This document provides an overview of common urology cases that may appear in OSCE exams, including histories, examinations, and skills. It discusses renal colic, UTIs, prostate issues, and hematuria. Examinations covered include renal transplant, testicular exam, and prostate exam. Skills mentioned are catheter placement and urine dip. Additional history taking points for prostate, pyelonephritis, and hematuria issues are outlined. The document also reviews examinations, investigations, renal calculi, dialysis access, bladder tumor procedures, and basics of GFR.

1. Common Urology/renal
cases
Mr Patrick Gordon
CT1 Urology Derriford

2. Common OSCE topics
Histories
• Renal Colic
• UTI’s/pyelonephritis
• Prostate
• Haematuria
Examinations
• Renal Transplant
• Testicular
• Prostate
Skills
• Catheter
• Urine dip
30min presentation so will briefly touch on what commonly comes up in
exams, additional points can be discussed in breakout sessions.

3. Additional points in Urological
History
Remember the actors will lead you in the right direction, stick to
usual format plus a few of these key points to score top marks
Prostate
Flow, double micturation, nocturia, urgency, perineal pain (prostitis)
: back pain, weight loss, retention, FHx, loss appetite
Pyelonephritis
Fevers, Rigors, dysuria, polyuria, vomiting, back/loin pain, previous
episodes. Pregnant? DM?

4. Haematuria: ‘TITS’
Blood thinners? Previous episodes? Painless? Systemic
features (rash-vasculitis), travel (parasites), new
medications
Testicular swelling: unlikely to come up, additional info
end of lecture
Testicular tumour:
80% painless lump, pain, signs mets, new hydrocoele,
previous undescended testes.

5. Examination

6. Dialysis access
 Peritoneal dialysis:
1. Continuous ambulatory peritoneal dialysis (CAPD)
2. Continuous cycling peritoneal dialysis (CCPD)
 Haemodialysis: around 6hrs x3 week

7. Investigations
Bloods: renal function, Ca2+ & Uric acid, PSA
Urine dip/MSU: glucose, ketones, blood, bilirubin, protein,
pH. Micro RCC,WBC, casts, crystals, organisms (>106
bacteria/ml +ve).
Imaging: USS, X-KUB, IVU, CT, radionuclide scan.
Cystoscopy: flexible or rigid.
Urodynamics: assess storage and voiding function.

8. Renal Calculi
 Def: Crystal aggregates: pelvis>urethra
 PP: 2% pop, : 4:1
 Types:
1. Ca2+ oxylate (diet,>Ca2+, idiopatic)
2. Uric acid (gout, ileostomies)
3. UTI induced (urease>ammonia>stone)

9. Presentation
 NOTHING!!!
 Pain: loin>groin, last hours, severe.
 Nausea & Vomiting
 Pyrexia (if assoc UTI)
 Haematuria (micro)
 Frequency: bladder stones
 Renal failure

10. Differential Diagnosis
 Pyelonephritis
 Renal Cell Carcinoma
 Muscular/rib pain
 Biliary colic
 Pancreatitis
 Appendicitis
 Salpingitis
 ECTOPIC
AAA/DISSECTION

11. Investigations
 Hx: diet, dehydration, predisposing illness
 Bloods: U&E’s, calcium & oxylate
 Urine dip/MSU
 Imaging: CTKUB, KUB-XR: visible scout?

12. Treatment
 Analgesia: PR diclofenac
 Antiemetics +/- abx
 α-blockers
 Increase fluid intake (>3L day)
 <5mm, usually pass (follow up clinic)
 If >6mm (pain, obstruction, growing):
1. ESWL (70%)
2. Endoscopy
3. Retrograde stents

13. Complications
 Infected hydronephrosis: not to miss, rapid
sepsis>death. Sepsis 6’s. Urgent decompression.
 Complete Ureteric obstruction
80% pass own, 20% hospitalised.
Recurrence 14% @ 1yr, 52% & 10yrs

14. Breakout sessions
What would you especially find useful?
Though we could talk through catheters, and do a couple
of scenarios with interesting twists.

15. Transurethral resection of bladder Tumour
procedure used to diagnose bladder cancer and remove any unusual growths or
tumours on your bladder wall.
Procedure: last 14-45mins, rigid cystoscopy passed and fluid
filling bladder to visualise bladder. With special loop with
electrical current cut lesion out.
After: After catheter left in place (usually 24hrs) and irrigation if
clots. Observed overnight and appointment for TWOC if
needed. Drink +++ fluids and abx if given
SE: infection, haematuria, pain
Complications: hole, retention, pain.
Offer a leaflet!

16. basics
 GFR V-I: <15, 15-30, 30-60, 60-90, >90
 GFR IV formula age, sex, race, normalised S.A. Can be
measured.
 Nephrectomy/complete obstruction reduce GFR 20%

17. Testicular Swellings
Cystic/separate testis: epididymal cyst, spermatocoele.
Testis lie within swelling: Hydrocoele (transilluminate),
haematocoele (no transillumination).
Solid/separate testis: epididymitis, torsion hydatid morgagni.
Solid/within testis: torsion, tumour, gumma, orchitis
Can’t get above: direct inguinal, varococoele
***Prehn’s sign: pain testicle relieved on raising scrotum –ve
torsion, +ve epididymitis