Urology Practice Questions

Q: In a patient with stage T1 (tumor invading lamina propria) transitional cell carcinoma of the urinary bladder, the recommended treatment is

Trans urethral resection of bladder tumour (TURBT). ***Trans urethral resection of bladder tumour (TURBT)*** - For **stage 1 (confined to mucosa and submucosa) transitional cell carcinoma** of the urinary bladder, TURBT is the primary and often curative treatment. - This procedure allows for both diagnostic staging and complete resection of visible tumors. *Radiation therapy* - **Radiation therapy** is generally reserved for more advanced stages or for patients who are not surgical candidates. - It is often used in combination with chemotherapy or as a palliative measure, not typically as monotherapy for early-stage disease. *Systemic chemotherapy* - **Systemic chemotherapy** is typically indicated for advanced, metastatic bladder cancer or as neoadjuvant/adjuvant therapy in muscle-invasive disease. - It is not the primary treatment for early-stage, non-muscle invasive bladder cancer. *Radical cystectomy* - **Radical cystectomy** is a major surgical procedure involving removal of the entire bladder and surrounding structures. - It is reserved for **muscle-invasive bladder cancer** or recurrent high-grade non-muscle invasive bladder cancer that has failed conservative treatments.

Q: A 70 year old man comes to Emergency with pain lower abdomen and not passing urine for eight hours. He has a past history of urgency, hesitancy and frequency of urine. On examination, he has a lump up to the umbilicus which is slightly tender. What is the next step of management?

Per urethral catheterise the patient. ***Per urethral catheterise the patient*** - The patient presents with **acute urinary retention**, indicated by the inability to pass urine for eight hours and a tender palpable bladder up to the umbilicus. - **Catheterization** is the immediate and most effective way to relieve bladder distension, pain, and prevent potential kidney damage. *Get an urgent USG* - While a **ultrasound** can confirm bladder distention and identify underlying causes, it is not the immediate priority. - Relieving the obstruction takes precedence over diagnostic imaging in **acute urinary retention**. *Start antibiotics* - There are no specific signs of infection (e.g., fever, dysuria) to necessitate **immediate antibiotic administration**. - While urinary retention can increase the risk of infection, **antibiotics** should be reserved for confirmed infections or as prophylaxis after catheterization in high-risk patients. *Per rectal examination* - A **per rectal examination** would be performed as part of the initial assessment to evaluate the prostate in a male patient with urinary symptoms. - However, it does not directly address the immediate need to relieve the **urinary obstruction** in acute retention.

Q: Anderson‐Hynes operation is performed for:

Pelvi-ureteric junction obstruction. ***Pelvi-ureteric junction obstruction*** - The **Anderson-Hynes pyeloplasty** is a widely used surgical procedure to correct obstruction at the **pelvi-ureteric junction (PUJ)**. - This operation involves **resecting the stenotic (narrowed) or obstructed part of the renal pelvis and ureter** and then rejoining the healthy segments to restore normal urine flow. *Pseudo-pancreatic cyst* - Management of a **pseudopancreatic cyst** typically involves percutaneous drainage, endoscopic transmural drainage, or surgical cyst-gastrostomy or cyst-jejunostomy. - The **Anderson-Hynes operation** is not indicated for this condition, which is a complication of pancreatitis. *Achalasia cardia* - **Achalasia cardia** is a disorder of esophageal motility, primarily treated with procedures like **Heller myotomy** (surgical cutting of the lower esophageal sphincter muscle) or pneumatic dilation. - The **Anderson-Hynes procedure** is entirely unrelated to the esophagus or its disorders. *Pyloric stenosis* - **Pyloric stenosis** in infants is generally treated with a **Ramstedt pyloromyotomy**, which involves surgically incising the hypertrophied pyloric muscle without opening the mucosa. - This condition involves the stomach outlet, and therefore, the **Anderson-Hynes operation** is not relevant.

Q: All of the following statements are correct about vasectomy EXCEPT:

It increases the incidence of testicular cancer. ***It increases the incidence of testicular cancer*** - Research has consistently shown **no causal link** between vasectomy and an increased risk of testicular cancer. - The reported incidence of testicular cancer in men who have undergone vasectomy is similar to that in the general population. *No Scalpel Vasectomy (NSV) was first developed in China.* - The **no-scalpel vasectomy (NSV)** technique was indeed developed in China by Dr. Li Shunqiang in 1974. - This method involves a smaller puncture incision rather than a traditional scalpel incision, leading to fewer complications. *It is less time consuming than tubectomy* - Vasectomy is generally a **simpler, less invasive, and quicker procedure** than tubectomy (female sterilization). - Tubectomy often requires general anesthesia and a more complex surgical approach, making it more time-consuming overall. *Addition contraception should be used for 3 months after vasectomy* - It takes approximately **3 months or 20 ejaculations** for all residual sperm to be cleared from the reproductive tract after a vasectomy. - Therefore, additional contraception is crucial during this period until a **sperm analysis (semen analysis)** confirms azoospermia (absence of sperm).

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: Which of the following is not true regarding ‘no scalpel’ vasectomy?

Scrotal skin is cut with LASER to expose the vas.. ***Scrotal skin is cut with LASER to expose the vas.*** - The "no-scalpel" technique specifically avoids cutting the scrotal skin with a **scalpel** or **LASER**. - Instead, a **small puncture** is made using a specialized instrument to access the vas deferens. *The failure rate is same as that of conventional vasectomy.* - The failure rate for no-scalpel vasectomy is generally very low and comparable to, or even slightly lower than, conventional vasectomy. - This is due to the precise identification and handling of the **vas deferens** through the small puncture. *Special instruments are used to deliver the vas instead of cutting the skin.* - This statement is true; the no-scalpel technique utilizes **specialized forceps** to puncture and stretch the scrotal skin. - This creates a small opening to access the vas deferens without needing a traditional incision. *It is a very popular method in China.* - The no-scalpel vasectomy technique was developed in China in 1974 by Dr. Li Shunqiang, where it gained widespread adoption. - Its popularity in China significantly contributed to its global recognition as a minimally invasive and effective method for male contraception.

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.

Question 1

In a patient with stage T1 (tumor invading lamina propria) transitional cell carcinoma of the urinary bladder, the recommended treatment is

Accepted Answer

Trans urethral resection of bladder tumour (TURBT)

Answer

Radiation therapy

Answer

Systemic chemotherapy

Answer

Radical cystectomy

Question 2

A 70 year old man comes to Emergency with pain lower abdomen and not passing urine for eight hours. He has a past history of urgency, hesitancy and frequency of urine. On examination, he has a lump up to the umbilicus which is slightly tender. What is the next step of management?

Accepted Answer

Per urethral catheterise the patient

Answer

Get an urgent USG

Answer

Start antibiotics

Answer

Per rectal examination

Question 3

Anderson‐Hynes operation is performed for:

Accepted Answer

Pelvi-ureteric junction obstruction

Answer

Pseudo-pancreatic cyst

Answer

Achalasia cardia

Answer

Pyloric stenosis

Question 4

All of the following statements are correct about vasectomy EXCEPT:

Accepted Answer

It increases the incidence of testicular cancer

Answer

No Scalpel Vasectomy (NSV) was first developed in China.

Answer

It is less time consuming than tubectomy

Answer

Additional contraception should be used for 3 months after vasectomy

Question 5

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 6

Which of the following is not true regarding ‘no scalpel’ vasectomy?

Accepted Answer

Scrotal skin is cut with LASER to expose the vas.

Answer

The failure rate is same as that of conventional vasectomy.

Answer

Special instruments are used to deliver the vas instead of cutting the skin.

Answer

It is a very popular method in China.

Question 7

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 8

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 9

Hyperchloremic acidosis is a common complication of:

Accepted Answer

Ureterosigmoidostomy

Answer

Ileostomy

Answer

Vomiting

Answer

Diarrhoea

Question 10

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

Urology — MCQs

Urology — MCQs

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