Urological Surgery (Kidneys, Bladder, Prostate, Urethra, Testis) MCQs

Surgery · 176 free questions with answers & explanations.

A 65-year-old man presents with lower urinary tract symptoms (hesitancy, poor stream, nocturia). DRE reveals a hard, irregular, fixed prostate. PSA is 45 ng/mL. Prostate biopsy shows Gleason score 4+4=8 adenocarcinoma. Bone scan shows multiple metastases. The most appropriate treatment is:
A 25-year-old man presents with a painless, progressive swelling of the right testis. Ultrasound shows a heterogeneous intratesticular mass. Serum AFP is 800 ng/mL and beta-hCG is normal. The most likely tumour type is:
A 5-year-old boy is brought with bilateral undescended testes. Orchidopexy is recommended. What is the recommended age for orchidopexy to maximise fertility potential?
A 60-year-old man presents with painless haematuria. Cystoscopy reveals a papillary tumour on the posterior wall of the bladder. Transurethral resection reveals grade 2 urothelial carcinoma invading the muscularis propria (T2). The most appropriate treatment is:
A 68-year-old man with a PSA of 14 ng/mL and a Gleason score 4+3=7 (Grade Group 3) prostate cancer confined to the prostate. His MRI shows organ-confined disease with no extracapsular extension. He is medically fit. The treatment option with the lowest risk of urinary incontinence while maintaining equivalent oncological control is:
A 30-year-old man presents with sudden onset severe right testicular pain. Doppler ultrasound shows absent intratesticular blood flow. Exploratory scrotal surgery at 4 hours from symptom onset reveals a viable testis after detorsion. The correct definitive management is:
Transitional cell carcinoma of the bladder is staged T2b. What does T2b specifically denote in TNM staging for bladder cancer?
A patient with von Hippel-Lindau (VHL) disease presents with bilateral multifocal clear cell renal cell carcinomas, all <3 cm. The preferred management strategy to preserve maximal renal function is:
A 32-year-old man presents with a painless left testicular swelling. Serum AFP is markedly elevated at 4500 IU/mL and beta-hCG is mildly elevated. CT shows retroperitoneal lymphadenopathy >5 cm. The correct staging and classification of this non-seminomatous germ cell tumour is:
Transitional cell carcinoma of the renal pelvis is managed differently from renal cell carcinoma. For a G3 T2 urothelial carcinoma of the renal pelvis with no distant metastases, the standard surgical treatment is:
In the management of urethral stricture disease, which investigation provides the most anatomical information about stricture length and location in the posterior urethra, and is the gold standard for planning urethroplasty?
A 68-year-old man with high-risk prostate cancer (PSA 22, Gleason 4+5=9, clinical stage T3a) undergoes radical prostatectomy. Pathology reveals extracapsular extension and positive surgical margins. Which postoperative intervention has the highest level of evidence for reducing biochemical recurrence in this setting?
Bladder exstrophy is a severe congenital anomaly involving failed midline fusion of the infraumbilical abdominal wall. Which associated musculoskeletal deformity is universally present and requires orthopaedic correction at the time of bladder closure?
A 68-year-old man with newly diagnosed prostate cancer (Gleason grade group 2, PSA 8 ng/mL, cT2a) undergoes active surveillance. The criteria for active surveillance initiation per international guidelines (PROTECT trial/EAU 2024) include all EXCEPT:
A 45-year-old man presents with painless hematuria. Cystoscopy reveals a papillary tumor. TURBT shows high-grade non-muscle-invasive bladder cancer (NMIBC) with lamina propria invasion (T1 G3), carcinoma in situ (CIS), and size >3 cm. Risk stratification places him in the 'very high risk' NMIBC group. The most appropriate intravesical treatment per EAU guidelines for very high-risk NMIBC is:
A 32-year-old man presents with a painless right testicular lump. Ultrasound confirms a 2.8 cm hypoechoic mass. Post-orchidectomy histology confirms pure seminoma, pT1, no lymphovascular invasion. CT thorax/abdomen/pelvis shows no retroperitoneal lymphadenopathy. AFP is normal; beta-hCG is mildly elevated. The tumor marker pattern (elevated beta-hCG in 'pure seminoma') is explained by:
A 55-year-old man with symptomatic BPH (IPSS 22, Qmax 8 mL/s, prostate volume 75 mL) fails medical therapy with an alpha-1 blocker and 5-alpha reductase inhibitor combination after 12 months. He has no urinary retention history and PSA is 2.4 ng/mL (biopsy negative). The most appropriate surgical intervention given the prostate size and desire for minimal sexual side effects is:
A 65-year-old man with prostate cancer (PSA 8 ng/mL, Gleason 3+4=7, clinical stage T2a) undergoes radical prostatectomy. Pathology reveals positive surgical margins at the apex. Post-op PSA at 6 weeks is 0.08 ng/mL. What is this biochemical finding called and what is the threshold for initiating salvage radiotherapy?
A 50-year-old man is evaluated for painless gross hematuria. Cystoscopy reveals a 3 cm papillary tumor on the posterior bladder wall. TURBT pathology shows urothelial carcinoma invading the muscularis propria (T2). Staging CT shows no lymphadenopathy or distant metastases. What is the standard of care treatment?
A 3-year-old boy is found to have a right-sided Wilms' tumor (nephroblastoma) on ultrasound — a 9 cm lesion with intact capsule and no IVC involvement. According to COG (Children's Oncology Group) protocol, what is the correct management sequence?
A 25-year-old man presents with a non-tender left testicular mass. Serum AFP is elevated at 450 ng/mL. Radical orchidectomy pathology confirms non-seminomatous germ cell tumor (NSGCT), stage I. Post-orchidectomy AFP remains elevated at 6 weeks. What does this indicate?
A 68-year-old man with PSA 12 ng/mL undergoes transrectal ultrasound-guided biopsy showing Gleason 4+3 = 7 (Grade Group 3) prostate cancer, confined to the prostate (cT2c). He is fit for surgery. According to current risk stratification, he is categorised as which risk group and what is the recommended primary treatment approach?
A 70-year-old man with a 45 g prostate and IPSS score of 22 (severe LUTS) fails medical therapy with alpha-blockers and 5-alpha reductase inhibitors. A urodynamic study confirms bladder outlet obstruction. Which surgical intervention has the best long-term efficacy with the highest retreatment rates avoided in this size prostate?
A 28-year-old man presents with a painless right testicular mass. AFP is 450 IU/mL, β-hCG is 5 IU/L, and LDH is mildly elevated. Radical orchidectomy histology confirms pure embryonal carcinoma. CT reveals retroperitoneal lymph nodes of 2.5 cm maximum diameter. According to IGCCCG classification, what is the prognostic group and what tumour marker pattern best characterises pure embryonal carcinoma?
In the management of upper ureteric calculus (7 mm), which treatment option is associated with the highest single-session stone-free rate when the stone is at the ureteropelvic junction level?
A 68-year-old man with prostate cancer (Gleason 4+3=7, PSA 12 ng/mL, cT2b) undergoes radical prostatectomy. Final pathology shows positive surgical margins and extraprostatic extension (pT3a). According to current EAU guidelines for adjuvant therapy after radical prostatectomy with pT3a disease:
Which of the following is the most important prognostic factor in muscle-invasive bladder cancer (MIBC) treated with radical cystectomy?
A 25-year-old man with a left testicular mass undergoes orchidectomy. Histology shows 80% embryonal carcinoma and 20% teratoma. AFP is 2500 ng/mL and beta-HCG is 50 IU/L. CT chest shows 5 lymph nodes in the retroperitoneum, the largest being 3 cm (no visceral metastases). According to IGCCCG classification, what is the prognostic group?
The PCPT (Prostate Cancer Prevention Trial) demonstrated which unexpected finding regarding 5α-reductase inhibitors?
The ProtecT trial (UK) randomized men with localized prostate cancer (PSA-detected) to active monitoring, radical prostatectomy, or radical radiotherapy. Which was the primary outcome finding at 10-year follow-up?
Bladder cancer is staged as cT2N0M0 (muscle-invasive) on TURBT. During robot-assisted radical cystectomy, standard lymphadenectomy template is performed. Which lymph node dissection template is associated with the highest 5-year survival in muscle-invasive bladder cancer?
A 70-year-old male with benign prostatic hyperplasia (BPH) has refractory urinary retention despite medical management (alpha-blocker + 5-alpha reductase inhibitor). Urodynamics show poor detrusor contractility with maximum flow of 3 mL/s. Prostate volume is 55 mL. Which surgical option is MOST appropriate?
A 28-year-old presents with a 3-day history of left testicular pain. Doppler ultrasound shows absent flow to the left testis. On exploration, the testis is found to be twisted 720° with a 'bell-clapper' deformity bilaterally. Following detorsion, the ischaemia-reperfusion assessment at 6 hours from onset shows a dusky blue testis that does not recover its color after warming. What should be done?
A 68-year-old man has a PSA of 9.2 ng/mL. MRI-guided targeted biopsy (PIRADS 4 lesion in the peripheral zone) reveals Gleason grade group 3 (4+3=7) prostate cancer in 4 of 6 cores. Clinical staging: T2c N0 M0. According to EAU 2023 guidelines for intermediate-high risk prostate cancer, which management option offers highest cancer-specific survival at 10 years?
A 25-year-old male presents with acute onset painless left testicular swelling over 4 weeks. Serum AFP is 420 ng/mL (elevated), beta-hCG is 2 IU/L (normal), and LDH is normal. CT chest/abdomen/pelvis shows no metastasis. Orchidectomy specimen shows a pure yolk sac tumour. What stage and risk classification determines the next step in management?
A 55-year-old man with muscle-invasive bladder cancer (T2N0M0, urothelial carcinoma) is planned for radical cystectomy. Preoperative renal function shows GFR 52 mL/min. According to ASCO/NCCN guidelines, which statement best reflects current evidence-based perioperative management?
A 72-year-old man with a 35g benign prostate gland undergoes TURP under spinal anaesthesia. During the procedure lasting 90 minutes, he develops confusion, bradycardia, nausea, and hyponatraemia (serum Na 118 mEq/L). Visual disturbances are also noted. Which electrolyte/osmolality parameter best distinguishes TURP syndrome caused by glycine absorption from simple dilutional hyponatraemia?
A 68-year-old man with a PSA of 8.2 ng/mL and a prostate MRI showing a PI-RADS 4 lesion in the peripheral zone (apex) undergoes MRI-targeted biopsy. Histology reveals Gleason score 3+4=7 (Grade Group 2) in 2 of 3 targeted cores. According to EAU 2023 guidelines, the preferred management is:
A 35-year-old man presents with sudden onset left testicular pain and swelling. Ultrasound shows absent blood flow on Doppler. The testis is explored and found viable after detorsion at 4 hours. The Bell clapper deformity found bilaterally. The correct next step is:
A 72-year-old man undergoes radical cystectomy for muscle-invasive bladder cancer (pT3bN1M0). He receives cisplatin-based neoadjuvant chemotherapy (MVAC regimen). Pathology shows complete pathological response (pT0N0). According to CheckMate 274 trial, what adjuvant therapy has demonstrated improved disease-free survival in this setting?
A 55-year-old man with a 4.2 cm solid enhancing renal mass (cT1bN0M0) is evaluated for surgery. He has a solitary contralateral kidney with borderline function (eGFR 55). The preferred surgical approach according to EAU guidelines is:
A 70-year-old man is diagnosed with localised high-risk prostate cancer: PSA 22 ng/mL, Gleason score 4+4=8 (Grade Group 4), clinical stage T2cN0M0. He has no significant comorbidities. The current EAU/NCCN guideline-recommended management for high-risk localised prostate cancer is:
A 65-year-old patient with muscle-invasive bladder cancer (T2bN0M0, transitional cell carcinoma) is fit for surgery. The SWOG 8710 trial established which management paradigm for muscle-invasive bladder cancer?
A 4-year-old boy is brought by his parents with a painless left scrotal mass. Ultrasound shows a heterogeneous solid testicular mass. Serum AFP is markedly elevated at 8,500 ng/mL. His age-adjusted AFP must be considered because AFP is physiologically elevated in infants. The most likely diagnosis and correct initial management is:
A 45-year-old man presents with a 4 cm enhancing solid mass in the left kidney on CT. CT guided biopsy confirms clear cell renal cell carcinoma. Pre-operative workup shows a solitary kidney on the right. The left kidney GFR is 35 mL/min. What is the surgical preference in this scenario?
A 65-year-old man has PSA 12 ng/mL and multiparametric MRI (mpMRI) shows a PI-RADS 4 lesion in the right peripheral zone. Targeted MRI-fusion biopsy confirms Gleason score 4+3=7 (Grade Group 3) in 3 of 12 cores. His clinical T stage is T2c. According to the NCCN risk stratification, he is classified as:
In the management of a 4 mm ureteric calculus at the vesicoureteric junction (VUJ) in a 30-year-old with mild renal colic, medical expulsive therapy (MET) is initiated with an alpha-blocker. According to EAU guidelines, the stone most likely to pass spontaneously based on size and location is a stone:
A 25-year-old man presents with sudden onset scrotal pain and high-riding testis with absent cremasteric reflex. The clinical diagnosis is testicular torsion. Doppler US confirms absent intratesticular blood flow. What is the maximum ischemia time within which salvage rates remain >90%?
A patient with transitional cell carcinoma (TCC) of the bladder, T1G3 (high-grade) confirmed on TURBT, is planned for intravesical BCG immunotherapy. BCG induction course consists of:
A 68-year-old man is diagnosed with high-risk prostate cancer (Gleason 4+4=8, cT3a, PSA 22 ng/mL). He undergoes radical prostatectomy and final pathology shows pT3bN1 disease. According to RADICALS-HD and GETUG-AFU 22 trial data, what adjuvant treatment offers the best oncological outcomes?
A 55-year-old man presents with a 3 cm enhancing renal mass in the left kidney, staged cT1bN0M0. What approach is supported by the CARMENA trial regarding nephrectomy in metastatic disease, and what is the primary treatment for this localized lesion?
A 72-year-old man presents with painless total hematuria. Flexible cystoscopy reveals a 3 cm papillary lesion on the posterior wall. TURBT confirms high-grade pT1 urothelial carcinoma. What is the most appropriate next step per EAU guidelines?
A 25-year-old man presents with a painless right testicular mass. Serum AFP is 2,800 ng/mL, beta-hCG is 45 IU/L, and LDH is 1.8× ULN. CT reveals retroperitoneal lymphadenopathy up to 3 cm. After right radical orchiectomy, histology shows pure seminoma. How do you interpret the elevated AFP in this context?
A 68-year-old male with prostate cancer has PSA 22 ng/mL, Gleason score 4+4=8, and a bone scan showing 2 pelvic lymph node metastases but no bone metastases. He is ECOG 0. According to EAU/NCCN guidelines, what is the current standard of care?
A 30-year-old male presents with sudden-onset left scrotal pain and a 'bell-clapper' deformity on ultrasound showing absent intratesticular blood flow. He is 6 hours from symptom onset. What is the Delorme's rule for salvage and what is the recommended operative approach?
A 55-year-old male with a 6 cm upper pole renal cell carcinoma (clear cell) and no clinical nodal involvement is evaluated. His eGFR is 70 mL/min. What is the surgical approach of choice per AUA/EAU guidelines?
Which urinary diversion following radical cystectomy for muscle-invasive bladder cancer involves bringing both ureters to the skin as stomas (non-continent), and what is the major long-term metabolic complication of ileal conduit diversion?
A 68-year-old man is diagnosed with prostate cancer (Gleason score 4+4=8, PSA 15 ng/mL, clinical stage T2cN0M0). He receives radical radiotherapy combined with androgen deprivation therapy (ADT). The STAMPEDE and ENZAMET trials have established that for high-risk localised or metastatic hormone-sensitive prostate cancer, which treatment intensification strategy demonstrates the greatest overall survival benefit beyond standard ADT?
A 55-year-old man presents with haematuria. Cystoscopy reveals a 3 cm papillary lesion at the right lateral wall; TURBT confirms pT1G3 (high-grade) urothelial carcinoma with lamina propria invasion, no muscularis propria in the specimen. What is the most appropriate next step?
A 28-year-old man presents with a painless right testicular lump. Ultrasound confirms a 1.5 cm intratesticular heterogeneous mass. Tumour markers: AFP 850 ng/mL (elevated), beta-hCG 12 IU/L (mildly elevated), LDH normal. After right orchidectomy, histology shows 90% embryonal carcinoma, 10% teratoma — no yolk sac elements. Three weeks post-orchidectomy, AFP remains elevated at 500 ng/mL. Staging CT shows no retroperitoneal lymphadenopathy. What is the most appropriate next step?
A 70-year-old diabetic man presents with a 3-day history of swollen, erythematous, oedematous scrotum with foul-smelling discharge. CT shows scrotal gas with fascial plane extension to the perineum. Haemodynamically unstable. The LRINEC score concept is applied to risk-stratify suspected necrotising fasciitis. Which of the following C-reactive protein levels in isolation most reliably predicts necrotising fasciitis according to the LRINEC score?
A 65-year-old man with high-risk prostate cancer (PSA 28 ng/mL, Gleason 4+4=8, T3a on MRI) is to receive definitive radiotherapy. Which adjuvant/concurrent systemic therapy reduces prostate cancer-specific mortality most significantly?
Which classification system grades urothelial carcinoma of the bladder in terms of muscular invasion and is used to determine need for radical cystectomy?
A 32-year-old man presents with a 2-month history of a painless left testicular mass. AFP is 380 ng/mL, beta-hCG is normal, LDH is normal. CT shows retroperitoneal lymphadenopathy up to 2.8 cm. Post-orchidectomy histology shows pure yolk sac tumor (non-seminomatous GCT). How is this staged and what is the preferred treatment?
The RIFLE criteria and AKIN criteria for acute kidney injury stratification in a postoperative urology patient differ from the KDIGO 2012 definition. What serum creatinine rise within 48 hours defines AKI per KDIGO?
In radical prostatectomy, the nerve-sparing technique preserves which neurovascular bundle, and what functional outcome does this most critically influence?
A 70-year-old man with NMIBC (Ta, high-grade) recurs 3 months after BCG induction therapy. According to EAU guidelines, BCG-unresponsive disease is defined by which criterion, and what is the preferred next treatment?
Renal cell carcinoma invading the inferior vena cava (IVC) with supradiaphragmatic thrombus but no distant metastases (T3cN0M0) requires which surgical approach?
Regarding the management of testicular torsion, which statement correctly reflects the critical time-dependent salvage rates?
A 68-year-old man has a PSA of 18 ng/mL and Gleason grade group 4 prostate cancer (Gleason 4+4=8) confined to the prostate on MRI (cT2c). The ProtecT trial compared active surveillance, radical prostatectomy, and radical radiotherapy. Which oncological outcome was significantly different between treatments at 15 years?
Renal cell carcinoma staging: A patient has a 9 cm tumor in the left kidney with renal vein tumor thrombus extension but no inferior vena cava involvement and no nodal or distant metastases. What is the pTNM stage?
A 35-year-old man presents with a painless left testicular swelling. Ultrasound shows a heterogeneous intratesticular mass. Tumor markers: AFP 850 ng/mL, beta-hCG 12 IU/L, LDH elevated. After radical orchiectomy, histology shows mixed germ cell tumor (teratoma + embryonal carcinoma). CT shows para-aortic nodes measuring 2.5 cm. What is the IGCCCG risk classification?
In the management of ureteric calculi, which parameter best predicts the need for urological intervention (ureteroscopy or ESWL) over expectant management according to the EAU guidelines?
A 65-year-old man has a PSA of 12 ng/mL and a multiparametric MRI showing a PI-RADS 4 lesion in the left peripheral zone. Systematic plus targeted transperineal biopsy shows Gleason 4+3=7 (Grade Group 3) in 4/14 cores, all from the target lesion. Clinical stage is T2c N0 M0. He has a 15-year life expectancy. The recommended initial management is:
A 35-year-old man presents with a painless left testicular mass. Beta-hCG is 2400 mIU/mL and AFP is 180 ng/mL. CT shows no retroperitoneal lymphadenopathy and no pulmonary metastases. Orchidectomy confirms a mixed germ cell tumour (teratoma + embryonal carcinoma). Pathological stage is pT2 N0 M0 S2 (IGCCC intermediate risk). The recommended post-orchidectomy management is:
A 55-year-old man undergoes TURBT for a 3 cm papillary bladder tumour. Histology shows high-grade T1 urothelial carcinoma with lamina propria invasion but no muscularis propria in the specimen. What is the most appropriate next step?
A 70-year-old man with benign prostatic hyperplasia (IPSS 24, prostate volume 85 mL, Q-max 6 mL/s) is on tamsulosin but remains symptomatic. Surgical options are discussed. The procedure with the lowest risk of retrograde ejaculation compared to standard TURP is:
A 68-year-old man has a PSA of 12 ng/mL. MRI prostate shows a PIRADS 5 lesion in the left peripheral zone. Targeted biopsy confirms Gleason score 4+4=8 (Grade Group 4) prostate cancer. Bone scan and CT show no metastases. After discussion of options, he opts for radical prostatectomy (RP). Which nerve-sparing approach offers the best combination of oncological clearance and functional outcome for this high-risk localised disease?
A 72-year-old man with metastatic castration-resistant prostate cancer (mCRPC) progresses after docetaxel chemotherapy. Genomic testing reveals a pathogenic BRCA2 mutation. The MOST appropriate next-line therapy is:
A 25-year-old man presents with a painless scrotal swelling. Ultrasound shows a 3 cm heterogeneous intratesticular mass. Tumour markers: AFP 1200 IU/mL, beta-hCG 350 IU/mL, LDH 2× ULN. After radical orchidectomy, histology confirms mixed non-seminomatous germ cell tumour (NSGCT). CT staging shows retroperitoneal lymph nodes 2.5 cm, no distant metastases. Stage IIA, IGCCCG good risk. The standard treatment is:
A 45-year-old man presents with macroscopic haematuria. Cystoscopy reveals a 2 cm sessile lesion at the bladder trigone. TURBT histology confirms high-grade T1 urothelial carcinoma with carcinoma in situ (CIS). After re-TURBT confirms T1 high-grade with CIS, what is the MOST appropriate next definitive management?
A 58-year-old man presents with a 4.5 cm left renal mass on CT characterised by heterogeneous enhancement, areas of calcification, and fat. The renal vein is not involved and there are no distant metastases. What is the MOST appropriate management?
In urethral stricture disease, the Barbagli flap urethroplasty uses tissue from which donor site?
The PIVOT trial compared radical prostatectomy versus observation for clinically localised prostate cancer. After 20 years of follow-up (published 2022), the primary outcome showed:
A 62-year-old man presents with recurrent urinary tract infections and painless haematuria. Cystoscopy reveals a papillary lesion. Biopsy confirms high-grade non-muscle-invasive bladder cancer (HG-NMIBC), T1 stage. After TURBT and BCG induction (6 weekly instillations), he has persistent disease at 3-month cystoscopy. The most appropriate next step is:
Retroperitoneal lymph node dissection (RPLND) templates for right-sided testicular non-seminomatous germ cell tumour (NSGCT) include which primary landing zone?
Ureteroscopic management of a 12 mm upper ureteric stone is planned. The EAU guideline stone-free rate for ureteroscopy (URS) for proximal ureteric stones versus SWL (shock wave lithotripsy) shows:
A 65-year-old man is diagnosed with prostate cancer with a Gleason score of 4+4=8 (Grade Group 4), PSA 18 ng/mL, clinical stage cT2b, and no evidence of metastasis. According to D'Amico risk classification, what risk category is this, and what is the standard treatment recommendation?
A 28-year-old man presents with sudden-onset left testicular pain without preceding trauma. Examination reveals a high-riding, transversely oriented testicle. The cremasteric reflex is absent. What is the immediate management?
A 55-year-old man with muscle-invasive bladder cancer (T2N0M0, transitional cell carcinoma) is planned for radical cystectomy. According to current guidelines, what is the recommended neoadjuvant approach?
A 45-year-old man presents with left flank pain and hematuria. CT urography reveals a 3.5 cm left renal mass with enhancement characteristics suggesting renal cell carcinoma. There is no evidence of metastasis. According to Fuhrman grading, which grade is associated with the worst prognosis in RCC?
A 70-year-old man with metastatic castration-resistant prostate cancer (mCRPC) has progressed on abiraterone. He has no visceral metastases but has extensive bone disease. Which of the following agents targets bone metastases and has been shown to improve overall survival in mCRPC with bone metastases but no visceral metastases?
A 35-year-old man undergoes orchiectomy for a right testicular tumor. Histopathology shows a pure seminoma with tumor confined to the testis, no lymphovascular invasion, and all post-orchiectomy tumor markers normalise. CT staging shows no retroperitoneal lymphadenopathy. What is the preferred management for clinical stage I pure seminoma?
According to the D'Amico classification, a patient with PSA 7 ng/mL, Gleason score 3+4=7 (Grade Group 2), and clinical stage T2a prostate cancer falls into which risk category?
The Whitaker test is performed to differentiate obstructed from non-obstructed renal pelvis dilatation by:
Fournier's gangrene is a polymicrobial necrotizing fasciitis of the perineum and genitalia. The cornerstone of treatment in this condition is:
The Nuck canal is the embryological remnant in females that is analogous to the processus vaginalis in males, and the corresponding female equivalent of an indirect inguinal hernia containing ovary and fallopian tube is called:
Testicular torsion presenting within 6 hours of symptom onset is associated with testicular salvage rates of approximately:
A 70-year-old man with metastatic castration-resistant prostate cancer (mCRPC) progresses after docetaxel chemotherapy. His tumor is found to harbor a BRCA2 germline mutation. The most appropriate next-line targeted therapy is:
A 35-year-old man is found to have a right testicular mass on ultrasound. Tumor markers: AFP 2300 ng/mL, beta-hCG 15 mIU/mL, LDH 1.2× normal. CT chest shows three pulmonary nodules measuring 1.5 cm each. According to IGCCCG classification, this patient is in which prognostic group?
A 60-year-old man presents with gross hematuria. Cystoscopy shows a papillary bladder tumor. TURBT reveals high-grade T1 transitional cell carcinoma with lamina propria invasion, no muscularis propria in specimen. What is the most appropriate next management step?
A 45-year-old man with a 3 cm solid right renal mass on CT (homogeneous enhancement, no fat) undergoes percutaneous biopsy showing clear cell renal cell carcinoma. He is fit for surgery. The most appropriate surgical approach is:
The D'Amico risk classification for prostate cancer stratifies patients into low, intermediate, and high risk based on three parameters. A patient with PSA 12 ng/mL, Gleason score 7 (3+4), and clinical stage T2b is classified as:
In the staging of renal cell carcinoma, a tumour that extends through the renal capsule into the perirenal fat but remains confined within Gerota's fascia with no renal sinus invasion is classified as TNM stage:
A 28-year-old man presents with a right testicular mass. Tumour markers show: AFP 1800 ng/mL, beta-hCG 2000 IU/L, LDH 1.5× upper limit of normal. CECT reveals 4 retroperitoneal lymph nodes each <2 cm and no visceral metastases. According to IGCCC classification, his prognosis group is:
A 70-year-old man undergoes TURP for benign prostatic hyperplasia. Postoperatively he develops confusion, bradycardia, and hyponatraemia with serum sodium of 118 mEq/L. The irrigating fluid most likely responsible for this complication when used in monopolar TURP is:
A 65-year-old man presents with haematuria and a 5 cm renal mass on CT with radiological features of clear cell renal cell carcinoma. There is no evidence of venous involvement or distant metastasis. He has a solitary functioning kidney. The preferred nephron-sparing approach is:
The PIVOT trial evaluated radical prostatectomy versus active surveillance in men with localised prostate cancer. Its key finding regarding overall mortality was:
A 22-year-old man presents with a 2-day history of sudden onset severe left testicular pain and a high-riding, horizontal-lying testis with absent cremasteric reflex. Ultrasound is equivocal. The correct management is:
Which of the following best characterises the T3 stage of muscle-invasive bladder cancer according to the TNM classification?
The PIVOT trial (Prostate Intervention versus Observation Trial) compared radical prostatectomy versus active surveillance for localized prostate cancer. What was the KEY finding regarding overall mortality at 20-year follow-up?
A 70-year-old male presents with gross hematuria. Cystoscopy reveals a sessile, non-papillary bladder mass. Transurethral resection biopsy shows T2 disease (muscle-invasive bladder cancer). According to standard management, what is the most appropriate next step?
A 28-year-old male with a painless right testicular mass has AFP 850 IU/mL, beta-hCG 12 mIU/mL, and LDH 1.5× ULN. CT shows retroperitoneal lymph nodes up to 2.5 cm and no visceral metastases. According to IGCCCG classification, this is which prognostic group?
Regarding ureteroscopy for ureteric calculi, the JJ (double-J) stent placed before the procedure primarily serves which purpose?
A 68-year-old man with locally advanced prostate cancer (T3bN1M0, Gleason 9) is initiated on androgen deprivation therapy (ADT). The STAMPEDE trial informed combined treatment. What did the addition of docetaxel to ADT demonstrate in this trial?
Testicular torsion is a surgical emergency. Which statement regarding the Bell-Clapper deformity is most accurate?
A 55-year-old man with transitional cell carcinoma (TCC) of the bladder invading the muscularis propria (T2) undergoes radical cystectomy. Ileal conduit urinary diversion is fashioned. Which statement about intravesical BCG therapy is MOST accurate?
In renal cell carcinoma (RCC), the Fuhrman nuclear grade (now largely replaced by WHO/ISUP grading) correlates with prognosis. Which histological subtype of RCC carries the WORST prognosis?
A 65-year-old man has a PSA of 18 ng/mL and a Gleason score 8 (4+4) prostate adenocarcinoma on biopsy. PSMA PET-CT shows no distant metastases. He is clinically T2cN0M0. Which STAMPEDE trial–based approach best improves overall survival in this high-risk localized setting?
A 55-year-old man presents with a painless right testicular mass. Serum AFP is 12,000 ng/mL, beta-hCG is 800 mIU/mL, and LDH is 4x upper limit of normal. CT shows multiple bilateral pulmonary nodules (largest 3 cm) and retroperitoneal lymphadenopathy. Per IGCCCG (International Germ Cell Cancer Collaborative Group) classification, this is:
A 72-year-old man presents with painless haematuria. Cystoscopy reveals a 3 cm papillary bladder tumour. TURBT specimen shows high-grade urothelial carcinoma invading the muscularis propria (pT2). He has no distant metastases. The standard of care is:
A 45-year-old man presents with sudden-onset severe left loin pain radiating to the groin. CT KUB reveals a 5 mm calculus at the left vesico-ureteric junction (VUJ). Serum creatinine is normal. What is the most appropriate initial management?
During a radical nephrectomy for a right renal cell carcinoma with inferior vena cava (IVC) thrombus extension to just below the hepatic veins (Mayo Level II), which vessel must be controlled first before IVC clamping?
A 67-year-old man has a PSA of 12 ng/mL and a systematic biopsy shows Gleason 7 (3+4) in 3 of 12 cores. MRI of the prostate shows a PI-RADS 4 lesion in the peripheral zone. He is offered active surveillance vs. treatment. The Gleason grade group corresponding to Gleason 3+4=7 is:
A 58-year-old male presents with frank haematuria and on cystoscopy a 3 cm papillary tumour is found on the posterior bladder wall. CT urogram shows no upper tract disease. Transurethral resection of the bladder tumour (TURBT) histology reveals T1 high-grade urothelial carcinoma with detrusor muscle in the specimen and no lymphovascular invasion. The appropriate next step is:
In a child presenting with an acute painful scrotal swelling, the cremasteric reflex is absent, the testis lies high and horizontal (Brunzel sign), and Doppler shows absent flow to the affected testis. These findings are pathognomonic of:
A 35-year-old man is found to have a left renal mass measuring 2.8 cm on CT. The lesion is entirely exophytic, clearly separated from the collecting system, and has a RENAL nephrometry score of 4 (low complexity). His contralateral kidney is normal. The preferred management per EAU 2024 guidelines for this small renal mass is:
A 74-year-old man with International Prostate Symptom Score (IPSS) of 24 (severe LUTS), PSA of 2.8 ng/mL, and prostate volume of 80 mL on TRUS fails medical therapy with alpha-blocker and 5-alpha-reductase inhibitor combined for 12 months. He has no indications for absolute surgery. The minimally invasive surgical option with the best evidence for volume reduction in large prostates (> 80 mL) is:
A 60-year-old man undergoes radical cystectomy for muscle-invasive bladder cancer (MIBC). The pathology shows pT3b N1 M0 urothelial carcinoma. The urinary diversion created involves an ileal segment anastomosed to the urethra allowing voluntary voiding. This diversion is called:
A 70-year-old man with metastatic castration-resistant prostate cancer (mCRPC) progresses on enzalutamide. Tumour genomic profiling reveals BRCA2 biallelic loss-of-function mutation. Which treatment is most appropriate next?
A 35-year-old male presents with a painless right testicular mass. Tumour markers show: AFP 1200 ng/mL (N <10), beta-hCG 3 IU/L (N <5), LDH 2x upper limit of normal. CT shows no retroperitoneal nodes and no visceral metastases. According to IGCCCG risk classification, which prognostic group does this patient belong to?
A 65-year-old man with T2 muscle-invasive bladder cancer (MIBC) is considered for radical cystectomy. Neoadjuvant chemotherapy with cisplatin-based regimen (MVAC or gemcitabine-cisplatin) is offered. The absolute survival benefit of neoadjuvant chemotherapy in MIBC is approximately:
A 28-year-old man presents with acute onset severe left testicular pain and a high-riding transversely lying testis. There is absence of cremasteric reflex on the left side. What is the most important first action?
Posterior urethral valves (PUV) in a male neonate produce bladder outlet obstruction. Which antenatal ultrasound finding most specifically suggests this diagnosis?
In localised prostate cancer management, the ProtecT trial compared active monitoring, radical prostatectomy, and radiotherapy. The primary finding at 10 years regarding prostate cancer-specific mortality was:
A 35-year-old man presents with a painless, firm testicular swelling. Ultrasound confirms an intratesticular mass. Serum AFP is 1400 IU/mL and beta-hCG is 3 IU/L. Post-orchidectomy histology shows non-seminomatous germ cell tumour (NSGCT). AFP level one week later is 700 IU/mL. What does this AFP trend suggest?
The PIVOTAL trial established the non-inferiority of narrow-margin bipolar TURP compared to standard monopolar TURP. Bipolar TURP uses isotonic saline as irrigant primarily to avoid:
Wilms' tumour (nephroblastoma) in children is staged by the COG (Children's Oncology Group) staging system. A Wilms' tumour involving both kidneys is classified as:
In the assessment of a patient with renal cell carcinoma (RCC), the Fuhrman nuclear grading system has been largely replaced by which classification endorsed by the International Society of Urological Pathology (ISUP)?
A 55-year-old male with recurrent urinary tract infections and haematuria undergoes flexible cystoscopy showing a 2 cm papillary bladder tumour. TURBT histology reveals high-grade Ta urothelial carcinoma with no lamina propria invasion. Adjuvant intravesical therapy of choice is:
The STAMPEDE trial evaluated docetaxel added to long-term androgen deprivation therapy (ADT) for newly diagnosed hormone-sensitive metastatic prostate cancer (mHSPC). The landmark finding was:
The PIVOT trial compared radical prostatectomy to active observation in localized prostate cancer. Its primary finding after 20 years of follow-up was:
Which finding on staging imaging most accurately defines T3b stage in renal cell carcinoma according to TNM 8th edition?
In testicular germ cell tumors, the International Germ Cell Cancer Collaborative Group (IGCCCG) classification defines 'good prognosis' non-seminoma based on all EXCEPT:
In the evaluation of microscopic hematuria, which feature according to AUA guidelines most strongly warrants immediate cystoscopy rather than deferral for repeat urinalysis?
Wilms' tumor (nephroblastoma) staging according to the Children's Oncology Group (COG) defines Stage III disease based on which criterion?
The EAU (European Association of Urology) guidelines classify non-muscle-invasive bladder cancer (NMIBC) into risk groups. Which feature most strongly indicates high-risk NMIBC requiring BCG maintenance therapy?
Posterior urethral valves (PUV) are the most common cause of severe obstructive uropathy in male neonates. The Young-Dees classification (Types I–III) recognizes which type as the most common?
The ProtecT trial compared active monitoring, radical prostatectomy, and radiotherapy for localised prostate cancer. The primary outcome at 15-year follow-up regarding prostate cancer mortality was:
A 70-year-old man with a 4 cm enhancing renal mass (cT1b) and solitary functioning kidney is being evaluated for treatment. Which nephron-sparing approach is preferred over radical nephrectomy?
The International Germ Cell Cancer Collaborative Group (IGCCCG) classifies testicular germ cell tumours into good, intermediate, and poor prognosis based on markers and metastatic sites. Which marker level defines 'poor prognosis' for non-seminomatous GCTs?
In the Whitaker test for upper urinary tract obstruction, which perfusion pressure above baseline is considered diagnostic of obstruction?
A 68-year-old man with bladder cancer undergoes TURBT; pathology shows T2 high-grade urothelial carcinoma. After neoadjuvant cisplatin-based chemotherapy, which surgical procedure is the gold standard?
In muscle-invasive bladder cancer (MIBC, T2–T4a N0M0), the SWOG 8710 trial established which treatment as the standard of care over radical cystectomy alone?
A 68-year-old man has a PSA of 12 ng/mL with a Gleason score 4+3=7 (Grade Group 3) prostate cancer in 4 of 12 cores. The lesion is organ-confined on MRI. According to the EAU risk stratification, this is classified as which risk group and what treatment is preferred?
In the management of a Stage I (T1–T2 N0M0) non-seminomatous germ cell tumour (NSGCT) of the testis after radical orchidectomy, which parameter on histology defines a 'high-risk' Stage I NSGCT that may benefit from one cycle of adjuvant BEP chemotherapy?
The classification of fournier gangrene severity uses the Fournier's Gangrene Severity Index (FGSI). Mortality in Fournier's gangrene is most independently predicted by which clinical factor?
A 68-year-old man with newly diagnosed prostate cancer has PSA 18 ng/mL, Gleason score 4+3=7 (Grade Group 3), and clinical stage T2b. He has no metastases on bone scan. According to the D'Amico risk stratification, which category does he belong to?
A 68-year-old man with newly diagnosed prostate cancer has PSA 22 ng/mL, Gleason score 4+4=8, and clinical stage T2c. According to the D'Amico risk stratification, which category does he belong to?
A 25-year-old man presents with sudden onset severe right scrotal pain for 4 hours, with a high-riding testis and absent cremasteric reflex. Doppler ultrasound is being arranged. What is the MOST critical next step?
A 58-year-old man presents with painless total haematuria. Cystoscopy reveals a papillary tumour at the right lateral wall. TURBT shows pT1 high-grade urothelial carcinoma with no muscularis propria invasion. What is the MOST appropriate next management step?
A 55-year-old man presents with a non-tender, hard testicular mass. Serum AFP is 850 ng/mL, beta-hCG is 10 IU/L, and LDH is elevated. CT abdomen/pelvis shows retroperitoneal lymph nodes 3 cm. Which is the MOST likely histology and appropriate staging?
A 65-year-old man presents with lower urinary tract symptoms and AUA/IPSS score of 22. Flow rate is 8 mL/s and post-void residual is 250 mL. Medical therapy with alpha-blockers and 5-alpha reductase inhibitors failed. Which surgical option has the BEST evidence for long-term outcomes in BPH?
A 55-year-old man with a 10 cm right renal mass undergoes radical nephrectomy. Pathology reveals renal angiomyolipoma (AML) with epithelioid features and perivascular epithelioid cell (PEComa) characteristics. This variant is associated with which genetic syndrome?
A 40-year-old woman presents with recurrent urinary tract infections and CT scan shows a horseshoe kidney with a 1.2 cm lower pole calculus. For stone fragmentation in a horseshoe kidney, which modality is least effective due to impaired drainage?
A 70-year-old man has a PSA of 18 ng/mL. Systematic and targeted MRI-guided biopsy (TRUS/MRI fusion) shows Gleason Grade Group 4 (Gleason 4+4=8) prostate cancer in 6/12 cores, clinical stage T2cN0M0. He is fit for curative treatment. Which treatment option offers equivalent oncological outcomes to radical prostatectomy?
A 40-year-old man presents with a painless, firm, non-translucent right testicular mass. AFP is 450 ng/mL, beta-hCG is 1200 mIU/mL, and LDH is 350 U/L. CT staging shows retroperitoneal lymph nodes up to 2.5 cm; no visceral metastases. What is the appropriate initial surgical management?
The TNM staging for renal cell carcinoma — a T3b tumour is defined as:
Which classification system grades the severity of hypospadias based on the location of the urethral meatus?
The TNM 2017 staging for renal cell carcinoma classifies a tumour with direct invasion of the ipsilateral adrenal gland (contiguous extension, not by haematogenous spread) as:
A 70-year-old man has a PSA of 8.2 ng/mL. TRUS-guided 12-core biopsy reveals Gleason 3+4=7 (Grade Group 2) in 4/12 cores, maximum 35% core involvement, bilateral. Clinical stage T2b. Which active surveillance criteria does this patient FAIL to meet?
In renal transplantation, the most common cause of early graft dysfunction within the first week is:
In nephrolithiasis, the Hounsfield unit (HU) density threshold on non-contrast CT that distinguishes uric acid stones (potentially amenable to alkalinisation therapy) from calcium oxalate stones is:
A 22-year-old man presents with acute-onset left testicular pain for 4 hours. On examination there is a high-riding left testis with a horizontal lie. Cremasteric reflex is absent. What is the diagnosis and the maximum ischaemia-free window for surgical intervention?
A 65-year-old man with benign prostatic hyperplasia has a postvoid residual of 350 mL, bilateral hydronephrosis, and a creatinine of 2.8 mg/dL. He reports two episodes of urinary retention treated with catheterisation. Which is the most appropriate definitive management?
A 20-year-old male presents with sudden severe left testicular pain for 4 hours. Ultrasound Doppler shows absent blood flow to the left testis. What is the standard surgical procedure and the critical time window for testicular salvage?

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