@UrologyQuiz

Quiz2 Follow-up MCQs: (ANSWERS BELOW!)

1. Frank purulent discharge from the ureteric orifice us at the time of passing a retrograde wire up
the ureter should prompt a urologist TO DO these things EXCEPT:

A) abandon plans to deal with the stone at this particular surgery

B) perform an extensive retrograde pyelogram to delineate the system for stent positioning

C) place a stent to unobstruct as the primary treatment option at this particular surgery

D) send a culture of urine from the bladder and possibly the ureter if a ureteric catheter is passed

2. appropriate antibiotics to commence as a course when purulent discharge is found INCLUDES

A) considering a further course being NOT applicable as a stat dose of antibiotics at the time of stent
placement as the infection will settle rapidly with adequate drainage

B) gentamicin or a similar drug in most instances

C) broad spectrum including gram positive coverage

D) being based solely on local zoology of urinary infections

3. The MOST appropriate time to operate on the obstructing ureteric stone will be:

A) when imaging confirms the stone is still in the ureter

B) after 48 hours and when the operating room is available

C) when the patient wants surgery

D) when the patient is no longer septic and is medically stable

ANSWERS
Q1 Answer B: an extensive retrograde pyelogram will increase the pressure due to contrast being injected into an already
obstructed system and potentially cause pyelo-venous backflow of organisms into the bloodstream precipitating sepsis-
some would argue to do minimal retrograde pyelography to confirm anatomy and even avoid pyelography by acting on
instinct if the wire appears curled in the pelvis prior to stent deployment under image intensifier (or ultrasound) guidance

Q2 Answer B: gram negatives most likely and most regimens include gentamicin but beware dosing in renal failure; A)
whilst drainage will help sepsis will require at least three days of antibiotics to clear, but likely 7 or more; C) gram positives
rarely responsible for UTI but possible in very immunosuppressed; D) local zoology important for antibiotic selection but
always start broad

Q3 Answer D: A) imaging may not always be required as a 6mm stone is unlikely to pass even if the ureter dilates with the
stent. Urine may be strained whilst the patient is in hospital and if a stone is captured surgery may be avoided. Plain x-ray if
done prior to stenting may be useful if the stone was seen but a non-contrast CT would be best. Imaging with stenting can
be problematic even with CT so clinical caution is indicated in most instances and accepting the stone may still be present;
B) and C) obviously incorrect whilst D) is correct as sepsis and being fit are key once unobstructed