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Urology (MBBS): Course Outline

Introduction

Introduction /Rationale 

This module is designed to enable the students to manage common urological problems in primary care settings. As discussed in 1st spiral of this module, kidney is an organ concerned with homeostasis. Beyond kidneys the rest of the urinary tract acts as a conduit for the outward passage of urine. Although, unlike heart, lungs or brain, sudden severe derangement of its function does not cause immediate death, but the life cannot be sustained for longer periods without functioning kidneys or renal support therapy.

Prostate and testes are the organs concerned with the reproduction. This again have a profound psycho-social impact on the life of individual in addition to that on the continuity of human race. Ailments involving these systems are not only common but also have significant effect on both quality and maintenance of life. Apart from their scale of severity or psycho-social impact, the diseases of these organs are common and constitute considerable workload catered by family physicians and even if some of these cases will ultimately land with the specialists, they initially present to the family physicians.

Like any other system, diseases of these organs range from trivial easily treatable entities to very complex conditions requiring intensive multi-disciplinary approach. Truly speaking many of these conditions are dealt with by specialists rather than the graduates alone.  However, the purpose of its teaching at this stage is not to make them all nephrologists or urologists. Rather the rationale for its inclusion in undergraduate curriculum is to give students a “holistic” view of the subject that will enable them.

Course outline

  • Compare and contrast the patterns of incontinence due to different causes
  • Interpret investigations in incontinence due to different causes
  • Describe role of urodynamics in diagnosis of  non- neurogenic  bladder dysfunctions Outline management of incontinence due to causes discussed above Define nocturnal enuresis
  • Enlist causes of enuresis

Enlist treatment options in enuresis

  • Differentiate between benign and malignant prostatic conditions (Benign prostatic hyperplasia, prostatitis, and prostatic carcinoma) based on clinical findings, pathogenesis, morphologic features and relevant investigations.
  • Relate the salient morphological features with respect to Gleason grading of prostatic carcinoma.
  • Identify causes of retention of urine in different clinical situations
  • Diagnose BPH based on clinical features and investigations
  • Identify complications of BPH in different clinical scenarios
  • Describe emergency management of acute retention of urine
  • Identify correct treatment option in different scenarios of BPH
  • identify clinical indications for operative treatment of BPH in different scenarios
  • Identify the complications of prostatectomy in different clinical situations
  • identify symptoms of carcinoma of prostate among different lower urinary tract and systemic features
  • Interpret results of diagnostic investigations for Ca prostate

Outline treatment plan of Ca prostate according to TNM staging

Formulate treatment plans for following anomalies based on their clinical features and complications

 • rationlaize clinical features of urethritis relating them to the anatomy and physiology of urinary tract

 

•           Outline treatment plan in urethritis

•              Outline treatment plan of peri-urethral abscess based on a clinical diagnosis

  • Assign correct diagnosis to different clinical situations related to urethral trauma
  • Interpret results of diagnostic investigations for urethral rupture
  • Demonstrate emergency treatment for urethral trauma

Outline treatment plans for urethral trauma in different clinical situations

  • Attribute correct diagnosis in different clinical situations of penile trauma
  • Outline treatment plan in penile injuries
  • Outline treatment plan of different clinical situations given by the faculty related to:
    • testicular / scrotal trauma
    • Injuries to the penis
  • Formulate treatment of gonorrhea based on a clinical diagnosis confirmed by investigation
  • Relate the lifecycle of Trichomonas vaginalis to its pathogenesis, clinical features and diagnostic investigations

 

 

•  Discuss differential diagnosis of genital ulcers with special consideration of syphilis

 

• Interpret results of diagnostic investigations    for different stages of syphilis

• Discuss the treatment plan for different stages of syphilis

  • Relate given clinical scenarios to different etiologies of urethral strictures
  • Assign appropriate diagnosis to different clinical situations given by the faculty related to urethral strictures
  • Interpret diagnostic investigations for urethral strictures

Outline management plans for given scenarios of urethral strictures

•   Assign correct diagnosis to different clinical situations given by the faculty related to maldescent of testes

•   Interpret investigations for diagnosis of mal-descent of testis

•   Outline management plans in different clinical situations related to mal- descent of testis

  • Enlist causes of acute painful swellings of testes
  • Describe clinical presentation of torsion of testis
  • enlist complications of torsion
  • Interpret results of diagnostic investigations for testicular torsion
  • Outline treatment plan for torsion testis
  •  Enlist clinical features of epididymoorchitis
  • Interpret      results    of            investigations        of epidedymo-orchitis
  • Outline treatment plan for epidedymoorchitis 
  • Identify following conditions in different clinical situations
    • Varicocele
    • Vaginal Hydrocele
    • Congenital Hydrocele
    • Hematocele
    • Filariasis /Elephantiasis
    • Spermatocele
    • Epididymal cysts
    • testicular tumours
  • differentiate between testicular swellings on basis of clinical features
  • Interpret results of diagnostic investigations for painless scrotal swellings

Outline treatment plans in in different clinical situations related to above mentioned conditions

Differentiate between different testicular tumors with reference to patient age, morphologic features and associated tumor markers in given clinical situations.

  • diagnose different clinical situations based on clinical features of testicular tumors
  • Identify stage of testicular tumor based on interpretation of given investigations

Outline management plans in different clinical situations related to testicular tumors

  • Define terms:
    • Azospermia              
    • Oligospermia
    • Pyospermia 
    • Hematospermi
    • necrozospermia
  • Classify causes  of  male infertility
  • Interpret results of diagnostic investigations    for common causes of infertility

enlist   surgical and medical treatment   options   for common   conditions   leading to infertility

  • Identify erectile dysfunction in different clinical scenarios
  • Identify causes of erectile dysfunction in different clinical scenarios given to you by the faculty
  • Generate treatment plans in different clinical scenarios given to you by the faculty related to ED
  • identify the following conditions in given clinical scenarios
    • Premature ejaculation
    • Delayed ejaculation

Retrograde ejaculation

  • Identify the following urogenital lesions on image:
  • Post-streptococcal glomerulonephritis
  • Membranous nephropathy
  • Crescentic glomerulonephritis
  • Diabetic nephropathy
  • Hydronephrosis
  • Renal stones
  • Pyelonephritis
  • Renal tumors
  • Bladder tumors
  • Benign prostatic hyperplasia
  • carcinoma of prostate
  • Testicular tumors

Justify your findings based on morphologic features

After going through this module, the 4th year medical student will be able to:

  • Integrate the basic science knowledge with clinical sciences to identify & manage the cases Genito-urology/nephrology among the general patients.
  • Develop a problem-solving approach in managing various types of Genito urological problems 
  • Justify a provisional diagnosis of any given urological disease based on history and clinical examination
  • Plan investigations for a urological case to confirm the provisional diagnosis and rule out differential diagnosis
  • Correctly interpret urologic investigation reports while relating them to basic science knowledge
  • Correctly interpret urologic diagnostic images
  • Outline plan of care for a urological patient
  • Generate rational prescriptions for common clinical conditions in the module
  • Identify incompatible drug combinations related to common clinical conditions in the module
  • Appropriately refer complex urological conditions to the specialist doctor
  • Identify ethical issues related to transplant
  • Demonstrate commitment with Islamic perspective on transplantation of human organs/tissues
  • Effectively counsel a patient demonstrating all attributes of medical professionalism
  • Demonstrate appropriate behaviors for team building and participation in collective activities
  • Effectively communicate with patient, attendants, and families observing good mannerism
  • Differentiate between different types and causes of incontinence in the clinical scenarios
  • Detect patterns of incontinence in different clinical scenarios
  • Interpret results of urodynamic investigations in incontinence due to neurogenic bladder dysfunction
  • Assign correct diagnosis of neuropathic bladder complications to different clinical scenarios given by the faculty
  • Generate management plans for incontinence patients according to scenarios given by the faculty
  • Identify causes of enuresis in different scenarios given by the faculty
  • Generate management plans for enuresis patients according to scenarios given by the faculty

BLOCK-B: DISEASES OF URETER AND BLADDER

  • Enumerate clinical features of ureter stones
  • Differentiate between causes of loin to groin flank pain on basis of clinical features
  • Interpret results of diagnostic investigations for flank pain
  • Enumerates general emergency treatment
  • measures for ureteric pain
  • describe indications of emergency surgical
  • intervention in ureteric stones
  • Enlist complications of ureteric stones Describe the definitive treatment options for ureteric calculi
  • Discuss common ureteric injuries
  • Describe clinical features of ureteric injuries
  • Interpret results of investigations for ureteric injuries
  • Discuss plan of management for ureteric injuries
  • Describe types of bladder trauma
  • Discuss causes of bladder traumatic rupture
  • Describe clinical features of bladder rupture Interpret results of diagnostic investigations in bladder trauma
  • outline management plan in bladder trauma

Discuss post-operative care of bladder trauma

  • Define terms Anuria, Obstructive uropathy, Hydronephrosis
  • Enlist     causes of ureteric obstruction including pelvi-ureteric and vesico- ureteric junctions
  • Describe clinical features              of            ureteric obstruction
  • Enumerate         complications    of            ureteric obstruction
  • Interpret results of diagnostic investigations for ureteric obstruction
  • Outline  treatment  plan       for          ureteric obstruction
  • Discuss types of vesical calculi on basis of etiology
  • Describe types of stones based on chemical composition
  • Discuss etiological factors for vesical stone formation
  • Describe clinical features of vesical stone Interpret diagnostic investigation for vesical calculi
  • Outline treatment plan for vesical calculi
  • Discuss clinical features of urethral calculi

Describe emergency treatment for urethral calculi 

  • Discuss etiology of
      • Isolated UTIs
      • Recurrent UTIs 
      • Persistent UTIs
      • Complicated UTIs 
      • uro-sepsis  (gram   negative endotoxemia)
  • Describe clinical features of cystitis
  • Discuss   causes    of frequency- dysuria syndrome
  • Interpret results of investigations in UTI
  • Outline treatment plan in cystitis
  • Describe management of uro-sepsis
  • Discuss clinical features of acute and chronic prostatic infections

Outline management of prostatic infections 

  • Relate the morphologic features of common urinary bladder carcinomas with their underlying etiopathology and clinical findings.
  • Differentiate between the morphological features of different grades of urothelial carcinoma.
  • Recognize bladder tumors by going through clinical features and results of investigations
  • Assign correct diagnosis and stage of bladder tumors based on different cystoscopy findings
  • Interpret results of staging investigations for invasive bladder tumors
  • Generate the management plan based on TNM classification of bladder tumors

Diseases of KIDNEY

  • diagnose polycystic kidney disease by going through clinical scenarios
  • diagnose polycystic kidney disease complications by going through clinical scenarios
  • Interpret investigations for PCKD
  • Outline treatment plan for PCKD and its complications
  • justify correct diagnosis to different types of renal cysts based on sonological features
  • relate the underlying immune mechanisms of Type II hypersensitivity reaction in different clinical situations.
  • relate the underlying immune mechanisms of Type III hypersensitivity reaction in different clinical situations
  • Differentiate between various types of proteinuria based on etiology and pathogenesis
  • Select and justify appropriate biochemical test in different patients presenting with proteinuria
  • Interpret test results of a patient with suspected proteinuria in a clinical scenario
  • formulate a differential diagnosis
  • Relate the morphological findings of common glomerular diseases with the clinical features and laboratory findings of nephrotic and nephritic syndromes.
  • Identify the underlying mechanisms of various glomerular diseases in different clinical situations

Differentiate between the morphological findings in the glomeruli in patients with minimal change disease, post-streptococcal glomerulonephritis, and diabetic nephropathy

  • Describe clinical features of nephrotic syndrome (NS)
  • Enlist causes of NS
  • Interpret lab findings seen in general and specific investigations
  • Describe the complications of nephrotic syndrome.
  • Plan general and specific management.
  • Define nephrotic syndrome (NS).
  • Justify clinical features of typical NS based on its pathophysiology.
  • Interpret the result of investigations for diagnosis of NS in children.
  • Predict complications of NS in each clinical situation.
  • Formulate management of NS in children.
  • Define acute glomerulonephritis.
  • Describe etiology of acute post-streptococcal glomerulonephritis
  • Correlate the clinical features of APGN with the pathophysiological mechanism.
  • Interpret investigations for diagnosis of APGN.
  • Devise management plan of APGN.
  • Predict the complications   & prognosis of APGN in each clinical situation.
  • Correlate the morphological findings and pathologic mechanism of amyloidosis in different clinical conditions with respect to renal disease.
  • Relate the deposition of different chemical forms of amyloid in different clinical conditions.
  • Correlate the morphologic features and etio-pathogenic mechanisms with the clinical features
  • Correlate the morphologic findings and pathophysiologic mechanisms of different types of tubulointerstitial nephritis.
  • Relate the etio-pathogenic mechanisms of urinary tract infection leading to acute and chronic pyelonephritis with reference to the clinical and laboratory findings.
  • Identify the different outcomes and complications associated with pyelonephritis in given clinical situations.
  • diagnose correctly acute pyelonephritis by going through clinical scenarios
  • diagnose correctly chronic pyelonephritis by going through clinical scenarios
  • justify differential diagnosis of pyelonephritis
  • Interpret results of investigations of upper UTI
  • Outline plan of management in acute pyelonephritis
  • outline plan of management in chronic pyelonephritis
  • Enlist etiology of UTI in children.
  • Identify risk factors of UTI in children.
  • Assess clinical features of a child with UTI.
  • Interpret the result of investigations required for diagnosis of UTI.
  • Devise management plan of a child with UTI.
  • Enumerate Renal Function Tests
  • Analyse the clinical significance of routine lab tests used to estimate the renal functions
  • Explain the complete procedure of Creatinine Clearance Test
  • Evaluate the importance of CCT in the diagnosis/ prognosis of renal diseases effecting the GFR
  • Relate different scenarios of Pylonephrosis, renal and peri- renal abscesses to their possible etiology
  • Assign correct diagnosis to different scenarios of Pyonephrosis, renal and peri- renal abscesses based on clinical features
  • Interpret results of diagnostic investigations for Pyonephrosis, renal and peri-renal abscess
  • outline treatment for Pyonephrosis, renal and peri- renal abscesses

Correlate the morphological findings and pathogenic mechanisms underlying acute tubular injury in given clinical situations.

  • Describe function of nephron
  • Describe oliguria
  • Enlist causes of ARF
  • Describe clinical course of tubular necrosis relating to its pathogenesis
  • Interpret Lab investigation in ARF