Examkin

Question

Difficulty: MediumUrologic Surgery

Match each clinical presentation of a urologic condition to the most appropriate definitive surgical or procedural intervention.

  • A 55-year-old man with a 3-cm solid, enhancing exophytic mass in the lower pole of the right kidney.Partial nephrectomy
  • A 32-year-old man with a painless, firm right testicular mass and elevated serum alpha-fetoprotein.Radical inguinal orchiectomy
  • A 68-year-old man with refractory urinary retention and a markedly enlarged prostate volume of 120 mL.Simple prostatectomy
  • A 42-year-old woman with intractable colicky pelvic pain and a 14-mm calculus lodged in the distal ureter.Ureteroscopic lithotripsy

Answer

The 3-cm renal mass is treated with partial nephrectomy. The solid testicular mass requires radical inguinal orchiectomy. The 120-mL prostate causing retention is managed with simple prostatectomy. The 14-mm distal ureteral stone is treated with ureteroscopic lithotripsy.
Each clinical presentation aligns with current urologic guidelines for definitive procedural management, prioritizing organ preservation where safe (kidney), strict oncologic boundaries (testis), minimization of perioperative complications (prostate), and maximal efficacy (ureter).

Step-by-Step Solution

1
Analyze the management of the 3-cm renal mass.
Identify it as a stage T1a tumor appropriate for nephron-sparing surgery.
Small, exophytic renal masses under 4 cm are optimally managed by excising the tumor while preserving the remaining healthy kidney parenchyma.
2
Determine the surgical approach for a solid testicular mass.
Select radical inguinal orchiectomy.
Testicular cancer must be removed en bloc along with the spermatic cord up to the internal ring to prevent lymphatic alteration and scrotal seeding.
3
Evaluate the surgical options for a 120-mL prostate.
Choose simple prostatectomy.
Standard transurethral resection of the prostate (TURP) is generally contraindicated for prostates larger than 80-100 mL due to the high risk of dilutional hyponatremia (TUR syndrome) from prolonged operative time.
4
Select the optimal intervention for a 14-mm distal ureteral stone.
Choose ureteroscopic lithotripsy.
Large stones in the lower ureter have poor clearance rates with shock wave lithotripsy and are best directly visualized and fragmented via ureteroscopy.

Key Concept

Definitive surgical management of common urologic conditions based on lesion size, anatomical location, and oncologic principles.
Rate this question

Topics

Urologic Surgery

More questions from this topic