FEBU cheat sheet

PSA is organ-specific, not cancer-specific: benign prostatic hyperplasia, prostatitis, urinary retention, catheterisation and ejaculation all raise it; a repeat PSA after 4-6 weeks, ideally after treating infection, is the standard confirmation step.

PSA density (PSA/prostate volume) above 0.15 ng/mL per mL and PSA velocity above 0.75 ng/mL per year are classical triggers for biopsy; free-to-total PSA below 10-15% shifts probability toward cancer, above 25% toward benign disease.

Prostate cancer risk stratification (D'Amico/EAU): low risk = PSA <=10 ng/mL, Gleason <=6 (ISUP 1), cT1-cT2a; intermediate = PSA 10-20 or ISUP 2-3 or cT2b; high = PSA >20 or ISUP 4-5 or >=cT2c.

Gleason grading: patterns 1-5 summed; ISUP grade group 1 = Gleason 3+3, group 2 = 3+4, group 3 = 4+3, group 4 = 8 (4+4, 3+5, 5+3), group 5 = 9-10. Tertiary pattern 5 upgrades the score.

Testicular germ cell tumours: pure seminoma is radiosensitive and usually stage I managed by surveillance or single-agent carboplatin; non-seminoma stage I is managed by surveillance, nerve-sparing RPLND or one cycle BEP depending on risk factors (lymphovascular invasion, embryonal predominance).

Renal cell carcinoma: partial nephrectomy is preferred for T1 tumours when technically feasible; radical nephrectomy for tumours unsuitable for nephron-sparing surgery. Clear cell RCC is the commonest subtype and is sensitive to VEGF-targeted therapy and checkpoint inhibitors.

Upper tract urothelial carcinoma: radical nephroureterectomy with bladder cuff excision is standard for high-risk disease; post-operative single instillation of intravesical chemotherapy and adjuvant systemic chemotherapy are used for high-risk disease.

Bladder cancer: non-muscle-invasive disease (Ta, T1, CIS) is managed by TURBT plus risk-adapted intravesical therapy - BCG for high-risk and CIS; radical cystectomy for BCG-unresponsive disease or muscle-invasive (>=T2) disease.

Stones: <5 mm stones pass spontaneously in most cases; 5-10 mm may be managed by ESWL or ureteroscopy; >10 mm or impacted stones favour ureteroscopy or PCNL. Uric acid stones dissolve with urinary alkalinisation; struvite stones require complete removal plus treatment of infection.

Oral stations are typically structured as: clinical scenario, diagnostic reasoning, investigation choice, management options with risks/benefits, and follow-up; answer in that order to demonstrate a systematic approach.

Justify every investigation by stating what decision it changes: e.g. CT urography for haematuria evaluates upper tract urothelial carcinoma; MRI prostate for staging before radical treatment; DMSA for differential renal function in paediatric or obstructed kidneys.

For any oncological answer, state TNM stage, grade/ISUP, risk group, then treatment options and their trade-offs (continence, potency, renal function, survival).

When asked about complications, use the Clavien-Dindo classification: grade I no intervention, grade II pharmacological, grade III intervention (IIIa/IIIb), grade IV organ failure/ICU, grade V death.

Emergency scenarios to rehearse aloud: obstructed infected kidney (urgent decompression by nephrostomy or stent plus antibiotics), testicular torsion (immediate scrotal exploration, no imaging delay), priapism (corporal aspiration/irrigation for ischaemic priapism), Fournier's gangrene (surgical debridement plus broad-spectrum antibiotics).

Guideline sources to cite by name: EAU guidelines, AUA, NICE, ICC (International Continence Society) terminology for urodynamics and incontinence; state the year and the recommendation grade where possible.

For paediatric urology questions, know the key numbers: undescended testis orchidopexy ideally by 12-18 months; vesicoureteric reflux grades I-V; posterior urethral valve presents with bilateral hydronephrosis and thick-walled bladder in a male infant.

Andrology and infertility: WHO 2021 semen analysis reference limits include volume >=1.4 mL, concentration >=16 million/mL, total motility >=42%, normal morphology >=4%; varicocele repair is considered for palpable varicocele with abnormal semen parameters.

Incontinence and urodynamics: stress incontinence = leakage on effort; urgency incontinence = leakage with urgency; detrusor overactivity on cystometry; bladder outlet obstruction on pressure-flow study = high pressure, low flow.