Page 24 of 26
SU29.1-11 | Urinary System Surgery — Graded Quiz
Click any question card to reveal the correct answer.
A 70-year-old retired dye-industry worker and lifelong smoker reports a single episode of painless visible haematuria three weeks ago. His urine is now clear, dipstick is negative, and culture is sterile. He feels well. What is the correct next step?
Correct. Even a single episode of painless visible haematuria in a high-risk adult (smoker, occupational aromatic-amine exposure) mandates full work-up — cystoscopy and CT urogram — regardless of clearing urine. Tumours bleed intermittently.
Even ONE episode of painless visible haematuria in an adult requires full work-up. Tumours bleed intermittently; clearing urine does not reassure.
A single painless visible bleed in an at-risk adult still demands the full work-up. Urothelial tumours bleed intermittently, so clear urine and a negative dipstick now do not exclude malignancy. Aromatic-amine (dye) exposure increases bladder cancer risk.
Click to reveal answer
An asymptomatic 50-year-old man is found on ultrasound to have a markedly dilated right pelvicalyceal system (hydronephrosis) with cortical thinning, due to a chronic obstructing pelvi-ureteric junction. What is the principal danger of leaving obstructive hydronephrosis untreated?
Correct. Sustained back-pressure from obstruction progressively destroys renal parenchyma (cortical thinning) and causes irreversible loss of function; relief of obstruction aims to preserve the remaining kidney function.
Obstructive hydronephrosis → progressive irreversible renal damage. Relieve obstruction to preserve function.
Untreated obstructive hydronephrosis causes progressive, irreversible loss of renal function from sustained back-pressure (cortical thinning). The principle of management is to relieve obstruction to preserve function.
Click to reveal answer
A patient has a 4 mm calculus lodged in the distal ureter with mild hydronephrosis but no infection, no intractable pain and normal renal function. What is the most appropriate initial management?
Correct. Small ureteric stones (generally ≤5 mm) without infection, uncontrolled pain or renal impairment are managed conservatively (analgesia, hydration, medical expulsive therapy) as most pass spontaneously. Intervention is reserved for larger stones or complications.
Stone management is size-based: small uncomplicated stones pass spontaneously (conservative). Intervene for large stones, infection, obstruction, or uncontrolled pain.
Management of stones is size- and complication-based. A small distal stone (≤5 mm) with no infection/obstruction-impairment is managed conservatively — most pass spontaneously. PCNL/surgery is for larger or complicated stones.
Click to reveal answer
A 55-year-old man from an endemic region presents with painless haematuria and a contracted, calcified bladder. Cystoscopic biopsy shows squamous cell carcinoma. Which underlying condition most likely predisposed him?
Correct. Chronic schistosomiasis causes persistent bladder irritation and is the classic cause of squamous cell carcinoma of the bladder, in contrast to the smoking-related transitional cell carcinoma.
Bladder SCC ← chronic irritation, classically schistosomiasis. Smoking ← TCC.
Squamous cell carcinoma of the bladder arises from chronic irritation — classically schistosomiasis (and chronic stones/catheters). Smoking-related cancer is transitional cell carcinoma.
Click to reveal answer
A 68-year-old man with bothersome lower urinary tract symptoms has a high IPSS score, a smooth symmetrically enlarged prostate on DRE, and only a mildly raised PSA proportional to gland size. Medical therapy has failed. What is the standard surgical treatment for symptomatic benign prostatic hyperplasia?
Correct. TURP is the standard surgical treatment for symptomatic BPH refractory to medical therapy. Radical prostatectomy and radiotherapy are treatments for localised prostate cancer, not BPH.
Symptomatic BPH (high IPSS, smooth gland) failing drugs → TURP. Radical prostatectomy/radiotherapy = prostate cancer.
TURP is the surgical mainstay for symptomatic BPH failing medical therapy. Radical prostatectomy/radiotherapy treat prostate cancer; orchidectomy is androgen-deprivation for advanced cancer.
Click to reveal answer
After relieving an episode of chronic high-pressure retention by catheterisation, the nursing staff report a large volume of dilute urine (several litres in hours). What is this phenomenon and the correct response?
Correct. Relief of chronic high-pressure retention can be followed by post-obstructive diuresis. Management is careful monitoring of fluid balance, weight and electrolytes, with appropriate replacement to avoid dehydration and electrolyte disturbance.
After relieving chronic high-pressure retention, watch for post-obstructive diuresis: monitor fluids/electrolytes and replace losses.
Decompressing chronic high-pressure retention can cause post-obstructive diuresis. The correct response is to monitor fluid balance and electrolytes and replace losses — not to remove the catheter.
Click to reveal answer
A 4-year-old child presents with an abdominal mass and haematuria; imaging shows a large solid intrarenal tumour. Which is the most likely diagnosis?
Correct. Wilms tumour (nephroblastoma) is the commonest renal malignancy of early childhood, presenting with an abdominal mass. Renal cell carcinoma is the adult tumour.
Child + renal mass = Wilms tumour (nephroblastoma). Adult = renal cell carcinoma.
An abdominal mass with a solid renal tumour in a young child is Wilms tumour (nephroblastoma). RCC is the adult equivalent.
Click to reveal answer
A man with a known bulbar urethral stricture presents in acute urinary retention. Repeated gentle attempts to pass a urethral catheter fail because the catheter will not negotiate the narrowing. What is the most appropriate immediate step to relieve the obstructed bladder?
Correct. When urethral catheterisation fails (as is common with a stricture), the obstructed bladder is drained by a suprapubic catheter. Definitive stricture treatment (e.g., urethroplasty/optical urethrotomy after RGU) follows.
Failed urethral catheterisation (e.g., stricture) → suprapubic catheter. Never force a catheter through a stricture.
When a stricture blocks urethral catheterisation, drain the bladder suprapubically — never force a stiff catheter (risk of false passage). Definitive stricture management follows after RGU assessment.
Click to reveal answer