Understanding the FRCS(Urol) Part 1 Syllabus: What You Need to Know

The FRCS(Urol) Part 1 is the written component of the Intercollegiate Specialty Examination in Urology — the exam you need to pass to obtain CCT and work as a consultant urologist in the UK. It's a big exam with a broad syllabus, and knowing what's actually in scope can help ensure you revise appropriately.

The Structure

The exam consists of two papers, sat on the same day at a Pearson Vue test centre:

Paper 1: 120 Single Best Answer questions (2 hours 15 minutes)
Paper 2: 120 Single Best Answer questions (2 hours 15 minutes)

There's no negative marking, and the pass mark is set using a modified Angoff method — meaning it varies by sitting based on question difficulty.

The exam runs twice a year, in January and July. You need ARCP outcome 1 at ST5 to be eligible, so most trainees sit it in ST6.

Basic Sciences

Don't underestimate the basic science content. The syllabus expects you to know:

Anatomy & Embryology

Detailed anatomy of the urinary tract, including 3D relationships to adjacent structures
Abdomino-pelvic anatomy: bony pelvis, pelvic floor, endopelvic fasciae
Lymphatic drainage of all pelvic organs
Retroperitoneal anatomy and the femoral triangle
Embryological development relevant to congenital abnormalities

Physiology

Nephron function, GFR, tubular physiology
Renin-angiotensin-aldosterone system
Neurophysiological control of micturition
Physiology of erection and ejaculation
Pain pathways

Pathology

Tumour biology and molecular oncology
Inflammation, infection, and wound healing
Histopathology of common urological malignancies

Pharmacology

Drugs affecting the lower urinary tract (antimuscarinics, beta-3 agonists, alpha-blockers, 5-ARIs)
Chemotherapy agents and intravesical therapies
Anticoagulation and bridging
Immunosuppressants in transplantation

Clinical Domains

The clinical syllabus covers the full breadth of urology:

Uro-Oncology (Heavily Weighted)

Prostate cancer: PSA, Gleason/ISUP, active surveillance, radical treatment, hormonal therapy, CRPC
Bladder cancer: NMIBC risk stratification, TURBT, intravesical therapy, radical cystectomy, urinary diversion
Kidney cancer: RCC subtypes, Bosniak classification, partial vs radical nephrectomy, systemic therapy
Testicular cancer: Tumour markers, staging, surveillance, chemotherapy, RPLND
Penile cancer: Staging, inguinal lymphadenectomy, organ preservation
UTUC: Investigation, risk stratification, nephro-ureterectomy

Stone Disease

Pathophysiology of stone formation and metabolic evaluation
Medical expulsive therapy
ESWL, ureteroscopy (rigid and flexible), PCNL
Management of complex and staghorn calculi

Functional Urology & Neurourology

ICS terminology and urodynamics
Overactive bladder and detrusor overactivity
Stress urinary incontinence (male and female)
Neurogenic bladder management
Botulinum toxin, sacral neuromodulation, artificial urinary sphincter

BPH/LUTS

BPE, BPO, BOO — know the distinctions
Medical therapy: alpha-blockers, 5-ARIs, combination therapy
Surgical options: TURP, HoLEP, laser ablation, open prostatectomy
TUR syndrome: recognition and management

Andrology, Paediatrics, Infections, Trauma & Transplant

The syllabus also covers erectile dysfunction, male infertility, Peyronie's disease, paediatric conditions (undescended testis, VUR, PUJ obstruction, hypospadias), UTIs, Fournier's gangrene, TB, urological trauma, priapism, and transplant principles.

Guidelines You Need to Know

The FRCS(Urol) draws on multiple guideline sources:

EAU Guidelines — the backbone for most clinical management
NICE Guidelines — essential for UK-specific practice (know the Quick Reference Guides)
ICS Standards — for functional urology terminology
TNM Classification — AJCC/UICC staging for all malignancies

Don't neglect NICE. Questions often test UK-specific pathways — PSA testing, haematuria investigation, referral thresholds.

Recommended Resources

Campbell-Walsh-Wein Urology — the reference textbook (read selectively, not cover to cover)
Oxford Handbook of Urology — portable, concise, good for building a framework
EAU Guidelines — free online, regularly updated
NICE Guidelines — especially Quick Reference Guides
Essentials of Paediatric Urology — covers paediatrics comprehensively

Question banks and practice papers are essential for exam technique. The more SBAs you do, the better.

Urobank and the Syllabus

Urobank is designed to align with the FRCS(Urol) syllabus. Our questions are organised into topics that mirror the exam's scope: Anatomy, Basic Science, Stats, BPH, Functional, Urolithiasis, Infections, Emergency Urology, Trauma, Prostate Cancer, Bladder Cancer, Renal Cancer, UTUC, Testicular Cancer, Penile Cancer, Urethral Cancer, Andrology, Paediatric Urology, Transplant, and Technology.

Whether you want to work through the syllabus systematically or target specific weak areas, the structure is there to support your revision.

Final Advice

The FRCS(Urol) Part 1 syllabus is broad but logical. It tests whether you have the knowledge base to work as a consultant — basic science foundations plus clinical decision-making across the specialty.

Start early, cover the syllabus systematically, and practice questions. Know your guidelines. And remember: this exam is passable with consistent, focused preparation.