FRCS(Urol) Part 2 Practice Scenarios

Suggested scenario themes across all eight stations to help structure your study group practice.

Practice is the most important element of Part 2 preparation. As we suggest in the main body of our guide, a big part of this is getting a study group together and grilling each other regularly.

You may find scenarios written by and handed down from previous trainees, but we've compiled a list of suggested topics for each of the different stations to consider. For our practice we'd write scenarios to quiz each other around these potential stations and suggest it's a good way to learn and then practice answering. For example, if four of you are studying together and each write two scenarios, you can then practice 6 scenarios for every two you write.

These are not exhaustive but are a suggestion of what you might want to consider covering.

Station 1: Oncology — Kidney & Bladder

Renal Cancer

Incidental small renal mass: surveillance, cryotherapy, RFA, and biopsy
Incidental small renal mass: partial nephrectomy vs radical nephrectomy
T2 renal mass for radical nephrectomy
Locally advanced renal cancer: paraneoplastic syndromes, lymph node involvement, and adjuvant treatment
Renal cell carcinoma with tumour thrombus and large lymph nodes
Metastatic renal cancer: cytoreductive nephrectomy and systemic treatment
Bosniak cyst classification and RCC histological subtypes
Familial RCC: Von Hippel–Lindau disease and Birt–Hogg–Dubé syndrome

Bladder Cancer

Haematuria clinic: assessment and investigation pathway
Visible haematuria with small bladder tumour: TURBT and mitomycin C
Non-visible haematuria with positive urine cytology: CIS, BCG, photodynamic diagnosis, and salvage intravesical treatments
First TURBT revealing high-grade tumour: re-resection, BCG vs cystectomy
Long-term catheter and squamous cell carcinoma: diversion techniques
Urachal cancer and variant histology
Locally advanced and metastatic bladder cancer
Risk factors, surveillance, post-operative follow-up, and urethral recurrence
Tumour in a diverticulum

Upper Tract Urothelial Carcinoma (UTUC)

Upper tract lesion: ureteroscopy vs radical nephroureterectomy
Endoscopically managed upper tract TCC
Metastatic upper tract lesion with intractable bleeding

Station 2: Oncology — Prostate, Testis & Penis

Prostate Cancer

Screening scenario and risk factors
Incidental raised PSA in a young man: biopsy/MRI focus (Grade Group 2 with unfavourable factors)
Incidental raised PSA in a young man: radical prostatectomy focus
Incidental raised PSA in an older man: radical radiotherapy
Biochemical recurrence post prostatectomy
Locally advanced prostate cancer with obstruction (retention/hydronephrosis)
Metastatic prostate cancer: non-emergency management
Metastatic prostate cancer: emergency management
Incidental raised PSA in a young man interested in focal therapy
Active surveillance
Metastatic prostate cancer with obstruction (emergency)
Watchful waiting

Testicular Cancer

Testicular microlithiasis: risk factors and germ cell neoplasia in situ (GCNIS)
Incidental scrotal mass in a young man, including adjuvant treatment
Incidental scrotal mass in an older man
Scrotal mass with associated infertility: onco-TESE and prosthesis
Locally advanced testicular cancer and treatment options
Metastatic testicular cancer (emergency): upfront chemotherapy
Tumour markers and histopathological features

Penile Cancer

Red patch on the glans
Glans lesion with non-palpable nodes
Locally advanced disease with palpable nodes
Fungating nodal lesion
Locally advanced disease with retention
Unexpected finding during circumcision

Station 3: Paediatric Urology

Phimosis
Undescended testis
Recurrent UTI and vesicoureteral reflux (VUR)
Antenatal unilateral hydronephrosis
Posterior urethral valves
Megaureter
Pelviureteric junction obstruction (PUJO)
VUR: emergency presentation
Disorders of sex development (DSD)
Nephroblastoma (Wilms' tumour)
Hypospadias and epispadias
Nocturnal enuresis
Spina bifida
Varicocele
Testicular torsion
Duplex kidney

Station 4: Emergency Urology

Kidney trauma
Ureteric trauma
Bladder trauma
Genital trauma
Anterior urethral injury
Posterior urethral injury and pelvic fracture
Testicular injury
Infected obstructed kidney
Emphysematous pyelonephritis (see also Infections)
Xanthogranulomatous pyelonephritis (see also Infections)
Acute retention: unable to catheterise
Testicular torsion
TUR syndrome
Post-TURP bleeding
Post-PCNL bleeding
Pelvic haematoma
Fournier's gangrene (see also Infections)

Station 5: UTI & Urolithiasis

Infections

Recurrent UTI
Prostatitis: acute and chronic
UTI with prostate abscess
Urinary tuberculosis
Schistosomiasis
Renal abscess and sepsis (evidence base)
Urethritis and sexually transmitted infections
Testicular infection and abscess in an older man
Fournier's gangrene
Xanthogranulomatous pyelonephritis (XGP)
Struvite staghorn calculus
Emphysematous pyelonephritis (EPN)

Urolithiasis

Small distal ureteric stone: elective management and medical expulsive therapy
Large proximal ureteric stone (acute, non-infected): urgent management
Asymptomatic renal stone and ESWL
Symptomatic renal pelvis stone
Large lower pole stone: PCNL
Staghorn calculus
Nephrocalcinosis
Hyperoxaluria
Hypercalciuria
Cystinuria
Hyperuricosuria
Renal tubular acidosis
Stone in pregnancy

Station 6: Imaging & Technology

Imaging

Plain radiography (X-ray)
Fluoroscopy
X-ray safety and radiation protection
Contrast agents and contrast reactions
CT: principles and how it works
CT phases
MRI: principles and how it works
MRI phases
MRI contrast agents
MRI safety
PET: principles and how it works
PET radiopharmaceuticals (radiolabels and radioisotopes)
PET indications in urology
Ultrasound: principles and how it works
Ultrasound Doppler
Contrast-enhanced ultrasound (CEUS)
MAG3 renogram
DMSA scan
DTPA scan
MDP bone scan

Technology

Urinalysis
GFR and eGFR calculations
EDTA clearance
Group and save / crossmatch
Nucleic acid amplification testing (NAAT)
Procalcitonin
C-reactive protein (CRP)
Blood cultures
Flow testing: types and curve interpretation
Blood products
Shock classification
Massive transfusion protocol
Major haemorrhage protocol
Complications of blood transfusion
MHRA Yellow Card scheme
Autotransfusion
Haemostatic products
Antiplatelet and anticoagulant medications and their reversal
Tranexamic acid (TXA)
Peritoneal dialysis: peritoneal catheters and ambulatory PD
Haemofiltration and haemodialysis
Dialysis access
Transplant: schedules and types of donors
Approach to transplant
Flexible cystoscope
Rigid cystoscope
Resectoscope
Rigid ureteroscope
Flexible ureteroscope
Nephroscope
Decontamination and disinfection of scopes (including Spaulding classification and autoclave)
Wires: types, composition, length, and diameter
Stents: classification and types
The perfect stent
Baskets: types and use
Biopsy forceps: front-loaded and back-loaded
Lasers in urology
Energy sources
Monopolar and bipolar diathermy
Harmonic scalpel
EnSeal
Laparoscopic stack
Robotic stack (overview)
Air embolism
Insufflation
Physiological effects of insufflation
Lithoclast
Trilogy
Access sheaths
ESWL machines and types
ESWL waveforms
ESWL energy for renal vs ureteric stones
Cryotherapy
Radiofrequency ablation (RFA)
Microwave ablation
High-intensity focused ultrasound (HIFU)

Station 7: Functional Urology

Young woman with spina bifida
Middle-aged man with spinal cord injury (lower urinary tract focus)
Older woman with multiple sclerosis and incontinence
Stroke patient with overactive bladder and recurrent UTIs
Spinal cord injury: emergency aspects (spinal shock, autonomic dysreflexia)
Man with chronic cauda equina syndrome
Young woman with overactive bladder: assessment, medical management, and botulinum toxin
Older woman with OAB and incontinence: surgical management with focus on sacral neuromodulation
Post-hysterectomy vesicovaginal fistula
Older woman: stress urinary incontinence management
Post-prostatectomy incontinence management
Mesh complications
Caesarean section ureteric injury
Mixed incontinence: urodynamics scenario focusing on interpretation
Failed OAB treatment: clam augmentation cystoplasty
Woman with urinary incontinence and pelvic organ prolapse: assessment and management
Bladder pain syndrome
Ketamine bladder
Urethral diverticulum
Intractable OAB with diversion
Female urethral stricture

Station 8: BPH & Andrology

Benign Prostatic Hyperplasia (BPH)

Acute urinary retention: medical management
High-pressure chronic retention
Low-pressure chronic retention
Elective: young man with 30cc prostate and LUTS
Elective: older man with 60cc prostate
Emergency haematuria in an older man with 110cc prostate
Elective: Parkinson's disease with LUTS and raised post-void residual

Andrology

Curved penis: medical and surgical management
Erectile dysfunction: medical management and risk factors
Erectile dysfunction in a young man: psychogenic
Erectile dysfunction: surgical management
Acquired hypogonadism
Fertility: retrograde ejaculation
Fertility: obstructive azoospermia and ejaculatory duct obstruction
Fertility: epididymal obstruction
Oligoasthenoteratozoospermia (OAT) and varicocele
Non-obstructive azoospermia
Vasectomy and subsequent reversal
Low-flow priapism
High-flow priapism
Penile fracture
Young man with post-chlamydia stricture: urethroplasty and Optilume
Older man post-TURP with bladder neck stenosis
Chronic testicular pain
Haematospermia
Premature ejaculation

Get Started

These scenario prompts act as a jumping off point to get started and write a set of questions to viva the others in your study group. Practice, practice, practice is the key — so get started!

Haven't read our Part 2 guide yet? Check out the Complete Guide to FRCS(Urol) Part 2.

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FRCS(Urol) Part 2: Practice Scenarios