13/08/2024 – Renal and Urology

Question Easy:
A 65-year-old man presents with symptoms of urinary urgency, frequency, and nocturia. On examination, his prostate is enlarged but smooth. What is the most likely diagnosis? 🤔

A) Prostate cancer
B) Benign prostatic hyperplasia
C) Acute prostatitis
D) Bladder cancer
E) Urethral stricture

Explanations & Answers:

Question Easy Answer:
B) Benign prostatic hyperplasia

Question Easy Explanation:
Benign prostatic hyperplasia (BPH) is common in older men and presents with urinary urgency, frequency, nocturia, and a smooth, enlarged prostate on examination. NICE guidelines suggest managing BPH with lifestyle modifications and medical treatment if necessary, such as alpha-blockers or 5-alpha reductase inhibitors.

Question Medium:
A 42-year-old woman presents with recurrent urinary tract infections (UTIs). On further investigation, she is found to have renal stones. Which of the following is the best initial imaging modality to diagnose renal stones? 🔍

A) Intravenous urography
B) Abdominal X-ray
C) Non-contrast CT scan
D) Renal ultrasound
E) MRI

Explanations & Answers:

Question Medium Answer:
C) Non-contrast CT scan

Question Medium Explanation:
A non-contrast CT scan is the gold standard for diagnosing renal stones, providing high sensitivity and specificity. The NHS and NICE guidelines recommend this modality for rapid and accurate detection of stones, especially in the context of recurrent UTIs or suspected complications.

Question Hard:
A 28-year-old man presents with hematuria and flank pain. Imaging reveals a 3 cm mass in the left kidney. Further tests indicate it is a renal cell carcinoma. Which of the following is the best surgical treatment option for this patient? ✂️

A) Surveillance
B) Nephrectomy
C) Partial nephrectomy
D) Radiotherapy
E) Chemotherapy

Explanations & Answers:

Question Hard Answer:
C) Partial nephrectomy

Question Hard Explanation:
For a small renal cell carcinoma (less than 4 cm), partial nephrectomy is often preferred over radical nephrectomy to preserve renal function, as per NICE and NHS guidelines. This approach is recommended when the tumour is amenable to partial resection and the patient is a suitable candidate for surgery.

Medical fact of the day:
The average adult kidney filters approximately 180 liters of blood per day, producing around 1.5 liters of urine. This highlights the kidney’s critical role in both filtration and waste elimination. 🇬🇧

Quote of the day:
“Compassion in healthcare is just as essential as knowledge and skill – it is the human touch that fosters healing.” 🌟