FEBU Part 1 cheat sheet

Male hypogonadism is confirmed by two morning fasting total testosterone measurements; testosterone replacement is contraindicated in untreated or metastatic prostate cancer and active thromboembolic disease.

Erectile dysfunction: PDE5 inhibitors are first-line therapy; they are contraindicated with any nitrate, and testosterone should be checked when libido is low or PDE5 therapy fails.

Left varicocele results from internal spermatic vein drainage into the left renal vein; repair is offered for infertility with abnormal semen parameters or symptomatic scrotal pain.

Peyronie disease surgery is reserved for the stable phase, defined as more than 3 months without progression, with curvature greater than 30 degrees or bother; plication, grafting, or prosthesis is selected by erection quality.

Testicular torsion is a clinical diagnosis; Doppler ultrasound must not delay exploration, and bilateral orchidopexy is performed when the testis is salvageable.

Hydrocele transilluminates and is repaired only when symptomatic; a solid, non-transilluminating scrotal mass requires ultrasound and tumor markers.

PSA is prostate-epithelium specific but not cancer-specific; it rises with benign prostatic hyperplasia, prostatitis, ejaculation, instrumentation, and prostate cancer.

Paraphimosis is reduced manually after compression; dorsal slit is performed if reduction fails; recurrent balanoposthitis or ballooning phimosis is an indication for circumcision.

Prostate cancer risk groups use PSA, Gleason/ISUP grade group, and TNM; ISUP group 1 is Gleason 3+3, group 2 is 3+4, group 3 is 4+3, group 4 is Gleason 8, and group 5 is Gleason 9-10.

PSA screening is a shared decision, typically discussed between ages 55 and 69; screening is generally stopped when life expectancy is less than 10-15 years.

Non-muscle-invasive bladder cancer risk stratification: low-grade Ta is low risk; T1, high-grade Ta, CIS, multifocal, or recurrent disease warrants intravesical BCG; muscle-invasive disease is treated with neoadjuvant cisplatin-based chemotherapy plus radical cystectomy.

Pure seminoma may elevate beta-hCG and LDH but not alpha-fetoprotein; elevated AFP indicates nonseminomatous or mixed germ cell tumor, and radical inguinal orchiectomy is the initial treatment for suspected testicular cancer.

Clear cell renal cell carcinoma is the most common subtype and is linked to VHL inactivation; papillary and chromophobe subtypes have distinct genetics and behavior.

Upper tract urothelial carcinoma is associated with aristolochic acid, Lynch syndrome, and tobacco; high-risk disease is treated with radical nephroureterectomy and bladder cuff excision.

Penile cancer is usually squamous cell carcinoma and is linked to HPV; organ-sparing surgery is possible for small distal lesions, and lymph node status is the strongest prognostic factor.

Metastatic prostate cancer: androgen deprivation therapy is the backbone; an androgen receptor pathway inhibitor or docetaxel is added for high-volume or high-risk metastatic disease.

Calcium oxalate stones are the most common; struvite stones are infection-related and associated with urease-producing organisms such as Proteus.

Non-contrast CT of the kidneys, ureters, and bladder is first-line imaging for suspected acute ureteral colic in adults; ultrasound is preferred in pregnancy and children.

NSAIDs are first-line analgesia for renal colic; they are avoided in renal impairment, peptic ulcer disease, and the third trimester of pregnancy.

Ureteral stones smaller than 5 mm pass spontaneously in most cases; stones larger than 10 mm rarely pass; alpha-blocker medical expulsive therapy may help distal ureteral stones of 5-10 mm.

An obstructing stone with fever or sepsis is an emergency: urgent decompression with a ureteral stent or percutaneous nephrostomy plus antibiotics.

Uric acid stones are radiolucent and dissolve with urine alkalinization to pH 6.5-7.0; over-alkalinization above pH 7.0 promotes calcium phosphate stones.

Percutaneous nephrolithotomy is first-line for renal stones larger than 2 cm or staghorn calculi; ureteroscopy is used for mid/distal ureteral stones and selected renal stones; ESWL is used for selected renal stones smaller than 2 cm.

Cystine stones show hexagonal crystals and a positive nitroprusside test; treatment is high fluid intake, urine alkalinization, and cystine-binding thiol drugs.

Overactive bladder is urgency with frequency and nocturia, with or without urgency incontinence; initial therapy is behavioral therapy and bladder training, followed by an antimuscarinic or beta-3 agonist.

Stress urinary incontinence is leakage with effort, cough, or sneeze; pelvic floor muscle training is first-line, and midurethral sling is a standard surgical option.

Urodynamics assess detrusor overactivity, compliance, capacity, and leak point pressures; invasive testing is not required before conservative therapy for uncomplicated overactive bladder.

Neurogenic bladder: suprasacral lesions cause detrusor overactivity and risk of high storage pressure; sacral or lower lesions cause areflexia; clean intermittent catheterization protects the upper tract.

BPH/LUTS: the IPSS quantifies symptoms; alpha blockers improve symptoms quickly; 5-alpha reductase inhibitors reduce prostate volume and are best for glands larger than 30-40 mL; combination therapy is used for progression risk.

Acute urinary retention is painful and requires immediate catheterization; chronic retention is painless with high residual volume and can cause overflow incontinence.

Post-void residual should be measured when retention is suspected; a bladder diary is essential for evaluating nocturia and frequency.

Nocturnal polyuria is present when nighttime urine volume exceeds 20% of 24-hour volume in young adults or 33% in older adults.

Undescended testis: referral is indicated if the testis has not descended by 6 months corrected age; orchidopexy by 12-18 months reduces infertility and malignancy risk.

Hypospadias: ventral meatus, dorsal hood, and possible chordee; circumcision is avoided before repair, which is usually performed at 6-18 months of age.

Posterior urethral valves: male infant with poor stream, bilateral hydronephrosis, and a thick-walled bladder; initial management is catheter drainage followed by cystoscopic valve ablation.

Vesicoureteral reflux is graded I-V; febrile urinary tract infection in a child warrants evaluation; antibiotic prophylaxis and surgery are selected for high-grade reflux or breakthrough infections.

Antenatal hydronephrosis: postnatal ultrasound timing depends on severity; most mild cases resolve; MAG3 assesses drainage and function, while DMSA assesses renal scarring.

Wilms tumor presents as an abdominal mass in a young child; treatment is nephrectomy plus chemotherapy, often after preoperative chemotherapy for large tumors; WT1 and WAGR associations exist.

Nocturnal enuresis after age 5 is treated with an alarm or desmopressin; constipation, diabetes, urinary tract infection, and sleep apnea are excluded first.

Testicular torsion in boys is associated with bell-clapper deformity and requires urgent exploration; neonatal torsion is extravaginal and often presents as a firm scrotal mass.

Renal trauma: most blunt injuries are managed nonoperatively when hemodynamically stable; contrast-enhanced CT is the imaging standard; surgery is indicated for hemodynamic instability or grade V vascular injury.

Suspected urethral injury: blood at the meatus, perineal hematoma, and high-riding prostate; retrograde urethrogram is performed before catheterization; suprapubic catheter is placed for complete disruption.

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

Penile fracture: tunica albuginea tear causes a snap, detumescence, and hematoma; immediate surgical repair reduces long-term curvature and erectile dysfunction.

Testicular rupture: scrotal ultrasound is used, followed by urgent exploration and repair of the tunica albuginea; orchiectomy is performed if the testis is nonviable.

Urethral stricture: retrograde urethrogram assesses anterior stricture; buccal mucosa graft is preferred for long anterior strictures; posterior strictures may require anastomotic urethroplasty.

Iatrogenic ureteral injury during pelvic surgery is repaired with stenting or reimplantation; delayed diagnosis causes urinoma or fistula.

Traumatic ureteral avulsion during ureteroscopy may not be manageable with stenting alone; open repair or ileal ureter is used for long defects.

Uncomplicated cystitis in women: nitrofurantoin, fosfomycin, or trimethoprim-sulfamethoxazole; fluoroquinolones are avoided as first-line therapy.

Acute pyelonephritis: fever, flank pain, and pyuria; admission is indicated for sepsis, obstruction, pregnancy, or inability to take oral therapy; an obstructed infected kidney requires decompression.

Acute bacterial prostatitis: fever, perineal pain, and a tender prostate; vigorous prostate massage is avoided; treatment is a fluoroquinolone or third-generation cephalosporin.

Epididymitis: tender epididymis; Doppler ultrasound excludes torsion; sexually transmitted pathogens are common in young sexually active men, and enteric organisms in older men.

Fournier gangrene: polymicrobial necrotizing fasciitis; treatment is urgent broad-spectrum antibiotics and surgical debridement, often repeated.

Sterile pyuria: consider tuberculosis, chlamydia, stones, malignancy, interstitial cystitis, and recent antibiotic use; TB cultures and risk-factor evaluation are obtained.

Urethritis: gonorrhea and chlamydia are common; NAAT is performed on first-void urine; treatment is ceftriaxone plus doxycycline.

Intravesical BCG can cause BCG sepsis; treatment is isoniazid, rifampin, and corticosteroids; BCG is not given after traumatic catheterization.

CKD is staged by GFR: G1 is at least 90, G2 is 60-89, G3a is 45-59, G3b is 30-44, G4 is 15-29, and G5 is less than 15 mL/min/1.73 m2.

AKI by KDIGO: creatinine rise of at least 0.3 mg/dL within 48 hours, at least 1.5 times baseline within 7 days, or urine output less than 0.5 mL/kg/h for 6 hours.

Dialysis indications are remembered as AEIOU: acidosis, electrolyte disorder such as hyperkalemia, intoxication, fluid overload, and uremia.

Transplant immunosuppression: induction with basiliximab or antithymocyte globulin; maintenance with tacrolimus, mycophenolate, and corticosteroids.

Hyperacute rejection is antibody-mediated and occurs minutes after reperfusion; acute cellular rejection occurs days to months; chronic rejection causes progressive graft dysfunction.

Post-transplant complications include ureteral stenosis or leak, lymphocele, renal artery thrombosis, BK nephropathy, and CMV; creatinine and immunosuppression levels are monitored.

Living donor kidney transplantation has better long-term outcomes than deceased donor transplantation; donor evaluation includes GFR, blood pressure, proteinuria, and diabetes screening.

Hyperkalemia with ECG changes: intravenous calcium gluconate is given first, then insulin-glucose, a beta-2 agonist, bicarbonate if acidotic, and dialysis for refractory renal failure.

Testicular torsion: urgent exploration, detorsion, and bilateral orchidopexy; Doppler ultrasound must not delay surgery when clinical suspicion is high, because salvage falls with time.

Ischemic priapism lasting more than 4 hours: aspirate the corpora cavernosa and inject phenylephrine; surgical shunt is used if this fails.

Obstructed infected kidney: fever plus hydronephrosis plus stone requires urgent decompression with a stent or nephrostomy plus antibiotics.

Acute urinary retention: urethral catheterization is first; suprapubic catheterization is used if urethral catheterization fails; post-obstructive diuresis is monitored.

Paraphimosis: manual reduction after compression; dorsal slit is performed if reduction is unsuccessful.

Fournier gangrene: immediate broad-spectrum antibiotics and surgical debridement; imaging must not delay treatment.

Renal colic with a solitary kidney or bilateral obstruction: urgent decompression is indicated when there is anuria or renal failure.

Penile fracture and testicular rupture both require urgent surgical exploration.

Renal blood flow is 20-25% of cardiac output; GFR is about 125 mL/min; the proximal tubule reabsorbs about 65-70% of filtered sodium and water.

Aldosterone increases sodium reabsorption and potassium secretion in the distal nephron; ADH increases collecting duct water permeability through aquaporin-2.

Micturition: parasympathetic fibers from S2-S4 contract the detrusor; sympathetic fibers from T10-L2 relax the detrusor and contract the bladder neck; the pudendal nerve controls the external sphincter.

Prostate zones: the peripheral zone is the main site of prostate cancer; the transition zone is the main site of benign prostatic hyperplasia; the central zone surrounds the ejaculatory ducts.

Testosterone is produced by Leydig cells under LH stimulation; FSH stimulates Sertoli cells and spermatogenesis; inhibin B provides negative feedback on FSH.

Kidney embryology: pronephros, mesonephros, and metanephros; the ureteric bud induces the metanephric blastema; failure of ascent causes pelvic kidney; horseshoe kidney is trapped by the inferior mesenteric artery.

Acid-base handling: the kidneys reabsorb filtered bicarbonate and excrete hydrogen and ammonium; hyperkalemia impairs ammonium excretion and worsens metabolic acidosis.

Stone formation requires supersaturation, nucleation, crystal growth, and aggregation; inhibitors include citrate, magnesium, and macromolecules.