Urology Practice Questions

Q: All of the following are the risk factors for testicular tumors except:

Acute Epididymo- Orchitis (EDO). ***Acute Epididymo- Orchitis (EDO)*** - **Acute epididymo-orchitis** is an inflammation or infection of the epididymis and testes, typically caused by bacteria or viruses, and is not a known risk factor for testicular tumors. - While it can cause testicular pain and swelling, it does not predispose individuals to the development of germ cell tumors or other testicular malignancies. *Testicular feminization syndrome* - This syndrome, also known as **Androgen Insensitivity Syndrome (AIS)**, is a significant risk factor for testicular germ cell tumors due to the presence of undescended testes (gonads) and abnormal hormonal environments. - Individuals with AIS have XY chromosomes but are phenotypically female, and if the gonads are not removed, they carry an increased risk of developing **dysgerminoma or seminoma**. *Klinefelter's syndrome* - **Klinefelter's syndrome** (47, XXY) is associated with an increased risk of extragonadal germ cell tumors, particularly **mediastinal germ cell tumors**, as well as a slightly elevated risk of testicular germ cell tumors. - This genetic condition is characterized by primary testicular failure, gynecomastia, and infertility, and the abnormal chromosomal complement contributes to the oncogenic risk. *Administration of DES in utero* - Maternal use of **diethylstilbestrol (DES)** during pregnancy has been linked to an increased risk of reproductive tract abnormalities and certain cancers in offspring, including testicular cancer. - Exposure to DES in utero has been associated with **epididymal cysts**, cryptorchidism, and an elevated risk of **clear cell adenocarcinoma** of the vagina/cervix in females, and testicular germ cell tumors in males.

Q: Renal trauma is best treated by -

Observation and supportive measures. ***Observation and supportive measures*** - Most cases of **renal trauma**, especially blunt trauma, are managed **non-operatively** with observation, bed rest, fluid resuscitation, and pain control. - This approach minimizes unnecessary interventions and allows the kidney to heal spontaneously, preserving **renal parenchyma**. *Nephrostomy* - **Nephrostomy** is primarily indicated for **urinary diversion** in cases of unresolving urinoma or obstruction, not as the initial treatment for all renal trauma. - It is an invasive procedure and carries risks of infection and further injury, making it unsuitable for first-line management of stable renal trauma. *Heminephrectomy* - **Heminephrectomy** involves surgical removal of a portion of the kidney and is reserved for **severe renal injuries** with extensive damage to a segment or pole of the kidney that cannot be salvaged. - It is a highly invasive procedure with potential morbidity and is not indicated for the majority of renal trauma cases. *Early drainage of perirenal haematoma* - **Early drainage of a perirenal haematoma** is generally avoided unless the haematoma is expanding, infected, or causing significant compression, as it can disrupt the natural tamponade effect. - In most cases, perirenal haematomas resolve spontaneously with conservative management without requiring surgical intervention.

Q: Straining and dribbling of urine in a male infant with recurrent urinary infection should lead to the suspicion of :

Posterior urethral valve. ***Posterior urethral valve*** - **Posterior urethral valves (PUV)** are obstructive membranes in the posterior urethra of male infants, leading to **straining** during micturition and poor stream (dribbling). - This obstruction causes urinary stasis, predisposing to **recurrent urinary tract infections (UTIs)** and potential kidney damage. *Vesico – ureteric reflux* - **Vesico-ureteric reflux (VUR)** involves the retrograde flow of urine from the bladder to the ureters, which can cause recurrent UTIs. - However, VUR does not typically present with obstructive symptoms like **straining** or **dribbling** as seen in this clinical scenario. *Phimosis* - **Phimosis** is a condition where the foreskin cannot be fully retracted over the glans penis, which can sometimes interfere with urinary flow and hygiene. - While it can predispose to UTIs, it rarely causes significant **obstructive voiding symptoms** like straining and dribbling in infancy that would suggest a more distal anatomical obstruction. *Pelvic ureteric junction obstruction* - **Pelvic ureteric junction (PUJ) obstruction** is a blockage at the junction of the renal pelvis and the ureter, often leading to hydronephrosis. - This condition primarily affects urine drainage from the kidney and does not cause **straining** or **dribbling** during micturition, nor does it directly lead to recurrent UTIs via bladder outflow obstruction.

Q: A person after a pelvic fracture, could not pass urine. On examination bladder is not palpable. What is the probable diagnosis?

Extraperitoneal rupture of bladder. ***Extraperitoneal rupture of bladder*** - This typically occurs with **pelvic fractures**, especially pubic rami fractures, as the bony fragments can lacerate the bladder wall outside the peritoneum. - The inability to pass urine and a **non-palpable bladder** suggest that urine has escaped into the surrounding tissues, but not into the peritoneal cavity, and is not distending the bladder. *Intraperitoneal rupture of bladder* - Usually results from a **direct blow to a full bladder**, rather than a pelvic fracture, causing urine to spill into the peritoneal cavity. - While there would be an inability to pass urine, the bladder would likely be **distended and palpable** initially, or there would be signs of peritonitis. *Rectourethral injury* - This involves a tear between the rectum and the urethra, often associated with severe pelvic trauma. - While it causes an inability to void, the primary concern would be **fecal leakage into the urethra** or urinary leakage into the rectum, not necessarily a non-palpable bladder due to rupture into surrounding tissues. *Posterior urethra rupture with retention of urine* - A rupture of the posterior urethra, common with pelvic fractures, would indeed cause **retention of urine** and an inability to void. - However, in this scenario, the bladder would be **distended and palpable** above the symphysis pubis due to the retained urine, which contradicts the "non-palpable bladder" finding.

Q: Which of the following is not seen in testicular carcinoma?

Inguinal lymphadenopathy. ***Inguinal lymphadenopathy*** - **Testicular carcinoma** does NOT spread to inguinal lymph nodes under normal circumstances. - The testis has **lymphatic drainage to para-aortic/retroperitoneal lymph nodes**, bypassing the inguinal region. - **Inguinal lymphadenopathy** would only occur if there was prior inguinal surgery, scrotal skin involvement, or invasion of scrotal wall—very rare scenarios. - This is the key anatomical distinction that differentiates testicular tumor spread from scrotal pathology. *Epididymo-orchitis* - This is an **inflammatory/infectious condition** of the epididymis and testis, not a feature of testicular carcinoma. - It is an important **differential diagnosis** that can clinically mimic testicular cancer with swelling and discomfort. - While both conditions can present as a testicular mass, epididymo-orchitis is a **separate pathological entity**, not something "seen in" or caused by testicular carcinoma. - However, rarely, inflammation may coexist with an underlying tumor, making careful clinical assessment essential. *Hydrocele* - A **hydrocele** (fluid collection around the testis) can occur as a **secondary reactive phenomenon** in 10% of testicular tumors. - The presence of a hydrocele does NOT rule out underlying **testicular carcinoma**—careful palpation through the fluid and ultrasound evaluation are essential. - **New-onset hydrocele** in adults should raise suspicion for underlying testicular pathology. *Abdominal lump* - **Testicular carcinoma** frequently metastasizes to **retroperitoneal (para-aortic) lymph nodes**, which can enlarge and become palpable as an **abdominal mass**. - This is a common presentation in **advanced disease**, particularly with non-seminomatous germ cell tumors. - May be the presenting complaint in some patients before testicular symptoms are noticed.

Q: Induration of seminal vesicle is seen most often in

Tuberculosis. ***Tuberculosis*** - **Tuberculosis** of the male genital tract often affects the seminal vesicles, leading to extensive tissue damage and **induration** due to granuloma formation and fibrosis. - This involvement can be part of disseminated tuberculosis or primary genitourinary tuberculosis, presenting with symptoms like **hematuria**, **epididymo-orchitis**, and painful ejaculation. *Lymphogranuloma venereum* - Characterized by **lymphadenopathy**, **genital ulcers**, and **proctitis**, but does not typically cause induration of the seminal vesicles. - Primarily affects **lymphatic tissues** in the inguinal and pelvic regions. *Syphilis* - Manifests with **chancres**, **rashes**, and later neurological or cardiovascular complications, but direct involvement and induration of seminal vesicles are not typical features. - While it can affect various organs, induration of the seminal vesicles is not a classic presentation. *Gonorrhea* - Causes **urethritis**, **epididymitis**, and sometimes prostatitis, but significant **induration** of the seminal vesicles is uncommon. - It primarily involves mucous membranes and often leads to purulent discharge.

Q: Reflux into grossly dilated ureter belongs to which grade of Vesicoureteric Reflux?

Grade V. ***Grade V*** - **Grade V** VUR is characterized by reflux into a **grossly dilated** and tortuous ureter, often with blunting of the **renal calyces**. - This is the most severe form, indicating significant renal parenchymal damage risk and often associated with a non-functioning kidney. *Grade III* - **Grade III** VUR shows reflux into the ureter and renal pelvis, with **mild to moderate dilation** of the ureter and renal pelvis, but without blunting of the calyces. - The ureter is still relatively straight or mildly tortuous. *Grade II* - **Grade II** VUR involves reflux into the ureter, renal pelvis, and calyces, but without any **dilation** of these structures. - The reflux does not cause any anatomical changes to the kidney or ureter. *Grade IV* - **Grade IV** VUR presents with reflux into a **moderately dilated** and tortuous ureter, with moderate blunting of the **renal calyces**. - While significant, it is less severe than Grade V, which involves gross dilation and extensive calycial blunting.

Q: What could be the cause of the condition given in the CT below?

Bladder outlet obstruction. **Bladder outlet obstruction** - The CT image (b) shows **significant ascites** (fluid accumulation in the abdominal cavity), particularly pooling in the lower abdomen and pelvis. This pattern, combined with the presence of **bilateral hydroureteronephrosis** (dilated ureters and renal pelves) often seen with bladder distension, is highly suggestive of **bladder outlet obstruction** leading to urine reflux and renal complications. - The associated image (a) illustrates the peritoneal fluid pathways, and the CT image depicts extensive fluid accumulation consistent with a chronic process that could be secondary to prolonged obstruction. *Diverticulosis coli* - **Diverticulosis coli** is characterized by the presence of diverticula in the colon and typically does not cause widespread ascites or bilateral hydroureteronephrosis unless there is a severe complication like perforation leading to peritonitis. - The CT image does not provide direct evidence of diverticula or their complications as the primary cause of the depicted ascites and upper urinary tract dilatation. *Ureteric stricture* - A **ureteric stricture** typically causes **unilateral hydroureteronephrosis** (dilatation of the ureter and kidney on one side) proximal to the stricture. - The image shows **bilateral hydroureteronephrosis** and extensive ascites, which are not characteristic findings of a solitary ureteric stricture. *Carcinoma colon* - **Carcinoma of the colon** can cause ascites if it metastasizes to the peritoneum (peritoneal carcinomatosis) or if it obstructs lymphatic flow. - While colonic carcinoma can cause ascites, it typically does **not directly lead to bilateral hydroureteronephrosis** unless it causes direct compression of both ureters in the pelvis, which would likely also present with other signs of the primary tumor, which are not clearly evident as the primary cause here.

Q: Which of the following is the preferred treatment for a urethral diverticulum?

Diverticulectomy. ***Diverticulectomy*** - **Diverticulectomy** is the preferred and most definitive treatment for a urethral diverticulum, involving **surgical excision of the diverticular sac**. - This method effectively removes the source of symptoms and prevents recurrence, leading to a long-term cure. *Transurethral electrosurgical fulguration* - This technique involves **burning or destroying tissue** using an electric current, typically used for smaller lesions or to coagulate bleeding. - It is generally **not sufficient to completely excise** a urethral diverticulum and may result in recurrence or incomplete resolution of symptoms. *Diverticulum marsupialization* - Marsupialization involves **opening the diverticular sac** and suturing its edges to the surrounding tissue, creating a continuously open pouch. - While it can drain the diverticulum, it **does not remove the sac** and may leave a persistent cavity that can still become infected or problematic. *Partial diverticular sac ablation* - **Partial ablation** involves destroying part of the diverticular sac, often with laser or electrocautery. - This approach is **less effective than complete excision** and carries a higher risk of recurrent symptoms or incomplete treatment as the remaining diverticular tissue can continue to cause issues.

Q: A patient is seen on the second postoperative day after a difficult abdominal hysterectomy complicated by ureteral injury during ligation of the left uterine artery pedicle. The patient has developed sepsis. If the ureteral injury had been recognized at the time of surgery, which of the following procedures could have been recommended?

Ureteral reimplantation into the bladder. ***Ureteral reimplantation into the bladder*** - For a **distal ureteral injury** near the bladder, as would likely occur during a hysterectomy involving the uterine artery pedicle, **ureteral reimplantation** directly into the bladder (ureteroneocystostomy) is the reconstructive procedure of choice. - This method provides a **robust and long-lasting repair**, typically performed acutely when the injury is recognized immediately during surgery. *Placement of a ureteral stent without anastomosis* - This is an insufficient intervention for a **frank transection or significant injury** to the ureter; a stent alone cannot repair a severed ureter. - Stents are typically used for **intraluminal obstruction** or to protect an anastomosis, not as a solitary treatment for a complete ureteral injury. *Percutaneous nephrostomy* - This procedure diverts urine from the kidney externally and is primarily used for **temporary drainage** in cases of ureteral obstruction, fistula, or severe sepsis/urosepsis to protect kidney function, often as a temporizing measure before definitive repair. - It does not **repair the ureteral injury** itself, making it an inappropriate direct surgical solution if the injury is recognized and can be repaired at the time of surgery. *Ureteroureteral anastomosis* - This involves **reconnecting the two ends of a severed ureter** but is generally reserved for **mid-ureteral injuries** or when there is sufficient length to achieve a tension-free repair. - Given the injury near the uterine artery pedicle during a hysterectomy, it is more likely to be a **distal ureteral injury**, where reimplantation into the bladder is usually preferred due to shorter mobilized segments and better long-term patency rates.

Question 1

All of the following are the risk factors for testicular tumors except:

Accepted Answer

Acute Epididymo- Orchitis (EDO)

Answer

Testicular feminization syndrome

Answer

Klinefelter's syndrome

Answer

Administration of DES in utero

Question 2

Renal trauma is best treated by -

Accepted Answer

Observation and supportive measures

Answer

Nephrostomy

Answer

Heminephrectomy

Answer

Early drainage of perirenal haematoma

Question 3

Straining and dribbling of urine in a male infant with recurrent urinary infection should lead to the suspicion of :

Accepted Answer

Posterior urethral valve

Answer

Vesico – ureteric reflux

Answer

Phimosis

Answer

Pelvic ureteric junction obstruction

Question 4

A person after a pelvic fracture, could not pass urine. On examination bladder is not palpable. What is the probable diagnosis?

Accepted Answer

Extraperitoneal rupture of bladder

Answer

Intraperitoneal rupture of bladder

Answer

Rectourethral injury

Answer

Posterior urethra rupture with retention of urine

Question 5

Which of the following is not seen in testicular carcinoma?

Accepted Answer

Inguinal lymphadenopathy

Answer

Epididymo-orchitis

Answer

Hydrocele

Answer

Abdominal lump

Question 6

Induration of seminal vesicle is seen most often in

Accepted Answer

Tuberculosis

Answer

Lymphogranuloma venereum

Answer

Syphilis

Answer

Gonorrhea

Question 7

Reflux into grossly dilated ureter belongs to which grade of Vesicoureteric Reflux?

Accepted Answer

Grade V

Answer

Grade III

Answer

Grade II

Answer

Grade IV

Question 8

What could be the cause of the condition given in the CT below?

Accepted Answer

Bladder outlet obstruction

Answer

Diverticulosis coli

Answer

Ureteric stricture

Answer

Carcinoma colon

Question 9

Which of the following is the preferred treatment for a urethral diverticulum?

Accepted Answer

Diverticulectomy

Answer

Transurethral electrosurgical fulguration

Answer

Diverticulum marsupialization

Answer

Partial diverticular sac ablation

Question 10

A patient is seen on the second postoperative day after a difficult abdominal hysterectomy complicated by ureteral injury during ligation of the left uterine artery pedicle. The patient has developed sepsis. If the ureteral injury had been recognized at the time of surgery, which of the following procedures could have been recommended?

Accepted Answer

Ureteral reimplantation into the bladder

Answer

Placement of a ureteral stent without anastomosis

Answer

Percutaneous nephrostomy

Answer

Ureteroureteral anastomosis

Urology — MCQs

Urology — MCQs

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