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SurgSpace / Specialties / Urology
Urology
Kidneys, ureters, bladder, prostate and the male reproductive tract: stones and the obstructed infected kidney that cannot wait, bladder cancer surveyed and resected through the urethra, and a specialty that reached keyhole surgery before almost anyone else.
Apply it
Cases & Practice
Patients to decide on, images to interpret, and the first day on the rotation.
Patients to decide on, images to interpret, and the briefing for the first day on the rotation.
Decisions, one patient at a time
Cases
Imaging practice
Read the image, then decide
Surgical decision-making
Does this patient need surgery?
An obstructed infected kidney at 01:00: BP 100/60 on fluids, lactate 2.8. Retrograde stent or percutaneous nephrostomy?
Retrograde ureteric stent
From below, in theatre, under anaesthesia: quick where an endoscopy team is ready, and avoids a tube through the flank.
Percutaneous nephrostomy
From above, in radiology, under local anaesthesia: spares the sick patient a general, and drains reliably even when the stone blocks retrograde access.
Both decompress and both are right answers: the wrong answer is the delay while the two teams debate. Local availability, patient stability and anatomy pick the route; the principle, obstructed plus infected equals drained tonight, is not up for discussion.
First acute retention, 900 mL drained, creatinine normal: catheter home and trial without catheter, or list for TURP?
Alpha-blocker and trial without catheter
The standard first move: many men void successfully after a first episode and defer surgery for years or forever.
TURP on this admission's pathway
For the failed trial, high-pressure chronic retention with renal impairment, or the man already at the end of the medication road.
Retention is a symptom with an exit ramp: the trial without catheter sorts those who needed a bad day treated from those who need an operation. The kidneys' involvement is the overriding vote: renal impairment from high-pressure retention removes the leisurely options.
Gleason 3+3 disease in two cores, PSA 6, MRI unimpressive, in a 64-year-old: treat, or watch on purpose?
Active surveillance
Scheduled PSA, MRI and re-biopsy with intent to treat on progression: for low-risk disease this preserves quality of life without sacrificing the window.
Radical treatment now
Surgery or radiotherapy for those whose disease, anxiety or preferences make surveillance the wrong home: a defensible choice with known costs.
Active surveillance is a management plan, not an absence of one: the evidence supports it firmly for low-risk disease, and the consultation's work is separating the cancer's actual threat from the word 'cancer'.
The rotation
Your first day here
- Learn the drainage law first: obstructed plus infected equals decompression tonight. It is the specialty's one non-negotiable, and it will be tested on your first on-call.
- Catheters are the house skill: sizes, types, the three-way, and the honest escalation when one will not pass. Ask for a teaching session in week one.
- Sudden testicular pain in the young is theatre-first: know the pathway before the referral call comes.
- Painless visible haematuria never gets reassured away: know the two-part answer (cystoscopy plus upper tract imaging) and you know the clinic.
- In endoscopic theatre lists, watch the screen and ask about the irrigation: the fluid physiology is the invisible half of the operation.
- Write residual volumes down: the number on the catheter's first bag changes diagnoses, and it exists only if someone records it.
Hub shaped by the Surgical Specialties Lead with the Urology reviewer (open seat). Images and videos carry their source; educational use for supervised learning, not clinical guidance.