Q Most common testicular tumor in infants
a) Embryonal cell carcinoma
b) Seminoma
c) Yolk sac tumor
d) Choriocarcinoma

Answer
c

Yolk sac tumor is the commonest on infants. Seminoma occurs in young adults. Embryonal cell carcinoma occurs in the mixed form at an average age of 31.Pure  embryonal cell carcinoma occur in only 10% cases.  Choriocarcinoma also commonly affects young men.

Renal Stones/ renal colic

Q The best modality for treating lower pole renal calculus 1.5 cm in size is

a) ESWL (Extra Corporeal Shock Wave Lithotripsy ( ESWL)
b) Percutaneous  Nephrolithotomy ( PCNL)
c) Pyelolithotomy
d) Neohrolithotomy







Answer
b

Stone location as well as size is known to have an important bearing on choosing the modality for treatment of renal calculi. ESWL is not so successful in clearing lower pole calculi because of limited clearance of fragments from the dependent lower pole of kidney.
European association of Urological guidelines for stones recommend PCNL for stones more than 2 cm anywhere and more than 1.5 cm in lower pole calyces.

Pear Shaped Urinary Bladder

Question
All are causes of "pear shaped"  Urinary Bladder except
a.Pelvic lipomatosis
b. Pelvic fibrosis
c) Iliopsoas hypertrophy
d) Retroperitoneal fibrosis

Answer
d) Pear Shaped urinary bladder is also known as tear drop urinary bladder. It is a condition in which the normal oval structure of UB is compressed and it resembles a pear. Any collection in pelvis or around UB can lead to this. Retroperitoneal fibrosis is far away to cause any changes in the bladder wall

Link to Detailed Reference

Retroperitoneal fibrosis

1. Causes of Retroperitoneal Fibrosis

a) Idiopathic in 2/3rd of cases

b) Use of drugs-- Methysergide, Ergot derivatives

c) Retroperitoneal hemorrhage, Urinary Extravasation

d) Trauma

e) Inflamatory bowel disease, Collagen disease

2. Symptoms

a) Pain with girdle like distribution, Pain relieved by NSAIDs and not narcotics

b) Uremia occurs late

Benign Enlargement Prostate

1.Most Common Cause of Lower Urinary tract symptoms- BEP

2. Tamsulosin works on alpha1 receptor

3. Newer Modalities like Microwave resection should not be used if prostate size is more than 100g

4. Rule out B/L Hydronephrosis if a person with BEP (Benign Enlargement of Prostate ) develops increased levels of serum creatinine

5. Methods to stop unidentified bleeding during TURP ( Transuretheral Resection of Prostate)

a) Check the other side of prostate capsule

b) Check Bladder neck

c) Fill the bladder

Urinary Diversion

Most common electrolyte abnormality seen when the following conduits are used

1. Stomach- Hypochloremic metabolic alkalosis. This is secondary to the HCl secretion by                            the stomach segment, involving the H+/K+ ATPase secretory mechanism of the                                  gastric mucosa.

2. Jejunum- Hyponatremic, hypochloremic, hyperkalemic metabolic acidosis. Also                           known as “jejunal conduit syndrome.” This syndrome can be quite debilitating,                                 resulting in nausea, anorexia, lethargy, fever, and even death. The jejunum should                           be used only when there are no other acceptable segments available for use.

3. Ileum- Hyperchloremic metabolic acidosis. This is caused by the substitution of                              ammonium for sodium in the Na/H transport. Therefore, ammonium chloride is                              absorbed into the bloodstream in exchange for carbonic acid (CO2 and H2O).

Injury to Ureters

Q) Management of ureteral injury at the time of Left Colectomy

A) Mobilization of the two ends of the ureter and anastomoses of the spatulated ends over a stent

Q) Which portion of the ureter is at chance of injury during hysterectomy

A) At the level of broad ligament where ureter passes under the uterine vascular pedicle in relation to the cervix

Q) What are the contraindications of using ileum as a ureteic implant

A) Impaired renal function (Creatinine more than 2mg%)

      Bladder outlet obstruction

    Impaired emptying of bladder