MCQ bank · 34 questions · free
Urology MCQs with answers
34 single-best-answer questions on renal colic, urinary retention, haematuria, testicular and prostate disease. Try each one, then open the answer to see the explanation, why the other options are wrong, and the guideline or trial behind it.
A 38-year-old man has severe loin-to-groin pain, vomiting and blood in the urine. He is afebrile with normal kidney function. What is the first-line pain relief and imaging?
- An NSAID (e.g. intramuscular or rectal diclofenac), and a non-contrast CT of the kidneys, ureters and bladder within 24 hours
- Paracetamol only, and plain X-ray only
- Morphine first, and an intravenous urogram
- Antispasmodics, and ultrasound of the bladder only
- No analgesia until imaging is done
Show the answer and explanation
Answer: A. An NSAID (e.g. intramuscular or rectal diclofenac), and a non-contrast CT of the kidneys, ureters and bladder within 24 hours. NSAIDs are the most effective first-line analgesia for renal colic, provided kidney function is normal. Non-contrast low-dose CT KUB is the most accurate test; ultrasound is used first in pregnancy and children.
Why not the others? Opioids are used if NSAIDs are contraindicated or insufficient. Antispasmodics add nothing.
References
A 52-year-old woman with a 6-mm obstructing ureteric stone has a temperature of 39 °C, rigors and a blood pressure of 88/50. What is the most important treatment?
- Antibiotics and urgent decompression of the kidney (nephrostomy or ureteric stent)
- Ureteroscopy and laser fragmentation of the stone tonight
- Observe for 48 hours for the stone to pass
- Extracorporeal shock wave lithotripsy
- Tamsulosin and oral antibiotics at home
Show the answer and explanation
Answer: A. Antibiotics and urgent decompression of the kidney (nephrostomy or ureteric stent). An infected, obstructed kidney is a urological emergency that can progress quickly to septic shock. The kidney must be drained urgently, by percutaneous nephrostomy or retrograde stent, together with resuscitation and antibiotics. Definitive stone treatment is delayed until the infection has cleared.
Why not the others? Treating the stone in the presence of sepsis risks worsening it.
References
A 72-year-old man with prostatic symptoms cannot pass urine and has a painful, palpable bladder. A urethral catheter drains 900 mL. What do you do next?
- Start an alpha-blocker (e.g. tamsulosin) and plan a trial without catheter after a few days
- Remove the catheter after 1 hour
- Discharge with no follow-up
- Immediate transurethral resection of the prostate
- Antibiotics for 6 weeks
Show the answer and explanation
Answer: A. Start an alpha-blocker (e.g. tamsulosin) and plan a trial without catheter after a few days. In acute urinary retention due to benign prostatic enlargement, an alpha-blocker started at catheterisation increases the chance of passing urine at the trial without catheter. Look for precipitating causes such as constipation, anticholinergic drugs and infection, and check kidney function. Surgery is considered if the trial fails.
Why not the others? Decompression should not be clamped or rushed. Antibiotics are only for infection.
References
A 63-year-old smoker has had one episode of painless visible haematuria. His urine culture is negative. What is the correct pathway?
- Treat with antibiotics
- Reassure, as one episode is not significant
- PSA test only
- Urgent suspected-cancer referral for cystoscopy and imaging of the upper tracts (CT urogram)
- Repeat urine dipstick in 6 months
Show the answer and explanation
Answer: D. Urgent suspected-cancer referral for cystoscopy and imaging of the upper tracts (CT urogram). Unexplained visible haematuria at age 45 or over is a red flag for bladder or upper tract cancer. Smoking is the main risk factor for urothelial cancer. The bladder is examined by cystoscopy and the kidneys and ureters by CT urography.
Why not the others? A single episode still needs full investigation. Antibiotics are inappropriate without infection.
References
A 28-year-old man has a painless, hard lump in the right testis. Ultrasound shows a solid intratesticular mass. What is the next step after blood tests for tumour markers?
- Antibiotics for 2 weeks and repeat ultrasound
- Radical inguinal orchidectomy
- Scrotal biopsy
- Trans-scrotal orchidectomy
- Chemotherapy before any surgery
Show the answer and explanation
Answer: B. Radical inguinal orchidectomy. A solid intratesticular mass is cancer until proven otherwise. AFP, β-hCG and LDH are taken first, then the testis is removed through the groin with early clamping of the cord. A CT of the chest, abdomen and pelvis completes staging, and sperm banking is offered.
Why not the others? Scrotal biopsy or a scrotal approach breaches a different lymphatic drainage and risks seeding the tumour.
References
After a crush injury, a man has an unstable pelvic fracture, blood at the urethral meatus and is unable to void. What should be done before any urethral catheter is passed?
- Retrograde urethrogram; if the urethra is injured, place a suprapubic catheter
- Pass a large catheter firmly to overcome resistance
- Wait for him to void
- Intravenous urogram
- Cystoscopy in the emergency department
Show the answer and explanation
Answer: A. Retrograde urethrogram; if the urethra is injured, place a suprapubic catheter. Blood at the meatus after a pelvic fracture suggests a posterior urethral injury. A blind catheter can turn a partial tear into a complete one. A retrograde urethrogram shows the injury; the bladder is then drained suprapubically and the urethra is repaired later.
Why not the others? Forcing a catheter is the classic error.
References
A 30-year-old man with sickle cell disease has had a painful, rigid erection for 6 hours. Cavernosal blood gas shows dark blood with a low oxygen and a pH of 7.1. What is the first treatment?
- Aspiration of blood from the corpora cavernosa, with irrigation and intracavernosal phenylephrine if needed
- Ice packs and review in 24 hours
- Embolisation of the pudendal artery
- Oral sildenafil
- Penile prosthesis immediately
Show the answer and explanation
Answer: A. Aspiration of blood from the corpora cavernosa, with irrigation and intracavernosal phenylephrine if needed. This is ischaemic (low-flow) priapism, a compartment syndrome of the penis. Corporal aspiration and phenylephrine should start as soon as possible, because erectile tissue begins to be permanently damaged after about 4–6 hours. Shunt surgery follows if these fail. Sickle cell disease is managed with the haematology team in parallel.
Why not the others? Embolisation is for high-flow (arterial) priapism, which is painless and non-ischaemic.
References
A 45-year-old man has a 7-mm stone in the distal ureter. His pain is controlled with NSAIDs, he has no infection, and his kidney function is normal. Which is a reasonable first approach?
- Antibiotics for 4 weeks
- Nephrectomy
- Medical expulsive therapy with an alpha-blocker (tamsulosin) and analgesia, with follow-up imaging
- Discharge with no follow-up
- Open ureterolithotomy
Show the answer and explanation
Answer: C. Medical expulsive therapy with an alpha-blocker (tamsulosin) and analgesia, with follow-up imaging. For distal ureteric stones between 5 and 10 mm, an alpha-blocker increases the chance of passing the stone. Follow-up imaging confirms it has passed. Ureteroscopy or lithotripsy is offered if pain persists, the stone does not pass within about 4 weeks, or complications develop.
Why not the others? Infection, a solitary kidney or uncontrolled pain changes the plan to active treatment.
References
After a fall from a horse, a 25-year-old man has left flank pain and visible haematuria. He is haemodynamically stable. CT shows a deep renal laceration (grade IV) with urinary extravasation but no active bleeding. What is the management?
- Nephrectomy
- Immediate angioembolisation without bleeding
- Non-operative management with bed rest, monitoring and repeat imaging; ureteric stent or drainage if a urinoma persists
- Open repair of the kidney
- Discharge home
Show the answer and explanation
Answer: C. Non-operative management with bed rest, monitoring and repeat imaging; ureteric stent or drainage if a urinoma persists. Most blunt renal injuries, including high-grade injuries, are managed without surgery in stable patients. Urinary leaks often seal. Angioembolisation is used for active bleeding, and surgery is reserved for instability or failure of non-operative treatment.
Why not the others? Early surgery often ends in nephrectomy and loses a kidney that could have healed.
References
A 66-year-old man has bothersome frequency, a weak stream and nocturia. Examination shows a smoothly enlarged prostate of about 50 mL. PSA is consistent with benign enlargement and his kidney function is normal. What drug treatment is appropriate?
- An alpha-blocker, with a 5-alpha reductase inhibitor added because the prostate is large
- Long-term antibiotics
- An anticholinergic alone as first choice
- Testosterone
- Immediate TURP for every man with symptoms
Show the answer and explanation
Answer: A. An alpha-blocker, with a 5-alpha reductase inhibitor added because the prostate is large. Alpha-blockers relax the prostate smooth muscle and act within days. 5-alpha reductase inhibitors shrink a large prostate (over about 30–40 mL) over months and reduce the risk of retention and surgery; combination therapy is offered for moderate-to-severe symptoms with a large gland.
Why not the others? Surgery is for failed drug treatment, retention, or complications such as stones, recurrent infection or renal impairment.
References
A sexually active 24-year-old man has had a painful, swollen left testis for 3 days with dysuria and urethral discharge. Doppler shows increased blood flow to the epididymis. What is the treatment?
- Analgesia only
- Scrotal exploration
- Ciprofloxacin alone for 3 days
- Orchidectomy
- Ceftriaxone plus doxycycline, with testing for sexually transmitted infections and partner notification
Show the answer and explanation
Answer: E. Ceftriaxone plus doxycycline, with testing for sexually transmitted infections and partner notification. In younger men, epididymo-orchitis is usually caused by sexually transmitted gonorrhoea or chlamydia, so treatment covers both (ceftriaxone and doxycycline). In older men, enteric organisms from urinary infection are more likely, and a quinolone is used.
Why not the others? If torsion cannot be excluded (sudden onset, absent flow), the scrotum must be explored instead.
References
After blunt trauma with a pelvic fracture and haematuria, CT cystography shows contrast leaking freely into the peritoneal cavity around the bowel loops. What is the treatment?
- Urethral catheter alone for 10 days
- Surgical repair of the bladder (intraperitoneal rupture)
- Suprapubic aspiration
- Observation
- Antibiotics only
Show the answer and explanation
Answer: B. Surgical repair of the bladder (intraperitoneal rupture). Intraperitoneal bladder rupture, usually at the dome, needs surgical repair because urine leaks continuously into the peritoneum. Most uncomplicated extraperitoneal ruptures heal with catheter drainage alone.
Why not the others? A plain CT without bladder filling can miss bladder rupture; CT cystography is the test.
References
A 64-year-old man has a PSA of 8.5 ng/mL and an irregular prostate on rectal examination. What is the recommended first investigation?
- Bone scan only
- Antibiotics and repeat PSA
- Immediate radical prostatectomy
- Multiparametric MRI of the prostate before biopsy
- Repeat PSA in 5 years
Show the answer and explanation
Answer: D. Multiparametric MRI of the prostate before biopsy. Pre-biopsy MRI identifies suspicious areas for targeted biopsy, improves detection of significant cancer and avoids some unnecessary biopsies. Biopsy is then guided by the MRI findings and clinical risk.
Why not the others? Treatment decisions require a tissue diagnosis and staging.
References
CT for back pain shows an incidental 3-cm solid enhancing mass in the lower pole of the right kidney. Staging shows no spread. The patient is 55 and fit. What is the preferred treatment?
- Observation for every patient
- Chemotherapy
- Partial nephrectomy (nephron-sparing surgery)
- Radical nephrectomy as first choice
- Biopsy followed by radiotherapy
Show the answer and explanation
Answer: C. Partial nephrectomy (nephron-sparing surgery). For small renal masses (T1a, 4 cm or less), partial nephrectomy gives cancer control similar to radical nephrectomy while preserving kidney function, which reduces long-term cardiovascular risk. Active surveillance or ablation is considered in older or frail patients.
Why not the others? Removing the whole kidney for a small tumour increases the risk of chronic kidney disease.
References
A 50-year-old has a 2.5-cm stone in the renal pelvis causing recurrent pain and infections. What is the first-line treatment?
- Antibiotics alone
- Open nephrectomy
- Observation
- Percutaneous nephrolithotomy (PCNL)
- Medical expulsive therapy with tamsulosin
Show the answer and explanation
Answer: D. Percutaneous nephrolithotomy (PCNL). Renal stones larger than 2 cm are best treated by PCNL, which gives the highest stone-free rates. Smaller stones can be treated with shock wave lithotripsy or flexible ureteroscopy.
Why not the others? Medical expulsive therapy is for small ureteric stones, not large renal stones.
References
Towards the end of a long transurethral resection of the prostate using glycine irrigation, the patient (under spinal anaesthesia) becomes confused, nauseated, hypertensive and bradycardic. What is the likely cause?
- Hypoglycaemia
- Myocardial infarction only
- Anaphylaxis to the spinal anaesthetic
- Normal response to surgery
- TUR syndrome from absorption of irrigation fluid, causing dilutional hyponatraemia; stop surgery promptly, check sodium and treat
Show the answer and explanation
Answer: E. TUR syndrome from absorption of irrigation fluid, causing dilutional hyponatraemia; stop surgery promptly, check sodium and treat. Absorption of large volumes of hypotonic irrigation fluid causes fluid overload and hyponatraemia, which can lead to confusion, seizures, visual disturbance and cardiovascular instability. Risk increases with long resection times. Bipolar resection with saline irrigation has largely reduced this complication.
Why not the others? Spinal anaesthesia helps because the patient’s confusion is noticed early.
References
A patient with a long-term urinary catheter has fever and suprapubic pain. What should be done before starting antibiotics?
- Replace the catheter (if in place for more than 7 days) and send a urine sample from the new catheter
- Dipstick the urine to decide on antibiotics
- Give no antibiotics because bacteria are always present
- Take urine from the old catheter bag
- Irrigate the catheter with antibiotics
Show the answer and explanation
Answer: A. Replace the catheter (if in place for more than 7 days) and send a urine sample from the new catheter. Long-term catheters are colonised with biofilm, so a sample from the old catheter does not reflect true infection. Replacing the catheter and sampling from the new one gives a reliable culture and removes the infected biofilm. Dipsticks are unreliable in catheterised patients.
Why not the others? Asymptomatic bacteriuria in catheterised patients should not be treated.
References
During an open sigmoid colectomy, you notice that the left ureter has been divided cleanly in its middle third. What is the best management?
- Nephrectomy
- Immediate repair: tension-free spatulated end-to-end ureteric anastomosis over a stent, with a urologist if available
- Leave it and arrange a nephrostomy in 6 months
- Ligate the ureter and leave it
- Ignore it and close the abdomen
Show the answer and explanation
Answer: B. Immediate repair: tension-free spatulated end-to-end ureteric anastomosis over a stent, with a urologist if available. A ureteric injury recognised during surgery should be repaired at the time, which gives the best outcome. Mid-ureteric transection is repaired with spatulated uretero-ureterostomy over a stent. Lower injuries are usually reimplanted into the bladder. Placing ureteric stents before surgery can help identify the ureters in difficult pelvic cases.
Why not the others? Unrecognised injuries present later with urinoma, fistula or loss of the kidney.
References
During sexual intercourse, a man heard a crack, lost his erection immediately, and now has a swollen, purple, bent penis (“aubergine deformity”). What is the treatment?
- Aspiration of the haematoma
- Urgent surgical exploration and repair of the tunica albuginea, checking the urethra
- Oral antibiotics
- Tadalafil daily
- Ice packs and review in 2 weeks
Show the answer and explanation
Answer: B. Urgent surgical exploration and repair of the tunica albuginea, checking the urethra. Penile fracture is a tear of the tunica albuginea of the corpus cavernosum. Early surgical repair gives fewer complications (curvature, erectile dysfunction) than conservative treatment. Blood at the meatus or difficulty passing urine suggests an associated urethral injury.
Why not the others? Conservative treatment leads to more curvature and erectile dysfunction.
References
Cystoscopy in a 68-year-old shows a single 1.5-cm papillary bladder tumour. What is the standard treatment?
- Observation
- Systemic chemotherapy only
- Radical cystectomy
- Transurethral resection of the bladder tumour (TURBT) with a single immediate post-operative instillation of chemotherapy (e.g. mitomycin C) if appropriate
- Radiotherapy alone
Show the answer and explanation
Answer: D. Transurethral resection of the bladder tumour (TURBT) with a single immediate post-operative instillation of chemotherapy (e.g. mitomycin C) if appropriate. TURBT both diagnoses and treats non-muscle-invasive bladder cancer. A single instillation of chemotherapy within 24 hours reduces recurrence in suitable low- and intermediate-risk tumours. Further treatment (such as BCG) and cystoscopic surveillance depend on the risk group.
Why not the others? Cystectomy is for muscle-invasive or very high-risk disease.
References
A 76-year-old man has painless urinary dribbling and a large, non-tender bladder. A catheter drains 2.2 litres. His creatinine is raised and ultrasound shows bilateral hydronephrosis. What must be watched for over the next 24–48 hours?
- Restrict fluids completely
- Nothing; remove the catheter tomorrow
- Post-obstructive diuresis: monitor urine output, fluid balance, electrolytes and kidney function closely
- Hyperglycaemia only
- Hypercalcaemia
Show the answer and explanation
Answer: C. Post-obstructive diuresis: monitor urine output, fluid balance, electrolytes and kidney function closely. High-pressure chronic retention can cause large-volume diuresis after relief of the obstruction, leading to dehydration and electrolyte loss. The catheter stays in, and these patients usually need definitive treatment such as TURP rather than a trial without catheter.
Why not the others? Overflow incontinence (dribbling) can hide chronic retention.
References
A woman who is 28 weeks pregnant has right loin pain and suspected renal colic. What is the first imaging test?
- Intravenous urogram
- Retrograde pyelography
- Ultrasound of the kidneys and bladder
- Non-contrast CT KUB
- Plain X-ray
Show the answer and explanation
Answer: C. Ultrasound of the kidneys and bladder. Ultrasound avoids radiation and is first-line in pregnancy, though mild dilatation of the right kidney is normal in pregnancy. MRI or low-dose CT is considered if ultrasound is inconclusive. Infected obstruction is drained with a stent or nephrostomy.
Why not the others? CT KUB is first-line outside pregnancy.
References
A poorly controlled diabetic woman has pyelonephritis that is not responding to antibiotics. CT shows gas within the kidney tissue. What is the management?
- Insulin only
- Oral antibiotics at home
- Lithotripsy
- Observation
- Emphysematous pyelonephritis: resuscitation, antibiotics and urgent drainage (percutaneous or stent), with nephrectomy for those who do not improve
Show the answer and explanation
Answer: E. Emphysematous pyelonephritis: resuscitation, antibiotics and urgent drainage (percutaneous or stent), with nephrectomy for those who do not improve. Emphysematous pyelonephritis is a necrotising gas-forming infection, mostly in diabetics, often with obstruction. Most patients now survive with antibiotics and percutaneous drainage, with nephrectomy reserved for failure or extensive disease.
Why not the others? Glucose control is also essential.
References
Ureteroscopy and biopsy show a large high-grade urothelial carcinoma in the right renal pelvis. CT shows no metastases. What is the standard surgery?
- Partial nephrectomy
- Simple nephrectomy, leaving the ureter
- Radiotherapy alone
- Radical nephroureterectomy with excision of a bladder cuff
- Endoscopic laser ablation for every tumour
Show the answer and explanation
Answer: D. Radical nephroureterectomy with excision of a bladder cuff. Upper tract urothelial carcinoma tends to recur along the urothelium, including the remaining ureter and its opening into the bladder, so the whole kidney, ureter and a cuff of bladder are removed for high-risk disease. Low-risk tumours can be treated endoscopically.
Why not the others? Leaving the ureter behind leads to recurrence in the stump.
References
TURBT shows muscle-invasive urothelial bladder cancer (T2) in a fit 64-year-old with normal kidney function and no metastases. What is the standard treatment?
- BCG instillations
- Observation
- Mitomycin instillation
- Cisplatin-based neoadjuvant chemotherapy followed by radical cystectomy (or bladder-preserving chemoradiotherapy in selected patients)
- Repeated TURBT only
Show the answer and explanation
Answer: D. Cisplatin-based neoadjuvant chemotherapy followed by radical cystectomy (or bladder-preserving chemoradiotherapy in selected patients). Neoadjuvant cisplatin-based chemotherapy improves survival in muscle-invasive bladder cancer. Radical cystectomy with pelvic lymphadenectomy and urinary diversion is standard; trimodality bladder preservation is an alternative in selected patients.
Why not the others? BCG and intravesical chemotherapy are for non-muscle-invasive disease.
References
A 66-year-old has low-risk localised prostate cancer (Gleason 3+3, PSA 6, small volume on MRI). What is the preferred management?
- Immediate radical prostatectomy for everyone
- No follow-up
- Active surveillance with regular PSA, MRI and repeat biopsy as needed, with curative treatment if the disease progresses
- Chemotherapy
- Hormone therapy for life
Show the answer and explanation
Answer: C. Active surveillance with regular PSA, MRI and repeat biopsy as needed, with curative treatment if the disease progresses. Low-risk prostate cancer rarely threatens life within 10–15 years. Active surveillance avoids the side effects of treatment (incontinence, erectile dysfunction) while preserving the option of cure if the cancer shows signs of progression. The ProtecT trial showed no difference in prostate cancer mortality at 15 years between surveillance and radical treatment.
Why not the others? Watchful waiting (no curative intent) is different from active surveillance.
References
A 45-year-old man has a weak stream from a short (1.5-cm) bulbar urethral stricture, with no previous treatment. What is a reasonable first treatment, and what is the treatment of recurrence?
- Antibiotics only
- A single urethrotomy or dilatation first; recurrence is best treated by urethroplasty rather than repeated urethrotomy
- Permanent urethral catheter
- Prostatectomy
- Repeated urethrotomies for life
Show the answer and explanation
Answer: B. A single urethrotomy or dilatation first; recurrence is best treated by urethroplasty rather than repeated urethrotomy. Urethrotomy can cure some short, first-time bulbar strictures, but success falls with each repeat. Urethroplasty has the highest long-term success and is recommended after failure, or for longer strictures. Retention from a stricture is managed with a suprapubic catheter.
Why not the others? Repeated urethrotomy makes strictures longer and more difficult to repair.
References
A 65-year-old has non-visible haematuria found on dipstick, without dysuria or infection. Repeat testing confirms it. When does NICE recommend an urgent suspected-cancer referral?
- Never for non-visible haematuria
- Only if the patient is under 40
- Only if visible haematuria has occurred 3 times
- Age 60 or over with unexplained non-visible haematuria and either dysuria or a raised white cell count
- Only with a palpable kidney
Show the answer and explanation
Answer: D. Age 60 or over with unexplained non-visible haematuria and either dysuria or a raised white cell count. NICE recommends urgent referral for unexplained visible haematuria at 45 or over, and for non-visible haematuria at 60 or over with dysuria or a raised white cell count. Others are assessed for kidney disease and may still need non-urgent urology review based on risk.
Why not the others? Smoking and occupational exposure raise the risk of bladder cancer.
References
After passing his second calcium oxalate stone, a 40-year-old asks how to prevent another. What is the most important general advice?
- Eat a high-salt diet
- Drink enough fluid to produce at least 2.5 litres of urine a day, with normal calcium intake and less salt and animal protein
- Drink less water
- Avoid all calcium in the diet
- Take vitamin C supplements
Show the answer and explanation
Answer: B. Drink enough fluid to produce at least 2.5 litres of urine a day, with normal calcium intake and less salt and animal protein. High fluid intake is the most effective stone prevention measure. Dietary calcium should not be restricted, as it binds oxalate in the gut; restriction increases stone risk. Recurrent stone formers need metabolic evaluation for targeted treatment.
Why not the others? High-dose vitamin C increases oxalate excretion.
References
A healthy 55-year-old man asks for a PSA test to screen for prostate cancer. What is the right approach?
- Refuse the test
- Perform a biopsy without PSA
- Start hormone therapy
- Discuss the potential benefits and harms (overdiagnosis, biopsy complications), then test if he wishes after an informed decision
- Test without discussion
Show the answer and explanation
Answer: D. Discuss the potential benefits and harms (overdiagnosis, biopsy complications), then test if he wishes after an informed decision. PSA testing can reduce prostate cancer deaths but also leads to overdiagnosis and overtreatment of slow-growing cancers. Guidelines recommend shared decision-making for well-informed men, with MRI before biopsy reducing unnecessary biopsies.
Why not the others? A raised PSA has many causes, including enlargement and infection.
References
After radical orchidectomy, a 32-year-old has a stage I pure seminoma with normal markers and no spread on CT. What is the preferred management?
- Active surveillance, with adjuvant single-dose carboplatin as an alternative for some patients
- Removal of the other testis
- Three cycles of BEP chemotherapy
- No follow-up
- Radical retroperitoneal lymph node dissection
Show the answer and explanation
Answer: A. Active surveillance, with adjuvant single-dose carboplatin as an alternative for some patients. Stage I seminoma has an excellent prognosis. Surveillance avoids overtreatment, as most patients never relapse, and relapses are curable. Sperm banking is offered before any treatment.
Why not the others? Overtreatment exposes young men to late effects of chemotherapy and radiotherapy.
References
A patient has metastatic renal cell carcinoma with many lung metastases and is intermediate risk. Is removal of the primary kidney tumour routinely indicated before systemic therapy?
- No treatment is available
- Yes; remove both kidneys
- Yes; always remove the kidney first
- No; immediate cytoreductive nephrectomy is not routinely recommended; systemic therapy (immunotherapy-based) is first, with nephrectomy considered in selected patients
- Radiotherapy to the kidney is first-line
Show the answer and explanation
Answer: D. No; immediate cytoreductive nephrectomy is not routinely recommended; systemic therapy (immunotherapy-based) is first, with nephrectomy considered in selected patients. The CARMENA trial showed that systemic therapy alone was not inferior to nephrectomy plus systemic therapy in intermediate- and poor-risk patients. Cytoreductive nephrectomy is now considered selectively, for example in good-risk patients or after a good systemic response.
Why not the others? Modern immunotherapy combinations have changed the role of surgery.
References
A 25-year-old has recurrent loin pain after drinking large volumes of fluid. Imaging shows hydronephrosis with a narrowed pelviureteric junction and reduced drainage on a renogram. What is the treatment?
- Pyeloplasty (often laparoscopic or robotic)
- Diuretics
- Observation only
- Nephrectomy as first choice
- Long-term antibiotics
Show the answer and explanation
Answer: A. Pyeloplasty (often laparoscopic or robotic). Symptomatic pelviureteric junction obstruction with impaired drainage or declining function is treated by dismembered pyeloplasty, which has high success rates. A crossing lower-pole vessel is a common cause in adults.
Why not the others? Nephrectomy is only for a kidney with negligible function.
References
After ureteroscopy, a patient has frequency, urgency and loin discomfort when passing urine because of the ureteric stent. What can relieve these symptoms?
- Diuretics
- Antibiotics for every patient
- Immediate removal of all stents in every patient
- Restricting fluid intake
- An alpha-blocker (such as tamsulosin) and/or an antimuscarinic, with simple analgesia, until the stent is removed
Show the answer and explanation
Answer: E. An alpha-blocker (such as tamsulosin) and/or an antimuscarinic, with simple analgesia, until the stent is removed. Stent-related symptoms are common. Alpha-blockers and antimuscarinics reduce them. Patients must have a plan for stent removal or exchange, because forgotten stents become encrusted and cause serious complications.
Why not the others? A register of stents helps prevent forgotten stents.
References