Now I have enough from all major sources. Let me compile the comprehensive master guide.
π₯ MASTER UROLOGY CLINICAL CHEAT CODE
Complete Diagnosis + Treatment + Drug Reference
PART 1: URINARY TRACT INFECTIONS (UTI)
Classification & Diagnostic Pathway
| Presentation | Diagnosis | Key Criteria |
|---|
| Dysuria + frequency + urgency, no fever | Uncomplicated cystitis | Lower tract only, non-pregnant, no structural abnormality |
| Fever + loin pain + dysuria | Acute pyelonephritis | Upper tract; β₯10β΅ organisms/mL urine |
| Bacteriuria without symptoms | Asymptomatic bacteriuria (ASB) | Defined as >10β΅ organisms/mL |
| Cystitis + any complicating factor | Complicated UTI | Pregnancy, DM, obstruction, catheter, male sex, immunocompromised |
| Recurrent UTIs β₯2/6 months or β₯3/year | Recurrent UTI | Culture each episode separately |
Cheat: Common Organisms
- E. coli - >70% of all UTIs (the default answer on exams and clinics)
- Klebsiella spp.
- Proteus mirabilis (especially with obstruction, struvite stones, DM)
- Staphylococcus saprophyticus (young sexually active women)
- Enterococcus, Pseudomonas (nosocomial/catheter-associated)
Urine Definitions (Memorize These)
- ASB: >10β΅ organisms/mL, no symptoms
- Cystitis: as few as 10Β² organisms/mL if pyuria + symptoms present
- Pyelonephritis: >10β΅ organisms/mL + upper tract symptoms
- Significant pyuria: >10 WBC/hpf on microscopy
- (Comprehensive Clinical Nephrology, 7th Ed.)
UTI Drug Chart - Complete Drug Doses
Uncomplicated Cystitis (Women)
| Drug | Dose | Frequency | Duration | Notes |
|---|
| Nitrofurantoin (DOC) | 100 mg (macrocrystal) | BID | 5-7 days | Avoid if CrCl <30; avoid at term |
| Trimethoprim-sulfamethoxazole (TMP-SMX) | 160/800 mg | BID | 3 days | Use only if local resistance <20% |
| Fosfomycin trometamol | 3 g sachet | Single dose | 1 day | Excellent for ESBL organisms |
| Pivmecillinam | 400 mg | BID-TID | 3-7 days | Europe mainly |
| Ciprofloxacin (2nd line) | 250 mg | BID | 3 days | Reserve - fluoroquinolone resistance growing |
| Cephalexin | 500 mg | BID-QID | 3-7 days | Safe in pregnancy |
Pyelonephritis (Outpatient)
| Drug | Dose | Frequency | Duration |
|---|
| Ciprofloxacin (DOC oral) | 500-750 mg | BID | 7-10 days |
| Levofloxacin | 750 mg | OD | 5-7 days |
| TMP-SMX | 160/800 mg | BID | 14 days |
Pyelonephritis (Inpatient/IV)
| Drug | Dose | Frequency | Duration |
|---|
| Ceftriaxone (DOC IV) | 1-2 g | OD | 7-14 days, transition oral when afebrile 24-48h |
| Ampicillin + Gentamicin | Amp 1g q6h + Gent 3-5 mg/kg/day | BID/OD | As guided by culture |
| Piperacillin-tazobactam | 3.375 g | q6h | For pseudomonal/ESBL risk |
| Imipenem or Meropenem | 500 mg-1g | q8h | ESBL/carbapenem if required |
UTI in Pregnancy - Drug of Choice
| Condition | Drug | Dose | Duration |
|---|
| ASB/cystitis | Cephalexin (DOC) | 500 mg BID | 7-10 days |
| ASB/cystitis | Nitrofurantoin | 100 mg BID | 3-7 days (avoid 3rd trimester) |
| ASB/cystitis | Amoxicillin | 500 mg TID | 7 days |
| ASB/cystitis | TMP-SMX | 160/800 mg BID | 3 days (avoid 1st & 3rd trimester) |
| Pyelonephritis (admit) | Ceftriaxone IV | 1g OD | Until afebrile 24-48h, then oral 14 days |
| (Rosen's Emergency Medicine; Comprehensive Clinical Nephrology 7th Ed.) | | | |
CHEAT CODE - Screen all pregnant women for ASB at 12-16 weeks (USPSTF Grade A). Treating ASB reduces pyelonephritis risk by >80% and cuts preterm birth risk. If untreated, 30% of women with ASB develop pyelonephritis.
Recurrent UTI Prevention
| Strategy | Drug | Dose | Notes |
|---|
| Continuous prophylaxis | TMP-SMX | 40/200 mg OD at bedtime | 6-12 months |
| Continuous prophylaxis | Nitrofurantoin | 50-100 mg OD at bedtime | 6-12 months |
| Post-coital prophylaxis | Ciprofloxacin 125 mg or TMP-SMX 40/200 mg | Single dose after intercourse | Very effective |
| Topical estrogen | Vaginal estrogen cream | 0.5 g vaginally 2x/week | Postmenopausal women |
| (AUA Guidelines 2024 - Recurrent UTI) | | | |
PART 2: NEPHROLITHIASIS (KIDNEY STONES)
Stone Types & Diagnostic Clues
| Stone Type | % | Radio-opaque? | pH | Classic Association | Morphology |
|---|
| Calcium oxalate | 70-80% | YES (dense) | Any | Hypercalciuria, hyperoxaluria | Envelope/dumbbell shaped |
| Calcium phosphate | 10% | YES | Alkaline | RTA type I, hyperPTH | Star-shaped crystals |
| Uric acid | 5-10% | NO (radiolucent) | Acid (<5.5) | Gout, DM, high purine diet | Rhomboid/needle shaped |
| Struvite (triple phosphate) | 5-10% | YES (staghorn) | Alkaline (>7) | Proteus UTI (urease-producing) | Coffin lid crystals |
| Cystine | 1-2% | Faintly opaque | Acid | Autosomal recessive, young patients | Hexagonal crystals |
Diagnosis Pathway
CLINICAL: Acute flank pain β colicky, radiates to groin/testes/labia (CLASSIC)
N/V, hematuria, restlessness (can't find comfortable position)
STEP 1: Urinalysis β hematuria (85-90%), crystals (variable)
STEP 2: Non-contrast CT KUB (gold standard) β detects all stones except rare drug stones
KUB X-ray β only for radiopaque stones, follow-up
USS β preferred in pregnancy, children (no radiation)
IVU/IVP β historic, largely replaced by CT
STEP 3: Stone size classification:
<5 mm β 90% pass spontaneously
5-10 mm β 50% pass with MET (medical expulsive therapy)
>10 mm β usually require intervention
Metabolic Workup (24-hour urine - for recurrent stones)
- Calcium, oxalate, uric acid, citrate, creatinine, sodium, phosphate, pH
- Serum: calcium, phosphate, uric acid, PTH, bicarbonate
Stone Treatment Drug Chart
Medical Expulsive Therapy (MET)
| Drug | Dose | Frequency | Duration | Mechanism |
|---|
| Tamsulosin (DOC for MET) | 0.4 mg | OD | Until stone passes (up to 4 weeks) | Alpha-1 blocker - relaxes ureteral smooth muscle |
| Nifedipine | 30 mg | OD | Until stone passes | CCB - reduces ureteral spasm |
| Doxazosin | 4 mg | OD | Until stone passes | Alpha-blocker alternative |
Pain Management for Renal Colic
| Drug | Dose | Route | Notes |
|---|
| Diclofenac (DOC for colic) | 75 mg | IM/IV or 100 mg PR | NSAIDs reduce ureteral spasm - first choice |
| Ketorolac | 30-60 mg | IM/IV | Very effective IV NSAID |
| Morphine | 0.1 mg/kg | IV/IM | For severe pain - opioid |
| Tramadol | 50-100 mg | Oral | Moderate pain |
CHEAT CODE: NSAIDs > opioids for renal colic. NSAIDs work on both pain AND ureteral smooth muscle. Avoid NSAIDs if obstructing stone in single kidney (risk of AKI).
Stone-Specific Prevention Drugs
| Stone Type | Drug | Dose | Mechanism |
|---|
| Calcium oxalate - hypercalciuria | Hydrochlorothiazide | 25-50 mg OD | Reduces urinary calcium |
| Calcium oxalate - hypercalciuria | Chlorthalidone | 25 mg OD | Alternative thiazide |
| Calcium oxalate - hypocitraturic | Potassium citrate | 20-40 mEq BID-TID | Alkalinizes urine, chelates calcium |
| Calcium oxalate - hyperuricosuric | Allopurinol | 100-300 mg OD | Reduces uric acid - prevents nucleation of CaOx |
| Uric acid stones | Potassium citrate (DOC) | 20-40 mEq TID | Alkalinize urine to pH 6.5-7 |
| Uric acid stones | Allopurinol | 100-300 mg OD | If hyperuricosuria |
| Uric acid stones | Sodium bicarbonate | 650 mg TID | Alternative alkalinizer |
| Struvite stones | Acetohydroxamic acid (AHA) | 250 mg TID | Urease inhibitor |
| Cystine stones | Potassium citrate | 20-40 mEq TID | Alkalize urine |
| Cystine stones | D-Penicillamine | 1-2 g/day | Chelates cystine (poorly tolerated) |
| Cystine stones | Tiopronin | 800 mg/day | Better tolerated than penicillamine |
| Recurrent CaOx - general | High fluid intake | >2.5 L/day urine output | First-line non-pharmacologic |
| (Campbell Walsh Wein Urology; EAU Guidelines 2024; Comprehensive Clinical Nephrology) | | | |
Intervention Options (by stone size/location)
| Intervention | Indication |
|---|
| ESWL (lithotripsy) | Renal/upper ureteral stones <2 cm, no obstruction |
| Ureteroscopy + laser (URS) | Ureteral stones any size, lower pole renal stones |
| PCNL (percutaneous nephrostolithotomy) | Large stones >2 cm, staghorn, failed ESWL |
| Laparoscopic/open | Failed endoscopic, complex anatomy |
| Oral chemolysis | Uric acid stones only - potassium citrate alkalinization |
PART 3: BENIGN PROSTATIC HYPERPLASIA (BPH)
Diagnosis Pathway
MAN >50 YEARS + LUTS (lower urinary tract symptoms)
β
Voiding symptoms: hesitancy, weak stream, intermittent stream, straining, dribbling
Storage symptoms: frequency, urgency, nocturia, urge incontinence
β
IPSS Score (International Prostate Symptom Score):
0-7 = Mild | 8-19 = Moderate | 20-35 = Severe
β
DRE (Digital Rectal Exam) β size, consistency, tenderness
PSA (if prostate cancer excluded) β rule out malignancy
Urinalysis + urine culture (r/o infection)
Uroflowmetry β Qmax:
>15 mL/s = normal
10-15 mL/s = borderline
<10 mL/s = obstructed (low, indicates BOO)
Post-void residual (USS) β >200 mL = significant retention
β
Urodynamics (if unclear) β pressure-flow study confirms BOO
High voiding pressure + low flow = BOO
(Bailey and Love's Surgery 28th Ed.)
CHEAT CODE: Voiding pressures >80 cmHβO = obstructed. Qmax <10 mL/s = significant BOO. Always check PSA to rule out prostate cancer before diagnosing BPH.
BPH Drug Chart
Alpha-1 Blockers (Relax prostate smooth muscle - works in days)
| Drug | Dose | Frequency | Notes |
|---|
| Tamsulosin (DOC) | 0.4 mg | OD (30 min after meal) | Uroselective Ξ±1A; lowest orthostatic hypotension risk |
| Alfuzosin | 10 mg XR | OD | Uroselective; less sexual SE |
| Silodosin | 8 mg | OD | Most uroselective; retrograde ejaculation common |
| Doxazosin | 1-8 mg | OD (at bedtime) | Non-selective; antihypertensive benefit |
| Terazosin | 1-10 mg | OD (at bedtime) | Non-selective; antihypertensive benefit |
| Prazosin | 0.5-2 mg | BID-TID | Older, less used |
5-Alpha Reductase Inhibitors - 5ARIs (Reduce prostate size - works in months)
| Drug | Dose | Frequency | Notes |
|---|
| Finasteride | 5 mg | OD | Blocks type 2 5AR; reduces DHT; ~25% prostate volume reduction in 6-12 months |
| Dutasteride | 0.5 mg | OD | Blocks type 1 + 2 5AR; more complete DHT suppression |
CHEAT CODE for 5ARIs: Works best in large prostates (>40 mL). Take 3-6 months to see full effect. Reduces PSA by 50% - adjust PSA interpretation (multiply by 2). SE: decreased libido, ED, retrograde ejaculation.
Combination Therapy (Best for large prostates + moderate-severe LUTS)
| Combination | Evidence |
|---|
| Tamsulosin + Dutasteride | CombAT trial - superior to monotherapy |
| Tamsulosin + Finasteride | Also evidence-based |
Anticholinergics (for storage LUTS component)
| Drug | Dose | Frequency | Notes |
|---|
| Solifenacin | 5-10 mg | OD | For overactive bladder/urgency component |
| Tolterodine | 4 mg XR | OD | Well studied in BPH + OAB |
| Darifenacin | 7.5-15 mg | OD | M3-selective |
CAUTION: Anticholinergics can worsen urinary retention - use only if PVR <200 mL and Qmax is reasonable.
PDE-5 Inhibitors (BPH + ED combination)
| Drug | Dose | Notes |
|---|
| Tadalafil 5 mg OD | 5 mg daily | FDA approved for both BPH and ED simultaneously |
Surgical Options
- TURP (gold standard) - for moderate-severe LUTS not responding to medical therapy
- Holmium laser enucleation (HoLEP) - for large glands
- Urolift, REZUM - minimally invasive, preserves sexual function
PART 4: ACUTE KIDNEY INJURY (AKI)
Diagnostic Classification
DEFINITION: Rise in serum creatinine β₯0.3 mg/dL within 48h OR
β₯1.5x baseline within 7 days OR
Urine output <0.5 mL/kg/h for β₯6 hours (KDIGO)
| Type | Pre-renal (55%) | Intra-renal (35%) | Post-renal (10%) |
|---|
| Cause | Hypovolemia, shock, HF, hepatorenal | ATN, GN, AIN, contrast, drugs | BPH, stones, cancer, stricture |
| BUN:Cr ratio | >20:1 | <10:1 | Variable |
| Urine sodium | <20 mEq/L | >40 mEq/L | Variable |
| FeNa | <1% | >2% | Variable |
| Urine osmolality | >500 mOsm/kg | <350 mOsm/kg | Variable |
| Response to fluids | YES | NO | NO - needs decompression |
CHEAT CODE - FeNa formula: FeNa (%) = (Urine Na Γ Serum Cr) / (Serum Na Γ Urine Cr) Γ 100
- FeNa <1% = pre-renal (kidneys holding on to sodium)
- FeNa >2% = intrinsic renal (tubules damaged, can't retain Na)
- FeNa <1% but ATN = contrast nephropathy, myoglobinuria, early obstruction (use FeUrea instead)
KDIGO AKI Staging
| Stage | Serum Creatinine | Urine Output |
|---|
| 1 | 1.5-1.9x baseline OR β₯0.3 mg/dL increase | <0.5 mL/kg/h for 6-12h |
| 2 | 2.0-2.9x baseline | <0.5 mL/kg/h for β₯12h |
| 3 | β₯3x baseline OR Cr β₯4 mg/dL OR RRT | <0.3 mL/kg/h for β₯24h or anuria for β₯12h |
AKI Management Drugs
| Indication | Drug | Dose | Notes |
|---|
| Volume resuscitation | Normal saline | 500 mL bolus, reassess | Pre-renal AKI |
| Hyperkalemia (K >6.5) | Calcium gluconate 10% | 10-20 mL IV over 5-10 min | Membrane stabilization - FIRST step |
| Hyperkalemia (K >5.5) | Sodium bicarbonate | 50-100 mEq IV | Shifts K into cells |
| Hyperkalemia | Insulin 10U + Dextrose 50% 50 mL | IV push | Shifts K into cells |
| Hyperkalemia | Salbutamol (albuterol) | 10-20 mg nebulized | Shifts K into cells |
| Hyperkalemia (chronic) | Sodium polystyrene sulfonate (Kayexalate) | 15-30 g | PO/PR - removes K from GI |
| Hyperkalemia (chronic) | Patiromer | 8.4 g OD | Newer - better tolerated |
| Metabolic acidosis | Sodium bicarbonate | 44-132 mEq IV (or oral) | If pH <7.15 or HCO3 <15 |
| Pulmonary edema/overload | Furosemide | 40-200 mg IV | Dialysis if refractory |
| Contrast prophylaxis | N-Acetylcysteine | 600 mg BID x 2 days | Oral, day before and day of procedure |
| Contrast nephropathy | IV normal saline hydration | 1 mL/kg/h for 3-12h before/after | More evidence than NAC |
Indications for Dialysis (AEIOU mnemonic)
- A - Acidosis (pH <7.1, refractory)
- E - Electrolytes (K >6.5, refractory to medical management)
- I - Ingestion/Intoxication (lithium, methanol, salicylates)
- O - Overload (pulmonary edema refractory to diuretics)
- U - Uremia (pericarditis, encephalopathy, BUN >100-150 mg/dL)
PART 5: CHRONIC KIDNEY DISEASE (CKD)
GFR-Based Staging (KDIGO)
| Stage | GFR (mL/min/1.73mΒ²) | Description |
|---|
| G1 | β₯90 | Normal/high - kidney damage markers |
| G2 | 60-89 | Mildly decreased |
| G3a | 45-59 | Mild-moderately decreased |
| G3b | 30-44 | Moderately-severely decreased |
| G4 | 15-29 | Severely decreased - prepare for RRT |
| G5 | <15 | Kidney failure (dialysis or transplant) |
CKD Management Drugs
| Problem | Drug | Dose | Target |
|---|
| Hypertension + proteinuria | ACE inhibitor (e.g. Ramipril) | 2.5-10 mg OD | BP <130/80; proteinuria reduction |
| Hypertension + proteinuria | ARB (e.g. Losartan, Candesartan) | 25-100 mg OD | Same benefit as ACEi |
| DM + CKD (proteinuria) | SGLT2i (Empagliflozin, Dapagliflozin) | 10-25 mg OD | Reno-protective beyond glucose |
| DM + CKD (proteinuria) | Finerenone (MR antagonist) | 10-20 mg OD | New - reduces AKI-CKD progression |
| Anemia of CKD | Erythropoietin (EPO/Epoietin alfa) | 50-300 IU/kg 3x/week SC | Target Hb 10-12 g/dL |
| Anemia | Darbepoetin alfa | 0.45 mcg/kg weekly SC | Longer-acting EPO |
| Anemia | IV iron (ferric carboxymaltose) | 500-1000 mg IV | If iron deficient |
| Hyperphosphatemia | Calcium carbonate | 500 mg TID with meals | Phosphate binder |
| Hyperphosphatemia | Sevelamer carbonate | 800-1600 mg TID with meals | Non-calcium binder - less vascular calcification |
| Hyperphosphatemia | Lanthanum carbonate | 500-1000 mg TID with meals | Chewable phosphate binder |
| Secondary hyperPTH | Calcitriol (Vitamin D3) | 0.25-0.5 mcg OD | Suppress PTH |
| Secondary hyperPTH | Cinacalcet | 30-180 mg OD | Calcimimetic - reduces PTH |
| Metabolic acidosis | Sodium bicarbonate | 0.5-1 mEq/kg/day | Oral - target HCO3 >22 |
| Hyperkalemia (chronic) | Patiromer | 8.4-25.2 g OD | Potassium binder |
| Hyperkalemia (chronic) | Sodium zirconium cyclosilicate | 10 g TID x 2 days, then 5-10 g OD | Newer K binder |
PART 6: OVERACTIVE BLADDER (OAB) & URINARY INCONTINENCE
Types
| Type | Symptoms | Mechanism |
|---|
| Stress incontinence | Leak with cough/sneeze/exercise | Urethral sphincter weakness |
| Urge incontinence / OAB | Sudden urgency β wet before reaching toilet | Detrusor overactivity |
| Overflow incontinence | Continuous dribbling, large PVR | Detrusor underactivity OR obstruction |
| Mixed | Both stress and urge components | Combined mechanism |
OAB/Urge Incontinence - Drug Chart
First Line: Anticholinergics (Antimuscarinics)
| Drug | Dose | Frequency | Notes |
|---|
| Solifenacin (DOC) | 5-10 mg | OD | M3 selective; fewer CNS SE |
| Oxybutynin | 5-15 mg IR or 10 mg XR | TID (IR) or OD (XR) | Most studied; dry mouth, constipation |
| Tolterodine | 2 mg (IR) or 4 mg XR | BID or OD | Well tolerated |
| Trospium | 20 mg (IR) or 60 mg XR | BID or OD | Quaternary ammonium - doesn't cross BBB (elderly-friendly) |
| Darifenacin | 7.5-15 mg | OD | M3-selective |
| Fesoterodine | 4-8 mg | OD | Prodrug of tolterodine active metabolite |
Second Line: Beta-3 Agonist
| Drug | Dose | Frequency | Notes |
|---|
| Mirabegron (DOC - second line) | 25-50 mg | OD | Beta-3 agonist; no anticholinergic SE; use if elderly/glaucoma/constipation issues |
| Vibegron | 75 mg | OD | Newer beta-3 agonist |
Third Line: Botulinum Toxin
- OnabotulinumtoxinA (Botox) - 100 units intradetrusor injection (cystoscopy guided) - repeat q6-12 months
Stress Urinary Incontinence
| Drug | Dose | Notes |
|---|
| Duloxetine | 20-40 mg BID | SNRI - strengthens urethral sphincter via pudendal nerve; off-label in US |
| Topical estrogen | Vaginal cream 0.5g 2x/week | Postmenopausal - restores urethral mucosa |
CHEAT CODE: Mirabegron preferred over anticholinergics in elderly (no cognitive SE, no dry mouth, no constipation). Combine with anticholinergic only if monotherapy insufficient.
PART 7: BLADDER CANCER
Diagnosis Pathway
HEMATURIA (painless gross hematuria = bladder cancer until proven otherwise)
β
Urinalysis + urine cytology
CT urogram (replacing IVU) β evaluate upper tracts + bladder filling defect
Cystoscopy (gold standard for diagnosis) β visualize lesion
Biopsy/TURBT (transurethral resection of bladder tumor) β histology + staging
Staging & Treatment
| Stage | Description | Treatment |
|---|
| Ta, T1, CIS (NMIBC) | Non-muscle invasive | TURBT (resect) + intravesical therapy |
| T2-T4a (MIBC) | Muscle invasive | Radical cystectomy Β± neoadjuvant chemo |
| T4b, N+, M+ | Metastatic | Systemic chemo + immunotherapy |
Bladder Cancer Drug Chart
Intravesical Therapy (NMIBC)
| Drug | Indication | Dose/Regimen | Notes |
|---|
| BCG (Bacillus Calmette-Guerin) (DOC) | High-risk NMIBC, CIS | Weekly x6 weeks, then maintenance 3 years | Immunotherapy - prevents recurrence/progression |
| Mitomycin C | Low/intermediate risk NMIBC | Single dose immediately post-TURBT (50 mg), or weekly x6 weeks | Cytotoxic |
| Epirubicin | Low risk immediate | Single instillation post-TURBT | |
| Gemcitabine | BCG failure/alternative | Weekly x6 weeks | |
Systemic Chemotherapy (MIBC/Metastatic)
| Drug | Regimen | Notes |
|---|
| Gemcitabine + Cisplatin (GC) (DOC) | Standard 1st line | Preferred if cisplatin-eligible |
| Dose-dense MVAC | Methotrexate + Vinblastine + Doxorubicin + Cisplatin | Aggressive; for fit patients |
| Gemcitabine + Carboplatin | If cisplatin-ineligible | Less nephrotoxic |
Immunotherapy (2nd line or maintenance)
| Drug | Mechanism | Indication |
|---|
| Pembrolizumab | Anti-PD-1 | 2nd line metastatic; high-risk NMIBC BCG failure |
| Nivolumab | Anti-PD-1 | Adjuvant after cystectomy (MIBC) |
| Avelumab | Anti-PD-L1 | Maintenance after platinum chemo (1st line) |
| Atezolizumab | Anti-PD-L1 | 2nd line |
Targeted Therapy
| Drug | Target | Indication |
|---|
| Enfortumab vedotin | Nectin-4 antibody-drug conjugate | Post-platinum, post-PD-1 |
| Erdafitinib | FGFR3 inhibitor | FGFR-altered urothelial cancer |
| Ramucirumab | VEGFR-2 | Combination |
PART 8: RENAL CELL CARCINOMA (RCC)
Diagnosis Pathway
Classic triad (rare - <10%): Flank pain + Hematuria + Palpable mass
Most common: Incidental finding on CT scan
Paraneoplastic syndromes: Hypertension (renin), Polycythemia (EPO), Hypercalcemia (PTHrP)
β
CT abdomen with and without contrast (DOC) β evaluate mass, IVC thrombus
MRI if CT inadequate or IVC invasion
Chest CT for staging (lung mets)
Biopsy only if metastatic disease planned for systemic therapy
β
TNM staging β guides surgical vs systemic treatment
RCC Drug Chart
| Drug | Class | Indication | Dose |
|---|
| Sunitinib | TKI (VEGFR) | 1st line mRCC (intermediate/poor risk) | 50 mg OD x4 weeks on, 2 off |
| Pazopanib | TKI (VEGFR) | 1st line mRCC | 800 mg OD |
| Cabozantinib | TKI (VEGFR/MET/AXL) | 1st or 2nd line | 60 mg OD |
| Ipilimumab + Nivolumab | CTLA-4 + PD-1 | 1st line intermediate/poor risk | Ipilimumab 3mg/kg + Nivo 1mg/kg q3weeks x4, then Nivo maintenance |
| Pembrolizumab + Axitinib | PD-1 + TKI | 1st line all-risk | Pemb 200 mg q3weeks + Axitinib 5mg BID |
| Nivolumab + Cabozantinib | PD-1 + TKI | 1st line all-risk | CheckMate-9ER regimen |
| Nivolumab | Anti-PD-1 | 2nd line post-TKI | 240 mg q2weeks |
| Everolimus | mTOR inhibitor | 2nd line post-TKI | 10 mg OD |
| Temsirolimus | mTOR inhibitor | Poor-risk mRCC | 25 mg IV weekly |
| Belzutifan | HIF-2Ξ± inhibitor | VHL disease-associated RCC, 3rd line | 120 mg OD |
PART 9: PROSTATE CANCER
Diagnosis Pathway
Elevated PSA OR abnormal DRE β TRUS-guided biopsy or MRI-targeted biopsy
Gleason Score/Grade Groups:
Grade 1 = Gleason 6 (3+3) = Low risk
Grade 2 = Gleason 7 (3+4) = Favorable intermediate
Grade 3 = Gleason 7 (4+3) = Unfavorable intermediate
Grade 4 = Gleason 8 = High risk
Grade 5 = Gleason 9-10 = Very high risk
Staging: Bone scan (if PSA >20, Gleason β₯8, T3/4), CT/MRI pelvis
Prostate Cancer Drug Chart
Androgen Deprivation Therapy (ADT) - Backbone of Treatment
| Drug | Class | Dose | Notes |
|---|
| Leuprolide (Lupron) | LHRH agonist | 7.5 mg IM monthly or 22.5 mg q3months | Testosterone castration levels; testosterone flare with first dose |
| Goserelin (Zoladex) | LHRH agonist | 3.6 mg SC monthly | Implant |
| Degarelix (Firmagon) | LHRH antagonist (DOC) | 240 mg SC, then 80 mg q4weeks | No testosterone flare; faster castration |
| Relugolix (Orgovyx) | Oral LHRH antagonist | 360 mg once, then 120 mg OD | Oral; cardiovascular benefit over LHRH agonists |
Antiandrogens (Combined with LHRH agonist)
| Drug | Class | Dose | Notes |
|---|
| Bicalutamide | Non-steroidal antiandrogen | 50-150 mg OD | Block flare with LHRH agonist start |
| Flutamide | Non-steroidal | 250 mg TID | Older; hepatotoxic |
| Enzalutamide | Novel antiandrogen | 160 mg OD | mCRPC, nmCRPC; no food effect |
| Apalutamide | Novel antiandrogen | 240 mg OD | nmCRPC; shorter time to metastasis |
| Darolutamide | Novel antiandrogen | 600 mg BID | nmCRPC; lower CNS SE |
For Metastatic Castration-Resistant Prostate Cancer (mCRPC)
| Drug | Dose | Notes |
|---|
| Abiraterone + Prednisone | Abi 1000 mg OD + Pred 5 mg BID | CYP17 inhibitor; with food or fasted per formulation |
| Docetaxel | 75 mg/mΒ² q3weeks | Chemo backbone for mCRPC |
| Cabazitaxel | 20-25 mg/mΒ² q3weeks | Post-docetaxel |
| Radium-223 (Xofigo) | 50 kBq/kg IV q4weeks x6 | Bone mets only; alpha emitter |
| Olaparib | 300 mg BID | BRCA1/2 or HRR mutation-positive mCRPC |
| Rucaparib | 600 mg BID | BRCA-mutated mCRPC |
| Pembrolizumab | 200 mg q3weeks | MSI-H or TMB-high mCRPC |
| Lutetium-177-PSMA-617 | 7.4 GBq q6weeks x6 | PSMA-positive mCRPC (VISION trial) |
PART 10: NEUROGENIC BLADDER
Drug Chart
| Drug | Indication | Dose | Notes |
|---|
| Oxybutynin | Detrusor overactivity | 5 mg TID-QID | Anticholinergic |
| Solifenacin | Detrusor overactivity | 5-10 mg OD | Less dry mouth |
| Mirabegron | Detrusor overactivity (if anticholinergics failed) | 25-50 mg OD | Beta-3 agonist |
| OnabotulinumtoxinA | Refractory detrusor overactivity | 200-300 units intradetrusor | Neurogenic; q6-9 months |
| Intermittent self-catheterization (CIC) | Incomplete emptying, elevated PVR | Every 4-6 hours | Primary management |
| Bethanechol | Underactive detrusor | 10-50 mg TID-QID | Cholinergic agonist - stimulates voiding |
| Baclofen | Detrusor-sphincter dyssynergia | 5-20 mg TID | Intrathecal for severe spasticity |
| Tamsulosin | Dyssynergia | 0.4 mg OD | Relaxes external sphincter |
PART 11: ERECTILE DYSFUNCTION (ED) IN UROLOGY
| Drug | Class | Dose | Duration of Action |
|---|
| Sildenafil | PDE-5 inhibitor | 25-100 mg | 4-6 hours (take 1h before) |
| Tadalafil | PDE-5 inhibitor | 5 mg daily or 10-20 mg PRN | 36 hours (daily or PRN) |
| Vardenafil | PDE-5 inhibitor | 5-20 mg | 4-8 hours |
| Avanafil | PDE-5 inhibitor | 50-200 mg | 6 hours (take 15 min before) |
| Alprostadil (ICI) | Prostaglandin E1 | 5-40 mcg intracavernosal | For PDE-5i failures |
ABSOLUTE CONTRAINDICATION: PDE-5 inhibitors + Nitrates = severe hypotension/death. Also contraindicated with alpha-blockers (orthostatic hypotension) except tamsulosin 0.4 mg - give 4 hours apart.
MASTER CHEAT CODES SUMMARY TABLE
| Condition | DOC (Drug of Choice) | Key Tip |
|---|
| Uncomplicated cystitis | Nitrofurantoin 100 mg BID x5-7d | Not for CrCl <30 or near term |
| Pyelonephritis (outpatient) | Ciprofloxacin 500mg BID x7-10d | Culture first |
| Pyelonephritis (inpatient) | Ceftriaxone 1g IV OD | Switch to oral when afebrile 48h |
| UTI in pregnancy | Cephalexin 500mg BID x7-10d | Screen all at 12-16 weeks |
| Renal colic (pain) | Diclofenac 75mg IM/IV | NSAIDs > opioids |
| MET (ureteral stone) | Tamsulosin 0.4mg OD x4 weeks | <10mm stones only |
| Uric acid stones | Potassium citrate (alkalinize urine pH 6.5-7) | Radiolucent stones on CT only |
| Ca-Ox stones / hypercalciuria | HCTZ 25-50mg OD | Monitor K+ |
| BPH (small prostate) | Tamsulosin 0.4 mg OD | Works in days |
| BPH (large prostate >40mL) | Tamsulosin + Dutasteride | 5ARI needs months to work |
| BPH + ED | Tadalafil 5 mg OD | Single drug for both |
| OAB/urge incontinence | Solifenacin 5mg OD or Mirabegron 50mg OD | Mirabegron preferred elderly |
| Stress incontinence | Pelvic floor exercises + Duloxetine (if meds needed) | Surgery (sling) for refractory |
| NMIBC (high risk) | TURBT + BCG intravesical | BCG > Mitomycin for high risk |
| NMIBC (low risk, immediate) | Single-shot Mitomycin C post-TURBT | Immediate within 6h |
| MIBC (systemic) | GC (Gemcitabine + Cisplatin) | Neoadjuvant before cystectomy |
| RCC (metastatic) | Ipilimumab + Nivolumab (poor risk) or TKI+IO | Nephrectomy + systemic |
| mCRPC | Enzalutamide OR Abiraterone + Prednisone | BRCA+ β add Olaparib |
| Hyperkalemia (emergency) | Calcium gluconate 10% IV (membrane stabilization) | FIRST step before K lowering |
| Indications for dialysis | AEIOU (Acidosis, Electrolytes, Ingestion, Overload, Uremia) | |
Sources: Campbell Walsh Wein Urology (9780323546423) | Bailey & Love's Surgery 28th Ed. | Comprehensive Clinical Nephrology 7th Ed. | Rosen's Emergency Medicine | Brenner and Rector's The Kidney | AUA Guidelines 2024 (Recurrent UTI) | EAU Guidelines 2024 (Urolithiasis, Urological Infections)
