Urology

Topics in this chapter

• Renal and Ureteric Stones
• Benign Prostatic Hyperplasia
• Bladder Cancer and Urinary Diversion
• Renal Tumors and Nephron-Sparing Surgery
• Acute Scrotum and Varicocele
• Urotrauma and Urethral Injury
• Pediatric Urologic Surgery

Practice questions

1. Question 1Q-488290

   A 45-year-old male presents with painless gross total hematuria. Cystoscopy reveals a 3 cm papillary growth on the lateral wall of the urinary bladder. Transurethral resection of bladder tumor (TURBT) is performed, and histopathology shows a high-grade urothelial carcinoma invading the lamina propria but sparing the muscularis propria (T1). What is the most appropriate next step in management?

   1. A.Immediate radical cystectomy with bilateral pelvic lymph node dissection
   2. B.Intravesical Bacillus Calmette-Guérin (BCG) immunotherapy
   3. C.Systemic platinum-based combination chemotherapy alone
   4. D.Active surveillance with cystoscopy every 3 months
   See the answer and solution
2. Question 2Q-AA51D2

   A 32-year-old male is brought to the emergency department following a motor vehicle collision. He presents with pelvic fractures, blood at the external urethral meatus, inability to void, and a high-riding prostate on digital rectal examination. Which of the following is the most appropriate initial management step?

   1. A.Attempt immediate passage of a Foley transurethral catheter
   2. B.Perform a retrograde urethrography (RUG) prior to any instrumentation
   3. C.Perform immediate primary realignment via open surgery
   4. D.Perform an emergency scrotal exploration
   See the answer and solution
3. Question 3Q-DBB36E

   A 65-year-old man undergoes evaluation for lower urinary tract symptoms. His IPSS score is 22 (severe), and prostate-volume on transrectal ultrasound is 60 cc. He has persistent post-void residual urine of 180 mL and has experienced two episodes of acute urinary retention despite being on a maximal dose of an alpha-1 blocker (tamsulosin) and a 5-alpha-reductase inhibitor (finasteride) for 9 months. What is the definitive management of choice?

   1. A.Add a phosphodiesterase-5 inhibitor (tadalafil)
   2. B.Switch finasteride to dutasteride
   3. C.Transurethral resection of the prostate (TURP) or simple prostatectomy
   4. D.Clean intermittent self-catheterization (CISC) indefinitely without surgery
   See the answer and solution
4. Question 4Q-98EF9E

   A 28-year-old male presents with a dull, heavy dragging sensation in his left scrotum. On physical examination, the left hemiscrotum reveals a collection of tortuous veins that increase in size with the Valsalva maneuver and disappear when the patient lies supine. An abdominal ultrasound confirms a left varicocele. Which of the following underlying renal or retroperitoneal abnormalities should be specifically ruled out?

   1. A.Renal cell carcinoma with left renal vein thrombosis
   2. B.Right-sided renal angiomyolipoma
   3. C.Horseshoe kidney with ureteropelvic junction obstruction
   4. D.Polycystic kidney disease
   See the answer and solution
5. Question 5Q-820F25

   A 55-year-old female presents with recurrent urinary tract infections and left flank pain. Non-contrast CT scan of the abdomen shows a large staghorn calculus occupying the renal pelvis and multiple calyces of the left kidney, measuring approximately 4.5 cm in diameter. Urine culture grows Proteus mirabilis. Which of the following is the most effective definitive treatment for this stone burden?

   1. A.Extracorporeal shock wave lithotripsy (ESWL) monotherapy
   2. B.Percutaneous nephrolithotomy (PCNL)
   3. C.Oral chemoprophylaxis with potassium citrate alone
   4. D.Diagnostic ureteroscopy with laser lithotripsy
   See the answer and solution