EAU Entrance Exam cheat sheet

Prostate cancer risk stratification (D'Amico): low = PSA ≤10 ng/mL, Gleason ≤6 (ISUP 1), cT1–T2a; intermediate = PSA 10–20 or Gleason 7 (ISUP 2–3) or cT2b; high = PSA >20 or Gleason 8–10 (ISUP 4–5) or ≥cT2c.

Renal cell carcinoma subtypes: clear cell ~75% (VHL/3p loss), papillary 10–15% (type 1 MET, type 2 FH), chromophobe ~5%; clear cell responds to VEGF-TKI and mTOR inhibitors, papillary and chromophobe less so.

Bladder cancer: non-muscle-invasive (Ta, T1, CIS) treated by TURBT ± intravesical BCG (high risk) or mitomycin; muscle-invasive (≥T2) requires radical cystectomy or trimodality therapy; CIS is a flat high-grade lesion with the highest progression risk.

Upper tract urothelial carcinoma: radical nephroureterectomy with bladder cuff is standard for high-grade or ≥T1 tumors; kidney-sparing ureteroscopy/laser is reserved for low-grade, low-volume, or imperative indications.

Testicular germ cell tumors: seminoma vs non-seminoma distinguished by AFP (never elevated in pure seminoma); HCG may rise in both; orchiectomy is both diagnostic and first therapeutic step; stage I seminoma options are surveillance, single-agent carboplatin, or radiotherapy.

Penile cancer: SCC most common; HPV-related basaloid/warty subtypes; lymph node staging by inguinal lymphadenectomy for ≥T1b or palpable nodes; primary treatment is organ-sparing surgery (glansectomy, partial penectomy) with 2 cm margins.

Adrenal incidentaloma workup: assess hormonal function (cortisol, aldosterone/renin, metanephrines, androgens) and imaging; >4–6 cm or heterogeneous/irregular lesions raise malignancy risk and favor adrenalectomy.

Erectile dysfunction first-line: PDE5 inhibitors (sildenafil, tadalafil); contraindicated with nitrates; failure of PDE5i → intracavernosal alprostadil or vacuum device; refractory → penile prosthesis.

Testosterone deficiency: diagnose with two morning (before 11:00) total testosterone measurements <12 nmol/L plus symptoms; exclude hyperprolactinemia and check hematocrit, PSA, and liver function before and during therapy.

Premature ejaculation: lifelong (from first sexual experience) vs acquired; first-line behavioral therapy plus topical lidocaine/prilocaine or off-label SSRIs (dapoxetine where approved).

Peyronie's disease: stable phase (≥3 months, no pain) with curvature >30° and bother → surgery (plication for adequate length, grafting for severe curvature, prosthesis if ED).

Male infertility: azoospermia is obstructive (normal FSH, normal testicular volume, post-vasectomy) or non-obstructive (elevated FSH, small testes); micro-TESE for non-obstructive azoospermia.

Varicocele: left-sided in ~90% because the left internal spermatic vein drains at a right angle into the left renal vein; grade by Valsalva; treat if palpable with abnormal semen parameters or pain.

Priapism: ischemic (low-flow) is painful, rigid, and a urologic emergency requiring aspiration ± phenylephrine; non-ischemic (high-flow) is painless, often post-traumatic, and may be observed.

Stone composition: calcium oxalate ~70–80%, calcium phosphate ~5–10%, uric acid ~5–10% (radiolucent, dissolves with urine alkalinization), struvite (infection, staghorn), cystine (hexagonal, radiopaque).

Acute ureteral colic: non-contrast CT is gold standard; NSAIDs are first-line analgesia; stones ≤5 mm usually pass spontaneously; 5–10 mm may be offered MET (tamsulosin) or SWL; >10 mm or obstruction with infection → decompression (stent or nephrostomy).

Shockwave lithotripsy: best for stones <20 mm in the renal pelvis/upper ureter with favorable density (<1000 HU) and skin-to-stone distance <10 cm; contraindicated in pregnancy, coagulopathy, and untreated UTI.

Ureteroscopy with laser lithotripsy is first-line for distal ureteral stones and for stones >10 mm; PCNL is first-line for renal stones >20 mm or lower pole stones >10–15 mm.

Metabolic evaluation: 24-hour urine for calcium, oxalate, citrate, uric acid, sodium, and volume in recurrent or high-risk stone formers; hypercalciuria, hypocitraturia, and hyperoxaluria are common findings.

Prevention: fluid intake to achieve urine output >2.5 L/day; low sodium and normal dietary calcium; thiazides for hypercalciuria; potassium citrate for hypocitraturia; allopurinol for hyperuricosuria.

Struvite stones require complete stone removal plus eradication of urease-producing infection (Proteus, Klebsiella); residual fragments perpetuate infection.

Stress urinary incontinence: leakage with effort/sneezing, no detrusor overactivity; first-line pelvic floor muscle training; midurethral sling is standard surgical treatment; bulking agents for frail patients.

Overactive bladder: urgency, frequency, nocturia ± urge incontinence; first-line bladder training, fluid/caffeine modification, and pelvic floor training; then antimuscarinics or beta-3 agonist (mirabegron); third-line intradetrusor onabotulinumtoxinA, sacral neuromodulation, or tibial nerve stimulation.

Detrusor overactivity is diagnosed by urodynamics showing involuntary detrusor contractions during filling; it is not synonymous with symptoms of OAB.

Post-void residual: elevated PVR suggests detrusor underactivity or bladder outlet obstruction; in women, significant residual warrants evaluation for prolapse or neurologic disease.

Pelvic organ prolapse: POP-Q staging; anterior wall (cystocele) most common; asymptomatic prolapse can be observed; pessary or surgery (colporrhaphy, sacrocolpopexy) for symptomatic cases.

Benign prostatic obstruction: IPSS symptom score, uroflowmetry, PVR, PSA; medical therapy with alpha-blockers (rapid symptom relief) or 5-alpha-reductase inhibitors (prostate >40 mL, reduces progression); combination for larger glands.

Nocturia: assess with a bladder diary; causes include nocturnal polyuria (defined by nocturnal urine volume fraction >33% of 24-hour volume), reduced bladder capacity, and sleep disorders.

Uncomplicated cystitis in women: first-line nitrofurantoin (5 days), fosfomycin single dose, or trimethoprim-sulfamethoxazole (3 days if local resistance <20%); fluoroquinolones are reserved due to collateral damage.

Acute pyelonephritis: urine culture before antibiotics; outpatient therapy with fluoroquinolone or third-generation cephalosporin; admit for sepsis, obstruction, pregnancy, or inability to tolerate oral intake.

Complicated UTI: fever plus obstruction or structural abnormality; requires urgent decompression (stent/nephrostomy) plus culture-directed antibiotics; do not rely on antibiotics alone.

Prostatitis: acute bacterial (fever, perineal pain, do not massage prostate) vs chronic bacterial vs chronic pelvic pain syndrome (CP/CPPS, category III, no proven infection); alpha-blockers and antibiotics are used in chronic bacterial disease.

Epididymitis: in young sexually active men, Chlamydia trachomatis and Neisseria gonorrhoeae are common; in older men, Gram-negative enteric organisms; treat with ceftriaxone plus doxycycline when STI suspected.

Fournier's gangrene: necrotizing fasciitis of perineum/genitalia; polymicrobial; requires urgent surgical debridement plus broad-spectrum antibiotics; diabetes is a major risk factor.

Genital tuberculosis and schistosomiasis are causes of chronic granulomatous lower urinary tract disease; schistosomal infection is associated with bladder SCC.

Vesicoureteral reflux grades I–V; grade I–III often managed with surveillance and antibiotic prophylaxis, while grade IV–V or breakthrough infections may need ureteral reimplantation or endoscopic injection.

Hypospadias: triad of ventral meatus, ventral curvature (chordee), and dorsal hood; never circumcise before repair; repair at 6–18 months; distal types may be tubularized incised plate (TIP).

Undescended testis: if not descended by 6 months, orchiopexy is recommended, ideally by 12–18 months, to reduce infertility and malignancy risk; bilateral non-palpable testes suggest disorder of sex development.

Posterior urethral valves: antenatal hydronephrosis, thick-walled bladder, bilateral hydroureteronephrosis in a male infant; confirm with voiding cystourethrogram; treat with catheter drainage and valve ablation.

Cryptorchidism and disorders of sex development: karyotype and hormonal evaluation are required for ambiguous genitalia; do not assign sex before evaluation.

Vesicoureteral reflux and febrile UTI: febrile UTI in an infant warrants imaging; renal ultrasound plus VCUG when indicated; DMSA scan assesses cortical scarring.

Testicular torsion: acute scrotal pain with high-riding, transversely oriented testis and absent cremasteric reflex; surgical exploration within 6 hours is critical; bilateral fixation if viable.

Renal transplant workup: ABO compatibility, HLA typing, and crossmatch; panel-reactive antibody (PRA) and donor-specific antibodies guide immunologic risk; living donor grafts have superior outcomes to deceased donor grafts.

Immunosuppression: induction (basiliximab or anti-thymocyte globulin) plus maintenance with a calcineurin inhibitor (tacrolimus), an antimetabolite (mycophenolate), and corticosteroids.

Renal transplant complications: vascular thrombosis (early), ureteral stenosis/leak, lymphocele, and chronic allograft nephropathy; fever and graft tenderness suggest infection or rejection.

Renal artery stenosis: suspected in refractory hypertension, flash pulmonary edema, or worsening renal function after ACE inhibitor; treated with medical therapy; revascularization for selected cases.

Renal artery aneurysm: most are asymptomatic and managed by surveillance; intervention for size >2 cm, rapid growth, or in women of childbearing age.

Varicocele and nutcracker syndrome: left renal vein compression may cause hematuria and left-sided varicocele; treat with stenting or venous transposition in symptomatic cases.

Renal transplant rejection: hyperacute (minutes, preformed antibodies), acute (days–months, cellular or antibody-mediated), and chronic (months–years, interstitial fibrosis and tubular atrophy).

Renal trauma: most blunt injuries are managed nonoperatively; hemodynamic instability or grade V (shattered kidney, avulsion of pedicle) requires exploration; CT with contrast is the imaging standard.

Urethral injury: posterior (pelvic fracture) vs anterior (straddle injury); blood at meatus or high-riding prostate suggests urethral injury; do not catheterize; perform retrograde urethrogram.

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

Testicular trauma: blunt rupture requires urgent exploration and repair; ultrasound may show heterogeneous parenchyma or loss of tunica albuginea continuity.

Urethral stricture: anterior strictures often from trauma or instrumentation; treatment options include dilation, internal urethrotomy, and graft urethroplasty for recurrent or long strictures.

Ureteral injury: often iatrogenic during pelvic surgery; recognized intraoperatively by direct repair or stenting; delayed presentation with urinoma or fistula.

Penile fracture: sudden snap, detumescence, and hematoma; emergent surgical repair of tunica albuginea; associated urethral injury in 10–20%.

Renal physiology: glomerular filtration rate ~125 mL/min; proximal tubule reabsorbs ~65% of filtered sodium and water; loop of Henle creates the medullary osmotic gradient; ADH acts on the collecting duct.

Acid-base: the kidney regulates bicarbonate reabsorption and hydrogen ion secretion; type 1 renal tubular acidosis is a distal defect with inability to acidify urine (urine pH >5.5).

Imaging modalities: ultrasound is first-line for hydronephrosis and renal masses; non-contrast CT for stones; multiparametric MRI for prostate cancer staging; bone scan for prostate cancer metastases.

PSA: produced by prostatic epithelium; elevated in BPH, prostatitis, and prostate cancer; density and velocity improve specificity; PSA is not a screening test for women.

Renal mass imaging: Bosniak classification for cystic renal masses; category I–II benign, III indeterminate, IV malignant; contrast enhancement is the key feature.

Urodynamics: cystometry measures bladder compliance and detrusor activity; pressure-flow study distinguishes detrusor underactivity from outlet obstruction.

Tumor markers: AFP and beta-HCG for germ cell tumors; CA-125 not used for urologic cancers; CEA not specific; chromogranin for neuroendocrine tumors.