Urology Practice Questions

Q: Which of the following urethral anomalies is the most common?

Hypospadias. ***Hypospadias*** - **Hypospadias** is the most common urethral anomaly, occurring when the **urethral opening** is located on the underside of the penis rather than at the tip. - Its prevalence ranges from approximately **1 in 150 to 1 in 300 live male births**, making it significantly more frequent than other urethral malformations. *Pinhole meatus* - A **pinhole meatus** refers to an abnormally small urethral opening. - While it can be a component or consequence of other anomalies, it is **less common as a standalone finding** compared to hypospadias. *Epispadias* - **Epispadias** is a rare anomaly where the urethra opens on the **dorsal (top) aspect** of the penis. - Its incidence is much lower than hypospadias, estimated at **1 in 100,000 to 1 in 500,000 live births**. *Stricture of the urethra* - A **urethral stricture** is a narrowing of the urethra, often due to **scar tissue** from inflammation, trauma, or infection. - Although it can present at any age, it is more commonly an **acquired condition** rather than a congenital anomaly like hypospadias or epispadias.

Q: In which of the following surgeries is monopolar cautery preferred over bipolar cautery?

Surgery of the Hip. ***Surgery of the Hip*** - **Monopolar cautery** is preferred in surgeries like hip surgery where a larger area needs to be coagulated, as it provides a wider field of effect and can be more efficient for **deep tissue coagulation**. - Its mechanism relies on the current passing through the patient to a large **dispersive electrode (grounding pad)**, making it suitable for extensive tissue work. *Hand Surgery* - In **hand surgery**, delicate structures like nerves and tendons are abundant, making **bipolar cautery** safer due to its localized current flow and reduced risk of inadvertent thermal spread. - **Bipolar cautery** limits the current to a small area between the two prongs of the instrument, thus minimizing damage to surrounding tissues. *Surgery around Penis* - **Bipolar cautery** is generally preferred in sensitive areas like the penis, due to its localized effect and reduced risk of thermal injury to adjacent delicate structures. - The avoidance of current passing through the body to a grounding pad in **bipolar modality** is especially important in areas with potential for nerve damage or scarring. *Surgery around the face* - Surgically around the face often involves delicate tissues and structures where **bipolar cautery** is favored to prevent widespread thermal damage and minimize scarring or nerve injury. - The confined current path of **bipolar cautery** makes it ideal for precision work in cosmetic or reconstructive facial surgery.

Q: A 65 year old male presents with CA prostate. The tumour is limited to the capsule and it is palpable on PR examination. The patient is diagnosed as stage T2a. What is the most appropriate treatment option?

Surgical removal of the prostate (Radical prostatectomy). ***Surgical removal of the prostate (Radical prostatectomy)*** - **Radical prostatectomy** is the **definitive treatment of choice** for **localized prostate cancer (T2a)** in patients with **good life expectancy (>10 years)**. - For a **65-year-old patient** with tumor confined to the prostate, **surgical removal offers excellent disease control** and potential cure. - This is the **preferred option** when the patient is **medically fit for surgery** and has adequate life expectancy. *External beam radiation therapy* - **External beam radiation therapy (EBRT)** is also an effective treatment for **localized T2a prostate cancer** with comparable long-term survival outcomes. - However, **radical prostatectomy is generally preferred** in younger, healthier patients as it: - Provides definitive pathological staging - Allows for immediate assessment of surgical margins - Preserves radiation as a salvage option if needed - EBRT is better suited for patients who are **not surgical candidates** due to comorbidities or patient preference. *Active surveillance* - **Active surveillance** is appropriate for **very low-risk prostate cancer** (T1c, PSA <10, Gleason ≤6). - For **T2a disease** (palpable tumor), the risk of progression is significant, making active surveillance **not the most appropriate first-line option**. - Would be considered only in patients with limited life expectancy or significant comorbidities. *Androgen deprivation therapy (ADT)* - **ADT** is used for **advanced, locally advanced, or metastatic prostate cancer** to reduce testosterone and slow tumor growth. - It is **not curative** and not appropriate as **monotherapy for localized T2a disease**. - May be used as adjuvant therapy with radiation in higher-risk cases, but not as primary treatment alone.

Q: Prostate cancer that is limited to the capsule and not the urethra would be staged as -

T2. ***T2*** - A T2 stage indicates that the prostate cancer is **confined within the prostate capsule**, meaning it has not spread beyond the outer layer of the prostate gland. - While it is not limited to the urethra, the key defining characteristic of T2 is **capsular confinement**, which is described in the question. *T1* - T1 stage prostate cancer is typically **non-palpable** on digital rectal exam (DRE) and not visible on imaging. - It is often found incidentally, for example, during a **transurethral resection of the prostate (TURP)** for benign prostatic hyperplasia. *T3* - A T3 stage indicates that the prostate cancer has **extended beyond the prostate capsule**, but has not metastasized to distant sites. - This typically involves invasion into the **seminal vesicles** or other periprostatic tissues. *T0* - T0 means there is **no evidence of primary tumor**, which is not consistent with a diagnosed prostate cancer. - This staging is used when there is no measurable tumor.

Q: Classic triad in Renal cell carcinoma includes all of the following, Except:

Hypertension. ***Hypertension*** - While hypertension can occur in patients with renal cell carcinoma due to **renin secretion** or other mechanisms, it is **not considered one of the classic triad symptoms**. - The classic triad represents symptoms that historically led to diagnosis, though most RCCs are now discovered incidentally. *Hematuria* - **Gross or microscopic hematuria** is a common symptom of renal cell carcinoma [1], resulting from tumor invasion into the collecting system. - It is one of the **three classic symptoms** associated with advanced disease. *Flank mass* - A palpable **flank mass** indicates a sizable tumor infiltrating the renal parenchyma and is a classic sign of renal cell carcinoma [1]. - This symptom is often associated with later-stage disease. *Abdominal Pain* - **Flank pain** or abdominal pain is a frequent symptom of renal cell carcinoma, which may be caused by tumor growth, hemorrhage, or obstruction. - This symptom, along with hematuria and a flank mass, constitutes the **classic diagnostic triad**.

Q: Which of the following is NOT a feature of membranous urethral injury?

Perineal butterfly hematoma. ***Perineal butterfly hematoma*** - A **perineal butterfly hematoma** is more characteristic of an injury to the **anterior urethra**, specifically the bulbar urethra, often caused by a straddle injury. - It occurs due to the extravasation of blood into the subcutaneous tissue of the perineum, outlining the shape of a butterfly. *blood at the meatus* - **Blood at the meatus** is a classic sign of urethral injury, regardless of the segment (anterior or posterior). - It indicates disruption of the urethral mucosa and bleeding from the damaged blood vessels. *Retention of urine* - **Retention of urine** can occur due to either a complete or partial urethral transection, preventing normal urine flow. - The inability to void can lead to bladder distension and is a significant symptom in assessing urethral trauma severity. *Pelvic fracture* - **Pelvic fractures** are frequently associated with **membranous urethral injuries** because the membranous urethra is fixed within the pelvic ring. - Shear forces from pelvic trauma can cause the prostatomembranous junction to avulse.

Q: A 45-year-old male is diagnosed with carcinoma of the penis. Which lymph nodes should the surgeon primarily consider for potential metastasis?

Inguinal lymph nodes (located in the groin region). ***Inguinal lymph nodes (located in the groin region)*** - The lymphatic drainage of the penis primarily bypasses the internal nodal basins and drains directly to the **superficial and deep inguinal lymph nodes**. - Metastasis to these nodes is the **most common initial spread** in penile carcinoma, making them the primary targets for surgical evaluation and dissection. *Para-aortic lymph nodes (located near the aorta)* - These nodes are typically involved in more advanced or widespread metastatic disease, following initial spread to the pelvic nodes. - They are not considered the primary draining lymph nodes for penile carcinoma. *External iliac lymph nodes (located along the external iliac vessels)* - While part of the pelvic lymph node chain, the external iliac nodes are usually involved after metastasis to the inguinal nodes, or in cases of direct invasion of the pelvic floor. - They are not the first echelon of lymphatic drainage for the penis. *Internal iliac lymph nodes (located along the internal iliac vessels)* - These nodes are involved in lymphatic drainage from organs like the bladder, prostate, and rectum. - The lymphatic drainage of the penis primarily bypasses these nodes for initial metastasis.

Q: A 54 year old woman is diagnosed as having carcinoma of the renal pelvis of size less than 4 cm without any metastasis. The best treatment option is

Radical Nephroureterectomy. ***Radical Nephroureterectomy*** - Carcinoma of the **renal pelvis** is a type of upper tract urothelial carcinoma (UTUC). Because of the multifocal nature and higher risk of recurrence of UTUC, **radical nephroureterectomy** (which includes removal of the kidney, ureter, and bladder cuff) is the standard treatment, even for smaller tumors. - Unlike renal cell carcinoma, partial nephrectomy is generally not recommended for renal pelvis carcinomas due to the risk of leaving behind residual disease in the ureter or bladder cuff. *Partial nephrectomy* - This is generally reserved for small, localized **renal cell carcinomas**, especially when kidney function preservation is a concern (e.g., solitary kidney, bilateral tumors). - For **renal pelvis carcinomas**, partial nephrectomy is associated with a higher risk of local recurrence because of the potential for tumor spread within the ureter and multifocal disease. *Chemotherapy and immunotherapy* - **Chemotherapy** (often cisplatin-based) might be used as neoadjuvant or adjuvant therapy for locally advanced or high-risk UTUC, or for metastatic disease. It is not the primary curative treatment for localized disease. - **Immunotherapy** is typically reserved for advanced or metastatic urothelial carcinoma that has progressed after chemotherapy. *Palliative Radiotherapy* - **Radiotherapy** has a limited role in the primary curative treatment of renal pelvis carcinoma. - It is mainly used in a **palliative setting** for symptom control (e.g., bone metastases, local pain) in advanced or metastatic disease, not for localized, resectable tumors.

Q: ESWL is contraindicated in which of the following stones -

Cystine stones. ***Cysteine stones*** - **Cystine stones** are very dense and hard, making them resistant to fragmentation by the shock waves generated during **Extracorporeal Shock Wave Lithotripsy (ESWL)**. - Due to their resistance to fragmentation, ESWL is generally ineffective for cystine stones, and other treatments like **ureteroscopy** or **percutaneous nephrolithotomy (PCNL)** are often preferred. *Oxalate Stones* - **Calcium oxalate stones** are generally **amenable to ESWL** as they are effectively fragmented by shock waves. - They are the **most common type of kidney stone** and often respond well to lithotripsy. *Urate stones* - **Uric acid stones** are typically **radiolucent** but are often **well-fragmented by ESWL**. - Their non-calcium composition does not hinder the effectiveness of shock waves. *Phosphate stones* - **Struvite (magnesium ammonium phosphate) stones** and **calcium phosphate stones** generally respond well to ESWL. - While sometimes large and branched (**staghorn calculi**), the individual components are susceptible to shock wave fragmentation, though multiple sessions or adjunctive therapies might be needed.

Q: RPLND and Chemotherapy may be used in management of?

Non-seminomatous germ cell tumors of the testis. ***Non-seminomatous germ cell tumors of the testis*** - **Retroperitoneal lymph node dissection (RPLND)** and **chemotherapy** are key components in the management of non-seminomatous germ cell tumors (NSGCTs), especially for metastatic disease or after initial orchidectomy. - The combination therapy addresses both local nodal involvement (RPLND) and widespread micrometastases (chemotherapy), which are common in NSGCTs. *Non-germ cell tumors* - This is a broad category, and while some non-germ cell testicular tumors may require surgery or chemotherapy, **RPLND** is not a standard part of their management in the same way it is for germ cell tumors. - The specific treatment depends on the tumor type (e.g., Leydig cell tumor, Sertoli cell tumor), stage, and histology, and often involves less aggressive approaches. *Seminomatous germ cell tumors* - **Seminomas** are highly radiosensitive and often respond well to **radiation therapy**, particularly for localized disease or retroperitoneal nodal involvement. - While chemotherapy is used for metastatic seminoma, **RPLND** is generally not indicated for seminomas due to their radiosensitivity and different metastatic patterns compared to NSGCTs. *Lymphoma of the testis* - Testicular lymphoma is a type of **non-Hodgkin lymphoma** and is primarily managed with systemic **chemotherapy** (e.g., R-CHOP) and sometimes radiation therapy. - **RPLND** is not a standard treatment modality for testicular lymphoma, as it is a systemic disease requiring systemic treatment, not local surgical excision of retroperitoneal nodes.

Question 1

Which of the following urethral anomalies is the most common?

Accepted Answer

Hypospadias

Answer

Pinhole meatus

Answer

Epispadias

Answer

Stricture of the urethra

Question 2

In which of the following surgeries is monopolar cautery preferred over bipolar cautery?

Accepted Answer

Surgery of the Hip

Answer

Surgery around Penis

Answer

Hand Surgery

Answer

Surgery around the face

Question 3

A 65 year old male presents with CA prostate. The tumour is limited to the capsule and it is palpable on PR examination. The patient is diagnosed as stage T2a. What is the most appropriate treatment option?

Accepted Answer

Surgical removal of the prostate (Radical prostatectomy)

Answer

External beam radiation therapy

Answer

Androgen deprivation therapy (ADT)

Answer

Active surveillance

Question 4

Prostate cancer that is limited to the capsule and not the urethra would be staged as -

Accepted Answer

T2

Answer

T1

Answer

T3

Answer

T0

Question 5

Classic triad in Renal cell carcinoma includes all of the following, Except:

Accepted Answer

Hypertension

Answer

Hematuria

Answer

Flank mass

Answer

Abdominal Pain

Question 6

Which of the following is NOT a feature of membranous urethral injury?

Accepted Answer

Perineal butterfly hematoma

Answer

blood at the meatus

Answer

Retention of urine

Answer

Pelvic fracture

Question 7

A 45-year-old male is diagnosed with carcinoma of the penis. Which lymph nodes should the surgeon primarily consider for potential metastasis?

Accepted Answer

Inguinal lymph nodes (located in the groin region)

Answer

Para-aortic lymph nodes (located near the aorta)

Answer

External iliac lymph nodes (located along the external iliac vessels)

Answer

Internal iliac lymph nodes (located along the internal iliac vessels)

Question 8

A 54 year old woman is diagnosed as having carcinoma of the renal pelvis of size less than 4 cm without any metastasis. The best treatment option is

Accepted Answer

Radical Nephroureterectomy

Answer

Palliative Radiotherapy

Answer

Chemotherapy and immunotherapy

Answer

Partial nephrectomy

Question 9

ESWL is contraindicated in which of the following stones -

Accepted Answer

Cystine stones

Answer

Urate stones

Answer

Phosphate stones

Answer

Oxalate Stones

Question 10

RPLND and Chemotherapy may be used in management of?

Accepted Answer

Non-seminomatous germ cell tumors of the testis

Answer

Non-germ cell tumors

Answer

Seminomatous germ cell tumors

Answer

Lymphoma of the testis

Urology — MCQs

Urology — MCQs

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