Urology and Transplant Surgery
What the exam tests
This domain covers renal colic, bladder outlet obstruction, prostate and bladder cancer, testicular torsion and the principles of kidney transplantation.
Core rules
- Suspected ureteric colic is investigated with non-contrast CT KUB; check renal function before contrast studies.
- An obstructed infected kidney is an emergency: resuscitate, give antibiotics and decompress with a nephrostomy or stent. Antibiotics alone are insufficient.
- Testicular torsion is a clinical diagnosis; detorsion and bilateral fixation should occur urgently, ideally within six hours.
- Prostate cancer assessment includes PSA, digital rectal examination, MRI and biopsy with Gleason grading; management depends on risk group and life expectancy.
- Transplant immunosuppression requires adherence and therapeutic monitoring; rising creatinine suggests rejection, drug toxicity, obstruction or infection.
Worked example
A 55-year-old presents with flank pain, fever and rigors. CT shows an obstructing ureteric stone with hydronephrosis. Blood cultures are taken, antibiotics are started, and an urgent nephrostomy is inserted. Definitive stone treatment is deferred until the infection is controlled.
Traps
Treating an infected obstructed kidney with antibiotics alone; dismissing testicular pain as epididymitis; giving intravenous contrast to a patient with deteriorating renal function without reassessment; and attributing a rising creatinine after transplant to dehydration only.