Urology

Dr. Bou Sopheab

1. What is the definition of Hydrocele?

a. A hydrocele (Br English: hydrocoele) denotes a pathological accumulation of serous fluid in

a body cavity.
b. A hydrocele testis is the accumulation of fluids around a testicle, and is fairly common. It is
often caused by fluid secreted from a remnant piece of peritoneum wrapped around the
testicle, called the tunica vaginalis. Provided there is no hernia present, hydrocoeles below the
age of 1 year usually resolve spontaneously. Primary hydrocoeles may develop in adulthood,
particularly in the elderly, particularly common in hot countries, by slow accumulation of
serous fluid, presumably caused by impaired reabsorption, which appears to be the
explanation for most primary hydroceles although the reason remains obscure. A hydrocele
can also be the result of a plugged inguinal lymphatic system caused by repeated,
chronic infection of Wuchereria bancrofti or Brugia malayi, two mosquito-
borne parasites of Africa and Southeast Asia, respectively. As such, the condition would be a
part of more diffuse sequelae commonly referred to as elephantiasis, which also affects the
lymphatic system in other parts of the body.

2. What is the definition of Varicocele?

a. A varicocele is an abnormal enlargement of the pampiniform venous plexus in the scrotum.
This plexus of veins drains the testicles. The testicular blood vessels originate in the abdomen
and course down through the inguinal canal as part of the spermatic cord on their way to
the testis. Upward flow of blood in the veins is ensured by small one-way valves that prevent
backflow. Defective valves, or compression of the vein by a nearby structure, can cause
dilatation of the testicular veins near the testis, leading to the formation of a varicocele.
Varicocele is known as one of the main causes for male infertility and can be treated by a
surgery or non-surgical treatments.
3. Mention the 3 different varicocele grade by physical examination?
a. Large varicoceles can be seen as a “bag of worms” under the scrotal skin.
b. Medium varicocels are readily detected by palpation, esp on standing.

1
 c. Small varicoceles can only be identified by feeling an impulse in the scrotum with
the Valsava maneuver or a difference in the size and fullness of the spermatic
cord when the pt moves from the standing to the supine position.

4. What is the definition of uretero vesical reflux?

a. Vesicoureteral reflux (VUR) occurs when urine passes backward from the bladder
to the ureters or kidneys.
5. What are the 5 grade of UVR classification based on voiding cysto-ureterography?
a. Grade I: reflux into ureter
b. Grade II: reflux into renal pelvis without dilation of calyces
c. Grade III: blunting of calyces, mild dilation of ureter
d. Grade IV: grossly dilated ureter, moderate calyceal dilation with maintained
papillary impressions
e. Grade V: grossly dilated ureter with loss of papillary impressions
6. What are the benefits of intra venous urography (IUV)?
a. Imaging of the urinary tract with IVP is a minimally invasive procedure.
b. IVP images provide valuable, detailed information to assist physicians in
diagnosing and treating urinary tract conditions from kidney stones to cancer.
c. An IVP can often provide enough information about kidney stones and urinary
tract obstructions to direct treatment with medication and avoid more invasive
surgical procedures.
d. No radiation remains in a patient's body after an x-ray examination.
e. X-rays usually have no side effects in the typical diagnostic range for this exam.
7. What is the weiger-meyer rule? Choose the correct answer in these following statement:
a. Upper role ureters insert inferomedially & lower pole ureters insert
superolaterally on the trigone
b. Upper pole ureters insert superolaterally & lower pole ureters insert
inferomedially on the trigone
c. Lower pole ureters insert inferolaterally & upper pole ureters insert
superomedially on the trigone
2
8. What are the complication of ureterocele?
a. Pyelonephritis, leading to renal scarring and renal failure or urosepsis
b. Vesicoureteral reflux, ipsilateral and contralateral
c. Bladder outlet obstruction, duo to prolapsigng ureterocele
d. Infarction of prolapsed ureterocele (rare)
e. Hemorrhage and bleeding of ureterocele (rare)
9. Choose the true or false answers in these following statement?
a. A duplex (duplicated) system refers to a kidney with two pelvicalyceal systems
generally referred to as the upper or lower poles.
b. If the kidney has 2 ureters that empty separately into the bladder (double ureter),
it is considered a complete duplication.
c. A partial or incomplete duplication is a common single ureter enter the bladder.
d. A bifidi system is a form of duplication with 2 pelvivicalyceal systems joining at
the ureteropelvic junction (bifid pelvis) or before emptying into the bladder
e. An ectopic ureter drains to an abnormal site & generally refers to an orifice
located medialy or caudally
10. What are the goals of surgical therapy in bringing the chryptochordism into the scrotum?
a. Goals in bringing the testis into the scrotum:
b. Prevent ongoing thermal damage to the testis.
c. Treat the associated hernia sac.
d. Prevent testis torsion/injury against the pubic bone.
e. Achieve a good cosmetic result/avoid psychological effects of empty scrotum.
f. Show the older child how to perform testicular self-exam for cancer.
11. What is the definition of ureterocele?
a. A ureterocele is a congenital abnormality found in the ureter. In this condition the distal
ureter balloons at its opening into the bladder, forming a sac-like pouch. It is most often
3
 associated with a duplicated collection system, where two ureters drain their
respective kidney instead of one.

12. What is the definition of Ureteropelvic Junction (UPJ) obstruction?

a. Ureteropelvic junction (UPJ) obstruction is a partial blockage of the kidney at the
point where the renal pelvis transitions into the proximal ureter.
13. Describe the etiology of the UPJ obstruction & give the example.
a. Intrinsic: a congenital narrowing of the UPJ, which is most commonly a result of
abnormal musculature and fibrosis of this area, resulting in an adynamic segment.
b. Extrinsic: kinking at the UPJ, which is most commonly a result of the renal pelvis
draping over a lower pole crossing vessel. This type of obstruction can be
intermittent.
14. What are the goals of surgical therapy of the cryptochordism into the scrotum?
a. Goals in bringing the testis into the scrotum:
b. Prevent ongoing thermal damage to the testis.
c. Treat the associated hernia sac.
d. Prevent testis torsion/injury against the pubic bone.
e. Achieve a good cosmetic result/avoid psychological effects of empty scrotum.
f. Show the older child how to perform testicular self-exam for cancer.
15. What are the 4 different classification form of Hydrocele?
a. Primary hydroceles
i. The swelling is soft and non-tender, large in size on examination and the testis
cannot usually be felt. The presence of fluid is demonstrated by trans illumination.
These hydrocoeles can reach a huge size, containing large amount of fluid, as these
are painless and are often ignored. They are otherwise asymptomatic, other than size
and weight, causing inconvenience. However the long continued presence of large
hydroceles causes atrophy of testis due to compression or by obstructing blood
supply. In most cases, the hydrocoele, when diagnosed early during
complete physical examination, are small and the testis can easily be palpated within
a lax hydrocele but aUltrasound imaging is necessary to visualize the testis if the

4
 hydrocele sac is dense, to reveal the primary abnormality. But these can become
large in cases when left unattended. Hydroceles are usually painless, as are testicular
tumors. A common method of diagnosing a hydrocele is by attempting to shine a
strong light (transillumination) through the enlarged scrotum. A hydrocele will
usually pass light, while a tumor will not (except in the case of a malignancy with
reactive hydrocele).

b. Secondary hydroceles
i. Secondary hydrocele due to testicular diseases, can be the result of, cancer, trauma
(such as a hernia), or orchitis (inflammation of testis), and can also occur in infants
undergoing peritoneal dialysis. A hydrocele is not a cancer but it should be excluded
clinically if a presence of a testicular tumor is suspected, however, there are no
publications in the world literature that report a hydrocele in association with
testicular cancer. Secondary hydrocele is most frequently associated with acute or
chronic epididymo-orchitis. It is also seen with torsion of the testis and with some
testicular tumors. A secondary hydrocele is usually lax and of moderate size: the
underlying testis is palpable. A secondary hydrocele subsides when the primary
lesion resolves.
1. Acute/chronic epididymo-orchitis
2. Torsion of testis
3. Testicular tumor
4. Hematocele
5. Filarial hydrocele
6. Post herniorrhaphy
7. Hydrocele of an hernial sac[1]
c. Infantile hydroceles
i. In infants and children, a hydrocoele is usually an expression of a patent processus
vaginalis (PPV). The tunica and the processus vaginalis are distended to the inguinal
ring but there is no connection with the peritoneal cavity.

d. Congenital hydroceles
i. The processus vaginalis is patent and connects with the general peritoneal cavity.
The communication is usually too small to allow herniation of intra-abdominal
contents. Digital pressure on the hydrocele does not usually empty it, but the
hydrocele fluid may drain into the peritoneal cavity when the child is lying

5
 down. Ascites or even ascitic tuberculous peritonitis should be considered if the
swellings are bilateral.
16. What are the 3 mains steps of hypospadias surgery principles?
a. Straightening of the penis (i.e., correction of chordee);
b. Reconstruction of the missing urethra (i.e., urethroplasty); and
c. Reconstruction of the tissues forming the ventral radius of the penis (i.e., glans,
corpus spongiosum, and skin).
17. What is the UVR diagnosis imaging in these following statement? Choose the correct
answer:
a. Ultrasound
b. DMSA renal scan
c. VCUG
d. CT Scan
18. What is the most useful imaging test for UPJ obstruction?
a. Ultrasound
b. VCUG
c. IVP
d. CT scan
19. These statements are correct, choose the incorrect one in the varying degrees of
hydronephrosis in the UPJ obstruction?
a. Mild form of UPJ obstruction result in dilation of the renal pelvis without loss of
function
b. More severe forms result in dilation of the renal pelvis & calyce with loss of renal
parenchyma & decrease function
c. In the most severe cases the kidney may have cystic dysplasia & very poor
function
d. Mild forms of UPJ obstruction result in dilation of the renal pelvis with loss of
renal function

6
20. These association anomalies are classifically found in the hypospadias penis, except on
a. An ectopic opening of the urethral meatus located at any place between the glans
& the base of the penis
b. Bladder extrpohy
c. A ventral curvature of the penis (chordee)
d. A headed foreskin with a marked excess of skin on the dorsum of the penis &
back of skin on scrotum
21. In these following statements of the scrotal swelling, which one is the urological
emergency’s disease?
a. Orchitis
b. Testicular tuberculosis
c. Testicular torsion
d. Testicular trauma