Urology Practice Questions

Q: A 12-year-old child presents to the OPD with a complaint of scrotal pain and a history of trauma 6 hours ago. On surgical exploration, the following finding is observed. What is the most likely diagnosis?

Testicular torsion with gangrene. ***Testicular torsion with gangrene*** - The combination of **scrotal pain**, history of **trauma**, and the image showing a **dark, necrotic testicle** (implying gangrene) is highly indicative of testicular torsion that has progressed to tissue death due to prolonged ischemia. - Testicular torsion is an emergency where the **spermatic cord** twists, cutting off blood supply; after 6 hours, especially following trauma, the risk of non-viability and gangrene is very high. *Torsion of testicular appendages with gangrene* - While torsion of appendages (e.g., appendix testis) can cause acute scrotal pain, it typically results in a **"blue dot sign"** and is usually a **less severe condition** than testicular torsion. - It would not typically lead to the extensive necrotic appearance of the entire testicle as suggested by the scenario, and surgical exploration revealing gangrene usually points to the whole testis being affected. *Gangrene* - While gangrene is present, this option is **incomplete** as it does not specify the underlying cause, which is critical for diagnosis and treatment. - The context of acute scrotal pain and trauma points to a specific etiology, namely torsion. *Hematoma* - A hematoma would present as a **blood collection**, potentially causing swelling and discoloration, but usually **not the black, necrotic changes** indicative of gangrene from ischemia. - While trauma could cause a hematoma, the description of gangrene points to a more severe vascular compromise.

Q: An 85-year-old male with prostate cancer, Gleason score of 6 , and PSA <8 ng/mL. What is the best management approach?

Active surveillance/Watchful waiting. Androgen deprivation therapy - **Hormonal therapy** is primarily used for advanced, metastatic, or high-risk localized prostate cancer [1], or as an adjunct to radiation therapy. - It is not indicated as a primary first-line treatment for **low-risk, localized prostate cancer** in an elderly patient, as its side effects (e.g., hot flashes, fatigue, bone loss, cardiovascular effects) can significantly impact quality of life without offering a survival advantage in this specific scenario.

Q: A 30-year-old male undergoes varicocele surgery to correct his left-sided varicocele. Following the procedure, the surgeon explains the postoperative changes to the patient. The patient asks, "Through which route does the venous drainage primarily occur after the surgery?" Which of the following is the correct response by the surgeon?

Cremasteric and deferential veins. ***Cremasteric and deferential veins*** - After varicocele surgery, the **internal spermatic veins** (pampiniform plexus) are ligated or embolized, eliminating the primary drainage route. - Venous drainage then shifts to **collateral pathways**: the **cremasteric veins** (which drain to the inferior epigastric vein) and the **deferential/vasal veins** (which drain to the vesical venous plexus). - These provide adequate alternative venous outflow from the testis, preventing venous congestion post-operatively. - This is a well-established anatomical principle in varicocele surgery. *Penile veins* - Penile veins primarily drain the **penis** itself (corpus cavernosum and spongiosum), not the testis. - They are anatomically distinct from the testicular venous drainage system and do not serve as a collateral route after varicocele repair. *Ectopic drainage in the iliac fossa* - This is not a recognized anatomical pathway for testicular venous drainage. - While cremasteric veins eventually drain to the external iliac system via inferior epigastric veins, referring to this as "ectopic drainage in the iliac fossa" is anatomically imprecise and not standard terminology. *At the usual location* - The usual pre-operative drainage is through the **pampiniform plexus → internal spermatic vein** (left side drains to left renal vein, right side to IVC). - This is the pathway that is **surgically interrupted** during varicocele repair (ligation or embolization). - Post-operatively, drainage cannot occur at this location as these vessels are deliberately occluded.

Q: A 50 year old male patient came to the outpatient department with complaints of hematuria. A 2 x 2 cm bladder mass is seen which is low grade transitional cell carcinoma. Which among the following is the ideal management?

Transurethral resection of the tumour. ***Transurethral resection of the tumour*** - For a **low-grade transitional cell carcinoma** that is 2x2 cm and thus considered small and localized, **transurethral resection of the tumor (TURBT)** is the initial and often definitive treatment. - This procedure allows for both **diagnosis** by obtaining tissue samples and **complete removal** of the visible tumor. *Resection with ileal conduit* - This option, involving a **radical cystectomy** and urinary diversion, is a more aggressive treatment reserved for **invasive, high-grade, or recurrent bladder cancers** that cannot be managed by less invasive means. - It would be **overtreatment** for a low-grade, relatively small bladder mass. *Partial cystectomy with bladder reconstruction* - **Partial cystectomy** is considered for solitary, muscle-invasive tumors located away from critical areas (like the trigone) when bladder preservation is desirable. - It is generally not the first-line treatment for **non-muscle-invasive, low-grade tumors** due to the potential for recurrence in the remaining bladder and the morbidity of open surgery compared to TURBT. *Neoadjuvant chemotherapy* - **Neoadjuvant chemotherapy** is typically administered before radical cystectomy for **muscle-invasive bladder cancer** to improve oncologic outcomes. - It is not indicated for **low-grade, non-muscle-invasive bladder cancer** which is usually managed surgically first, without systemic chemotherapy.

Q: The complication which will not occur after PCNL surgery:

Urethral stricture. ***Urethral stricture*** - **Urethral stricture** is a complication typically associated with transurethral procedures involving instrumentation through the urethra, such as a **Transurethral Resection of the Prostate (TURP)** or repeated urethral catheterisation. - **PCNL (Percutaneous Nephrolithotomy)** involves direct access to the kidney through the skin in the flank, bypassing the urethra entirely, therefore, making urethral stricture not a direct complication of this procedure. *Organ injury* - **Organ injury**, particularly to adjacent organs like the **colon**, **pleura**, or **spleen/liver**, can occur during PCNL if the access tract is misdirected or during instrumentation. - This is a well-recognised but infrequent complication requiring careful pre-operative planning and imaging guidance. *Bleeding* - **Bleeding** is a common complication of PCNL due to the invasive nature of the procedure, involving puncture of the kidney and fragmentation of stones. - It can range from minor self-limiting bleeding to significant haemorrhage requiring transfusion or further intervention such as **angiography** and **embolization**. *Sepsis* - **Sepsis** is a serious potential complication, particularly if the patient has pre-existing urinary tract infection or if bacteria are dislodged during stone fragmentation. - **Infection** can disseminate into the bloodstream, leading to severe systemic inflammatory response syndrome and septic shock.

Q: Which of these is the best for management of a 3 cm stone in renal pelvis without evidence of hydronephrosis?

PCNL. ***PCNL*** - **Percutaneous nephrolithotomy (PCNL)** is the gold standard treatment for large renal stones (>2 cm) due to its high stone-free rates in a single procedure. - For a 3 cm renal pelvis stone, PCNL provides the best clearance rate (~95%) with minimal need for repeat procedures. - It involves direct percutaneous access to the kidney, allowing fragmentation and removal of large stone burden efficiently. *ESWL* - **Extracorporeal shock wave lithotripsy (ESWL)** has limited efficacy for stones >2 cm, with stone-free rates dropping to 50-60% for 3 cm stones. - Multiple sessions are typically required, with increased risk of steinstrasse (stone street) formation and residual fragments. - While non-invasive, ESWL is not the optimal choice for this stone size. *Retrograde pyeloplasty* - This option appears to reference **retrograde endoscopic approaches** (such as retrograde intrarenal surgery - RIRS or ureteroscopy). - While retrograde ureteroscopy can treat renal stones, it is generally reserved for stones <2 cm due to longer operative time and lower stone-free rates for larger stones. - True "pyeloplasty" is a reconstructive procedure for ureteropelvic junction obstruction, not a stone removal technique. *Antegrade pyeloplasty* - This option likely refers to **antegrade endoscopic access** to the renal pelvis. - While antegrade access is used in PCNL, "pyeloplasty" specifically means surgical reconstruction of the UPJ for obstruction, not stone treatment. - Antegrade ureteroscopy alone (without nephroscopy) would be less effective than PCNL for a 3 cm stone.

Q: Prostatic cancer mostly seen in

Posterior. ***Posterior*** - The **peripheral zone** of the prostate, which is located posteriorly, is the most common site for the development of **prostatic adenocarcinoma**. - This anatomical location is why a **digital rectal exam (DRE)** is an important screening tool, as palpable nodules can be detected [1]. *Lateral* - While prostatic tissue extends laterally, this region is not the predominant site for cancer development. - Cancers originating here are less common than those in the posterior peripheral zone. *Anterior* - The **anterior fibromuscular stroma** and the anterior portion of the prostate are rarely the primary sites for prostate cancer. - Tumors found here are often extensions from more posteriorly located cancers. *Medial* - The **transition zone**, which is located medially and surrounds the urethra, is the most common site for **benign prostatic hyperplasia (BPH)**, not prostate cancer. - While cancer can occur in this zone, it is less frequent than in the peripheral zone.

Q: A 62-year-old female had a kidney stone and was treated with PCNL. After 2 days, she comes to the OPD with chills and fever. What is the complication?

Bacterial sepsis. ***Bacterial sepsis*** - **Chills and fever** two days after a **Percutaneous Nephrolithotomy (PCNL)** are highly suggestive of a systemic infection, specifically **bacterial sepsis**, as this procedure carries a risk of introducing bacteria into the bloodstream. - Urinary tract manipulation, especially in a patient with a potentially *infected kidney stone*, can lead to bacteremia and subsequent **sepsis** if not properly managed. *Acute pancreatitis* - **Acute pancreatitis** is not a common complication of PCNL. It typically presents with severe **epigastric pain** radiating to the back, often with nausea and vomiting, and is usually associated with gallstones or alcohol abuse. - While it can cause fever, the clinical presentation and context do not strongly support **pancreatitis** as the primary issue following a PCNL. *Ureteric stricture* - A **ureteric stricture** is a *late complication* of kidney stone treatment and typically leads to symptoms of **urinary obstruction**, such as flank pain, rather than acute fever and chills two days post-procedure. - It would not cause acute systemic signs like **chills and fever** within such a short timeframe after PCNL. *Splenic injury* - **Splenic injury** is a rare but possible complication of procedures around the left kidney; however, it would typically present with **abdominal pain**, signs of **hemorrhage** (e.g., hypotension), and sometimes shoulder pain, not primarily with fever and chills as the immediate post-operative concern. - While fever can occur with internal injuries, the primary and most immediate concern with fever and chills after a urological procedure is **infection**.

Q: Bell clapper deformity (abnormal testicular fixation) predisposes to which of the following conditions?

Testicular torsion. ***Testicular torsion*** - The **bell clapper deformity** describes an abnormally high attachment of the tunica vaginalis, leaving the testis and epididymis free to rotate within the scrotal sac. - This anatomical variation allows the spermatic cord to twist, cutting off blood supply to the testis, which is the mechanism of **testicular torsion**. *Hydrocele* - A **hydrocele** is a collection of fluid in the tunica vaginalis, resulting from an imbalance in fluid production and absorption, or a patent processus vaginalis. - It is not directly caused by abnormal testicular fixation. *Testicular atrophy* - **Testicular atrophy** is a reduction in testicular size, often due to conditions like cryptorchidism, mumps orchitis, or prolonged testicular torsion, but not predisposed by the bell clapper deformity itself unless torsion occurs. - While torsion can lead to atrophy if not promptly treated, the deformity directly predisposes to the torsion event, rather than atrophy itself. *Varicocele* - A **varicocele** is an abnormal dilation of the veins of the pampiniform plexus within the scrotum, usually due to incompetent valves or venous obstruction. - This condition is not associated with testicular fixation abnormalities.

Q: Time cut-off for diagnosis of Priapism is?

4 hours. ***4 hours*** - A penile erection lasting longer than **4 hours** is the established cut-off for the diagnosis of **priapism**. - Prolonged erection beyond this duration can lead to **ischemia** and permanent cavernosal damage. *2 hours* - While concerning, an erection lasting 2 hours is typically not classified as priapism, which requires a longer duration to meet diagnostic criteria. - At this stage, the risk of significant ischemic injury is lower compared to longer durations. *3 hours* - An erection lasting 3 hours is still below the clinically defined threshold for priapism. - Although it warrants close monitoring, intervention is usually recommended once the 4-hour mark is reached. *1 hour* - An erection of 1 hour is generally considered a normal physiological response and does not meet the criteria for priapism. - This duration is insufficient to cause the microvascular damage and cellular changes associated with priapism.

Question 1

A 12-year-old child presents to the OPD with a complaint of scrotal pain and a history of trauma 6 hours ago. On surgical exploration, the following finding is observed. What is the most likely diagnosis?

Accepted Answer

Testicular torsion with gangrene

Answer

Torsion of testicular appendages with gangrene

Answer

Gangrene

Answer

Hematoma

Question 2

An 85-year-old male with prostate cancer, Gleason score of 6 , and PSA <8 ng/mL. What is the best management approach?

Accepted Answer

Active surveillance/Watchful waiting

Answer

Radical prostatectomy

Answer

External beam radiation therapy

Answer

Androgen deprivation therapy

Question 3

A 30-year-old male undergoes varicocele surgery to correct his left-sided varicocele. Following the procedure, the surgeon explains the postoperative changes to the patient. The patient asks, "Through which route does the venous drainage primarily occur after the surgery?" Which of the following is the correct response by the surgeon?

Accepted Answer

Cremasteric and deferential veins

Answer

Penile veins

Answer

Ectopic drainage in the iliac fossa

Answer

At the usual location

Question 4

A 50 year old male patient came to the outpatient department with complaints of hematuria. A 2 x 2 cm bladder mass is seen which is low grade transitional cell carcinoma. Which among the following is the ideal management?

Accepted Answer

Transurethral resection of the tumour

Answer

Resection with ileal conduit

Answer

Partial cystectomy with bladder reconstruction

Answer

Neoadjuvant chemotherapy

Question 5

The complication which will not occur after PCNL surgery:

Accepted Answer

Urethral stricture

Answer

Organ injury

Answer

Bleeding

Answer

Sepsis

Question 6

Which of these is the best for management of a 3 cm stone in renal pelvis without evidence of hydronephrosis?

Accepted Answer

PCNL

Answer

Retrograde pyeloplasty

Answer

ESWL

Answer

Antegrade pyeloplasty

Question 7

Prostatic cancer mostly seen in

Accepted Answer

Posterior

Answer

Lateral

Answer

Answer

Medial

Question 8

A 62-year-old female had a kidney stone and was treated with PCNL. After 2 days, she comes to the OPD with chills and fever. What is the complication?

Accepted Answer

Bacterial sepsis

Answer

Acute pancreatitis

Answer

Ureteric stricture

Answer

Splenic injury

Question 9

Bell clapper deformity (abnormal testicular fixation) predisposes to which of the following conditions?

Accepted Answer

Testicular torsion

Answer

Hydrocele

Answer

Testicular atrophy

Answer

Varicocele

Question 10

Time cut-off for diagnosis of Priapism is?

Accepted Answer

4 hours

Answer

2 hours

Answer

3 hours

Answer

1 hour

Urology — MCQs

Urology — MCQs

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