Urology Practice Questions

Q: 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

2, 3 and 4. ***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.

Q: The following operative procedure can result in neurogenic voiding dysfunction except:

Ureterolithotomy. **Ureterolithotomy** - This procedure involves removing kidney stones from the **ureter** and generally does not involve dissection near the pelvic nerves responsible for bladder function. - It is a **localized procedure** that avoids the extensive pelvic dissection associated with damage to the **autonomic nerves controlling voiding**. *Radical hysterectomy* - This procedure involves the removal of the **uterus, cervix, parametrium, and a portion of the vagina**, which frequently necessitates extensive dissection in the pelvic area. - The dissection can injure the **pelvic plexus nerves**, leading to neurogenic bladder dysfunction. *Abdominoperineal resection* - This surgery involves removing the **rectum and anus**, requiring extensive dissection through the pelvic floor. - This procedure carries a significant risk of damaging the **inferior hypogastric plexus and sacral nerves**, which are crucial for bladder control. *Retroperitoneal lymph node dissection* - This procedure involves dissecting lymph nodes in the **retroperitoneal space**, especially in cases of testicular cancer. - While primarily affecting ejaculation, extensive or misplaced dissection can also impact the **sympathetic and parasympathetic efferent nerves originating from the pelvic plexus** that contribute to bladder function.

Q: Indications of TURP for Benign Prostatic Hyperplasia (BPH) include: 1. Urinary flow rate of less than 10 mL/second 2. Residual volume of urine >100 mL 3. Serum level of prostatic specific antigen >10 ng/mL 4. Trabeculated Urinary bladder Select the correct answer using the code given below:

1, 2 and 4. ***1, 2 and 4*** - Urinary flow rate ** 100 mL**, and the presence of a **trabeculated bladder** (indicating chronic bladder outlet obstruction) are all relevant indications for considering TURP in BPH. - These findings collectively suggest significant **obstruction** and potential complications of BPH that may warrant surgical intervention. *2, 3 and 4* - This option incorrectly includes a **PSA level > 10 ng/mL** as an indication for TURP, which is primarily a marker for **prostate cancer screening** and not a direct surgical indication for BPH. - While an elevated PSA might prompt further investigation (e.g., biopsy), it doesn't alone necessitate TURP for BPH symptoms. *1, 2 and 3* - This option also incorrectly includes **PSA level > 10 ng/mL** as an indication for TURP. - The other two points (low flow rate and high residual volume) are appropriate indications, but the inclusion of PSA makes this option incorrect. *1, 3 and 4* - This option includes **PSA level > 10 ng/mL** as an indication for TURP, which is incorrect. - Additionally, it omits **residual urine volume > 100 mL**, which is a significant indicator of obstruction and a common reason for considering TURP.

Q: Hyperchloremic acidosis is a common complication of:

Ureterosigmoidostomy. ***Ureterosigmoidostomy*** - This procedure directly connects the ureters to the sigmoid colon, allowing for the **reabsorption of urinary chloride and ammonium** by the colonic mucosa in exchange for bicarbonate secretion. - The mechanism involves **active reabsorption of chloride** from urine coupled with bicarbonate loss into the bowel lumen, leading to **hyperchloremic metabolic acidosis**. - This is the **classic urological cause** of hyperchloremic acidosis and the most specific answer in a surgical context. *Ileostomy* - **Ileostomy** typically leads to significant loss of fluids and electrolytes, including sodium and potassium, through the stoma. - While it can cause dehydration and electrolyte imbalances, it is more commonly associated with **hypokalemia, hyponatremia, and dehydration** rather than hyperchloremic acidosis. *Vomiting* - **Protracted vomiting** primarily results in the loss of gastric acid (HCl), leading to **hypochloremia** and **metabolic alkalosis** (not acidosis). - The loss of hydrogen ions from the stomach causes the kidneys to retain bicarbonate to maintain pH balance, resulting in elevated serum HCO3-. *Diarrhoea* - Severe **diarrhea** causes the loss of **bicarbonate-rich fluids** from the gastrointestinal tract, which can indeed lead to **normal anion gap metabolic acidosis** (hyperchloremic acidosis). - However, in the context of **surgical/urological complications**, **ureterosigmoidostomy** is the more specific and classic answer, as it involves a unique mechanism of **direct chloride reabsorption from urine** rather than simple bicarbonate loss. - Diarrhea-induced acidosis is also typically an acute medical condition rather than a surgical complication.

Q: Urinary bladder can be injured in all of the following operations EXCEPT:

Inguinal hernia repair. ***Inguinal hernia repair*** - While theoretically possible, bladder injury during **inguinal hernia repair** is exceedingly rare, often less than 1% as the bladder is not typically in the direct field of dissection. - The surgical approach for inguinal hernias generally involves layers superficial to the bladder, making direct injury much less common than in pelvic surgeries. - Rare cases occur with **sliding hernias** where the bladder may form part of the hernia sac wall. *Surgery for rectum* - **Anterior resection of the rectum** or abdominoperineal resection involves dissecting close to the bladder's posterior and inferior aspects, particularly the **bladder base** and **ureteral entries**. - Procedures like low anterior resection for rectal cancer pose a significant risk due to the **proximity of the bladder** to the surgical field in the pelvis. *Inguinal lymph node dissection* - **Inguinal lymph node dissection** is primarily a superficial groin procedure involving removal of superficial and deep inguinal nodes. - While bladder injury is **theoretically possible** if dissection extends unusually deep or medially toward the retropubic space, this is **extremely rare** in standard practice. - The risk is significantly lower than pelvic operations but higher than standard inguinal hernia repair due to the extent of dissection. *Hysterectomy* - During a **hysterectomy** (removal of the uterus), the bladder lies anterior and inferior to the uterus and cervix, making it highly susceptible to injury. - The dissection planes for detaching the bladder from the lower uterine segment and cervix pose a substantial risk, especially during **total abdominal hysterectomy** or **vaginal hysterectomy**. - This is one of the **most common** causes of iatrogenic bladder injury.

Q: Intraoperative recognition of ureter is by which of the following features? 1. Transparent tubular appearance 2. Pale glistening appearance 3. Longitudinal vessels on surface 4. Circumferential vessels on surface Select the correct answer using the code given below:

2 and 3. ***2 and 3*** - The ureter has a characteristic **pale, glistening appearance** (often described as "pearly white"), which helps distinguish it from surrounding tissues during surgery. - The presence of **longitudinal vessels** running along its surface is a key anatomical feature for intraoperative identification. - Additional identification feature: The ureter shows **peristaltic waves** when gently stimulated or pinched with forceps. *2 and 4* - While the ureter is indeed **pale and glistening**, the vessels on its surface are **longitudinal**, not circumferential. - **Circumferential vessels** would encircle the structure, which is not characteristic of ureteric vascular anatomy. *1 and 3* - The ureter is a tubular structure, but it is **not transparent**; it has a distinct **opaque, pale coloration**. - Although **longitudinal vessels** are correctly present, the transparency descriptor is inaccurate and not a reliable identification feature. *1 and 4* - The ureter is **not transparent** (it's opaque), and its vessels are **longitudinal**, not circumferential. - Neither of these features accurately describes the intraoperative appearance of the ureter.

Q: A 22-year-old male rugby player presents with acute scrotal pain that began 2 hours ago. Physical examination shows a high-riding, tender left testis with an absent cremasteric reflex. Doppler ultrasound shows decreased blood flow to the left testis. What is the time-sensitive factor most critical to testicular salvage?

Duration of symptoms. ***Duration of symptoms*** - **Testicular torsion** is a medical emergency requiring rapid intervention; the viability of the testicle significantly decreases with prolonged ischemia. - Surgical detorsion within **6 hours** of symptom onset offers the highest chance of testicular salvage. Salvage rates drop drastically after this timeframe. *Age of the patient* - While testicular torsion is more common in adolescents and neonates, the patient's age (22) is not the critical factor determining testicular salvage. - The patient's youth helps with recovery but doesn't change the time-sensitive nature of the condition. *Presence of nausea and vomiting* - Nausea and vomiting are common **sympathetic responses** to severe pain, which often accompanies acute testicular torsion. - These symptoms indicate pain severity but do not directly influence the window for testicular salvage. *Results of Doppler ultrasound* - Doppler ultrasound helps **confirm the diagnosis** of decreased blood flow, but the delay in obtaining and interpreting the results can waste precious time. - Clinical diagnosis is often sufficient to proceed with surgical exploration given the time-sensitive nature of the condition.

Q: Which of the following statements is incorrect regarding vasectomy?

Sterility is achieved 3 weeks after the procedure. ***Sterility is achieved 3 weeks after the procedure*** - Full sterility after vasectomy is not achieved instantly; it typically takes **at least 8-16 weeks** or approximately **20 ejaculations** to clear residual sperm. - Patients are advised to use other birth control methods until a **sperm count of zero** is confirmed by a semen analysis. *The procedure is done under local anesthesia* - Vasectomy is commonly performed using **local anesthesia**, often alongside mild sedation, making it an outpatient procedure. - This approach minimizes patient discomfort and avoids the risks associated with general anesthesia. *The vas deferens is the structure that is divided in the procedure* - The **vas deferens** is indeed the specific anatomical structure that is cut, tied, or sealed during a vasectomy. - This interruption prevents sperm from traveling from the epididymis to the urethra, thus preventing fertilization. *A no-scalpel technique is being widely used now* - The **no-scalpel vasectomy (NSV)** technique is a modern, less invasive approach that uses a puncturing instrument instead of a scalpel incision. - This method typically results in less pain, bleeding, and a quicker recovery compared to traditional incisional techniques.

Q: A patient presents with a penile lesion staged as T3, with clinically palpable lymph nodes. What is the most appropriate management?

Penectomy with deep ilioinguinal node dissection. ***Penectomy with deep ilioinguinal node dissection*** - A **T3 penile lesion** indicates invasion of the corpus cavernosum or corpus spongiosum, which is an aggressive stage requiring **radical local excision (penectomy)**. - **Clinically palpable lymph nodes** alongside a T3 tumor suggest nodal involvement (N1-N3), necessitating a **deep ilioinguinal lymph node dissection** to remove affected deeper lymph nodes that are not readily accessible by superficial dissection. *Penectomy* - While penectomy addresses the primary tumor, it does not manage the **clinically palpable lymph nodes**, which are crucial for staging and prognosis in advanced penile cancer. - This option would be insufficient given the documented **nodal involvement**, leading to likely recurrence and progression of the disease. *Penectomy with superficial node dissection* - This approach is inadequate for **palpable lymph nodes**, especially with a T3 lesion, because such nodes often indicate involvement of **deeper lymphatics (deep ilioinguinal)**. - Superficial dissection alone would likely leave residual disease, failing to properly stage and treat the extent of the cancer. *Chemoradiotherapy* - **Chemoradiotherapy** is typically reserved for patients who are not surgical candidates, or as a neoadjuvant/adjuvant therapy, not as primary treatment for a **T3 lesion with palpable nodes** where surgical intervention is the standard of care for optimal local and regional control. - While it may be used in certain settings, surgery (penectomy with lymph node dissection) offers the best chance for cure in this scenario.

Q: Identify the instrument shown in the image.

Ureteroscope. ***Ureteroscope*** - The image distinctly shows a long, thin, flexible scope with a working channel, consistent with a **flexible ureteroscope**. - The presence of a **guidewire** alongside the scope further indicates its use for navigating the narrow and tortuous ureter. *Nephroscope* - A nephroscope is typically a more rigid and wider instrument used for percutaneous access to the **kidney's collecting system**. - Its design is optimized for procedures within the kidney, not for navigating the ureter. *Cystoscope* - A cystoscope is used to visualize the **bladder** and urethra and is generally shorter and thicker than a ureteroscope. - While it can be flexible or rigid, the instrument shown is too long and thin to be a standard cystoscope. *Laparoscope* - A laparoscope is a rigid instrument used for **abdominal surgery**, inserted through the abdominal wall. - Its design and application are entirely different from the instrument shown, which is designed for internal urinary tract procedures.

Question 1

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

Accepted Answer

2, 3 and 4

Answer

1, 3 and 4

Answer

1, 2 and 3

Answer

1, 2 and 4

Question 2

The following operative procedure can result in neurogenic voiding dysfunction except:

Accepted Answer

Ureterolithotomy

Answer

Radical hysterectomy

Answer

Abdominoperineal resection

Answer

Retroperitoneal lymph node dissection

Question 3

Indications of TURP for Benign Prostatic Hyperplasia (BPH) include:

1. Urinary flow rate of less than 10 mL/second
2. Residual volume of urine >100 mL
3. Serum level of prostatic specific antigen >10 ng/mL
4. Trabeculated Urinary bladder

Select the correct answer using the code given below:

Accepted Answer

1, 2 and 4

Answer

2, 3 and 4

Answer

1, 2 and 3

Answer

1, 3 and 4

Question 4

Hyperchloremic acidosis is a common complication of:

Accepted Answer

Ureterosigmoidostomy

Answer

Ileostomy

Answer

Vomiting

Answer

Diarrhoea

Question 5

Urinary bladder can be injured in all of the following operations EXCEPT:

Accepted Answer

Inguinal hernia repair

Answer

Surgery for rectum

Answer

Inguinal lymph node dissection

Answer

Hysterectomy

Question 6

Intraoperative recognition of ureter is by which of the following features?

1. Transparent tubular appearance
2. Pale glistening appearance
3. Longitudinal vessels on surface
4. Circumferential vessels on surface

Select the correct answer using the code given below:

Accepted Answer

2 and 3

Answer

2 and 4

Answer

1 and 3

Answer

1 and 4

Question 7

A 22-year-old male rugby player presents with acute scrotal pain that began 2 hours ago. Physical examination shows a high-riding, tender left testis with an absent cremasteric reflex. Doppler ultrasound shows decreased blood flow to the left testis. What is the time-sensitive factor most critical to testicular salvage?

Accepted Answer

Duration of symptoms

Answer

Age of the patient

Answer

Presence of nausea and vomiting

Answer

Results of Doppler ultrasound

Question 8

Which of the following statements is incorrect regarding vasectomy?

Accepted Answer

Sterility is achieved 3 weeks after the procedure

Answer

The procedure is done under local anesthesia

Answer

The vas deferens is the structure that is divided in the procedure

Answer

A no-scalpel technique is being widely used now

Question 9

A patient presents with a penile lesion staged as T3, with clinically palpable lymph nodes. What is the most appropriate management?

Accepted Answer

Penectomy with deep ilioinguinal node dissection

Answer

Penectomy

Answer

Penectomy with superficial node dissection

Answer

Chemoradiotherapy

Question 10

Identify the instrument shown in the image.

Accepted Answer

Ureteroscope

Answer

Nephroscope

Answer

Cystoscope

Answer

Laparoscope

Urology — MCQs

Urology — MCQs

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