain, before ablation, or suspected lymphoma/metastasis; not routine for clear cell RCC.

Prostate cancer screening: PSA >4 ng/mL or abnormal DRE → biopsy; PSA velocity >0.75 ng/mL/year and free PSA <10% increase cancer risk.

Stone composition: calcium oxalate (70-80%), calcium phosphate (5-10%), uric acid (5-10%), struvite (5-10%, infection), cystine (1-2%).

Acute renal colic: first-line imaging = non-contrast CT abdomen/pelvis (sensitivity 95-98%); ultrasound preferred in pregnancy and children.

Medical expulsive therapy: alpha-blockers (tamsulosin) for distal ureteral stones 5-10 mm; NSAIDs first-line analgesia; avoid in pregnancy.

Indications for urgent decompression: obstructing stone with fever/infection (sepsis), solitary kidney, bilateral obstruction, refractory pain, or rising creatinine → percutaneous nephrostomy or ureteral stent.

Ureteral stone size and spontaneous passage: <5 mm ~80% pass, 5-7 mm ~50%, >7 mm unlikely; distal stones more likely to pass.

PCNL indications: stones >2 cm, staghorn calculi, lower pole stones >1 cm, shockwave failures; complications include bleeding, colonic injury, pleural injury.

Uric acid stones: radiolucent on plain film, treat with alkalinization (potassium citrate, target urine pH 6.5-7.0) and allopurinol if hyperuricemia.

Cystine stones: hexagonal crystals, positive nitroprusside test, treat with high fluid intake, alkalinization (pH >7.0), D-penicillamine or tiopronin.

Erectile dysfunction: first-line PDE5 inhibitors (contraindicated with nitrates); second-line vacuum erection device or intracavernosal alprostadil; third-line penile prosthesis.

Peyronie's disease: plaque in tunica albuginea, curvature >30° impairs intercourse; stable phase >3 months → collagenase or surgery (plication for <60°, grafting for >60°).

Hypogonadism: morning total testosterone <300 ng/dL on two occasions; treat with testosterone (contraindicated in prostate cancer, untreated severe BPH, polycythemia).

Male infertility evaluation: semen analysis (volume ≥1.5 mL, concentration ≥15 million/mL, motility ≥40%, morphology ≥4% by strict criteria); repeat after 3 months if abnormal.

Azoospermia: obstructive (normal FSH, normal testicular volume, epididymal dilation) vs non-obstructive (elevated FSH, small testes); micro-TESE for non-obstructive.

Varicocele: most common correctable cause of male infertility; left side (85-90%) due to internal spermatic vein drainage into left renal vein; treat if palpable, abnormal semen, or testicular atrophy.

Priapism: ischemic (low-flow) is urologic emergency → aspiration and irrigation, intracavernosal phenylephrine; non-ischemic (high-flow) often observation or embolization.

Premature ejaculation: intravaginal ejaculatory latency time <1 minute (lifelong) or <3 minutes (acquired); treat with behavioral techniques, topical anesthetics, or SSRIs/dapoxetine.

Stress urinary incontinence: leakage with increased abdominal pressure; first-line pelvic floor muscle training; midurethral sling for intrinsic sphincter deficiency or failed conservative therapy.

Overactive bladder: urgency, frequency, nocturia with or without urge incontinence; first-line behavioral therapy, second-line antimuscarinics or beta-3 agonist (mirabegron).

Urodynamics: detrusor overactivity = involuntary detrusor contractions during filling; stress incontinence = leakage with cough/Valsalva without detrusor contraction.

Pelvic organ prolapse quantification (POP-Q): stage 0 = no prolapse, stage 1 = leading edge >-1 cm, stage 2 = -1 to +1 cm, stage 3 = +1 to +(TVL-2), stage 4 = complete eversion.

Vesicovaginal fistula: continuous incontinence after pelvic surgery; diagnosis with speculum exam, methylene blue dye test; repair after 6-12 weeks of tissue healing.

Bladder outlet obstruction in women: uncommon, often iatrogenic (anti-incontinence surgery) or due to prolapse; urodynamics show high pressure/low flow.

Nocturnal enuresis in adults: evaluate for sleep apnea, diabetes, urinary tract infection, and bladder outlet obstruction; treat underlying cause.

Urethral diverticulum: triad of postvoid dribbling, dyspareunia, and dysuria; MRI is best imaging; surgical excision via vaginal approach.

Hypospadias: ventral urethral meatus, dorsal hood, chordee; avoid circumcision at birth; repair at 6-18 months; contraindicated in severe chordee or ambiguous genitalia until evaluation.

Undescended testis: if not descended by 6 months, refer; orchidopexy by 12-18 months to reduce malignancy and infertility risk; intra-abdominal testes may require laparoscopy.

Vesicoureteral reflux (VUR): grading I-V; grades I-III often resolve spontaneously; antibiotic prophylaxis for grades III-V or recurrent febrile UTIs; surgery for breakthrough infections.

Posterior urethral valves: most common cause of lower urinary tract obstruction in boys; prenatal hydronephrosis, thick-walled bladder; treat with catheter drainage and valve ablation.

Cryptorchidism and malignancy: intra-abdominal testes have higher risk of germ cell tumors; orchidopexy does not eliminate risk but allows surveillance.

Testicular torsion: acute scrotum, absent cremasteric reflex, high-riding testis; surgical exploration within 6 hours for salvage; bilateral orchiopexy.

Hydronephrosis in neonates: most common prenatal anomaly; grade by Society for Fetal Urology (SFU) 0-4; grade 4 or worsening renal function → pyeloplasty.

Exstrophy-epispadias complex: abdominal wall defect with exposed bladder; staged reconstruction (closure at birth, epispadias repair at 6-12 months, bladder neck reconstruction at 4-5 years).

Renal transplant workup: HLA typing, crossmatch, viral serologies (CMV, EBV, HIV, hepatitis), cardiac evaluation; living donor evaluation includes renal function and anatomy.

Immunosuppression: induction with basiliximab or antithymocyte globulin; maintenance with calcineurin inhibitor (tacrolimus), antimetabolite (mycophenolate), and steroids.

Transplant complications: vascular thrombosis (early), ureteral stenosis (6-8 weeks), lymphocele, urine leak, rejection (hyperacute, acute, chronic).

Urologic complications after transplant: ureteral stricture (most common, treated with stenting or reimplantation), vesicoureteral reflux, stones, urinary fistula.

BK virus nephropathy: presents with rising creatinine and decoy cells in urine; treat by reducing immunosuppression; graft loss in 10-50%.

Post-transplant malignancy: skin cancer most common, also post-transplant lymphoproliferative disorder (PTLD) associated with EBV; reduce immunosuppression if possible.

Donor nephrectomy: laparoscopic donor nephrectomy preferred; evaluate GFR >80 mL/min, no proteinuria, normal blood pressure.

Transplant ureteral stenosis: usually at ureterovesical anastomosis; treat with balloon dilation and stenting, or surgical revision if recurrent.

Renal trauma: most common solid organ injury in blunt trauma; grade I-IV managed non-operatively; grade V (shattered kidney or avulsion) may require nephrectomy if hemodynamically unstable.

Urethral injury: anterior (straddle injury) presents with blood at meatus, perineal hematoma; posterior (pelvic fracture) with high-riding prostate; avoid catheterization; suprapubic cystostomy if needed.

Urethral stricture: anterior strictures from trauma or infection; posterior from pelvic fracture; treatment options include dilation, internal urethrotomy (for short strictures), and urethroplasty (buccal mucosa graft for long or recurrent).

Bladder trauma: extraperitoneal rupture (associated with pelvic fracture) managed with catheter drainage; intraperitoneal rupture requires surgical repair.

Testicular trauma: blunt trauma → ultrasound to assess rupture; surgical exploration for hematocele or rupture; conservative for contusion.

Penile fracture: rupture of tunica albuginea during intercourse; emergent surgical repair to prevent curvature and erectile dysfunction.

Urethral reconstruction: buccal mucosa graft is gold standard for long anterior strictures; dorsal onlay graft preferred; avoid urethrotomy for strictures >2 cm.

Traumatic ureteral injury: often iatrogenic during pelvic surgery; recognize intraoperatively and repair with stent or reimplantation; delayed diagnosis → nephrectomy risk.

Urinary tract infection: uncomplicated cystitis in women → nitrofurantoin or fosfomycin; pyelonephritis → fluoroquinolone or cephalosporin; avoid fluoroquinolones for uncomplicated cystitis due to resistance.

Complicated UTI: associated with obstruction, catheter, or systemic disease; treat with broad-spectrum antibiotics and relieve obstruction.

Genitourinary tuberculosis: caused by Mycobacterium tuberculosis; presents with sterile pyuria, hematuria, frequency; diagnosis by urine AFB culture (3 early morning samples); treat with 4-drug regimen (isoniazid, rifampin, pyrazinamide, ethambutol) for 6 months.

Prostatitis: acute bacterial (fever, dysuria, tender prostate) → fluoroquinolone for 4-6 weeks; chronic bacterial (recurrent UTI) → 4-12 weeks; chronic pelvic pain syndrome (non-bacterial) → multimodal therapy.

Epididymitis: in young men <35 years, Chlamydia trachomatis or Neisseria gonorrhoeae; in older men, coliforms; treat with ceftriaxone plus doxycycline if STI suspected.

Fournier's gangrene: necrotizing fasciitis of perineum; polymicrobial; emergency debridement and broad-spectrum antibiotics; risk factors diabetes, immunosuppression.

Candiduria: asymptomatic in catheterized patients → no treatment; symptomatic or high-risk (neutropenic, urologic procedure) → fluconazole or amphotericin B.

Renal abscess: presents with fever, flank pain; small (<3 cm) → antibiotics; large (>5 cm) or not responding → percutaneous drainage.

Renal blood flow: 20-25% of cardiac output; autoregulation via afferent arteriole (myogenic) and tubuloglomerular feedback (macula densa).

Glomerular filtration rate: normal 125 mL/min; filtration fraction = GFR/renal plasma flow (~20%); creatinine clearance approximates GFR.

Embryology: ureteric bud from mesonephric duct induces metanephric blastema → kidney; failure of ureteric bud to meet blastema → renal agenesis; abnormal bud position → ectopic ureter or multicystic dysplastic kidney.

Bladder innervation: parasympathetic (S2-S4) via pelvic nerve → detrusor contraction; sympathetic (T11-L2) via hypogastric nerve → relaxation and internal sphincter contraction; somatic (S2-S4) via pudendal nerve → external sphincter.

Prostate anatomy: zones (peripheral, central, transition, anterior fibromuscular); peripheral zone most common site of cancer; transition zone for BPH.

Testosterone synthesis: Leydig cells stimulated by LH; spermatogenesis requires FSH and high intratesticular testosterone; negative feedback via inhibin B and testosterone.

Pharmacology: alpha-1 blockers (tamsulosin, alfuzosin) relax bladder neck and prostate; antimuscarinics for overactive bladder; PDE5 inhibitors potentiate nitric oxide-mediated smooth muscle relaxation.

Acid-base: kidney regulates bicarbonate reabsorption (proximal tubule) and hydrogen ion secretion (distal tubule); aldosterone increases sodium reabsorption and potassium/hydrogen secretion.

Testicular torsion: surgical exploration within 6 hours; if necrotic, orchiectomy; contralateral orchiopexy always.

Priapism: ischemic (low-flow) >4 hours → emergency; aspirate corpora cavernosa, irrigate with saline, inject phenylephrine (500 mcg every 3-5 minutes, max 10 doses); if fails → surgical shunt.

Obstructive pyelonephritis with sepsis: emergency decompression with ureteral stent or percutaneous nephrostomy within 6 hours; antibiotics after cultures.

Fournier's gangrene: emergency surgical debridement; broad-spectrum antibiotics (vancomycin + piperacillin-tazobactam + clindamycin); repeat debridement as needed.

Acute urinary retention: catheterize if unable; if unsuccessful → suprapubic catheter; treat underlying cause (BPH, stricture, neurogenic).

Perioperative antibiotics: for prosthetic surgery (penile prosthesis, artificial urinary sphincter) use vancomycin + gentamicin; for transrectal prostate biopsy use fluoroquinolone or ceftriaxone.

Venous thromboembolism prophylaxis: for major pelvic surgery (cystectomy, prostatectomy) use low-molecular-weight heparin plus mechanical prophylaxis.

Fluid management in urologic surgery: avoid overhydration in TURP (risk of TUR syndrome); use isotonic irrigation fluid (glycine or sorbitol) and monitor sodium.