Urology Basics — MCQs

A 70-year-old man with metastatic castration-resistant prostate cancer presents to the emergency department with severe back pain, bilateral lower extremity weakness (3/5 strength), and urinary retention that started 8 hours ago. He has known bone metastases and his PSA has been rising despite androgen deprivation therapy. MRI spine shows an epidural mass at T10 with severe spinal cord compression and near-complete canal obliteration. He is neurologically intact above T10. Radiation oncology, neurosurgery, and medical oncology are consulted. Evaluate the optimal management approach.

A 3-year-old boy is brought to the clinic for evaluation of an undescended left testicle noted since birth. The right testicle is in normal scrotal position. On examination, the left testicle is palpable in the inguinal canal and can be manipulated to the upper scrotum but retracts immediately upon release. The testicle appears smaller than the contralateral side. The parents report they were told to wait and see if it descends spontaneously. What is the most appropriate management at this time?

A 58-year-old man with a 15-pack-year smoking history undergoes radical cystectomy with ileal conduit urinary diversion for muscle-invasive bladder cancer. Final pathology shows pT3N1 disease with 3 of 18 lymph nodes positive for metastatic urothelial carcinoma, with negative surgical margins. His postoperative recovery is uncomplicated. The oncology team recommends adjuvant chemotherapy, but the patient has baseline chronic kidney disease with creatinine 2.0 mg/dL and GFR 35 mL/min/1.73m². Evaluate the optimal management strategy.

A 65-year-old man with benign prostatic hyperplasia (BPH) presents with acute urinary retention. A Foley catheter is placed, draining 1200 mL of clear urine. Over the next 6 hours, he produces 800 mL/hour of urine and becomes hypotensive with BP 85/50 mmHg. Laboratory studies show sodium 148 mEq/L, potassium 3.2 mEq/L, and creatinine 2.1 mg/dL (baseline 1.0 mg/dL). What is the underlying pathophysiologic mechanism and appropriate management priority?

A 28-year-old man presents with a painless right testicular mass discovered on self-examination. Ultrasound shows a 2.5 cm heterogeneous intratesticular mass. Tumor markers show AFP 450 ng/mL (normal <10), beta-hCG 25 mIU/mL (normal <5), and normal LDH. CT chest/abdomen/pelvis reveals a 3 cm retroperitoneal lymph node mass and multiple small pulmonary nodules. He undergoes radical inguinal orchiectomy, with pathology showing mixed germ cell tumor with elements of embryonal carcinoma and yolk sac tumor. What is the most appropriate next step?