Urology Overview
Master summary table of all urological conditions — definition, etiology, pathophysiology, clinical features, diagnosis, management, and complications at a glance.
Master Summary Table
Scroll horizontally to view all columns. Click any condition name to go to its full page.
| Urinary Stones | UTI | AROU | Hematuria | Bladder Cancer | BPH | Prostate Cancer | RCC | Testicular Cancer | PKD | |
|---|---|---|---|---|---|---|---|---|---|---|
| Definition | Formation of calculi anywhere in the urinary tract. 70–80% calcium oxalate. Lifetime prevalence up to 16% (M). Peak 30–50y. M:F ~4:3. | Inflammatory response of urothelium to bacterial invasion with bacteriuria + pyuria + symptoms. Bacteriuria alone ≠ UTI. 50% of women have ≥1 UTI in lifetime. | Sudden inability to pass urine despite full bladder; painful, acute onset. Most common urological emergency. ≠ anuria (kidneys not producing urine). | Blood in urine — gross (visible) or microscopic (≥3 RBC/HPF). A sign, not a diagnosis. Painless gross haematuria = malignancy until proven otherwise. Clots = always non-glomerular. | Malignant neoplasm of bladder; ~90% urothelial carcinoma. Key division: NMIBC (75%) vs MIBC (25%). M:F = 3:1, median age ~70. | Benign proliferation of prostatic glandular and stromal tissue in the transitional zone, causing LUTS. Histological BPH in >80% of men >80y. BPH ≠ LUTS ≠ BOO. | Malignant neoplasm of prostate; >95% adenocarcinoma. Arises in peripheral zone (palpable on DRE but late urinary symptoms). 3rd most common male cancer in HK. Graded by Gleason score. | Malignant neoplasm from renal tubular epithelium. Most common primary renal cancer (80–85%). "Internist's tumour." M:F = 2:1, peak 6th–8th decade. 50–60% found incidentally. | Malignant neoplasm of testis; >95% germ cell tumours. Seminoma (peak ~40y) vs NSGCT (peak 20–35y). Most common solid cancer in males 15–35. >95% 5-year survival. | Inherited disorder (AD or AR) with progressive bilateral renal cysts → massive kidney enlargement → ESRD. ADPKD = most common inherited kidney disease. Incidence ~1 in 400–1,000. |
| Etiology & Risk Factors | Dehydration • Hypercalciuria, hyperoxaluria • Primary hyperparathyroidism • High animal protein diet • Low dietary calcium (paradox — ↑ oxalate absorption) • Hot climate • FHx (2× risk) • Gout (uric acid stones) • Recurrent UTI with urease-splitting organisms (struvite) • Cystinuria (AR — COLA mnemonic) | E. coli (~80%), Klebsiella, Proteus, Enterococcus, Staph. saprophyticus (young women) • Female sex (short urethra) • Sexual activity • Pregnancy • DM • Urinary stasis (BPH, stones, neurogenic bladder) • Catheterisation (CAUTI) • Post-menopausal oestrogen deficiency • VUR (children) | BPH (~53% of male AROU) • Constipation / faecal impaction • Medications (anticholinergics, sympathomimetics, opioids) • Post-operative • UTI / prostatitis • Urethral stricture • Blood clots (clot retention) • Prostate/bladder cancer • Neurological (cauda equina, MS, diabetic neuropathy) • Alcohol excess | Age >40 (↑ malignancy risk) • Male sex • Smoking • Occupational chemical exposure (aromatic amines) • Anticoagulant therapy • Previous urological disease • UTI • Stones • BPH • Exercise (benign) | Smoking (#1 RF, 50% of cases) • Occupational chemicals (aromatic amines — rubber, dye, textile workers) • Schistosoma haematobium (→ SCC type) • Aristolochic acid (TCM — important in HK) • Chronic cystitis / indwelling catheter • Cyclophosphamide • Pelvic XRT • Male sex | Age >50 (strongest RF) • Intact testes / androgens (DHT essential) • FHx • Obesity / metabolic syndrome • Ethnicity (earlier onset in Black men) • Protective: castration before puberty | Age >50 (rare before 40) • Black ethnicity (highest incidence) • FHx (1st-degree → 2× risk) • BRCA2 mutation • High-fat / westernised diet • Obesity • Protective: Asian diet, lycopene, soy | Smoking (strongest modifiable RF, 2× risk) • Obesity • Hypertension • VHL syndrome (AD — bilateral clear cell RCC) • Acquired cystic kidney disease (dialysis) • FHx • Trichloroethylene, cadmium | Cryptorchidism (strongest RF — 3–50× risk, even after orchidopexy) • Contralateral testicular cancer • FHx (brother = 8–10× risk) • Testicular dysgenesis syndrome • Gonadal dysgenesis / DSD • HIV | PKD1 mutation (85%, ESRD ~54y) • PKD2 mutation (15%, ESRD ~74y) • Truncating mutations • Male sex • Hypertension • Early onset of symptoms • Large total kidney volume (TKV) |
| Pathophysiology | Supersaturation → nucleation on Randall's plaque → crystal growth and aggregation → obstruction → ↑ intraluminal pressure → renal capsule distension (pain) + mucosal trauma (haematuria) + stasis (infection). Stones lodge at 3 narrowings: PUJ, pelvic brim, VUJ. | Ascending infection via urethra → bladder (cystitis) → ± kidney (pyelonephritis). E. coli P-fimbriae bind uroepithelium. Host defences: urinary flow, acidic pH, Tamm-Horsfall protein. Stasis + impaired defences → bacterial proliferation → inflammation. | BOO → detrusor cannot overcome outflow resistance → inability to void → progressive bladder distension → pain. In BPH: prostatic hyperplasia compresses urethra. Precipitants (constipation, drugs, cold) tip from compensated to decompensated. | Glomerular: dysmorphic RBCs through damaged GBM → brown/cola urine, no clots, RBC casts. Non-glomerular: normal RBCs from collecting system/bladder/urethra → red/pink urine, ± clots. Clots = urological source (urokinase in glomeruli lyses clots). | Field change in urothelium → two pathways: (1) papillary (Ta, low-grade, recurs) vs (2) CIS/dysplasia (flat, high-grade, invasive). Muscle invasion through lamina propria → muscularis propria is the critical boundary. muscularis mucosae ≠ muscularis propria. | DHT (via 5α-reductase type 2) drives proliferation in transitional zone → nodular hyperplasia → urethral compression → BOO. Two components: static (physical mass) + dynamic (α₁-adrenergic smooth muscle tone). Bladder compensates (detrusor hypertrophy) then decompensates. | Androgen-driven. Arises from PIN in peripheral zone. Gleason grading: pattern (1–5) × 2 → score 6–10. Spreads: direct (seminal vesicles, bladder), lymphatic (obturator, iliac LN), haematogenous → bone (osteoblastic mets). | VHL pathway: VHL gene (3p) loss → HIF accumulation → ↑ VEGF/PDGF → angiogenesis (explains hypervascularity). Clear cell (75%): VHL. Papillary (15%): MET. Chromophobe (5%): best prognosis. Spreads: renal vein → IVC (tumour thrombus), haematogenous to lung, bone, brain. | GCNIS → seminoma OR NSGCT (embryonal, yolk sac, choriocarcinoma, teratoma). Markers: AFP (never ↑ in pure seminoma), β-hCG (choriocarcinoma >> seminoma), LDH (bulk). Lymphatic → retroperitoneal para-aortic LN. Haematogenous → lung. | Ciliopathy: PKD1/PKD2 encode polycystin-1/2 on primary cilia. Loss → impaired Ca²⁺ signalling → ↑ cAMP → cAMP-driven cell proliferation + fluid secretion → cyst growth. Two-hit hypothesis. Cysts compress parenchyma → fibrosis → CKD → ESRD. |
| Signs & Symptoms | Colicky loin-to-groin pain • N/V • Haematuria • Restlessness (cannot lie still — unlike peritonitis) • Irritative LUTS if stone at VUJ • Loin tenderness • Symptoms out of proportion to signs • Fever/rigors = infected obstructed system (emergency) | Cystitis: dysuria, frequency, urgency, suprapubic pain, cloudy urine, haematuria. Pyelonephritis: fever, rigors, loin/renal angle pain, N/V, systemically unwell. Elderly: atypical — confusion, falls, functional decline. | Sudden inability to void • Severe suprapubic pain • Palpable, percussible, tender bladder • Restlessness • Prior LUTS history (BPH) • DRE: enlarged smooth prostate (BPH) or hard irregular (cancer) | Gross: red/pink/brown urine ± clots. Microscopic: asymptomatic, dipstick only. Timing: initial (urethral), terminal (trigone), total (bladder/upper tract). Painful (stones, UTI) vs painless (cancer, BPH). | Painless gross haematuria (~85%) • Irritative LUTS (frequency, urgency — especially CIS) • Recurrent/refractory UTI • Pelvic/flank pain (advanced) • Constitutional symptoms (metastatic) | Obstructive LUTS: hesitancy, poor stream, intermittent stream, incomplete emptying, terminal dribbling. Storage LUTS: frequency, urgency, nocturia. DRE: smooth, symmetrically enlarged, firm, rubbery, loss of median sulcus. | Often asymptomatic early. Late: LUTS, haematuria, haematospermia. Metastatic: bone pain, pathological fractures, cord compression, weight loss. DRE: hard, irregular, nodular, asymmetric, fixed (locally advanced). | Classic triad (10–20%, = advanced): haematuria + flank pain + palpable mass. Most common: incidental on imaging. Paraneoplastic (40%): polycythaemia, hypercalcaemia, Stauffer syndrome, hypertension, fever. Left varicocele (left renal vein compression). | Painless testicular swelling • Heaviness • Hard, irregular mass; does NOT transilluminate • Within body of testis • Gynaecomastia (β-hCG) • Back pain (retroperitoneal LN) • Dyspnoea (lung mets) • Lymphoma if >60y | Bilateral palpable, enlarged kidneys • Flank pain • Hypertension (earliest sign, 60% before GFR decline) • Gross haematuria • Recurrent UTI/cyst infection • Nephrolithiasis • Extrarenal: hepatic cysts, berry aneurysms (8–12%), MVP |
| DDx | Pyelonephritis • Appendicitis • Ectopic pregnancy • AAA • Ovarian torsion • Biliary colic • Diverticulitis • Musculoskeletal pain | Urethritis (STI) • Vaginitis • Interstitial cystitis • Bladder cancer • Urinary stones • Prostatitis • Renal TB (sterile pyuria) • Appendicitis | CROU (painless, gradual) • UTI • Bladder stones • Urethral stricture • Prostatitis • Cauda equina • Constipation • Neurogenic bladder | Urological: bladder ca, RCC, stones, UTI, BPH, prostate ca, trauma • Glomerular: IgA nephropathy, thin BM, Alport, post-strep GN • Pseudo: myoglobinuria, haemoglobinuria, beetroot, rifampicin | UTI • Urinary stones • BPH • Prostate ca • RCC • Upper tract urothelial ca • Interstitial cystitis • Radiation cystitis | Prostate cancer (hard, nodular DRE) • OAB • UTI • Urethral stricture • Neurogenic bladder • Bladder ca • Bladder stones • Chronic prostatitis • DM (polyuria) | BPH (smooth DRE) • Chronic prostatitis • Prostate abscess • Granulomatous prostatitis (post-BCG) • UTI • Bladder ca • Elevated PSA from other causes | Simple cyst (Bosniak I–II) • Oncocytoma • Angiomyolipoma (fat on CT) • Upper tract urothelial ca • Renal abscess • Adrenal mass • Lymphoma | Epididymo-orchitis • Hydrocele (transilluminates) • Epididymal cyst • Inguinal hernia • Testicular torsion • Varicocele • Lymphoma (>60y) | Bilateral simple cysts (acquired) • ARPKD • VHL • Tuberous sclerosis • HNF1B • Acquired cystic kidney disease (dialysis) • Bilateral hydronephrosis |
| Key Investigations | CT KUB (gold standard, 97% sens) • KUB X-ray (radio-opaque only) • Urinalysis (haematuria, pH, crystals) • Bloods: Ca²⁺, urate, creatinine, FBC, CRP • USS (1st line pregnancy/children) • Stone composition analysis | Urine dipstick (nitrites + leucocytes) • MSU for M/C/S (gold standard) • Bloods: FBC, CRP, renal function, blood cultures (if septic) • USS KUB (upper tract/complicated) • CT if abscess suspected • Paediatric: USS + DMSA + MCUG | Bladder scan (>300–400 mL confirms) • Catheterised volume (>600 mL) • Bloods: renal function, PSA (after catheter), FBC • Urinalysis / MSU • After resolution: uroflowmetry, USS prostate + PVR, IPSS, urodynamics | Urinalysis + microscopy (dysmorphic RBCs? casts?) • Urine cytology • USS KUB • CT urogram (gold standard upper tract) • Flexible cystoscopy (gold standard bladder) • Bloods: FBC, renal function, coagulation, PSA • Renal biopsy (if glomerular) | Flexible cystoscopy (visualise) • TURBT (diagnostic + therapeutic — histology + depth) • Urine cytology (high-grade/CIS) • CT urogram (upper tract + staging) • MRI pelvis (local staging) • CT CAP (metastatic staging) | DRE (size, consistency, median sulcus) • IPSS (mild ≤7, moderate 8–19, severe 20–35) • PSA • Uroflowmetry (Qmax <10 mL/s = BOO) • USS: prostate volume + PVR • Urinalysis • Renal function • Urodynamics (if uncertain) | DRE + PSA • mpMRI (PI-RADS scoring — before biopsy) • TRUS / template biopsy (histology) • Gleason / ISUP Grade Group • Staging: CT CAP + bone scan (osteoblastic mets) • PSA kinetics | CT abdomen with contrast (gold standard — triphasic, enhancing mass) • Bosniak classification (cystic masses) • USS (screening) • MRI (IVC thrombus) • CT chest (lung mets) • Bone scan (if symptomatic) • No role for urine cytology | Scrotal USS • Tumour markers: AFP, β-hCG, LDH (pre- and post-orchidectomy) • Radical inguinal orchidectomy (diagnostic + therapeutic — NOT trans-scrotal) • CT CAP (staging) • Sperm banking (before treatment) | Renal USS (1st line — Pei-Ravine criteria by age) • Genetic testing (PKD1/PKD2) • MRI (TKV — Mayo classification) • Bloods: renal function, electrolytes • Urinalysis • MRA head (ICA screening if FHx of SAH) |
| Management | Acute: NSAIDs 1st line, opioids if renal impairment. MET: α-blocker (tamsulosin) for distal 5–10 mm. ≤4 mm: conservative (95% pass). >10 mm: URS or ESWL. Renal >20 mm: PCNL. Infected obstruction: IV abx + urgent JJ stent/PCN. Prevention: ↑ fluid, dietary modification, potassium citrate, thiazides. Uric acid: alkalinise urine. | Uncomplicated cystitis: nitrofurantoin or trimethoprim (3 days). Complicated / pyelo: IV co-amoxiclav or cephalosporin ± gentamicin, step down after 48h afebrile (7–14 days total). CAUTI: remove/replace catheter + abx. Recurrent (≥3/yr): low-dose prophylaxis, post-coital prophylaxis, cranberry, topical oestrogen. Always treat underlying cause. | Immediate: urethral catheterisation. SPC if fails. Monitor post-obstructive diuresis (>200 mL/hr). Start α-blocker (tamsulosin). TWOC at 48–72 h. If fails: long-term catheter → surgery. Definitive: TURP (BPH), treat underlying cause. | Treat underlying cause. Clot retention: 3-way catheter + irrigation. Malignancy: urgent referral if >40 with unexplained haematuria. Glomerular: nephrology referral. Anticoagulant-related: still investigate (unmasks pathology). | NMIBC: TURBT → risk stratify. Low-risk: surveillance. Intermediate: intravesical mitomycin C. High-risk/CIS: intravesical BCG. MIBC: neoadjuvant cisplatin chemo → radical cystectomy + LN dissection + urinary diversion. Unfit: chemoradiotherapy. Metastatic: cisplatin chemo, checkpoint inhibitors (pembrolizumab). | Mild (IPSS ≤7): watchful waiting + lifestyle. Moderate–severe: α₁-blockers (tamsulosin) ± 5α-reductase inhibitors (finasteride — for large prostates, 6-month onset). Combination for large + symptomatic. Failed / complications: TURP (gold standard). Alternatives: HoLEP, UroLift, PAE. | Low-risk (Gleason 6): active surveillance. Intermediate: radical prostatectomy or RT ± short ADT. High-risk: RP or RT + long-course ADT (2–3 yr). Metastatic: ADT + docetaxel or abiraterone. CRPC: enzalutamide, abiraterone, docetaxel, radium-223. | T1 (≤7 cm): partial nephrectomy (preferred). T2+: radical nephrectomy. T3–T4: radical nephrectomy ± IVC thrombectomy. Metastatic: cytoreductive nephrectomy + immunotherapy (nivolumab + ipilimumab) or TKIs (sunitinib). Ablation (RFA/cryo) for small tumours in unfit patients. | All: radical inguinal orchidectomy. Seminoma I: surveillance or adjuvant RT/carboplatin. NSGCT I: surveillance or adjuvant BEP ×1. Advanced: BEP ×3–4. Residual mass: RPLND (NSGCT) vs PET-guided observe (seminoma). Salvage: TIP/VeIP/high-dose chemo. | BP control: ACEi/ARB (target <110/75). Tolvaptan (V2-receptor antagonist — ↓ cAMP, slows cyst growth; Mayo 1C–1E). Cyst infection: fluoroquinolones (penetrate cysts). Pain: avoid NSAIDs. Nephrolithiasis: standard Mx. ESRD: dialysis or renal transplant (treatment of choice). ICA screening if FHx SAH. |
| Complications | Obstructive nephropathy / AKI • Hydronephrosis • Urosepsis (emergency) • Ureteric stricture • Recurrence: 50% at 10 years • Post-obstructive diuresis • Steinstrasse after ESWL | Pyelonephritis • Renal/perinephric abscess • Urosepsis • Emphysematous pyelonephritis (diabetics) • Chronic pyelonephritis → renal scarring → CKD • Xanthogranulomatous pyelonephritis • Pyonephrosis • Struvite stones | Post-obstructive diuresis (life-threatening electrolyte imbalance) • Ex vacuo haematuria • UTI / CAUTI • Obstructive nephropathy / AKI • TURP syndrome • Urethral injury (catheterisation) • Chronic retention → overflow incontinence | Anaemia • Clot retention (emergency) • Missed malignancy (if not investigated) • AKI (bilateral ureteric clots — rare) • Iron deficiency | NMIBC recurrence 50–70%, progression 10–30% • Lifelong cystoscopic surveillance • Cystectomy: stoma complications, sexual dysfunction, metabolic issues • Metastatic disease • Ureteric obstruction • BCG complications (BCG-osis) | AROU • Recurrent UTI • Bladder stones • Chronic retention → overflow incontinence • Obstructive nephropathy → CKD • Haematuria • Detrusor failure • TURP: TUR syndrome, bleeding, retrograde ejaculation, stricture | Bone mets (pathological fractures, cord compression — emergency) • Urinary obstruction → AKI • Lymphoedema • RP: ED (30–70%), incontinence (5–20%). RT: proctitis, cystitis. ADT: osteoporosis, metabolic syndrome, CVD risk, hot flushes, gynaecomastia | Metastasis: lung (75%), bone, brain, liver • IVC tumour thrombus (PE, Budd-Chiari) • Paraneoplastic syndromes • Post-nephrectomy CKD • TKI toxicity: hand-foot, HTN, diarrhoea • Checkpoint inhibitor toxicity: colitis, hepatitis, pneumonitis | Metastasis (lung, retroperitoneal LN, brain) • BEP toxicity: bleomycin → pulm fibrosis; cisplatin → nephro/ototoxicity; etoposide → secondary leukaemia • Infertility • Contralateral tumour (2–5%) • Retrograde ejaculation (RPLND) • CVD (long-term) | ESRD (leading morbidity) • Nephrolithiasis (20–30%) • Cyst infection • Cyst haemorrhage • ICA rupture → SAH (8–12% prevalence) • Hepatic cysts • MVP / aortic regurgitation • Cardiovascular death (leading cause before ESRD) |
Venous Thromboembolism
Venous thromboembolism is a condition encompassing deep vein thrombosis and pulmonary embolism, caused by pathological blood clot formation within the venous system that can obstruct blood flow and impair cardiopulmonary function.
Acute Retention Of Urine
Acute retention of urine is the sudden inability to pass urine voluntarily, resulting in painful distension of the bladder that requires urgent catheterization.