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I had been a urologic nurse practitioner for 9 years before I finally had the opportunity to take the cystoscopy course in the autumn of 2016, during the Society of Urologic Nurses and Associates (SUNA) Annual Conference. While I was the first adult nurse practitioner (NP) in our urology group when I was hired in 2007, historically, I have been a late bloomer. Late to lose my first tooth, late to marry, late to adopt the newest medications into my practice. Frankly, I was intimidated and anxious about cystoscopy. I had a worry that I would cause harm by missing something important. Yet I knew satisfaction and continuity of care suffered when my new patients with hematuria (122 of them in 2016) were referred to a physician colleague for a 2-minute future cystoscopy appointment, then back to me for follow up. This was problematic. Sometimes I was not copied on the cystoscopy reports. Sometimes the CT scan was ordered under the physician's name, and I did not see it until the 6-month follow up. Patients described their dissatisfaction directly to me. And I really abhor when patients are dissatisfied. I wanted to fix this problem.

The Certification Board for Urologic Nurses and Associates (CBUNA) is the only national certification body for urologic nurse practitioners (NPs), registered nurses, and associates. In 2021-2022, CBUNA performed a practice analysis survey of urology NPs to update the Certified Urologic Nurse Practitioner (CUNP) examination. Results of this practice analysis survey are presented, providing valuable insight into the current practice and breadth of skills of urology NPs nationally. These results also establish growth of the role of the urology NP in the evolving health care landscape.

A 76-year-old otherwise asymptomatic man presents to his primary care provider with febrile illness, suspected to be a urinary tract infection, and is referred to urology. He is ultimately found to have severe bladder outlet obstruction, a large bladder diverticulum, and a rare cancer. The urology care team must be alert to incidental findings and recognize the potential significance of unexplained findings.

Risk factors for prostate cancer include advancing age, a family history of prostate cancer in a first-degree relative, and African-American ethnicity. Considering the prevalence and impact of prostate cancer on urology patients, it is important to be familiar with prostate cancer risk factors, methods of screening and diagnosis, the varying grades and stages of prostate cancer, treatment options (procedures and medications), and the potential side effects of prostate cancer treatments when preparing for the certification examination. The correct answer is B. The ProtecT trial, which is the only randomized controlled trial comparing active local therapies, found that in the first report with 10-year follow up, there was no difference in cancer-specific mortality between surgery and radiation (Cooperberg et al., 2020). The correct answer is D. Grade Group 3, Gleason score 4+3=7 prostate cancer is considered moderately aggressive disease. pT3b staging is locally advanced disease beyond the prostatic capsule, with invasion of the seminal vesicles. [...]the grade of the disease describes the aggressiveness of the disease, and the staging of the disease describes the location of the disease.

What are the next steps in planning for Maria's upcoming surgery? a.Maria will meet with the ostomy/stomal nurse. b. Maria must learn to perform intermittent self-catheterization. c. Maria will plan for an outpatient procedure with discharge on the same day. d. Maria should plan to be incontinent of stool following the surgery. Which information would be most appropriate to provide? a. Jeffrey will receive sedation during the treatments and will require a family member present to drive him home. b. Jeffrey's preparation before the appointment will include a Fleets enema. c. Jeffrey must remain NPO (nothing by mouth) for 6 hours prior to procedure. d. Jeffrey should purchase bleach to have on hand during treatments. The associate is aware that the most common causes of bladder cancer are: a. Tobacco use and industrial exposure. b. Sedentary lifestyle and high-fat diet. c. Heart disease and diabetes. d. Dehydration and constipation.

The medical assistant's response is: a.Because you have had an allergic response to the dye, you should never receive contrast dye again. b.To question the patient further about her reaction and review symptoms with the provider prior to scheduling the test. c.The CT urogram does not use contrast dye, so there is no concern regarding an allergic reaction. d.An ultrasound will be scheduled instead and will provide similar results as the CT scan. Rationale: The correct answer is b. Patients who have had previous allergic reactions that are not lifethreatening may be pre-medicated with Benadryl and prednisone per institution protocol and still have the CT scan. The associate knows the next step in the evaluation should include: a. A visual endoscopic evaluation of the bladder urothelium. b. Administration of intravesical chemotherapy. c. Blood tests including an alpha feto-protein study d. A five-week session of neo-adjuvant radiation therapy. In your explanation about your plan of care for Henry, you advise them that typically the initial evaluation for testicular mass includes: a. A CT abdomen and pelvis. b. A scrotal ultrasound. c. Physical exam, with possible scrotal ultrasound and tumor markers. d. Treatment with antibiotics to see if the mass shrinks, because their son is too young to have cancer.

Obstructive uropathy is a major section on the certification examination at all levels. Kidney stones, major types, signs and symptoms, the diagnostic evaluation, and treatment options are important for all levels of clinicians taking the certification examination.

A 76-year-old otherwise asymptomatic man presents to his primary care provider with febrile illness, suspected to be a urinary tract infection, and is referred to urology. He is ultimately found to have severe bladder outlet obstruction, a large bladder diverticulum, and a rare cancer. The urology care team must be alert to incidental findings and recognize the potential significance of unexplained findings.