"Urology" — Practice

Question 1

A 15-year-old boy has sudden severe left scrotal pain with a high-riding testis and absent cremasteric reflex. What is the next step?

Accepted Answer

B

Question 2

A 62-year-old smoker has one episode of painless visible haematuria which has settled. What is required?

Accepted Answer

C

Question 3

A patient with recurrent calcium oxalate stones asks about diet. What advice is correct?

Accepted Answer

B

Question 4

A man on finasteride for 2 years has a prostate-specific antigen of 3.2. How should this be interpreted?

Accepted Answer

B

Question 5

A patient with an obstructing ureteric stone develops fever of 39 degrees and rigors. What is the definitive management?

Accepted Answer

B

Question 6

A 58-year-old man has a new left-sided varicocele that does not empty on lying down. What must be excluded?

Accepted Answer

B

Question 7

Why must orchidectomy for a suspected testicular tumour use an inguinal rather than a scrotal approach?

Accepted Answer

Because the testis and the scrotum drain to entirely different lymph node fields, a consequence of their different embryological origins. The testis develops on the posterior abdominal wall and descends, carrying its blood supply and lymphatic drainage with it, so it drains to the para-aortic nodes. The scrotal skin is a body wall structure and drains to the inguinal nodes.

An inguinal approach allows the cord to be clamped high before the testis is mobilised, preventing venous or lymphatic dissemination during handling, and keeps the operation entirely within the para-aortic field. A scrotal incision breaches the scrotal lymphatics and can seed tumour into inguinal nodes that were never at risk. That converts a predictable retroperitoneal pattern of spread into an unpredictable one, altering staging, radiotherapy fields and follow-up, and it is the reason a scrotal biopsy of a suspicious testicular mass is regarded as a serious error.

Question 8

What distinguishes active surveillance from watchful waiting in prostate cancer?

Accepted Answer

B

Question 9

An elderly man with painless retention has a creatinine of 340. After catheterisation, 2 litres drain and creatinine falls to 140 over 48 hours. What was the diagnosis, and what must be monitored?

Accepted Answer

This is high-pressure chronic retention. Painless retention indicates a bladder that has distended gradually enough for the detrusor to accommodate, and the raised creatinine that falls after catheterisation confirms that the renal impairment was obstructive rather than intrinsic. Back-pressure had produced bilateral hydronephrosis.

Two things must be monitored. Post-obstructive diuresis can follow, in which the kidneys excrete large volumes because accumulated solute is being cleared and the tubules have temporarily lost concentrating ability. Urine output, weight and electrolytes are measured, and losses are replaced if the diuresis is large enough to cause hypovolaemia or significant sodium and potassium depletion.

Decompression haematuria may also occur as the chronically stretched, ischaemic bladder mucosa reperfuses. It is usually self-limiting. The patient should not be discharged the same day, and definitive management of the obstruction follows once renal function has stabilised.

Practice — "Urology"

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