Chapter 7

General Urology Question and Answer Items

Do hydroceles require treatment? Generally, no

(unless they become very large)

Which scrotal masses Hydroceles

transilluminate?
&
Spermatoceles

What is a spermatocele? A uid collection in the outbound ducts

of the scrotum

How can you identify a spermatocele? 1. Transilluminates

2. Doesnt change with Valsalva
(varicocele would)
(hernia would)
3. Mass is behind & above testis

If something on the scrotal exam is A varicocele

described as being like a bag of (dilated, tortuous veins)
worms, what is the mass?

What is a varicocele? Dilated veins in the scrotum

(usually left sided)

Which veins are dilated in The pampiniform plexus

varicoceles? (of the scrotum)

Springer Science+Business Media New York 2016 153

C.M. Houser, Pediatric Tricky Topics, Volume 2,
DOI 10.1007/978-1-4939-3109-5_7
154 7 General Urology Question and Answer Items

How do you identify a varicocele? Usually left sided

Bag of worms consistency
Increased size with Valsalva
Decreases when lying down

Does a varicocele require treatment? If the testis becomes hypotrophic

or if sperm count decreases
Yes
(otherwise, no)

Is treatment needed for No

spermatoceles?

Do spermatoceles affect fertility? No

What is a hematocele? Blood in the scrotal sac due to trauma

Do hematoceles require treatment, If they become very large, then yes

and if so, what is it? Surgical drainage

How are hematocele symptoms Pain meds

treated? Ice packs
Scrotal elevation/bed rest

If a testicular neoplasm develops, Painless

is it usually painful or painless?

Why might a testicular tumor patient Retroperitoneal LAD (associated

present with back pain? with tumor)

What percentage of testicular 95 %

tumors develops from germ cells,
as opposed to structural (stromal)
tissue of the testis?

If infection affects the testis itself, Orchitis

what is it called?

If a testis atrophies following Testicular cancer

orchitis, what pathology is the
patient at increased risk to develop?
7 General Urology Question and Answer Items 155

Infertility following orchitis is usually Bilateral atrophy

accompanied by what physical exam
nding?

If mumps produces orchitis, Supportive only

what is the treatment?

What are the most common 1. C. trachomatis (most common)

causal organisms for epididymitis 2. N. gonorrhoeae
in an adolescent male?
(E. coli & pseudomonas are also
occasional culprits)

How are the Doppler flow studies Infection increased flow & perfusion
or radionucleotide scans different Torsion decreased flow & perfusion
for epididymitis/orchitis vs.
testicular torsion?

Which two radiological modalities US and MRI

are most preferred for evaluation
of the scrotal area?

Is torsion of the spermatic cord Yes

the same thing as torsion testis?

In a newborn male, how long should 34 cm

the penis be?

At what penile length would 2.5 cm

an endocrine work-up denitely
be indicated?

Should the scrotum have rugae Yes

at the time of a full-term birth?

If one testicle has not descended, how Less rugae

will the scrotal ndings at birth be
&
different from usual?
Empty scrotal sac
(on one side)

Chordee, or a ventral curving penis, Hypospadias

usually accompanies what minor
(although chordee often occurs without
penile malformation?
hypospadias)
156 7 General Urology Question and Answer Items

What usually is the course Slowly resolves spontaneously

for hydroceles present at birth?

True or false. The foreskin should False

be retracted on newborns to permit It is often adherent & will be damaged
proper cleansing? by retraction

At what age is it alright to fully Three years old

retract a foreskin?

If genitalia are ambiguous, Genetics

and the newborn is otherwise doing Figure that out rst
well, what is the rst consultation/ Then sort out the endocrine and
testing type you should pursue? developmental issues

What is epispadias? The meatal opening is on the top midline

of the penis
(vs. hypospadias, on the bottom)

Is torsion of the testicular Yes

appendage painful?

Is torsion of the testicular No

appendage a surgical emergency? No treatment needed other than pain
control

What is manual detorsion of a testis? A usually unsuccessful attempt to correct

torsion non-operatively

If one testis is documented to be Increased probability of torsion means

in torsion, why would surgery be both should be surgically fixed if one
recommended for both testes? torses

How does testicular torsion Unilateral groin pain/abdominal pain

present? with swelling of the affected testis
+/ nausea/vomiting

What rather unreliable sign of Loss of cremasteric reex

testicular torsion is often mentioned (testis doesnt move up when thigh is
on board exams? stroked)

Generally, the pain of testicular Sometimes the testis spontaneously

torsion should be sudden onset and detorses, and then torses again, creating
constant. Why could it also present as intermittent pain
intermittent pain?
7 General Urology Question and Answer Items 157

Is a torsed testicle tender Yes

to palpation?

How is torsion of the appendix testis Supportive care

managed? Pain meds & anti-inammatories

Where is the appendix of the testis? Upper pole

(It is about the size of a pea)

What will a radionuclide scan, Normal or sometimes increased

or Doppler flow study, show if the uptake/flow
problem is torsion of the appendix (due to the inammation)
testis?

What does blue dot sign refer When the testicular appendage torses
to in urology? You see a sharply defined blue area
through the skin (small)

What is the most common cause Torsion of the appendix testis

of testicular pain in boys 211 years
(rare in older age groups)
old?

What is Prehns sign? Decreased testicular pain with elevation

of the testes

Pain that decreases with testicular Epididymitis

elevation suggests what diagnosis?

Will the cremasteric reflex Present

be present or absent for patients
with epididymitis?

What is the typical age group <30 years

for testicular torsion?

What is the special term for the Bell clapper deformity

anatomical variation that leads
to testicular torsion?

What is the most common cause Testicular torsion

of testicular pain in boys
1218 years old?
158 7 General Urology Question and Answer Items

If a patient with testicular torsion No change

elevates a testicle what happen
Or
to his pain?
Worsening pain

Mumps orchitis can cause sterility, It is frequently unilateral

but usually does not. Why not?

What is the average age range for 2040 years

development of testicular cancer?

How is testicular torsion treated? Emergency surgical xation of both

testes

What is the usual source STDs

of epididymitis in men less than Ceftriaxone & doxycycline
50 years old, and how is it treated? or azithromycin

Which testicular tumors may cause Leydig cell tumors

precocious puberty in males, They secrete androgens
and why?

What is the most common type Seminoma

of testicular tumor? (a type of germ cell tumor)

What are the mainstays of treatment 1 Orchiectomy

for testicular cancer? 2 Radiation
(2)

What four findings suggest urethral 1. Boggy or high-riding prostate

injury? (depending on age)
2. Blood at the meatus
3. Severe pelvic fracture
4. Scrotal or perineal ecchymosis

If one of the four signs of urethral No Foley!

injury is present, what must you not A retrograde cystourethrogram
do until further diagnostics are
completed, and what is the additional
diagnostic needed?
7 General Urology Question and Answer Items 159

What is the difference between Incarcerated hernias are stuck,

an incarcerated hernia and but still have blood supply
a strangulated hernia? Strangulated bowel is stuck and
blood supply is compromised

Does replacing a cryptorchid No

testicle in the scrotum change
(. . . and the higher it was, the greater
the probability of later testicular
the chance of cancer developing . . .)
cancer?

When are undescended testes At about 12 months

typically surgically moved
to the scrotum?

What are the main risks of leaving 1. Malignancy

cryptorchid testes in place? 2. Infertility
(3) 3. Torsion

Which is preferred for cryptorchid Surgical relocation

testes, hormonal treatment or surgical
(hormones do stimulate testicular
relocation?
movement, but the success rate
is not great)

What is the other name for a struvite Magnesium ammonium phosphate stone
renal stone?

What causes a struvite stone? Ammonia-producing bacteria

(classically proteus)

Struvite stones have a characteristic Stag horns

appearance. What is it? (They ll the renal pelvices, so they look
like antlers)

About 85 % of kidney stones can be Uric acid stones

seen on x-ray. Which ones cannot?
(general type)

How are kidney stones usually <6 mm will pass on their own
treated?
Give fluids
Pain control
Strainer to see what kind it was
160 7 General Urology Question and Answer Items

What is special about uric acid stones? 1. Usually not seen on X-ray
(2) 2. May dissolve in alkaline urine!

If a stone will not pass, Surgically

how can it be removed? (endoscopically, if possible)
Or
Lithotripsy

How are kidney stones confirmed? Renal ultrasound

Or
CT stone protocol

Most renal stones are made Calcium

of _______? (75 %)

Although most calcium stones Malignancy

happen to otherwise healthy people, Hyperparathyroidism
what conditions put the patient Small bowel bypass
at increased risk?
(3)

What conditions increase Gout

the patients chance of developing Leukemia
uric acid stones?
(at time of treatment)
(2 groups)

Will a CT of the kidney show No

you whether a kidney stone Symptomatic stones are not in the
is causing your patients pain? kidney,
they are in the ureter, or at the UPJ
(ureteropelvic junction)

If a patient is found to have renal Usually nothing

stones while he or she is being Stones in the kidney are asymptomatic &
evaluated for something else, dont ordinarily cause problems
what should you do?

In otherwise healthy people, what 1. Dehydration

puts you at risk for kidney stones? 2. Personal or family history of stones
(2)
7 General Urology Question and Answer Items 161

Should renal colic (kidney stone) Usually not

patients be admitted? Give uids
Pain control
Antiemetics if needed
(Strainer to go home with)

If a stone does not pass while Yes

the patient is in the emergency If s/he can tolerate PO, can go home
department, can the patient still with pain meds
go home?

Which renal stone patients must be 1. Pyelonephritis with stone

admitted? 2. Uncontrollable pain
3. Uncontrollable vomiting
4. Single kidney
(& sometimes hydronephrosis)

How long will it take a ureteral About 2 weeks!

obstruction to damage the kidney
if it causes hydronephrosis?

Which mumps complication affects Orchitis

the GU system? Can cause sterility
(but usually doesnt because it is
typically unilateral)

Which patients develop acute 1. Benign prostatic hypertrophy

urinary retention? (not usually seen in kids!)
(2) 2. Post-op or instrumented patients with
clots

Why is it important to check They will receive a Foley

for urethral injury in a trauma Its contraindicated if the urethra is
patient? injured!

If urethral injury is suspected, Retrograde cystourethrogram

how do you evaluate it?
(Put dye into the urethra, then check on
X-ray to see whether it extravasates)

How are urethral disruptions Sometimes surgically, Sometimes

(traumatic injuries) treated? urology can place a tube to align the two
parts, & let them heal
162 7 General Urology Question and Answer Items

Why are varicoceles important? They sometimes cause pain or infertility

How is a varicocele different Hydroceles transilluminate

clinically from a hydrocele? Varicoceles disappear if the patient
lies down

How are varicoceles treated? They are surgically resected

(if symptomatic)

What treatment is needed Usually none

for hydroceles?

What is a hydrocele? A collection of peritoneal uid

in the scrotum

What is peritoneal uid doing It travels there through a slightly open

in the scrotum? processus vaginalis
(processus vaginalis the connective
tissue sheath the testes migrate through
to get to the scrotum)

What is hypospadias? Urethral meatus is on the bottom

(ventral side) of the penis

What critical item must you No circumcision

remember at the birth of a child The foreskin may be needed
with hypospadias? for correction

Is circumcision medically No
indicated? Unless the child has hydronephrosis/
reflux
(due to increased risk of UTIs in this
population)

Are UTIs more common in Yes

uncircumcised males? But still uncommon

What is phimosis? When the foreskin is too tight on the

glans to retract
(for whatever reason not necessarily
a problem)
7 General Urology Question and Answer Items 163

What is paraphimosis? When the foreskin is retracted behind

the coronal sulcus, and gets stuck!

What is the usual management for Manual reduction if possible

either phimosis or paraphimosis? Surgery often necessary (also to
prevent recurrence)

Why do posterior urethral valves In females, the structure becomes

only form in males? the hymen (so it is not incorporated
into the bladder at all!)

Currently, when are most patients Before birth (via ultrasound)

with posterior urethral valves
diagnosed?

If a patient is known to have Relief of the obstruction

a posterior urethral valve, The valve must be removed as soon as
what is the rst & most important possible, usually in the rst few days
treatment goal? after birth

After clearance of a posterior urethral VCUG

valve, which study should be done
Or
to conrm that the valve is gone
& the urethra appropriately healed? Cystoscopy
(2)
(typically 13 months after the initial
procedure)

If the valve (PUV) is removed Because the valve forms early in

shortly after birth, why do these embryological/fetal development, so
patients often continue to have increased pressure in the upper tract
renal & GU difculties? (bladder & kidneys) was present during
development & has already had an effect

In addition to renal changes occurring Elevated bladder pressures

during development due to PUV, what
&
other factors often contribute to
decreased kidney function? Recurrent UTIs

If a PUV patient develops symptoms Urethral stricture

of urinary outlet obstruction, what (at or near the site of valve)
complication should you especially
consider?
164 7 General Urology Question and Answer Items

How commonly do PUV patients About 1/3

develop actual renal failure (end-stage
renal disease)?

How common is diurnal enuresis About 1/3

in older (>5 years old) children Usually related to elevated bladder
with PUV? storage pressure & poor emptying

What are the typical treatment Anticholinergic medication

options for enuresis in the older Intermittent catheterization
PUV patient? Bladder augmentation (usually
(3) with other tissues)

How long is follow-up needed Lifelong

for a patient who has had PUV
as an infant?

How common is vesicoureteral Common

reux in patients with PUV? Present in up to 1/3 of patients
(but thought to be due to abnormally
high pressure, rather than an abnormal
ureter insertion location)

What is vesicoureteral reux A variation of PUV with vesicoureteral

dysplasia (VURD) syndrome? reux mainly on one side, producing one
hydronephrotic & nonfunctional kidney

Is VURD syndrome a good thing No

in a PUV patient? Their risk of renal failure is the same
as in PUV patients without VURD
(Note: This is a change VURD
syndrome was previously thought to be
helpful, by allowing a sort of pop-off
for the high pressures in the system to the
dysfunctional kidney. Recent data has not
shown this to be true)

While PUV is not kind to the renal Pulmonary problems

system, what is the more immediate Poor pulmonary development due
threat to survival of the infant with to oligohydramnios
PUV? (from the urinary outow obstruction)
7 General Urology Question and Answer Items
Which patients should automatically
be evaluated for possible PUV
shortly after birth?
How is the evaluation for PUV
generally done?
Some PUV patients are not detected
before or near the time of birth.
For these late presentations, what
symptoms are common?
Which ndings are suggestive of
PUV, and which are denitive?
If a patient with PUV has completed
urodynamic studies early in
childhood, and symptoms have not
changed, is it necessary to repeat the
studies later?
What are the consequences of the
brotic & noncompliant bladder that
can develop in PUV patients?
(4)
During cystoscopy for correction of a
PUV, what two complications
involving the urethra are of special
concern?
How common is it for a second valve
incision to be needed, after an
apparently successful rst one?
165
Males with evidence of hydronephrosis
on prenatal ultrasound
VCUG
UTI
Diurnal enuresis (also secondary)
older than 5 years
Voiding difculties, pain, or abnormal
urinary stream
Suggestive:
Thickened or trabeculated bladder
Dilated or elongated urethra
Yes
Bladder compliance sometimes
deteriorates over time
Increased risk for:
Urinary incontinence
Recurrent UTIs
Hydroureteronephrosis &
Renal function deterioration
(The bladder changes of significant
noncompliance & fibrosis are sometimes
known as valve bladder)
Urethral stricture
(possibly due to trauma during the
procedure)
&
Urethral sphincter injury
Common about 1/3
(this is why a follow-up cystoscopy is
often recommended as a routine measure
13 months after the initial procedure)