Urology Practice Questions

Q: A 70-year-old male chronic smoker is diagnosed with carcinoma in situ of the urinary bladder and undergoes transurethral resection (TUR). There is now a recurrence with the tumor extending into the muscle. What is the recommended treatment?

Radical cystectomy. ### Explanation The management of bladder cancer is primarily determined by the **depth of invasion**. This patient has progressed from Carcinoma in situ (CIS) to **Muscle-Invasive Bladder Cancer (MIBC)**, defined as stage T2 or higher. **Why Radical Cystectomy is the Correct Choice:** The standard of care for any patient with muscle-invasive bladder cancer (T2-T4a) who is fit for surgery is **Radical Cystectomy** with urinary diversion. Once the tumor involves the detrusor muscle, the risk of lymphatic and systemic metastasis increases significantly. Intravesical therapies are no longer sufficient because they cannot penetrate deep enough into the bladder wall to eradicate the invasive component. **Analysis of Incorrect Options:** * **A & B (Intravesical BCG/Chemotherapy):** These are the treatments of choice for **Non-Muscle Invasive Bladder Cancer (NMIBC)**, such as Ta, T1, or CIS. Since the tumor has now extended into the muscle, these local therapies are considered inadequate and would result in disease progression. * **C (Palliative Radiotherapy):** Radiotherapy is generally reserved for patients who are unfit for major surgery or as part of a "Bladder Preserving Protocol" (Tri-modality therapy) in highly selected cases. It is not the primary "recommended treatment" for a standard surgical candidate. **Clinical Pearls for NEET-PG:** * **Gold Standard:** Radical cystectomy includes removal of the bladder, prostate, and seminal vesicles in men, and the bladder, uterus, ovaries, and anterior vaginal wall in women (**Anterior Pelvic Exenteration**). * **Staging:** The detrusor muscle invasion marks the transition from T1 to **T2**. * **BCG Failure:** If CIS or T1 tumors recur or persist despite intravesical BCG, radical cystectomy is the next step (BCG-refractory disease). * **Smoking:** The most significant risk factor for bladder cancer; it increases the risk of recurrence and progression.

Q: Which of the following is NOT true about urethral injuries?

Catheterize the patient immediately.. **Explanation:** In the management of suspected urethral injury, **immediate catheterization is strictly contraindicated.** Attempting to pass a catheter in a patient with a urethral tear can convert a partial tear into a complete transection and introduce infection into a pelvic hematoma. The gold standard initial investigation to assess urethral integrity is a **Retrograde Urethrogram (RUG)**. Only after a RUG has ruled out injury should catheterization be attempted. **Analysis of Options:** * **Option A (Correct):** As stated, blind catheterization is dangerous. If the patient cannot void, a suprapubic cystostomy (SPC) is the preferred method of bladder drainage. * **Option B:** Posterior urethral injuries (specifically at the membranous urethra) are highly associated with **pelvic fractures** (up to 10% of cases), often due to the shearing forces at the puboprostatic ligaments. * **Option C:** High-energy trauma causing pelvic fractures often results in concomitant injuries to the bladder (extraperitoneal or intraperitoneal) along with the posterior urethra. * **Option D:** **Blood at the external urethral meatus** is the most reliable clinical sign of urethral injury. Other signs include a "high-riding prostate" on digital rectal exam and a perineal "butterfly" hematoma (in anterior injuries). **Clinical Pearls for NEET-PG:** * **Anterior Urethra Injury:** Most common site is the **bulbar urethra**, usually due to a "straddle injury" (falling astride). * **Posterior Urethra Injury:** Most common site is the **membranous urethra**, usually due to pelvic fractures. * **Triad of Urethral Injury:** Blood at meatus, inability to void, and a palpable distended bladder. * **Management:** If RUG shows a tear, the initial management is typically a **Suprapubic Catheter (SPC)** followed by delayed repair (Urethroplasty).

Q: A 23-year-old male known to have sickle cell anemia presents to the emergency department with a painful erection that started 3 hours ago. What is this condition called?

Priapism. **Explanation:** The clinical presentation of a prolonged, painful erection (lasting >4 hours) in a patient with sickle cell anemia is a classic description of **Priapism**. **1. Why Priapism is correct:** Priapism is a urological emergency characterized by a persistent erection unrelated to sexual stimulation. In patients with **Sickle Cell Anemia**, it is typically the **Ischemic (Low-flow)** type. The underlying mechanism involves the sickling of red blood cells within the corpora cavernosa, leading to venous stasis, outflow obstruction, and subsequent hypoxia and acidosis within the penile tissue. **2. Why the other options are incorrect:** * **Balanitis:** This refers to the inflammation of the glans penis, usually due to infection (fungal/bacterial) or poor hygiene. It presents with redness, itching, and discharge, not a persistent erection. * **Hypospadias:** A congenital anomaly where the urethral meatus opens on the ventral aspect of the penis. It is a structural defect present from birth. * **Peyronie Disease:** A condition involving the formation of fibrous plaques in the tunica albuginea, leading to penile curvature and painful erections during intercourse, but not a continuous, spontaneous state of tumescence. **Clinical Pearls for NEET-PG:** * **Ischemic Priapism** is a "compartment syndrome" of the penis. Blood gas analysis of the aspirate shows **low pO2, high pCO2, and low pH**. * **Management:** Initial steps include hydration and analgesia. Definitive treatment involves **aspiration of blood** followed by intracavernosal injection of alpha-agonists (e.g., **Phenylephrine**). * If conservative measures fail, surgical shunts (e.g., Winter’s or Quackels shunt) are performed. * **Stuttering Priapism:** Recurrent, short-lived episodes common in sickle cell patients; often managed with hormonal therapy (GnRH analogs) or PDE5 inhibitors (prophylactically).

Q: Subcapsular orchiectomy is done for cancer of?

Prostate. **Explanation:** **Subcapsular orchiectomy** (also known as Riba’s operation) is a surgical procedure where the androgen-producing glandular tissue (the parenchyma) is removed while leaving the tunica albuginea and epididymis intact. **Why Prostate Cancer is the Correct Answer:** Prostate cancer is an **androgen-dependent tumor**. The primary goal of treatment in metastatic or advanced cases is **Androgen Deprivation Therapy (ADT)**. Since 95% of testosterone is produced by the Leydig cells in the testes, a bilateral orchiectomy serves as "surgical castration," rapidly reducing serum testosterone to castrate levels (<50 ng/dL). The subcapsular technique is preferred over total orchiectomy for prostate cancer because it is **psychologically less traumatic** for the patient, as the scrotum does not feel entirely empty. **Why Other Options are Incorrect:** * **Testicular Cancer:** The standard of care is **Radical Inguinal Orchiectomy**. A subcapsular approach is contraindicated because it violates the testicular tunics, risking local tumor spillage and altering the lymphatic drainage. * **Penis & Urethra Cancer:** These malignancies are not primarily driven by testosterone. Treatment usually involves local excision, partial/total penectomy, and lymph node dissection, rather than hormonal manipulation via orchiectomy. **High-Yield Clinical Pearls for NEET-PG:** * **Gold Standard for ADT:** While LHRH agonists (e.g., Leuprolide) are common, bilateral orchiectomy remains the "gold standard" for rapid testosterone depletion. * **Indication:** Primarily used for **Metastatic Prostate Cancer (Stage D)** or as palliative care for bone pain. * **Comparison:** Subcapsular orchiectomy is as effective as total orchiectomy in lowering testosterone but offers a better cosmetic/psychological outcome.

Q: Urinary catheterization is indicated in cases of acute retention of urine, except in which of the following conditions?

Rupture. In urological emergencies, the primary goal of managing acute urinary retention (AUR) is to decompress the bladder. However, the method of decompression depends on the integrity of the urinary tract. **Why "Rupture" is the correct answer:** In cases of suspected **urethral rupture** (often associated with pelvic fractures or straddle injuries), blind urethral catheterization is **strictly contraindicated**. Attempting to pass a catheter can convert a partial urethral tear into a complete transection, introduce infection into a perivesical hematoma, or create a false passage. Clinical signs such as **blood at the meatus**, a **high-riding prostate** on digital rectal examination, or **perineal ecchymosis** (butterfly bruising) mandate a **Retrograde Urethrogram (RUG)** before any instrumentation. In these cases, a Suprapubic Cystostomy (SPC) is the preferred method of bladder drainage. **Analysis of incorrect options:** * **Stricture:** While a urethral stricture makes catheterization difficult, it is not an absolute contraindication. If a standard Foley fails, smaller caliber catheters or filiforms and followers are used. * **Postoperative:** AUR is a common complication after spinal anesthesia or pelvic surgery; urethral catheterization is the standard first-line management. * **Carcinoma of the Prostate:** Prostatic enlargement (benign or malignant) is a leading cause of AUR. Catheterization is indicated, though a Coudé tip catheter may be required to bypass the prostatic obstruction. **High-Yield Clinical Pearls for NEET-PG:** * **Gold Standard Investigation** for suspected urethral injury: Retrograde Urethrogram (RUG). * **Triad of Urethral Injury:** Blood at meatus, inability to void, and palpable distended bladder. * **Membranous Urethra:** The most common site of rupture in pelvic fractures. * **Bulbar Urethra:** The most common site of rupture in "straddle" (fall-a-stride) injuries.

Question 1

Regarding testicular torsion, all are true EXCEPT?

Accepted Answer

Immediate management is mainly medical and surgery is indicated later.

Answer

Is to be differentiated from acute epididymitis.

Answer

Bilaterality is common.

Answer

May not present with dysuria.

Question 2

Which of the following substances is NOT used as an irrigant during transurethral resection of the prostate?

Accepted Answer

Normal Saline

Answer

1.5% Glycine

Answer

5% Dextrose

Answer

Distilled Water

Question 3

A 70-year-old male chronic smoker is diagnosed with carcinoma in situ of the urinary bladder and undergoes transurethral resection (TUR). There is now a recurrence with the tumor extending into the muscle. What is the recommended treatment?

Accepted Answer

Radical cystectomy

Answer

Intravesical BCG

Answer

Intravesical chemotherapy

Answer

Palliative radiotherapy

Question 4

A 70-year-old man presents with urinary retention and back pain. Which investigation should be performed?

Accepted Answer

Serum acid phosphatase

Answer

Serum Calcium

Answer

Serum alkaline phosphatase

Answer

Serum electrophoresis

Question 5

Which of the following is NOT true about urethral injuries?

Accepted Answer

Catheterize the patient immediately.

Answer

Can be associated with fracture pelvis.

Answer

Bladder injury is associated with posterior urethral injuries.

Answer

Blood at the external urethral meatus is an important feature.

Question 6

A 23-year-old male known to have sickle cell anemia presents to the emergency department with a painful erection that started 3 hours ago. What is this condition called?

Accepted Answer

Priapism

Answer

Balanitis

Answer

Hypospadias

Answer

Peyronie disease

Question 7

Subcapsular orchiectomy is done for cancer of?

Accepted Answer

Prostate

Answer

Testes

Answer

Penis

Answer

Urethra

Question 8

A 50-year-old male presented to the ER with complaints of inability to pass urine after a recent accident. On examination, he has a scrotal hematoma, blood at the urethral meatus, and a high-riding prostate. A retrograde urethrogram has been performed. What should be the next step in the management of the patient?

Accepted Answer

Foley's catheterization

Answer

Immediate surgical repair of the urethra

Answer

Diuretic to increase urine output

Answer

Conservative management

Question 9

Which of the following statements is true regarding the management of a patient with hematuria diagnosed to have Stage II Transitional Cell Carcinoma of the bladder?

Accepted Answer

There is a 70% chance of requiring cystectomy within 5 years after transurethral resection.

Answer

Cystoscopic fulguration is the standard treatment.

Answer

History of smoking is not a risk factor.

Answer

There is no role for chemotherapy.

Question 10

Urinary catheterization is indicated in cases of acute retention of urine, except in which of the following conditions?

Accepted Answer

Rupture

Answer

Stricture

Answer

Postoperative

Answer

Carcinoma of the prostate

Urology — MCQs

Urology — MCQs

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