9.9 Prostate Disorders, Urinary Incontinence & Other Urologic Conditions

ABIM Internal Medicine Exam

Track your progress as you read

Finished sections get a check mark.

1 Chapter 0: The ABIM Exam, Blueprint & Study Strategy

0.1 Exam Format, Question Types & the 2026 Blueprint 0.2 Eligibility, Registration, Fees & Exam-Day Logistics 0.3 Scoring, the Passing Standard & Score Reports 0.4 Building a Blueprint-Weighted Study Plan

2 Chapter 1: Cardiovascular Disease (14% of Exam)

1.1 Ischemic Heart Disease & Acute Coronary Syndromes 1.2 Antithrombotic Therapy, Secondary Prevention & Mechanical Complications of MI 1.3 Atrial Fibrillation, Atrial Flutter & Stroke Prevention 1.4 Supraventricular Tachycardias, Ventricular Arrhythmias & Bradycardias 1.5 Heart Failure: Classification, Staging & Guideline-Directed Medical Therapy 1.6 Device Therapy, HFpEF & the Cardiomyopathies 1.7 Valvular Heart Disease & Endocarditis Prophylaxis 1.8 Pericardial Disease & Acute Aortic Syndromes 1.9 Hypertension: Classification, Diagnosis & Secondary Causes 1.10 Hypertensive Crises & Dyslipidemia 1.11 Adult Congenital Heart Disease & Coarctation of the Aorta 1.12 Syncope: Reflex, Orthostatic & Cardiac Causes 1.13 Cardiac Physical Examination, Murmurs & Antithrombotic Selection

3 Chapter 2: Endocrinology, Diabetes & Metabolism (9% of Exam)

2.1 Diabetes Mellitus: Diagnosis, Glycemic Targets & Pharmacotherapy 2.2 Insulin Therapy, Hyperglycemic Emergencies & Chronic Complications 2.3 Thyroid Function Testing & Hypothyroidism 2.4 Thyrotoxicosis, Thyroid Storm & Thyroid Nodules 2.5 Adrenal & Pituitary Disorders 2.6 Hypercalcemia, Hypocalcemia & Disorders of Mineral Metabolism 2.7 Osteoporosis & Paget Disease of Bone 2.8 Ovarian, Testicular & Reproductive Endocrine Disorders 2.9 Hypoglycemia, Endocrine Tumors, Polyglandular Syndromes & Severe Hypertriglyceridemia

4 Chapter 3: Gastroenterology & Hepatology (9% of Exam)

3.1 Esophageal Disease 3.2 Stomach & Duodenal Disease and Gastrointestinal Hemorrhage 3.3 Inflammatory Bowel Disease 3.4 Celiac Disease & Irritable Bowel Syndrome 3.5 Diverticular Disease & Colorectal Cancer Screening 3.6 Viral Hepatitis, Steatotic & Alcohol-Associated Liver Disease 3.7 Cirrhosis & the Complications of Portal Hypertension 3.8 Acute Pancreatitis 3.9 Chronic Pancreatitis & Biliary Tract Disease 3.10 Inherited, Autoimmune & Drug-Induced Liver Disease 3.11 Small Intestinal Disease, Ischemia & Gastrointestinal Complications of HIV

5 Chapter 4: Infectious Disease (9% of Exam)

4.1 Lower Respiratory Tract Infections & Sepsis Syndromes 4.2 Viral Respiratory Pathogens & Tuberculosis 4.3 Central Nervous System Infections 4.4 Skin, Soft Tissue, Bone & Joint Infections 4.5 Infective Endocarditis & Cardiovascular Infection 4.6 Clostridioides difficile & Catheter-Related Bloodstream Infection 4.7 HIV Diagnosis, Antiretroviral Therapy & Prevention 4.8 Opportunistic Infections & Sexually Transmitted Infections 4.9 Fever of Unknown Origin, Neutropenic Fever & Toxic Shock 4.10 Travel-Related Illness, Vector-Borne Disease & Outbreaks 4.11 Infection Prevention, Nosocomial Infection & Postexposure Prophylaxis 4.12 Rheumatic Fever, Poststreptococcal Disease, Enteric & Hepatic Infections

6 Chapter 5: Pulmonary Disease (9% of Exam)

5.1 COPD: Diagnosis, GOLD Classification & Initial Pharmacotherapy 5.2 Interventions That Reduce COPD Mortality & Exacerbation Management 5.3 Asthma: Diagnosis, Stepwise Therapy & Status Asthmaticus 5.4 Interstitial Lung Disease & Idiopathic Pulmonary Fibrosis 5.5 Sarcoidosis, Hypersensitivity Pneumonitis & Occupational Lung Disease 5.6 Pulmonary Embolism: Diagnosis, Risk Stratification & Anticoagulation 5.7 Pulmonary Hypertension & Sleep-Disordered Breathing 5.8 Acute Respiratory Distress Syndrome & Mechanical Ventilation 5.9 Pleural Disease, Empyema & Pneumothorax 5.10 Bronchiectasis, Cystic Fibrosis & Restrictive Lung Disease 5.11 Evaluation of Cough, Dyspnea, Hemoptysis & the Solitary Pulmonary Nodule

7 Chapter 6: Rheumatology & Orthopedics (9% of Exam)

6.1 Rheumatoid Arthritis: Diagnosis & Systemic Manifestations 6.2 Antirheumatic Pharmacotherapy & the Spondyloarthropathies 6.3 Gout: Pathophysiology & Acute Management 6.4 Urate-Lowering Therapy & Calcium Pyrophosphate Deposition Disease 6.5 Osteoarthritis 6.6 Systemic Lupus Erythematosus 6.7 Systemic Sclerosis, Sjogren Syndrome & Inflammatory Myopathies 6.8 The Vasculitides 6.9 Regional Musculoskeletal Syndromes, Back Pain & Sports Injuries 6.10 Other Primary Rheumatic Disorders & Mixed Connective Tissue Disease 6.11 Osteonecrosis & Metabolic Bone Disease

8 Chapter 7: Hematology (6% of Exam)

7.1 Approach to Anemia & the Microcytic Anemias 7.2 Macrocytic, Normocytic & Hemolytic Anemias 7.3 Hemoglobinopathies, Thalassemias & Paroxysmal Nocturnal Hemoglobinuria 7.4 Platelet Disorders, Thrombocytopenia & the Bleeding Patient 7.5 Coagulation Factor Disorders, Thrombophilia & Anticoagulant Reversal 7.6 Acute Leukemias, Chronic Leukemias & Myeloproliferative Neoplasms 7.7 Lymphomas & Plasma Cell Disorders 7.8 Myelodysplastic Syndrome, Myeloproliferative Neoplasms & Porphyria 7.9 Transfusion Medicine & Late Complications of Transplantation

9 Chapter 8: Medical Oncology (6% of Exam)

8.1 Breast, Lung, Colorectal & Prostate Cancer 8.2 Oncologic Emergencies 8.3 Genitourinary & Gynecologic Malignancies 8.4 Head and Neck, Bone & Soft Tissue Cancer and Cancer of Unknown Primary 8.5 Complications of Cancer & Its Treatment 8.6 Cancer Prevention, Survivorship & Psychosocial Care

10 Chapter 9: Nephrology & Urology (6% of Exam)

9.1 Acute Kidney Injury: Staging, Etiology & Urine Microscopy 9.2 Glomerular Disorders & Nephrotic Syndrome 9.3 Nephritic Syndromes, RPGN & Indications for Renal Replacement Therapy 9.4 Chronic Kidney Disease: Staging & Progression Retardation 9.5 Complications of Chronic Kidney Disease: Anemia, CKD-MBD & Acidosis 9.6 Hyponatremia, Hypernatremia & Water Balance 9.7 Potassium Disorders & Systematic Acid-Base Analysis 9.8 Renal Tubular Acidosis & Nephrolithiasis 9.9 Prostate Disorders, Urinary Incontinence & Other Urologic Conditions 9.10 Cystic Kidney Disease, Obstructive Uropathy, Tubulointerstitial Disease & Hematuria

11 Chapter 10: Neurology (4% of Exam)

10.1 Acute Ischemic Stroke: Syndromes & Reperfusion 10.2 Transient Ischemic Attack, Secondary Prevention & Hemorrhagic Stroke 10.3 Headache & Facial Pain 10.4 Seizures, Epilepsy & Movement Disorders 10.5 Multiple Sclerosis & Neuromuscular Junction Disorders 10.6 Motor Neuron Disease & Acute Peripheral Neuropathy 10.7 Cranial Neuropathies & Neuro-Ophthalmology 10.8 Peripheral Neuropathies, CNS Tumors & Other Neurologic Disorders

12 Chapter 11: Psychiatry & Behavioral Health (4% of Exam)

11.1 Major Depressive Disorder & Medical Mimics 11.2 Antidepressant Pharmacotherapy & Treatment-Resistant Depression 11.3 Bipolar Disorder, Mood Stabilizers & Lithium Toxicity 11.4 Anxiety, Stress-Related & Obsessive-Compulsive Disorders 11.5 Alcohol Use Disorder & Withdrawal 11.6 Pharmacotherapy for Alcohol & Opioid Use Disorder 11.7 Toxidromes, Psychiatric Emergencies & Suicide Risk Assessment 11.8 Psychotic, Somatic Symptom, Factitious & Personality Disorders 11.9 Eating Disorders, Sleep Disorders & Sexual Health

13 Chapter 12: Dermatology (3% of Exam)

12.1 Dermatitis, Papulosquamous & Inflammatory Dermatoses 12.2 Acne, Rosacea & Cutaneous Infections 12.3 Herpes Zoster & Autoimmune Blistering Diseases 12.4 Nodules, Tumors & Cutaneous Oncology 12.5 Dermatologic Emergencies & Severe Cutaneous Adverse Reactions 12.6 Pigment Disorders, Alopecia, Nail Disease & Photosensitivity 12.7 Vascular Dermatoses, Environmental Injury & Cutaneous Signs of Systemic Disease

14 Chapter 13: Obstetrics & Gynecology / Women's Health (3% of Exam)

13.1 Contraception, Preconception Care & Teratogenicity 13.2 Hypertensive Disorders of Pregnancy & Gestational Diabetes 13.3 Thyroid Disease & Venous Thromboembolism in Pregnancy 13.4 Menopause & Menopausal Hormone Therapy 13.5 Abnormal Uterine Bleeding, Endometrial Disease & Gynecologic Cancer Screening 13.6 Breast Disorders & Diseases of the Vulva and Vagina 13.7 Menstrual Disorders, Fibroids, Endometriosis & Early Pregnancy Complications

15 Chapter 14: Geriatric Syndromes (3% of Exam)

14.1 Comprehensive Geriatric Assessment & Frailty 14.2 Falls, Gait Assessment & Polypharmacy 14.3 Urinary Incontinence & Pressure Injuries in Older Adults 14.4 Mild Cognitive Impairment, Dementia & Its Subtypes 14.5 Delirium & the Pharmacotherapy of Cognitive Disorders 14.6 Palliative Care, Hospice & Advance Care Planning 14.7 Chronic Wounds, Nutrition, Swallowing, Constipation & Hip Fracture 14.8 Sensory Impairment, Dizziness, Elder Mistreatment & Care Settings

16 Chapter 15: Allergy & Immunology (2% of Exam)

15.1 Anaphylaxis: Recognition & Emergency Management 15.2 Urticaria & Angioedema 15.3 Drug Allergy, Desensitization & Adult Immunodeficiency 15.4 Food Allergy, Insect Venom Hypersensitivity, Serum Sickness & Contrast Reactions 15.5 Rhinitis, Conjunctivitis, Eosinophilic & Mast Cell Disorders

17 Chapter 16: Preventive Medicine, Immunization & Clinical Epidemiology

16.1 The USPSTF Framework & Evidence-Based Cancer Screening 16.2 Cardiovascular & Metabolic Screening and Primary Prevention 16.3 Adult Immunization & Vaccines in Special Populations 16.4 Clinical Epidemiology, Biostatistics & Study Design

18 Chapter 17: Miscellaneous - Ethics, Patient Safety & Quality Improvement (2% of Exam)

17.1 Principles of Bioethics & Decisional Capacity 17.2 Informed Consent, Treatment Refusal & Special Scenarios 17.3 Surrogate Decision-Making, Advance Directives & Confidentiality 17.4 Patient Safety Science, Medical Error & Diagnostic Reasoning 17.5 Quality Improvement Methods, Health Disparities & Health Equity

19 Chapter 18: Perioperative Medicine & Medical Consultation

18.1 Preoperative Cardiovascular Risk Assessment 18.2 Preoperative Pulmonary Risk & Perioperative Medication Management 18.3 Perioperative Anticoagulation, Bridging & Postoperative Complications

20 Chapter 19: Ophthalmology (1% of Exam)

19.1 The Acute Red Eye & Ophthalmic Emergencies 19.2 Painless Vision Loss & Chronic Ophthalmic Disease 19.3 Uveitis, Scleritis & Orbital Disease

21 Chapter 20: Otolaryngology & Dental Medicine (1% of Exam)

20.1 Dizziness, Vertigo & Epistaxis 20.2 Ear Disorders, Hearing Loss & Upper Respiratory Infections 20.3 Oral Cavity, Salivary Gland, Laryngeal & Taste and Smell Disorders

9.9 Prostate Disorders, Urinary Incontinence & Other Urologic Conditions

Key Takeaways Explain This Topic AI

Prostate disorders, other urologic disorders including testicular torsion and scrotal masses, urinary incontinence and urologic cancer screening are separately enumerated blueprint subsections.

Testicular torsion presents with acute severe pain, a high-riding transverse testis and an absent cremasteric reflex, and requires immediate surgical exploration.

Alpha-blockers relieve benign prostatic hyperplasia symptoms within days, while 5-alpha-reductase inhibitors take months but reduce prostate volume and retention risk.

Anticholinergic bladder agents are on the Beers list and should be used cautiously in older adults because of cognitive adverse effects.

Overflow incontinence is identified by an elevated post-void residual and is worsened rather than helped by antimuscarinic therapy.

Last updated: August 2026

1. Benign Prostatic Hyperplasia

Progressive prostatic enlargement produces lower urinary tract symptoms , conventionally divided into:

• Storage (irritative): urgency, frequency, nocturia
• Voiding (obstructive): hesitancy, weak stream, straining, incomplete emptying, terminal dribbling

Initial evaluation: symptom score, digital rectal examination, urinalysis (to exclude infection, hematuria and glycosuria), and a medication review . Anticholinergics, opioids, decongestants (alpha-agonists) and antihistamines all worsen voiding and are a frequently overlooked reversible cause.

A post-void residual should be measured when retention is suspected. Routine PSA is a shared decision, not automatic.

Pharmacotherapy

Class Onset Effect Adverse effects

Alpha-1 blockers (tamsulosin, alfuzosin, doxazosin) Days Relax smooth muscle; symptom relief only Orthostatic hypotension, dizziness, retrograde ejaculation , intraoperative floppy iris syndrome

5-alpha-reductase inhibitors (finasteride, dutasteride) 3 to 6 months Shrink the gland ; reduce retention and surgery Decreased libido, erectile dysfunction, gynecomastia; lowers PSA by about 50%

Anticholinergics / beta-3 agonists Weeks For storage symptoms Avoid anticholinergics with high residual volume

Phosphodiesterase-5 inhibitors (tadalafil) Weeks Symptoms plus erectile dysfunction Contraindicated with nitrates

Two examination points: finasteride halves the PSA , so a measured value must be doubled for interpretation, and a rising PSA on therapy is concerning regardless of the absolute number. Intraoperative floppy iris syndrome means an ophthalmologist must be told about tamsulosin exposure before cataract surgery — even remote exposure.

Indications for surgical referral: refractory retention, recurrent urinary infection, bladder stones, recurrent gross hematuria, renal insufficiency from obstruction, or failure of medical therapy.

2. Prostatitis

Acute bacterial prostatitis: fever, dysuria, pelvic pain and an exquisitely tender prostate. Vigorous prostatic massage is avoided because it can precipitate bacteremia. Treated with a fluoroquinolone or trimethoprim-sulfamethoxazole for a prolonged course.

Chronic bacterial prostatitis: recurrent urinary infections with the same organism; requires 4 to 6 weeks of therapy.

Chronic prostatitis / chronic pelvic pain syndrome: by far the most common form, with no identifiable infection; managed multimodally with alpha-blockers, anti-inflammatories and pelvic floor physical therapy.

3. Acute Scrotum and Other Urologic Disorders

Testicular torsion is the emergency. Testicular viability falls sharply after roughly six hours.

• Torsion Epididymitis Torsion of appendix testis
• Onset Sudden, severe Gradual Gradual
• Position High-riding, transverse Normal Normal
• Cremasteric reflex Absent Present Present
• Prehn sign (elevation) No relief Relief Variable
• Fever, pyuria Absent Often present Absent
• Sign — — Blue dot at upper pole

If torsion is strongly suspected, go to the operating room — do not delay for imaging. Ultrasound is used when the diagnosis is genuinely uncertain.

Scrotal masses: a solid intratesticular mass is malignant until proven otherwise . A hydrocele transilluminates; a varicocele feels like a bag of worms, is usually left-sided and decompresses when supine — a right-sided varicocele, or one that does not decompress supine, suggests retroperitoneal or renal pathology and requires abdominal imaging.

Priapism lasting more than four hours is a compartment emergency; ischemic (low-flow) priapism requires aspiration and phenylephrine injection. Sickle cell disease and intracavernosal or oral erectile agents are common precipitants.

4. Urinary Incontinence

The blueprint lists urinary incontinence in women and in men separately. Classification by mechanism determines treatment , and misclassification leads to therapy that worsens the problem.

Type Mechanism Trigger First-line therapy

Stress Urethral sphincter or pelvic support failure Cough, sneeze, laugh, lift Pelvic floor muscle training ; pessary; sling surgery

Urgency (overactive bladder) Detrusor overactivity Sudden urge , running water, key in door Bladder training, fluid and caffeine modification; beta-3 agonist or antimuscarinic

Overflow Impaired detrusor contractility or outlet obstruction Continuous dribbling; elevated post-void residual Relieve obstruction; catheterization; avoid antimuscarinics

Functional Cognitive or mobility limitation with an intact urinary tract Cannot reach the toilet in time Scheduled toileting, environmental modification

Mixed Stress plus urgency Both patterns Treat the more bothersome component first

Every evaluation begins with reversible causes , captured by the mnemonic DIAPPERS : Delirium, Infection, Atrophic vaginitis, Pharmaceuticals, Psychological, Excess urine output, Restricted mobility, Stool impaction.

Post-void residual measurement is the pivotal test. A high residual identifies overflow incontinence, in which an antimuscarinic — the reflexive treatment for urgency — precipitates frank retention. Getting this backwards is a classic exam trap.

In older adults, prefer a beta-3 agonist (mirabegron) over an antimuscarinic. Antimuscarinics such as oxybutynin appear on the AGS Beers Criteria because of anticholinergic cognitive burden, dry mouth, constipation and falls. Behavioral therapy has the best benefit-to-harm ratio and should be first-line at any age.

In men, new incontinence with an enlarged prostate is often overflow rather than urgency, which again makes post-void residual essential before prescribing.

5. Urologic Cancer Screening

A separately enumerated blueprint subsection, and the correct answers are mostly negative.

• Cancer Screening
• Prostate Shared decision-making for PSA roughly ages 55 to 69; not recommended at 70 and above
• Bladder Not recommended — evaluate hematuria instead
• Renal Not recommended in the general population

Testicular Not recommended ; USPSTF gives a D recommendation to screening in asymptomatic adolescents and adults

PSA counseling should cover the possibility of detecting a cancer that would never have caused harm, the biopsy and treatment cascade that follows an abnormal result, and the risks of incontinence and erectile dysfunction — set against a modest reduction in prostate cancer mortality.

Causes of an elevated PSA other than cancer: benign prostatic hyperplasia, prostatitis, urinary retention, recent ejaculation, prostate biopsy or instrumentation, and vigorous cycling. A single elevated value should be repeated after several weeks before proceeding.

6. Erectile Dysfunction

Enumerated under both other urologic disorders and testes and male reproductive health. The internist-relevant framing: erectile dysfunction is frequently an early marker of endothelial dysfunction and may precede a cardiovascular event by years, so a new diagnosis warrants cardiovascular risk assessment.

Review medications — thiazides, beta-blockers, selective serotonin reuptake inhibitors, finasteride, antiandrogens — and screen for diabetes, hypogonadism, depression and obstructive sleep apnea.

Phosphodiesterase-5 inhibitors are first-line but are absolutely contraindicated with nitrates in any form , including as-needed sublingual nitroglycerin, because of profound hypotension. Caution is also required with alpha-blockers, where staggered dosing reduces symptomatic hypotension.