Urology

Urology Indian Medical PG Question 1: The length of the female urethra is :

• A. 20 mm
• B. 60 mm
• C. 45 mm
• D. 40 mm (Correct Answer)

Urology Explanation: ***40 mm*** - The typical length of the **female urethra** is approximately **40 mm** (or 4 cm). - This relatively short length is a key reason why females are more susceptible to **urinary tract infections** compared to males. *20 mm* - **20 mm** (2 cm) is significantly shorter than the average female urethral length. - Such a short urethra would drastically increase the risk of **ascending infections** into the bladder. *60 mm* - **60 mm** (6 cm) is longer than the typical female urethra. - A urethra of this length would be more comparable to conditions in males or specific anatomical variations, not the average female. *45 mm* - While closer to the correct answer, **45 mm** is still slightly longer than the generally accepted average length for the female urethra. - The textbook average is usually cited as **4 cm** or 40 mm.

Urology Indian Medical PG Question 2: In response to an increase in glomerular filtration rate, the proximal tubule and the loop of Henle demonstrate an increase in the rate of sodium reabsorption. This phenomenon is called?

• A. Glomerulotubular balance (Correct Answer)
• B. Autoregulation of renal blood flow
• C. Mineralocorticoid escape (response to aldosterone)
• D. Saturation of tubular transport capacity

Urology Explanation: ***Glomerulotubular balance*** - This mechanism ensures that a relatively constant fraction of the filtered load of sodium and water is reabsorbed by the proximal tubule and loop of Henle, despite variations in GFR. - An increased GFR leads to an increased filtered load of sodium, which in turn stimulates greater reabsorption in these segments, maintaining constancy. *Autoregulation of renal blood flow* - This refers to the kidney's intrinsic ability to maintain a relatively constant **glomerular filtration rate (GFR)** and **renal blood flow (RBF)** despite fluctuations in systemic arterial pressure. - It involves mechanisms like the **myogenic response** and **tubuloglomerular feedback** at the afferent arteriole, but does not directly describe the proportional reabsorption of sodium. *Mineralocorticoid escape (response to aldosterone)* - This phenomenon describes the **limited effectiveness of aldosterone** in causing sustained sodium retention or edema due to compensatory mechanisms. - It involves an increase in atrial natriuretic peptide (ANP), pressure natriuresis, and decreased proximal tubule reabsorption in response to chronic aldosterone excess. *Saturation of tubular transport capacity* - This occurs when the amount of a substance filtered into the tubules exceeds the maximum rate at which the tubules can reabsorb or secrete it, leading to its excretion in urine. - This concept describes the **limit of tubular transport**, not the proportional adjustment in reabsorption in response to GFR changes.

Urology Indian Medical PG Question 3: Consider the following statements in respect of prostatic carcinoma : 1. Most originate from peripheral zone 2. Prostatic needle biopsy is better performed under trans rectal ultrasound 3. Prostate specific antigen is the specific test 4. L.H.R.H. analogues are used as medical treatment for metastatic disease Which of the statements given above is/are correct ?

• A. 1 and 3
• B. 1 and 2 only
• C. 1, 2 and 4 (Correct Answer)
• D. 2, 3 and 4

Urology Explanation: ***1, 2 and 4*** - **Most prostatic carcinomas originate from the peripheral zone** (approximately 70%), making this statement correct. This zone is palpable on digital rectal examination. - **Prostatic needle biopsy is indeed better performed under transrectal ultrasound (TRUS) guidance**, which allows for targeted and accurate sampling of suspicious areas. - **LHRH (Luteinizing Hormone-Releasing Hormone) analogues are a cornerstone of medical treatment for metastatic prostate cancer** as they suppress testosterone production, which fuels tumor growth. *1 and 3* - While statement 1 is correct (most prostate cancers originate from the peripheral zone), **prostate-specific antigen (PSA) is not a specific test** for prostate cancer. - **Elevated PSA can be caused by various conditions** such as benign prostatic hyperplasia (BPH), prostatitis, and even normal aging, making it a marker for prostate health rather than a definitive diagnostic test for cancer. *1 and 2 only* - Statements 1 and 2 are correct individually, but this option **incorrectly excludes statement 4**, which is also correct regarding the use of LHRH analogues in metastatic disease. - Therefore, this option is incomplete as it misses a true statement about prostate cancer management. *2, 3 and 4* - This option is incorrect because **statement 3 regarding PSA being a specific test is false**. - While PSA is used for screening and monitoring, its lack of specificity means it cannot definitively diagnose cancer.

Urology Indian Medical PG Question 4: Which of the following are correct about ectopic ureters? 1. They are more common in males 2. They drain the upper pole of the kidney 3. They are associated with duplex ureter 4. They may cause incontinence

• A. 1, 3 and 4
• B. 1, 2 and 3
• C. 2, 3 and 4 (Correct Answer)
• D. 1, 2 and 4

Urology Explanation: ***2, 3 and 4*** - Ectopic ureters primarily drain the **upper pole** of a **duplicated kidney** and are nearly always associated with some degree of renal dysplasia. - They are commonly associated with **duplex ureters** and can cause **incontinence**, especially in females, as they often bypass the bladder sphincter. *1, 3 and 4* - This option is incorrect because ectopic ureters are **more common in females** than males, particularly symptomatic cases involving incontinence. - While they are associated with duplex ureters and incontinence, the statement about being more common in males is inaccurate. *1, 2 and 3* - This option is incorrect because ectopic ureters are **more prevalent in females** and are a significant cause of continuous urinary incontinence in this population. - While they drain the upper pole and are associated with duplex ureters, the claim of being more common in males is false. *1, 2 and 4* - This option is incorrect as ectopic ureters are typically found more often in **females** and are a recognized cause of **incontinence** in affected individuals. - Although they drain the upper pole and may cause incontinence, the assertion that they are more common in males is inaccurate.

Urology Indian Medical PG Question 5: In human males, testosterone is mainly produced by

• A. Leydig cells (Correct Answer)
• B. Seminiferous tubules
• C. Epididymis
• D. Sertoli cells

Urology Explanation: ***Leydig cells*** - **Leydig cells** are located in the **interstitial tissue** between the seminiferous tubules in the testes and are responsible for producing **testosterone** in response to luteinizing hormone (LH). - These cells are crucial for the development of male secondary sexual characteristics and spermatogenesis. *Seminiferous tubules* - The **seminiferous tubules** are the primary sites of **spermatogenesis**, the process of sperm production. - While essential for male fertility, they do not directly produce testosterone. *Epididymis* - The **epididymis** is a coiled tube located on the posterior aspect of each testis, where **sperm mature** and are stored. - It plays no role in the production of testosterone. *Sertoli cells* - **Sertoli cells** are found within the **seminiferous tubules** and provide support, nourishment, and protection to developing sperm. - They also produce **androgen-binding protein (ABP)** and inhibin, but not testosterone.

Urology Indian Medical PG Question 6: A 40-year-old woman was brought to the casualty 8 hours after sustaining burns on the abdomen, both limbs, and back. What is the best formula to calculate the amount of fluid to be replenished?

• A. 2 mL/kg x %TBSA
• B. 4 mL/kg x %TBSA (Correct Answer)
• C. 8 mL/kg x %TBSA
• D. 4 mL/kg x %TBSA in first 8 hours followed by 2 mL/ kg/hour x %TBSA

Urology Explanation: ***4 mL/kg x %TBSA*** - This is the **Parkland formula** (also known as Baxter formula), which is the most widely accepted method for calculating fluid resuscitation in burn patients. - The formula calculates a **total 24-hour fluid requirement** of **4 mL of Ringer's lactate per kilogram of body weight per percentage of total body surface area (%TBSA)** burned. - **Timing protocol:** Half of the calculated total volume (2 mL/kg x %TBSA) is given in the **first 8 hours post-burn**, and the remaining half over the **next 16 hours**. - This is the **gold standard** for initial burn fluid resuscitation. *2 mL/kg x %TBSA* - This represents **only half the total 24-hour fluid volume** recommended by the Parkland formula. - Using only 2 mL/kg x %TBSA as the total would lead to **severe under-resuscitation**, increasing the risk of burn shock, acute kidney injury, and other complications. - This volume is correct only for the **first 8 hours**, not the total calculation. *8 mL/kg x %TBSA* - This suggests **twice the fluid volume** recommended by the Parkland formula. - Administering 8 mL/kg x %TBSA would result in **over-resuscitation**, leading to complications such as pulmonary edema, abdominal compartment syndrome, acute respiratory distress syndrome (ARDS), and extremity compartment syndrome. *4 mL/kg x %TBSA in first 8 hours followed by 2 mL/kg/hour x %TBSA* - This option incorrectly suggests giving the **entire 24-hour calculated volume** in the first 8 hours, then continuing with an additional **hourly rate**. - This would result in **massive over-resuscitation** and life-threatening complications. - The correct Parkland protocol gives **half the total** (2 mL/kg x %TBSA) in the first 8 hours, then the **remaining half over 16 hours** (not an additional continuous rate).

Urology Indian Medical PG Question 7: A woman was brought to the casualty 8 hours after sustaining burns on the abdomen, both the limbs and back. What will be the amount of fluid to be used for resuscitation in the first 24 hours as per Parkland formula?

• A. 2 mL/kg x %TBSA
• B. 8 mL/kg x %TBSA
• C. 4 mL/kg x %TBSA (Correct Answer)
• D. 4 mL/kg x %TBSA in first 8 hours followed by 2 mL/kg x %TBSA

Urology Explanation: ***4 mL/kg x %TBSA*** - The **Parkland formula** for fluid resuscitation in burn patients is **4 mL/kg** of Ringer's lactate per percent TBSA burned per 24 hours. - This gives the **total volume for 24 hours**: half is administered in the first 8 hours post-burn, and the remaining half over the subsequent 16 hours. *2 mL/kg x %TBSA* - This value represents only half of the required fluid resuscitation according to the **Parkland formula** and is insufficient for adequate resuscitation over 24 hours. - This amount would typically be given in scenarios where burns are minor or as maintenance fluid, not for acute burn resuscitation. *8 mL/kg x %TBSA* - This amount is **double** the recommended fluid resuscitation as per the standard **Parkland formula** and could lead to fluid overload, causing complications like **pulmonary edema** or **acute respiratory distress syndrome (ARDS)**. - Excessive fluid administration can also worsen tissue edema and compartment syndrome. *4 mL/kg x %TBSA in first 8 hours followed by 2 mL/kg x %TBSA* - This option is **incorrectly phrased** and suggests using two different formulas rather than understanding that 4 mL/kg x %TBSA is the **total 24-hour calculation**. - The Parkland formula calculates one total amount (4 mL/kg x %TBSA for 24 hours), which is then distributed as half in the first 8 hours and half in the next 16 hours—not calculated separately as this option implies.

Urology Indian Medical PG Question 8: A 45 year old underwent surgery for rectal prolapse. At present, he complains of sexual dysfunction which is probably due to the injury of:

• A. Pelvic autonomic nerves (Correct Answer)
• B. Urinary bladder
• C. Rectum
• D. Inferior mesenteric artery

Urology Explanation: ***Pelvic autonomic nerves*** - Surgical procedures in the **pelvic region**, such as for rectal prolapse, carry a risk of damaging the **pelvic autonomic nerves**, which are crucial for sexual function. - Injury to these nerves can lead to various forms of **sexual dysfunction**, including erectile dysfunction in men, due to impaired nerve signaling to the genital organs. *Urinary bladder* - While the urinary bladder is anatomically close to the rectum, direct injury to the bladder itself during rectal prolapse surgery typically leads to **urinary symptoms** (e.g., incontinence, retention), not primarily sexual dysfunction. - Though bladder dysfunction can indirectly impact sexual activity, it's not the direct cause of primary sexual dysfunction following injury in this context. *Rectum* - The surgery is performed on the rectum, and while complications can occur, direct injury to the rectal wall itself primarily results in issues such as **fecal incontinence, bleeding, or infection**. - The rectum's primary role is in digestion and defecation, and its injury does not directly cause sexual dysfunction unrelated to nerve damage. *Inferior mesenteric artery* - The **inferior mesenteric artery (IMA)** supplies blood to the distal colon and rectum, and its injury during surgery would primarily lead to **ischemia or necrosis** of the supplied bowel segments. - While a severely compromised blood supply could have systemic effects, direct injury to the IMA is not a direct or common cause of sexual dysfunction.

Urology Indian Medical PG Question 9: A person could not pass urine after a fall shown below. On examination vitals are stable but bladder is palpable. What is the probable diagnosis? (NEET Pattern 2018)

• A. Anterior urethra rupture
• B. Posterior urethra rupture (Correct Answer)
• C. Penile avulsion
• D. Recto-urethral injury

Urology Explanation: ***Posterior urethra rupture*** - The mechanism of injury, a **fall causing blunt perineal trauma** (as depicted by the man falling into a manhole), is a classic cause of posterior urethral injury, often associated with **pelvic fractures**. - The inability to pass urine with a **palpable distended bladder** indicates urinary retention due to complete urethral disruption, preventing urine flow from the bladder. - Classical triad: inability to void, blood at urethral meatus, and palpable bladder. *Anterior urethra rupture* - This typically results from a "straddle injury" (e.g., falling astride a beam or bike bar), which is different from the fall shown. - Anterior urethral injuries often manifest with **perineal extravasation of urine and blood (butterfly hematoma)**, and the bladder might still be palpable if retention occurs. *Penile avulsion* - This is a severe injury involving the **tearing away of penile skin or the entire penis**, which is not immediately suggested by the described symptoms of inability to urinate. - It would present with **obvious external hemorrhage** and tissue loss, not just urinary retention. *Recto-urethral injury* - This involves damage to both the **rectum and urethra**, usually from penetrating trauma or severe crush injuries. - While it could cause dysuria or inability to urinate, it would also likely present with **rectal bleeding or a palpable rectal injury**, which is not mentioned in the clinical scenario.

Urology Indian Medical PG Question 10: Following road traffic accident, a patient with vague abdominal pain was immediately taken to the operation theatre for emergency laparotomy. On examination, a large, contained, stable, non-pulsatile retroperitoneal hematoma was found on the right side. One-shot IVU shows a barely discernible nephrogram on the right side and prompt uptake and excretion on the left side. What should be the next step to be done?

• A. Isolate the proximal renal vessels, open the Gerota's fascia and explore the kidney (Correct Answer)
• B. Nephrectomy
• C. Perform on table retrograde pyelography
• D. Perform on table angiography

Urology Explanation: ***Isolate the proximal renal vessels, open the Gerota's fascia and explore the kidney*** - While **Zone II (lateral/perirenal) retroperitoneal hematomas** are generally NOT explored if stable, contained, and non-pulsatile, this case has a critical exception. - The **barely discernible nephrogram on IVU** suggests severe renal parenchymal or vascular injury, indicating the kidney may not be viable. - In the setting of a **non-functioning or poorly functioning kidney** (as evidenced by the IVU), exploration is warranted to assess salvageability. - The correct approach is to **first isolate the proximal renal vessels** (achieve vascular control) before opening Gerota's fascia to prevent uncontrolled hemorrhage during exploration. - This allows for **attempted renal salvage** or controlled nephrectomy if the kidney is non-salvageable. *Nephrectomy* - This is premature without first exploring to assess the extent of injury. - While the barely discernible nephrogram is concerning, immediate nephrectomy without exploration may remove a potentially salvageable kidney. - Nephrectomy should only be performed after exploration confirms **irreparable damage** or if hemorrhage cannot be controlled. *Perform on table retrograde pyelography* - Retrograde pyelography primarily evaluates the **collecting system and ureter** for injury or extravasation. - In this case, the main concern is **renal parenchymal or vascular injury** (suggested by the poor nephrogram), not collecting system injury. - This would delay definitive management and does not address the question of renal viability. - Retrograde pyelography is more useful when IVU is non-diagnostic and ureteral injury is suspected. *Perform on table angiography* - While angiography can identify **vascular injuries** and is valuable in stable patients, it is typically not performed on the operating table during emergency laparotomy. - The patient is already in the OR with an open abdomen, making direct surgical exploration more practical than angiography. - Angiography with possible **angioembolization** is more appropriate for stable patients managed non-operatively or in delayed settings.

Urology Flashcard 1 of 10

Question: Duplex collecting system is strongly associated with vesicoureteral _____ and/or ureteral obstruction

Answer: reflux

Urology Flashcard 2 of 10

Question: Because PSA can be also elevated in _____ and prostatitis besides Prostate Cancer, there is a questional risk/benefit for screening

Answer: BPH

Urology Flashcard 3 of 10

Question: _____ repair is done for stress urinary incontinence includes apposing medial fibres of puborectalis muscles in the midline under the bladder neck region to elevate it via a vaginal approach.

Answer: Pacey's

Urology Flashcard 4 of 10

Question: _____ stone is a type of renal stone that is protein rich and associated with recurrent infections

Answer: Matrix

Urology Flashcard 5 of 10

Question: In acute urinary retention due to a stricture, it is dilated with cystoscope, guide wires and urethral dilators and a _____ catheter is inserted

Answer: counsel tip

Urology Flashcard 6 of 10

Question: For tumors less than or equal to _____ cm in size and limited to the kidney (T1a), partial nephrectomy is performed.

Answer: 4

Urology Flashcard 7 of 10

Question: AUA IPSS score is done for grading symptoms of _____

Answer: benign prostatic hyperplasia

Urology Flashcard 8 of 10

Question: Which study is helpful to assess the difference between low Qmax secondary to either obstruction or a neurogenic bladder?_____

Answer: Cystometrogram

Urology Flashcard 9 of 10

Question: The following instrument is a _____ used in the rx of Peyronie's disease

Answer: penile extender

Urology Flashcard 10 of 10

Question: _____ Catheter is a self retaining Urinary Catheter with umbrella or flower tip.

Answer: Malecot