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Andrology
1. The most severe complications of intracavernosal injections are:

Α. inflammation of the corpora cavernosa

Β. haematoma

C. priapism

D. urethral injury

Ε. penile oedema

2. Intracavernosal injections are more effective, when used in men with:

Α. Diabetes Mellitus

Β. fibrosis of the corpora cavernosa

C. mild vasculopathy

D. hypertension

Ε. neurogenic disorder

3. The action mechanism of prostagladin:

Α. is indirect, blocking α-adrenergic receptors

Β. is direct, inducing relaxation of smooth muscle fibers

C. inhibits PDE5 (phosphodiesterase type 5)

D. has central effect

Ε. none of the above

4. To treat priapism after the use of intracavernosal injections, the first step is:

Α. intracavernosal administration of a sympathomimetic agent

Β. bloodletting

C. cold packs

D. invasive manipulation

5. The most common adverse event of intracavernosal injections is:

Α. priapism
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Β. haematoma

C. oedema

D. drop of blood pressure

Ε. pain

F. allergic reaction

6. PDE5 inhibitors act by:

Α. reducing cGMP degradation

Β. reducing NO composition

C. reducing cGMP intracellular levels

D. increasing free calcium levels

7. A 50-year old hypertensive patient reports that he has tried a PDE5i without result. The
next step would be:

Α. replacement with another PDE5i

Β. intracavernosal injections

C. full history taking concerning the route of drug administration and its dosage

D. immediate discontinuation of the anti-hypertensive regimen

8. The 3 available PDE5 inhibitors:

Α. have similar efficacy

Β. have similar pharmacokinetic features

C. have been approved for daily use

D. differ only with regard to the maximum recommended dose

9. PDE5 inhibitors:

Α. should be provided with caution to patients taking nitrates

Β. can be administered independently from food intake

C. must be provided to the maximul tolerated dose before characterizing a patient as

"non-responsive" to PDEi

D. is contra-indicated when the patient receives alfuzosin at the same time

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10. A 45-year old diabetic patient responding initially to sildenafil for about 3 years,
reports that his erection is no longer sufficient enough to achieve sexual intercourse. The
next step is to:

Α. increase the dose on demand up to 200mg

Β. test serum testosterone level

C. check diabetes control

D. test serum testosterone level, control diabetes and re-administrate sildenafil (100mg)

11. What do shock waves cause to corpora cavernosa?

Α. Activation of NO

Β. Activation of Cgmp

C. Proliferation of smooth muscle fibers

D. Neovascularisation of the corpora cavernosa

Ε. None of the above

12. Shock wave therapy is used in......

Α. Renolithiasis

Β. Chololithiasis

C. Peyronie's disease

D. Myocardial ischaemia

Ε. all the above

13. In a patient who does not respond to PDE5 inhibitors, what do we expect from fhe
shock-wave therapy?

Α. Functional restoration

Β. Improvement, but also need for supplementary use of PDE5i for functional erection

C. There is not rellay any clinically significant improvement

D. All the above are equally possible to occur

14. In a patient with moderate insufficiency of the corpora cavernosa, what do we expect
from the shock-wave therapy?
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Α. Functional restoration

Β. Improvement, but also need for permanent use of PDE5i for functional erection

C. No clinically significant improvement

D. All the above are equally possible to occur

15. A 67-year old hypertensive patient with erectile dysfunction for 5 years, was
prescribed with sildenafil 100mg. The patient took tablets at 10 different instances always
with empty stomach and at least 1 hour before sexual contact. 5 out of 10 times, his
erection was satisfactory with regard to rigidity and duration. Two (2) times his erection
was sufficient for penetration, without though satisfactory duration. The other 3 times
there was penile tumescence but this was not enough for penetration. This patient is
considered:

Α. to respond to sildenafil treatment

Β. not to respond to sildenafil treatment

16. According to a prospective, placebo-controlled, crossover clinical study, the add-on

therapy with intracavernosal PGE-1 every 2 weeks in patients with partial response even
to the maximum sildenafil dose significantly improves IIEF-EF score by:

Α. 15%

Β. 65%

C. 25%

D. 30%

17. Choose the correct answer.

Α. Intrapenile injections are highly effective and result in patients' high satisfaction.

Β. Intrapenile injections may achieve high satisfaction but may also lead to withdrawal.

C. Priapism occurs in 20% of patients using intrapenile injections.

D. Fibrosis of the corpora cavernosa occurs more often when there is also papaverine in
the mixture.

18. Choose the correct answer.

Α. The infection rate in intrapenile prostheses is 20%.

Β. Prosthesis with antiobiotic prophylaxis is absolutely indicated in diabetic patients.

C. The antibiotic prophylaxis does not prevent the formation of biofilm upon the prosthesis.
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19. Choose the correct answer

Α. The prosthesis provides the highest satisfaction rate for the sexual partner.

Β. The prosthesis has a reintervention rate >30% within the first 5 years.

C. Penile prosthesis is contra-indicated in diabetic patients.

20. Which of the following is required in order to have erection achieved?

Α. Sexual arousal

Β. Communication between brain nerves and penile nerves

C. Relaxation of blood vessels supplying the penis

D. All the above

21. All medications mentioned below may cause erectile dysfunction, apart from:

Α. antihypertensives

Β. antifungals

C. tranquillizers

D. anithistamines

22. Which hormonal factor is not required in order to assess erectile dysfunction?

Α. ACTH

Β. Prolactin

C. TSH

D. Τestosterone

23. Pharmaceutical agents for the treatment of erectile dysfunction act by inhibiting the
PDE5 action, which is responsible for:

Α. testosterone degradation

Β. degradation of cyclic-GMP in the penis

C.degradation of NO in the penis

D. None of the above

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24. A 50-year hypertensive man visits the Urologist due to erectile dysfunction. He tried a
PDE5 inhibitor with no result. The next step should be:

Α. to use another PDE5 inhibitor

Β. to switch to intracavernosal injections

C. to check thoroughly the drug administration route and dosage

D. to discontinue immediately the antihypertensive regimen

25. Which of the factors below contribute to the emergence of erectile dysfunction?

Α. Depression and unemployment

Β. Hypertension and heart diseases

C. Diabetes

D. All the above

26. Which of the conditions below may be related to normal erectile function?

A. Mild arterial insufficiency with normal venous closure mechanism

Β. Severe arterial insufficiency with normal venous closure mechanism

C Normal arterial blow with insufficient venous closure mechanism

D. All the above

27. Which of the below factors play a role in normal erection?

Α. Haemodynamics of the corpora cavernosa

Β. Biomechanical properties of tissues

C. Geometry of the penis

D. All the above

28. Why does the relaxation of a few cavernosous muscle fibres induce erection?

Α. Because the two corpora cavernosa communicate with each other

Β. Because there are gap junctions among smooth muscle fibers

C. Because the drug diffuses

D. None of the above

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29. What pO2 values of the penis are required to achieve erection?

Α. <20mmHg

Β. 40-50mmHg

C. 60-70mmHg

D. >80mmHg

Bladder Cancer

1. In 100 male patients visiting the Outpatient Clinic with LUTS and OAB:

Α. 1% are likely to develop bladder cancer

Β. 60% are likely to develop benign prostatic obstruction (BPO)

C.22% are likely to develop benign prostatic obstruction (BPO)

D. A & B are correct

E. A & C are correct

2. How many patients with bladder cancer undergoing secondary re-staging transurethral
resection (re-TUR), will be substaged after the re-TUR?

Α. 5%

Β. 13%

C. 25%

D. 40%

3. Which of the following factors plays the least role for survival in muscle-invasive
bladder cancer?

Α. Age

Β. Lymphnode metastases

C. The pathoanatomical stage of the disease

D. The ratio infiltrated : removed lymphnodes

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4. The best time period for assessing mortality and complications after radical cystectomy
is:

Α. 30 days after radical cystectomy

Β. 60 days after radical cystectomy

C. 90 days after radical cystectomy

D. throughout the patient's hospital stay

5. Which of the following complications occurs more often following cystectomy?

Α. Haemorrhage

Β. Urinary tract infection (UTI)

C. Paralytic ileus

D. Surgical wound dehiscence

6. Which of the following is not an exclusion criterion from a bladder-preservation

protocol, in a patient with muscle-invasive cancer?

Α. Age>75

Β. Hydronephrosis

C. Multifocal disease

D. CIS (carcinoma in situ)

7. Candidates for partial cystecomy after preoperative chemotherapy ARE NOT the
patients with:

Α. CIS (carcinoma in situ)

Β. good bladder capacity

C. solitary tumor

D. full response to chemotherapy

8. Which of the following statements about preoperative chemotherapy in bladder cancer

is true?

Α. Response is the most important prognostic factor.

Β. Preoperative chemotherapy is more effective than adjuvant chemotherapy.

C. Preoperative chemotherapy can be used in patients with lymphnode or visceral disease.

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D. Preoperative chemotherapy should be used in all patients.

9. Tri-modality therapy for bladder preservation includes:

Α. Radiotherapy - Chemotherapy - Cystectomy

Β. Chemotherapy – TUR – Radiotherapy

C. TUR – Radiotherapy – Chemotherapy

D. Chemotherapy - Cystectomy - Radiotherapy

10. Following Tri-modality therapy, the bladder is preserved by:

Α. 20%

Β. 50%

Γ. 5%

Δ. 80%

11. Restaging TUR (re-TUR) is recommended:

Α. when no muscle layer has been obtained

Β. when there is no residual tumor

C. in every T1G3 patient

D. in all the above cases

12. A secondary re-staging TUR inT1G3:

Α. reduces the relapse rate

Β. improves response to the adjuvant intravesical BCG therapy

C. Α & Β

D. has no benefit

13.The most effective adjuvant intravesical BCG therapy in patients with T1G3 tumor ........

Α. starts on the 3rd postoperative day, with only one single 12-week continuous infusion
therapeutic cycle

Β. consists of only one single 6-week continuous infusion therapeutic cycle

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C. consists of one single 6-week infusion therapeutic cycle, followed by a maintenance scheme
of one infusion/time during the follow-up period

D.consists of an initial 6-week infusion therapeutic cycle, followed by a maintenance

scheme of three weekly infusions/time during follow-up

14. When can immediate cystectomy be recommended In T1G3 patients?

Α. In every case of such a tumor

Β. When there are 3 major risk factors

C. When the tumor is localized on the dome of the bladder

D. Never

15. The use of photodynamic diagnosis in muscle-invasive bladder cancer reduces:

Α. the progression rate of the disease

Β. the relapse rate ≥20%

C. the relapse rate < 10%

D. none of the above

16. How many EORTC risk factors are needed in order to classify patients with
non-muscle invasive (Ta, T1) bladder tumor as low-moderate-high risk for relapse or
progression of the disease?

Α. 4

Β. 5

C. 6

D. 7

17. Which of the following statements is FALSE?

Α. Immediate postoperative intravesical infusion of cytotoxic agents benefits all patients.

Β. Mitomycin-C causes fewer complications than Farmorubicin when infused immediately

postoperatively.

C. The small extraperitoneal bladder rupture is not a contraindication for intravesical infusion
after 24 hours.

D. Α & C

Ε. All the above

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18. Which of the following statements is FALSE?

Α. A second BCG cycle in a Τ1G3 tumor does not offer any benefit.

Β. A third BCG cycle in a Τ1G3 tumor is more effective than the second cycle.

C. A second BCG cycle in a Τ1G3 tumor is a good alternative option to cystectomy at

relapse Τα/cis

D. A second BCG cycle in a Τ1G3 tumor is a good alternative option to cystectomy at relapse
Τ1G3.

19. Which of the following statements is FALSE?

Conservative treatment for a Τ1G3 tumor is a bad idea:

Α. in a patient with the first Τ1G3 relapse within 3-6 months

Β. in a patient with residual tumor Τ1 at re-TUR

C. in a young patient with a tumor >3cm in size

D. in all the above cases

20. Which of the following statements is TRUE?

Α. Τ1G3 tumors are rare.

Β. Τ1G3 tumors have a relapse rate of up to 80%.

C. Τ1G3 tumors have a relapse rate of 0%.

D. Τ1G3 tumors have a mortality rate of 0%.

21. Which of the below play/s a role in bladder tumor staging?

Α. The technique of transurethral resection with muscular layer in the specimen

Β. The presence of pericystic fat in the specimen

C. Cauterization of the base of the tumor

D. All the above

22. Re-staging TURB (re –TURB):

A. is performed 1 week after the first transurethral resection.

Β. does not offer more diagnostic information.

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C. reduces relapse rate.

D. is always performed in combination with intravesical administration of Gemcitabine.

23. The first laparoscopic cystectomy was performed in:

Α. 1991

Β. 1992

C. 2000

D. 2001

24. Which of the following is TRUE with regard to the value of intravesical infusion of
cytotoxic agents immediately after the transurethral resection (TUR) of a non-invasive
tumor ?

A. It reduces the relative relapse risk by 40%.

B. It is beneficial both in solitary and multiple tumors.

C. The greatest benefit occurs when the infusion takes place within 24 hours after TUR.

D. There are no differences between drugs, with regard to efficacy.

E. All the above

25. Which of the following answers is FALSE?

The use of stapling devices in cystectomy seems to:

A. significantly reduce blood loss in the hands of experienced surgeons

B. significantly reduce the duration of cystectomy in the hands of experienced surgeons

C. significantly help non-experienced Urologists by limiting blood loss during cystectomy

D. helps non-experienced Urologists by reducing the time needed for bladder removal

26. How likely is it for a Τ1G3 bladder tumor that has relapsed within the first trimester
after intravesical BCG infusions to invade the muscular wall?

A. < 10%

B. 20%

C. 30-50%

D. >80%
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27. The best treatment for bladder adenocarcinoma is:

A. Radiotherapy

B. Cystectomy

C. Chemotherapy

D. TUR + intravesical BCG infusions

Renal Cancer
1. RCC is multifocal in:

Α. 1% of cases

Β. 5% of cases

C. 10% of cases

D. 15% of cases

2. Removing perirenal fat in a patient with RCC:

Α. increases the perioperative mortality

Β. reduces the risk for local relapses

C. increases the relapse risk

D. increases postoperative morbidity

3. In radical nephrectomy for RCC, routine lymph-node dissection:

Α. is absolutely useless

Β. is performed only for staging

C. is essential only in a few patients

D. is always indicated

4. In partial nephrectomy, we DO NOT USE the:

Α. lateral lumbar approach

Β. transperitoneal approach

C. subcostal incision

D. Chevron incision
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Ε. thoracolumbar approach

5. Which of the following is NOT an indication for partial nephrectomy?

Α. Renal failure

Β. Bilateral tumors

C. Solitary kidney

D. Tumor size <4 εκ.

Ε. Renal pelvis size <2 cm

6. Which of the following statements is correct?

Α. There are no randomized studies clearly demonstrating the superiority of radical

nephrectomy versus simple nephrectomy.

Β. Lymphadenectomy contributes to the therapeutic treatment of renal cancer.

C. A negative CT for adrenal involvement has 89.4% negative prognostic value.

D. Tumor size <7cm is a relative indication for partial nephrectomy.

Ε. Partial nephrectomy is less effective in tumors <4cm than radical nephrectomy, with regard to
5-year disease-free survival.

7. Which of the following statements about metastatic renal cancer therapy is FALSE?

Α. Targeted therapy with Sunitinib is the first-line treatment for high-risk patients.

Β. Targeted therapy with Temsorilimus is the first-line treatment for high-risk patients.

C. Partial response rate to Sunitinib amounts to 40%.

D. Sorafenib is a second-line treatment in metastatic renal cancer.

Ε. Targeted therapy usually does not provide cure.

8. The​ ​strongest indication​ for using radio waves on the kidney is:

Α. transitional cell carcinoma of the renal pelvis

Β. angiomyolipoma of 4cm

C. renal tumor 7cm of the lower pole

D. renal tumor 3cm and ASA score 3

Ε. renal tumor 3cm and a normal contralateral kidney

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Prostate Cancer

1. Which of the following IS NOT a contra-indication for brachytherapy?

Α. Prostate size 90cm​3

Β. Clinical stageΤ3α

C. IPSS=9

D. Gleason Score 9(4+5)

Ε. None of the above

F. Β and C

2. Which of the following factors DOES NOT AFFECT survival rate after prostate cancer
therapy?

Α. iPSA

Β. Type of therapy

C. Clinical stage

D. Age

Ε. Β and D

F. Α and Β

3. Which of the following statements is FALSE?

Α. Preservation of erection capacity after 24-month brachytherapy is > 80%.

Β. There is no need for PDE5i following brachytherapy.

C. A patient with PSA>20ng/ml is not a good candidate for brachytherapy.

D. The 12-year disease-specific survival rate is > 90%.

Ε. Β and D

4. With regard to urinary symptoms after brachytherapy, which of the following is FALSE?

Α. Post-brachytherapy incontinence is very common.

Β. More than 90% of patients present increase of IPSS within the first months following
brachyterapy

C. Bladder-neck resection before brachytherapy may improve IPSS.

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D. None of the above

5. In a patient with T1 prostate cancer and survival expectancy over 10 years, radical
prostatectomy:

Α. provides cure

Β. improves quality of life

C. increases the survival rate

D. reduces the risk for metastasis

Ε. C and D

F. B and C

6. Which therapeutic method for localized prostate cancer is more effective according to
literature?

Α. Radical prostatectomy

Β. Radical external radiation

C. HDR brachytherapy

D. LDR brachytherapy

7. The continuously increasing development of technology and know-how upon radical

prostatectomy has led to:

Α. reduction of immediate complications

Β. reduction of long-term complications

C. reduction of intraoperative complications

D. better control of the disease

Ε. All the above

F. None of the above

8. Post-brachytherapy orthorrhagia occurs in:

Α. 20% of patients

Β. 15% of patients

C. 10% of patients

D. 5% of patients
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Ε. 3% of patients

F. 0%

9. Urinary Incontinence is NOT a long-term complication of brachytherapy.

Α. True

Β. False

10. Which of the following statements is FALSE?

Α. Anastomotic urine leak is less likely in robotic-assisted laparoscopic radical prostatectomy.

Β. Checking for anastomotic leak tightness has no prognostic value.

C. The fewer sutures in the anastomosis, the more chances for urine leak.

D. Β and C

Ε. All the above

11. Robotic radical prostatectomy:

Α. gives better functional result than open radical prostatectomy

Β. gives the same functional results as open radical prostatectomy

C. should be abandoned as a procedure, for it has very high cost

D. is the only technique that is allowed today to be used in all cases

12. Which finding from prostate biopsy is the most useful to predict extraprostatic
expansion of cancer?

Α. Degree of differentiation

Β. Number of positive biopsies

C. Perineural invasion

D. All the above

13. According to TNM 2009, microscopic bladder neck invasion is classified as:

Α. Τ4

Β. Τ3α

C. Τ3β
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D. Τ2β

14. Patients with Τ3 prostate adenocarcinoma present lymph-node metastasis in:

Α. 10%

Β. 40%

D. 60%

D. 70%

15. The risk for lymph-node metastasis in a patient with prostate cancer depends mainly
on the:

Α. age

Β. stage

C. Gleason score

D. B and C

16. Which of the following statement is TRUE?

Α. Prostate cancer T3 is more rare than stage T2.

Β. Prostate cancer T3 is successfully treated with radiation therapy.

C. Prostate cancer T3 progresses within 5 years after radical prostatectomy in 40% of

cases.

D. Prostate cancer T3 is successfully treated with radical prostatectomy.

​17. Which histological pathological finding/s from the radical prostatectomy specimen
can predict the presence of latent metastatic disease?

Α. Positive surgical margins

Β. Seminal vesicle invasion

C. Lymph-node invasion

D. B and C

Ε. A and B

18. For patients who presented biochemical relapse after radical prostatectomy, which of
the following factors are related more to local relapse than to remote metastasis?
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Α. First measurable PSA value 6 months after surgery, Gleason score ​>​7, pathological stage Τ3

Β. Age below 70y.o. at the time of relapse, first measurable PSA value < 2 ng/ml, Gleason score
<​5

C. Histological absence of seminal vesicles and lymph-nodes, Gleason score ​<​5, first
measurable PSA value one year after surgery, PSA doubling-time (PSADT) >6 months

D. Pathological stage Τ2, Gleason score 8 to 10, negative bone scintigram

Ε. First measurable PSA value 4 months after surgery, negative biopsy of prostatic bed, PSA
doubling-time (PSADT) <3 months

19. In clinically localized prostate cancer, what are the chances for biochemical
relapse-free survival within 5 years?

Α.. 0-10%

Β. 20-30%

C. 40-50%

D. 60-70%

Ε. 70-80%

20. According to Partin's Tables, a patient with PSA 7.4 before biopsy, Gleason score
3+4=7 at biopsy and negative digital examination (Τ1c) before biopsy has all following
risks APART FROM:

Α. 49% risk for localized disease inside the gland

Β. 40% risk for focal invasion of the capsule

C. 22% risk for pelvic lymph-node invasion

D. 97% risk for in situ/ localized disease

Ε. 8% risk for seminal vesicle invasion

21. All the following are prognostic factors for radiotherapy salvage after radical
prostatectomy, APART FROM:

Α. PSA levels before radiation therapy

Β. PSA doubling time (< 10-12 months)

C. time until the occurrence of biochemical relapse (< 2-3 years)

D. the patient's age

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22. Which of the following statements is TRUE?

Α. Laparoscopic radical prostatectomy is a new minimally invasive method for the treatment of
prostate cancer.

Β. Robot-assisted radical prostatectomy is a well-documented radical oncological

procedure that can be performed even with minimal access

23. Which of the following statements is TRUE?

Α. Laparoscopic radical prostatectomy requires high technical skills and should be performed
only in Specialized Centers.

Β. Surgical steps of the procedure have been thoroughly described and are simple and
reproducible. The only problem for the disemmination of the technique is lack of training
structures.

24. In order to achieve higher neuroprotection during nerve-sparing radical

prostatectomy, the periprostatic fascia (PPF) is incised:

Α. on the ventral aspect of the prostate

Β. superiorly, on the dorso-lateral aspect of the prostate

C.on the mid-lateral aspect of the prostate

D. at the apex of the prostate

Ε. at any point of the prostate - this does not seem to affect the number of nerve fibers spared.

25. During radical prostatectomy and in order to achieve a better oncological result, the
surgeon will procceed to prostate dissection following the:

A. interfascial technique

Β. intrafascial technique

C. extrafascial technique

D. posterior technique, through Denonvillier's fascia

Ε. All above techniques have the same oncological result.

26. Which of the following surgical procedures does NOT seem to play a particular role in
achieving continence after radical prostatectomy?

Α. Preservation of puboprostatic ligaments

Β. Fixation of the vesico-urethral anastomosis

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C. Restoration/ preservation of puboperineal muscles

D. At least 8 sutures for the vesicourethral anastomosis

Ε. Α and D

27. According to the latest literature on prostate biopsy, the following is true:

Α. Aspirin administration has to be discontinued and there is need for periprostatic xylocaine
infiltration.

Β. Aspirin administration has to be discontinued. Local anesthesia does not help.

C. Aspirin administration can continue. Local application of xylocaine gel reduces pain.

D. Aspirin has to be replaced with heparin. Local anesthesia with xylocaine gel is preferrable.

28. Which of the following clinical factors is positively correlated with the
pathoanatomical stage following salvage radical prostatectomy?

Α. The time period since the completion of radiation therapy.

Β. The degree of malignancy at the time of biopsy.

C. PSA<10ng/ml at the time of salvage surgery.

D. The patient's age at the initial diagnosis of prostate cancer.

Ε. PSADT (PSA doubling-time)

29. Following radiation therapy, prostate biopsy has to be negative:

Α. within 6 months

Β. within 12 months

C. within 18 months

D. within 30 months

Ε. None of the above

30. One year following radiation therapy, serum PSA dropped within "normal values" (2,5
ng/ml) and started rising again, with consecutive values 3,5 and 5,1 ng/ml within 6
months. What should be done next?

Α. Inform the patient that radiation therapy "did not work" and recommend salvage prostatectomy
and cryotherapy.

Β. Explain to the patient that his PSA is still normal and he should not worry.
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C. Inform the patient that his disease has relapsed and that increase in PSA implicates
systemic disease.

D. None of the above.

Ε. Α and Β

BPH

1.​ ​Which of the following statements about transurethral laser is TRUE?

Α. Transurethral laser can reduce prostatic volume even up to 45%

Β. Transurethral laser can reduce IPSS by 60-92%

C. Transurethral laser can reduce post-void residual urine by 60-88%

D. Α and Β

Ε. Α , Β and C

2. The use of KTP (Greenlight Laser) may lead to the following complication/s:

Α. urinary incontinence <1%

Β. urethral stricture <1%

C. urinary tract infection (UTI) 15-20%

D Α and Β

Ε. A, B and C

3.​ ​Marginal factor/s that may lead to failure with α-blockers include the following:

Α. prostate size > 50ml

B. Qmax < 15 ml/s

C. PSA > 2,5ng/ml

D. None of the above

Ε. All the above

4.​ ​The transurethral use of Laser:

Α. does not affect erectile function drastically

Β. causes retrograde ejaculation in 12-56% of cases (Greenlight)

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C. does not exclude the probability of biopsies

D. Α and Β

Ε. All the above are correct

5​. ​Which of the following statements is TRUE?

Α. CaP is 5-7% likely to be found in adenoma resection with TURP.

Β. Within 3 years, almost half patients discontinue α-blockers.

C. Use of laser may increase Q max even up to 23 ml/s.

D. Β and C

Ε. A, B and C

6. According to latest studies in males, antimuscarinic agents:

Α. are contra-indicated for obstruction cases.

Β. can be administered in every case irrespective of the presence and severity of obstruction.

C. can be administered relatively safely when there is concomitant OAB, for there is
minimal (only 2%) urinary retention.

D. have absolute criteria with reference to the degree of obstruction.

Ε. have no place in the treatment of males with OAB.

7. According to EAU Guidelines for LUTS in males with BPE:

Α. Surgery is the first-line treatment.

Β. Combination of α-blocker and 5a-reductase is the first-line treatment for high-risk patients.

C. Surgery is the second-line therapeutic treatment of LUTS-BPE, in case

pharmacotherapy fails.

D. B and C are correct

8. Which of the following techniques is NOT used for removing the Foley catheter?

Α. Overfilling of the balloon.

Β. Cross-section οf the balloon filling lumen.

C. Balloon perforation through the filling lumen.

D. Transrectal ultrasound-guided balloon perforation

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Ε. Mild continuous traction.

F. Through suprapubic cystotomy.

9. When complications of transvesical prostatectomy arise, there is need for blood

transfusion in:

Α. < 1% of cases

Β. <5% of cases

C. 5-15% of cases

D. >30% of cases

10​. ​Revision surgery due to a newly-occuring obstruction after transvesical

prostatectomy:

Α. is as likely as after transurethral prostatectomy

Β. as likely as after prostatectomy with the use of Greenlight Laser

C. is necessary in 1-2% of cases

D. is necessary in 10-20% of cases

11. Post-transurethral prostatectomy mortality rate in the 21st century is:

Α. <1%

Β. 1-2%

C. 3-5%

D. >5%

12. The most common complication from Greenlight Laser prostatectomy is:

Α. bleeding

Β. persistent irritating symptoms during urination

C. erectile dysfunction

D. urinary incontinence

13. Switching from original to generic 5a reductase inhibitors may:

Α. reduce PSA.
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Β. increase PSA, if the patient had been taking an original drug before switching to a
generic.

C. improve urinary flow.

D. reduce IPSS score.

Ε. reduce adverse events compared to the original drug.

14. Switching from original to generic α-adrenergic blockers in BPH patients may:

Α. increase urinary flow.

Β. reduce post-void residual urine.

C. reduce adverse events.

D. reduce IPSS score.

Ε. None of the above.

15. Which of the following statements about bipolar TUR-P is TRUE?

Α. There is no risk for TUR-syndrome.

Β. Some studies demonstrate that intraoperative bleeding is less than in unipolar TUR-P.

C. The fluid used in the resection is normal saline.

D. All the above.

16. Which of the following statements about monopolar TUR-P is true?

Α. The mortality rate is about 3%.

Β. The TUR-P syndrome occurs in 3-4%.

C. Blood transfusion is necessary in about 5% of the cases.

D. Retrogade ejaculation occurs in 30% of the cases.

17. Which of the following is true?

Α. Erectile dysfunction after TUR-P occurs in 40% of the cases.

Β. Retrogade ejaculation after TUR-P occurs in 40% of the cases.

C. Retrogade ejaculation is less common following bipolar TUR-P.

D.TUR-P has no significant effect on erectile function.

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18. With regard to long-term results following TUR-P:

Α. there is significant improvement of Qmax in 40-50% of cases.

Β. 8-10% of patients will undergo revision TUR-P within 12 years.

C. there is significant improvement of symptoms in 20-30% of cases.

D. all the above are true.

19. In PBE, the transition zone in the ultrasound image is:

Α. hypoechoic

Β. isoechoic

C. hyperechoic

D. of mixed echogenicity

Ε. all the above

F. none of the above

20. Which of the following statements about A-receptors (AR) is FALSE?

Α. α​1Α​ARs are the dominant receptors in the prostate gland.

Β. α​1D​ARs are the dominant receptors in the detrusor.

C. Silodosin shows higher selectivity for α​1Α​ARs compared to α​1Β​ARs and α​1D​ARs.

D. Alfuzosin shows higher selectivity for α​1Α​ARs compared to α​1Β​ARs -but not compared
to α​1D​ARs.

21. Which of the following statements about adrenergic blockers is true?

Α. They differ significantly with regard to their efficacy.

Β. They achieve 40-50% improvement of symptoms (IPSS).

C. They achieve 40-50% improvement of urinary flow.

D. They do not significantly reduce risk for symptom exacerbation.

22. Which of the following statements about a-adrenergic blockers is FALSE?

Α. The intraoperative floppy iris syndrome is caused by the presence of α​1Α​AR in the iris.

Β. The risk for retrograde ejaculation recurrence is not the same in all α-blockers.
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C. The most common adverse events from the use of α-blockers are fatigue, dizziness and
orthostatic hypotension.

D. Alfuzosin, Tamsulosin and Silodosin are superselective α-blockers, while Doxazosin

and Terazosin are not.

23. When investigating LUTS with U/S ......

Α. only the lower urinary tract needs to be screened with U/S.

Β. the lower urinary tract needs to be screened only after urination,so as to measure the prostate
volume and residual urine.

C. not only the lower urinary tract but also the upper urinary tract need to be screened.

D. the bladder should contain at least 350ml, so that the results are reliable.

24. Post-void residual urine (PVR)......

Α. should always be assessed.

Β. should be measured with a catheter in order to have a reliable assessment of urine volume.

C. should be measured after every urination with urine volume>300ml.

D. All answers are correct

Ε. All answers are wrong

25. Ultrasound screening (U/S) of the urinary tract and the other diagnostic tests:

Α. set the diagnosis of a urological disease.

Β. are all conducted and then studied by the physician who sets the diagnosis.

C. aim at answering specific diagnostic questions, in order to draw close to a diagnosis or

exclude a diagnosis.

D. All above answers are correct.

Ε. All above answers are wrong.

26. Photoselective Vaporization of Prostate (PVP) with Greenlight Laser (KTP) gives
results that are:

Α. equivalent to the results of Transurethral Prostatectomy (TURP)

Β. equivalent to the results of Transurethral Prostatectomy (TURP) but not equivalent to the
results of Open Prostatectomy.

C. satisfactory only in prostate glands < 50ml

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D. are equivalent to pharmacotherapy with α-adrenergic inhibitors

Ε. not possible to assess, for the method is still new.

27. Photoselective Vaporization of Prostate (PVP) with Greenlight Laser (KTP) .....

Α. is a safe method but the risk for the TURP syndrome still remains.

Β. is practically a non-invasive method and the catheter usually stays for less than 24
hours.

C. is performed with the use of straight-emitting Laser optic fibers.

D. is performed with the use of side-emitting Laser optic fibers, and a resectoscope to achieve
hemostasis.

Ε. has a big learning curve.

Lithiasis

1. Which of the following method/s is/are believed to have the lowest risk for stone
retropulsion during ureteroscopic lithotripsy?

Α. Ballistic Lithotripsy

Β. Ultrasounds (U/S)

C. Electrohydraulic waves

D. Holmium: YAG laser

Ε. C and D

2. Which of the following methods can achieve the most satisfactory ureteral orifice
dilatation during ureteroscopy?

Α. Balloon - dilator

Β. Plastic ureteral dilators

C. Dual-lumen ureteral catheter

D. Α and Β

Ε. Α, Β and C

3. What guidewire will you choose to bypass an impacted ureteral stone?

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Α. Straight-tip PTFE guidewire

Β. J-type tip PTFE guidewire

C. Hydrophilic guidewire with straight or slightly curved tip

D. Amplatz super stiff guidewire

Ε. Bentson super stiff guidewire with a J-type tip

4. Which of the following methods can achieve the final dilatation of the percutaneous
tract during percutaneous nephrolithotripsy?

Α. Balloon-dilator

Β. Plastic Amplatz dilators

C. Metallic Alken dilators

D. Only Α and Β are used today

Ε. Α, Β and C

5. The use of​ ​ureteral​ ​access​ ​sheath during ureteroscopic lithotripsy secures:

Α. continuous and easy access to the ureter

Β. low intrarenal pressures

C. the potential of removing large stones (>1cm) without the need of their fragmentation

D. Α and Β

Ε. Α, Β and C

6. Which of the following techniques is NOT USED for removing a calcified self-retaining
ureteral catheter?

Α. Extracorporeal lithotripsy

Β. Ureterolithotripsy

C. Open uretero-cystotomy

D. Watchful waiting while exerting mild traction on the catheter tip having pulled it to the
outer urethral orifice

Ε. C and D

7. One week after extracorporeal lithotripsy of a renal stone, a steinstrasse is formed at

the lower segment of the ureter. The patient complains about strong colic-like pain in the
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ipsilateral lumbar region that responds only a little to analgesics. Which therapeutic
method will you choose next?

Α. Placement of percutaneous nephrostomy and watchful waiting

Β. Ureteroscopic lithotripsy

C. Extracorporeal lithotripsy of the steinstrasse

D. All the above are acceptable therapeutic options

Ε. Only Β and C have therapeutic value in the specific case

8. In an asymptomatic patient with a stone in the upper ureteral segment (maximum

diameter 0,8cm) and mild (first grade) dilatation of the ipsilateral pyelocalyceal system,
which therapeutic option will you choose once the conservative treatment (watchful
waiting) has failed?

Α. Percutaneous (descending) ureteroscopy

Β. Extracorporeal in situ lithotripsy

C. Extracorporeal lithotripsy using the 'push-back' technique

D. Placement of percutaneous nephrostomy and extracorporeal lithotripsy

Ε. Laparoscopic ureterolithotomy

9. Which is considered today the method of choice for the treatment of staghorn calculi
(coral stones)?

Α. Monotherapy with extracorporeal lithotripsy

Β. Percutaneous Nephrolithotomy + extracorporeal lithotripsy

C. Anatrophic nephrolithotomy

D. Pyelolithotomy in combination with nephrolithotomies

E. Flexible ureteronephroscopic lithotripsy

10. Which is the treatment of choice for a uric acid stone (maximum diameter 2cm) lodged
in the renal pelvis ?

Α. Percutaneous nephrolithotripsy

Β. Extracorporeal lithotripsy

C. Alkalization of urine

D. Laparoscopic pyelolithotomy

Ε. Open pyelolithotomy
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11. The best approach for a symptomatic posterior calyceal diverticulum complicated with
lithiasis is:

Α. Watchful waiting

Β. Extracorporeal lithotripsy

C. Open surgery

D. Percutaneous nephrolithotomy (PCNL) - puncturing directly into the diverticulum and

removing the stone

Ε. None of the above

12. Following ureteroscopy, a stent must be placed:

A. if there is ureter perforation

B. if the stone that was removed was impacted with a large concomitant oedema

C. if dilatation of the ureteral orifice with a balloon has preceded

D. in cases Α and Β

Ε. in cases Α, Β and C

13. The flexible ureteroscope is usually inserted into the ureter .....​:

Α. alongside (adjacent to) a guidewire

Β. through a ureteroscopic access sheath

C. directly, as it happens with the the semi-flexible ureteroscope

D. Α and Β

Ε. Α, Β and C

14. Which of the following statement/s about the semi-flexible ureteroscope is/are true?

Α. It provides better visual field than the flexible ureteroscope.

Β. It is easier to handle.

C. It is the insturment-of-choice for removing stones lodged in the upper segment and
ureteropelvic junction

D. Α and Β

Ε. Α, Β and C
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15. What type of guidewire will you use to bypass an impacted ureteral stone in the
midline of the ureter?

Α. Simple PTFE guidewire 0,038 inch

B. Super stiff Amplatz guidewire 0,038 inch

C. Hydrophilic Terumo Glidewire 0,038 inch

D. Simple PTFE guidewire 0,038 inch with J-type tip

Ε. Nitinol guidewire 0,018 inch

16. Which of the following statements about flexible ureteroscopes is FALSE?

Α. Inserting instruments (e.g. grasping basket) through the working channel reduces the bending
angle of the ureteroscope tip.

Β. The flexible ureteroscope is particularly fragile and has limited life duration.

C. Inserting instruments through the working lumen reduces the flow of lavage fluid; that is why it
is recommended to use a special device to increase fluid pressure.

D.The flexible ureteroscope can be combined only with two types of endoscopic lithotripsy: laser
and electrohydraulic-wave lithotripsy

Ε. In modern instruments, the maximum bending angle of the tip does not exceed 120
degrees.

17. Which of the following statements about the anatomic position of kidneys and
percutaneous procedures is/are TRUE?

Α. When the patient is in the prone position, the angle formed by the posterior renal calyces and
the imaginary axis transversing the spine is about 30​o​.

Β. A part of the upper renal pole at the posterior-lateral aspect of the kidney, is covered by the
liver on the right and by the splene on the left.

C. The posterior calyces are usually projected distally from the anterior calyces.

D. Α, Β and C

Ε. Α and Β

18. Which of the following statements about ureteroscopy is true?

Α. The good design of a procedure does not have to do only with a good detailed medical history,
clinical examination and imaging methods, but it also requires the appropriate consumables and
instruments.

Β. Proper equipment and maintenance of a large stock of materials is essential (as long as the
economic situtation allows for it).
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C. Learning as many techniques as possible is essential.

D. When treating the upper urinary tract, it takes a lot of patience, technique flexibility and gentle
manipulations.

Ε. All the above

19. Which extraction/ grasping basket is the most appropriate to use?

Α. Tipless/ zerotip basket, allowing for stone retrieval even when there is not enough space
behind (e.g. calyceal stone manipulations).

Β. Endoscopic extraction basket either of the classical type or of the flexible and long type,
facilitating access behind an impacted stone

C. 3-wire grasping basket, which can be released from a stone if required

D. Multiple-wire or even double- wire grasping basket, capable of retrieving stone fragments
while dilating a narrow ureter around the stone.

Ε. Basket of 'kink-resistant' material, specially designed to resist to crushings and comminutions

by various lithotripters; also capable of dilating the ureter, when deploying within the lumen.

F. Grasping devices, such as «tri sept» or «graspit», allowing for immediate stone extraction
even when there is no space behind comminuted concrements in the case of an impacted stone
(commonly occurring with the ballistic lithotripter) or a stone lodged too close or projecting onto
the ureteral orifice.

G. Baskets with flexible tip and small diameter, that do not limit bending of flexible instruments,
do not reduce lavage flow and ensure a good visual field.

Η. Baskets with satisfactory diameter, strong and durable enough to be guided even through a
'difficult' ureter.

I. All the above should be available and used according to the case.

20. Which of the following statements about ureteroscopes is true?

Α. Large-diameter instruments (>8,5 Fr) , for they are:

- reliable

- strong and durable, advancing more easily through the ureter without the need of excessive
tip-bending and without loss of visual field.

- large working channel

- big visual field

- economical thanks to the higher endoscopic reliability and the potential of using strong and
durable multiple-use instruments in the large working channel

Β. Small-diameter instruments (< 8 Fr), which

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- rarely require ureteral dilatation

- are less traumatic and do not require «stenting» of the ureter

- are flexible and guided by wires

C. Flexible ureteroscopes of small diameter and big length, capable of accessing the whole
urinary drainage system .

D. All the above types of ureterscopes should be available in a well-organized Endourology

Department.

E.?

21. Which of the following is an absolute contra-indication for performing endoscopic

procedures in the upper urinary tract?

Α. Pathological obesity

Β. Prostatic hypertrophy

C. Pregnancy

D. Anticoagulant therapy

Ε. Active urinary tract infection

F. All the above

22. Which is the most appropriate therapeutic option for a patient with solitary stone
1,5cm in diameter lodged in the renal pelvis?

Α. pyelolithotomy

Β. ureteroscopy and lithotripsy with Ho:YAG laser

C. SWL and placement of ureteral stent

D. PNL

Ε. SWL in situ

23. Patient with congenital soliltary kidney presents staghorn calculi (coral stones)
branching in the lower and middle calyx. There is mild hydronephrosis, while renal
function is slightly affected. Which is the most appropriate therapeutic option?

Α. PNL

Β. Close monitoring with regular ultrasound screening, serum creatinine and general urine tests.

C. ESWL with placement of ureteral stent

D. Percutaneous nephrostomy followed by PNL

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Ε. Anatrophic Nephrolithotomy

24. Patient presents a stone, 0,8 in diameter, at the upper left ureter and concomitant
hydronephrosis. Which is the indicated treatment?

Α. ESWL in situ

Β. ESWL with placement of ureteral stent

C. Administration of Tamsulosin and 1-month monitoring

D. URS

Ε. Placement of ureteral stent and URS 1 week later

25. Extracorporeal lithotripsy is NOT a treatment of choice in:

Α. renal stones with maximum diameter >2cm

Β. ureteral stones <1cm

C. renal stones composed of calcium monohydrate and dihydrate oxalate with maximum
diameter of 1,5cm

D. stones in the lower calyx with maximum diameter <1cm

Ε. stones of the upper ureteral segment

26. Which of the following statements about staghorn renal calculi (coral stones) is true?

Α. ESWL as monotherapy is the treatment of choice.

Β. ESWL should be the primary therapeutic step and other methods (e.g. percutaneous
lithotripsy) should follow as supplementary treatment.

C. Open surgery is the treatment of choice.

D. Flexible ureteronephroscopy with the use of holmium:YAG laser is the most modern and
effective therapeutic method for this type of stones.

Ε. Percutaneous lithotripsy is the primary therapeutic choice, with supplementary use of

ESWL wherever needed.

27.What is the main indication for open ureterolithotomy?

Α. Upper ureteral stone > 1cm

Β. MIddle ureteral stone > 1 cm

C. Lower ureteral stone > 1 cm

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D. Ureteral stone resistant to extracorporeal lithotripsy

Ε. None

28. Patient with sizeable complicated staghorn calculus (coral stone) presents
considerable residual stone load after sandwich-PNL session. What is the most
appropriate therapeutic option?

Α. Open nephrolithotomy

Β. Flexible nephroscopy

C. Flexible uretero-nephroscopy

D. Monitoring

Ε. Nephrectomy

29. Woman 140kg in weight presents a renal pelvic stone of 4cm. What treatment will you
follow?

Α. ESWL in situ

Β. Administration of α-blocker

C. URS

D. Pyelolithotomy

Ε. Chemolysis

30. According to international data, the number of open procedures performed for the
treatment of urolithiasis is:

Α. 1-5%

Β. 5-10%

C. 10-15%

D. 15-20%

Ε. >20%

31. In percutaneous nephrolithotripsy, the initial puncture of the complicated posterior

calyx should be conducted with the tap needle in such a position that it forms an angle
with the vertical body axis about:

Α. 10​ο

Β. 30​ο
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C. 50​ο

D. 60​ο

Ε. 70​ο

Neurourology – Urinary Incontinence

1. Initial clinical assessment of patients with effort incontinence following prostatectomy

must include

A. a urodynamic study

B. a urination log

C. urethrocystoscopy

D. cystoscopy

2. What is correct regarding duloxetine?

Α. It is an inhibitor of serotonin/noradrenalin reuptake

B. It was approved for male effort incontinence three years ago

C. EAU guidelines include recommendations for treating male effort incontinence with duloxetine

D. I's most frequent side effect is constipation

3. Which of the following sling systems DO NOT cause obstruction:

Α. Remeex system

B. Invance sling

C. AdVance sling

D. Argus system

4. The method of choice for treating serious effort incontinence is:

A. injection of bulking substances

B. placement of an adjustable sling

C. placement of an artificial sphincter

D. placement of the Pro-Act-System

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5. What is correct when treating effort incontinence after prostatectomy?

A. long term results of injected bulking substances are very good

B. the Invance system is the treatment of choice for serious incontinence

C. surgical treatment is the first line method in treating incontinence after prostatectomy in the
first 6-12 months

D. the combination of pelvic floor exercises with duloxetine has been shown to be more
effective than pelvic floor exercises alone

6. Mixed incontinence affects quality of life:

Α. Less than urgency incontinence

Β. More than urgency incontinence

C. As much as urgency incontinence

7. The percentage of mixed incontinence in relation to overall incontinence in women is:

Α. 42%

Β. 11%

C. 29%

8. When there is mixed incontinence and the bladder neck is open, the best surgical
treatment is:

Α. Placement of a sling at the level of the urinary bladder neck

Β. Burch colposuspension

C. Non-stress midurethral sling placement

9. In mixed incontinence, the guidelines of the International Continence Society are:

Α. Specialized examination and treatment

Β. Treating the most distressing symptom first

C. Minimally invasive methods as first line treatment

D. Β+C

10. The evidence basis for surgical treatment of mixed incontinence concerns:

Α. Activation of urethral sensory fibers by leaking urine

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Β. Activation of detrusor contraction through stimulatory vesicourethral reflex

C. Both of the above

D. None of the above is correct

11. Which of the following sentences is correct concerning anticholinergics?

Α. All anticholinergics are equally well tolerated by patients

Β. Dariphenacin and oxybutynin present the most unfavorable tolerance profile

C. Oxybutynin has the highest rate of patients withdrawing from clinical trials

D. All of the above

12. Anticholinergics in therapeutic doses:

Α. Act mainly on the detrusor muscle but cause urinary retention in only a small percentage of
cases

Β. Act in the urinary storage phase

C. Increase bladder capacity and limit urination urgency, frequent urination and urinary
incontinence

D. Β+C are correct

13. Which of the following sentences is correct?

Α. Type 4 muscarinic receptors play key-role in normal detrusor contractions

Β. Blood-brain barrier permeability changes in neurological conditions and with age

C. Oxybutynin can affect cognitive functions, sleep and EEG results

D. All of the above

14. Antimuscarinic receptor level selectivity:

Α. Is higher for oxybutynin

Β. Is higher for dariphenacin

C. Is greater for tolterodine

D. None of the above

15. For preventing incontinence after radical prostatectomy pelvic floor muscle retraining
must commence
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Α. 2 weeks after catheter removal

Β. Pre-operatively and directly after surgery

C. 1 month after surgery

D. 3 months after surgery

16. What would you consult patients to do so as to decrease incontinence episodes after
radical prostatectomy:

Α. Practice bulbar urethral massage after urinating

Β. Treating their constipation

C. Decreasing their alcohol intake

D. All of the above

17. Physical therapy to treat incontinence after radical prostatectomy includes

Α. pelvic floor muscle exercises

Β. bladder retraining

C. biofeedback

D. all of the above

18. In incontinence after radical prostatectomy the pelvic floor muscle rehabilitation plan
should last:

Α. 3 weeks

Β. 8 weeks

C. 12 weeks

D. More than 18 weeks

19. Changing prescriptions from listed to generic anticholinergics may:

Α. increase incontinence episodes

Β. increase mouth dryness

C. increase urination frequency

D. All of the above

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20. Invasive urodynamic examinations are recommended for:

Α. Patients with urinary incontinence regardless of dysuric complaints

Β. Male patients with symptoms of non-complicated bladder outlet obstruction

C. Patients with mixed urinary incontinence after scheduled surgical restoration

D. All of the above

21. Urodynamic examinations in post-prostatectomy incontinence is indicated when

suspecting:

Α. Sphincter deficiency

Β. Detrusor overactivity

C. Presence of symptoms indicating mixed incontinence

D. All of the above are correct

22. In neurogenic dysfunctions of the lower urinary tract:

Α. Detrusor overactivity with a normally functioning outer sphincter is the most usual urodynamic
finding in multiple sclerosis

Β. Detrusor underactivity with a normally functioning outer sphincter is the most usual
udodynamic finding in multiple sclerosis

C. Detrusor underactivity with dyssynergia of the outer or inner sphincter is the most usual
finding in multiple sclerosis

D. Urodynamic examinations is indicated to assess the condition of the lower urinary tract
before applying any new form of treatment

23. In the surgical treatment of urinary incontinence:

Α. The morphology of the cervix is not important for the type of surgical treatment

Β. The presence of an overactive detrusor and is not a contraindication for surgical repair
of effort incontinence

C. Measuring ureteric pressures is irrelevant in choosing a surgical procedure

D. The presence of a cystocele affects the type of surgical procedure to be chosen

24. Mixed urinary incontinence, when compared to effort incontinence, is believed to

affect quality of life:
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Α. more

Β. less

C. equally

D. there are no relevant data

25. When correlated to age, effort incontinence rates

Α. increase

Β. remain the same

C. decrease

D. there are no relevant data

26. Which of the following is correct concerning urinary incontinence?

Α. Weight loss in seriously overweight women can improve urge incontinence to the same extent
as in effort incontinence

Β. Bladder retraining can help in cases of mixed incontinence

C. A decrease in caffeine intake, combined with bladder retraining, is more effective than bladder
retraining alone

D. All of the above

27. Which of the following is correct concerning urinary incontinence?

Α. Physical therapy is recommended as first line treatment in all types of incontinence

Β. Physical therapy is recommended as first line treatment only in effort incontinence

C. Physical therapy, in combination with biofeedback, is recommended as first line treatment in

all types of incontinence

D. Both magnetic and exterior surface electrostimulation surpass virtual incontinence treatment

28. Which of the following is correct concerning urinary incontinence?

Α. Estrogen therapy can help restore continence

Β. Anticholinergic treatment is effective in mixed incontinence

C. Mixed urinary incontinence is a positive prognostic factor in the surgical treatment of

incontinence
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D. All of the above

29. The term ‘mixed incontinence’ means:

Α. Incontinence due to effort and urgency

Β. Incontinence due to effort and urgency incontinence

C. Incontinence due to bladder overactivity and sphincter deficiency

30. Pad tests

Α. Objectively illustrates incontinence gravity

Β. Illustrates the type of incontinence

C. Neither of the above

31. The Q-tip​ ​test

Α. Assesses incontinence gravity

Β. Indicates whether a full urodynamic study is indicated

C. Illustrates the presence of bladder overactivity

32. The degree to which a drug affects the central nervous system depends on

Α. Whether it crosses the blood-brain barrier

Β. Its lipophilicity

C. Α+Β

D. None of the above

33. Mouth dryness is a side effect of anticholinergics, which

Α. is often serious, leading to treatment termination

Β. is common, but usually mild and well-tolerated, if the treatment is effective

C. is rare

34. Anticholinergics:

Α. Are of comparable effectiveness

Β. Have different safety and tolerance profiles

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C. Both Α+Β are correct

35. How long should an urination log ideally last?

Α. 1 day

Β. 3 days

C. 7 days

D. 10 days

36. What is the definition of night-time frequent urination?

Α. Evacuation of > 20% of daily urine volume during the night in young adults

Β. Evacuation of > 33% of daily urine volume during the night in young adults

C. Evacuation of > 20% of daily urine volume during the night in adults > 65 years

D. Evacuation of > 33% of daily urine volume during the night in adults > 65 years

Ε. A+D

F. Β+C

37. When evaluating nocturia we must:

Α. Take into account all urination after retiring for the night

Β. Also take into account the first urination of the following morning

C. Take into account the number of times one urinates interrupting a night's sleep

D. Take into account the number of times one urinates interrupting a night's sleep,
which are followed by and which follow sleeping

38. The most serious undesirable side effect of BOTOX bladder injection is:

Α. Developing antibodies/tolerance

Β. Needing intermittent catheterization post-operatively

C. General muscular weakness

D. Increased frequency of UTIs

39. BOTOX bladder injections:

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Α. Are equally effective in patients with multiple sclerosis as well as those with spinal cord
injury

Β. Are equally effective at 200 and 300 units

C. Are equally effective when administered repeatedly

D. All of the above are correct

40. The most appropriate antibiotics for the treatment of urinary tract mycoplasma
infection are:

Α. Tetracyclines

Β. Quinolones

C. Macrolides

D. Cephalosporins

41. What does the general pelvic floor neurological assessment include?

Α. The bulbar-cavernosus reflex

Β. Involuntary anal sphincter tone

C. Voluntary anal sphincter tone

D. Perineal sensitivity

E. All of the above

42. Which of the following is the correct treatment for overactive/hyper-reflexive

bladder?

Α. Pelvic floor physical therapy is a b line treatment following anticholinergic treatment failure

Β. Sacral root neuro-stimulation is an approved b line treatment

C. Urethra dilation is highly documented

D. Bladder botulinum toxin injections are an approved b line treatment

43. Choose the correct option

Α. Intermittent catheterizations are always performed after urination to ensure evacuation and
measure residual urine volume

Β. If the patient succeeds in emptying his/her bladder, they will not need intermittent
catheterization
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C. The thinnest possible catheter is used so as to avoid injuring the urethra

D. Increased intake of liquids (more than 2.5 litres a day) is necessary to limit UTIs.

Ε. All are incorrect

F. All are correct

44. Patients who are catheterized must:

Α. receive chemo-protection

Β. have a urine culture every month and follow a medication course based on the antibiogram

C. receive an antibiotic course of treatment only when a clinical UTI appears and is
symptomatic

D. have a urine culture every three months for monitoring purposes and use this as a therapeutic
tool, when a UTI appears

45. Choose what is correct for intermittent catheterization

Α. The cleaning technique entails reusing the same catheter after washing it and inserting
it with clean, washed hands

Β. The sterile technique is best, as it limits UTI likelihood

C. The aseptic technique requires cleaning of the genital area with a powerful antiseptic before
each catheterization

D. All of the above are correct

Ε. All of the above are incorrect

46. In children with persistent nocturnal enuresis when treated with scheduled
awakenings and desmopressin​:

Α. Nocturnal polyuria

Β. 44% present detrusor overactivity only during the night

C. Awakening disorders

D. Treatment was not performed as it should have been

47. The pelvic floor muscle which DOES NOT seem to play an important role in urine
continence is:

Α. The puboperinealis

Β. The puborectalis
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C. The rectourethralis

D. The pubococcyggealis

Ε. Α+D

48. The urethra sphincter:

Α.comprises striated muscle fibers in circular array

Β. Consists of smooth muscle fibers in semi-circular array

C. contains both striated and smooth muscle fibers in two layers

D. Has ​fast twitch​ muscle fibers

Ε. Α+C

49. What is NOT true in urinary effort incontinence

Α. The morphology of the cervix is important for the type of surgical treatment to be chosen

Β. Detrusor overactivity is a contraindication for stress incontinence surgery

C. Ureteric pressures measurements are important in choosing the surgical procedure to be

performed

D. Colposuspension also repairs/corrects cystocele

Ε. The presence of a cystocele does not affect the type of surgical procedure to be chosen

50. Following cystocele repair using a mesh, ​de nuovo​ effort incontinence ratios are:

Α. 5%

Β. 10%

C. 30%

D. 50%

Ε. 60%

External Genitalia Diseases

1. Which is the most reliable examination for the diagnosis of syphilis?

Α. Dark-field examination

Β. Culture from genital ulcer material

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C. PRL & VDRL

D. FTA abs & TPHA

2. What is the indicated therapy in relapsing genital herpes?

Α. 10-day application of anti-herpes ointment

Β. Per os episode therapy (5 days)

C. Per os 6-month suppressive therapy

D. Per os 12-month suppressive therapy

3. How long after the "bleaching" (whitening) therapy of condylomata acuminata, is the
patient considered to be a 'non-carrier'?

Α. After 3 months

Β. After 9 months

C. After 12 months

D. It is unknown.

4. What should be done in a recently-occurring solitary pigmented lesion on the penile

glans or vaginal lips?

Α. Removal of the lesion

Β. Clinical/ Dermatoscopic monitoring

C. Histological examination

D. Ablation with Cryopexy, Diathermy or Laser

5. What is the prognosis of Zoon's plasmocellular balanitis?

Α. Spontaneous remission

Β. Progression into SCC

C. Exacerbations and remissions

6. Which of the following statements about the treatment of genitalia condylomas is true?

A. The most common etiological factor is HPV, types 6 and 11.

Β. Histological examination is necessary only in atypical pigmented ulcerated lesions.

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C. Lesions of the outer urethral orifice are an absolute indication for screening the bladder and
urethral mucosa with urethrocystoscopy.

D. All the above are correct.

Ε. Α and Β are correct.

7. Which of the following statements is true concerning Balanitis Xerotica Obliterans in

children?

Α. Balanitis Xerotica Obliterans is 1-3% likely to progress into penile cancer before the age of 20.

Β. Topical corticosteroid therapy replaces surgery in 80-85% of cases.

C. The penile glans participates in the disease by 5-7%.

D.Balanitis Xerotica Obliterans is rare in children below 5 years old.

8. What is the proper order of steps for the surgical reconstruction of hypospadias?

Α. Straightening of the penis -Urethroplasty -Balanoplasty

Β. Urethroplasty -Balanoplasty -Straightneing of the penis

C. Balanoplasty - Straightening of the penis - Urethroplasty

D. Balanoplasty - Urehtroplasty - Straightening of the penis

9. All the following are mentioned as causes of chronic testicular pain apart from:

Α. Spermatocele

Β. Inguinal hernia

C.Constipation

D. Irritable bowel syndrome

Ε. Urethral stricture

10. Which of the following statements about circumcision is true?

Α. The most common complication of circumcision is bleeding from the frenular artery.

Β. There are indications in literature that circumcision improves sexual function and satisfaction.

C. Adhesiolysis (lysis of prepuce and balanus adhesions) is the most crucial surgical step
irrespective of which technique is followed afterwards

D. Α and C are correct.

Ε. All the above are correct.

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Infertility
1.Should the subclinical varicocele be operated?

Α. Only if it affects sperm parametres

Β. Only if it causes hormonal disorders (increase of FSH)

C. Only if it is accompanied with scrotal pain

D. No, it is not operated for it does not increase the chances of spontaneous gestation.

Ε. Μόνο εάν παρατηρηθεί υστερημένη ανάπτυξη του όρχεως σε σχέση με τον ετερόπλευρο
(ασυμμετρία >20%)

2. Does testis biopsy make sense during varicocele repair surgery and when?

Α. Only if we freeze testicular tissue and always from the fellow testis.

Β. Yes, and it could be conducted in every session of varicose surgery.

C. No, it makes no sense according to existing literature data.

D. Only if there are signs of progressive testicular impairment observed (e.g. asymmetry of
right-left testes >20% or increase of FSH)

Ε. In cases A and D.

3. When is varicocele operated in children?

Α. When there is progressive testicular growth retardation observed, confirmed by a series of

clinical examinations or scrotal pain.

Β. When varicocele is palpated bilaterally during clinical examination.

C. When another testicular pathology co-exists, which may affect future fertility, or when there is
increased response to LHRH testing.

D. When there are poor sperm parameters observed (in older adolescents).

Ε. In all the above cases.

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4. When performed before the use of some assisted-reproduction method in an infertile

couple, varicocele surgery may result in:

Α. double chances for implantation of fertilized embryos

Β. reduction of miscarriage rate during the 2nd gestation trimester

C. high chances for twin gestation

D. maintaining a stable number of spermatozoa that can be retrieved

5. In which cases after varicocele surgery, may chances to achieve gestation increase?

Α. Only when the number of produced spermatozoa (sperm cells) increases.

Β. When motility of spermatozoa increases after the 2nd hour of their incubation.

C. When spermatozoa with normal morphology are more than 4%, according to WHO criteria.

D. Irrespective of changes in microscopic sperm parameters, due to the positive effect on

the DNA package.

6. Which of the following statements about hydrocele surgical treatment is true?

A. Inguinal approach is the standard surgical approach when there is suspicion of testicular
pathology or the testes has not been tested.

Β. The "excision" technique is superior to the "plication" technique, with reference to hydrocele
relapse rate.

C. The most common surgical complication is hematoma followed by epididymal and spermatic
cord injuries.

D. All the above are correct.

Ε. None of the above is correct.

7. Which of the following statements about spermatic vein ligation is true?

A. Subinguinal approach is characterized by lower morbidity than in the inguinal approach (as
inguinal duct walls are not opened), but is a more demanding procedure from a technical point of
view.

Β. The most common complication from the inguinal or subinguinal approach without the use of
microsurgery is hydrocele formation (according to literature rates, such risk ranges from 3 to
39%) .

C. Injury of the testicular artery during varicocelectomy typically leads to testicular atrophy.
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D. All above anwers are correct.

Ε. Α and Β are correct.

8. In a patient with obstructive azoospermia and normal FSH levels participating in an

assisted-reproduction program, the method of choice for collecting male gametes is:

Α. Fine-needle aspiration of testicular cells

Β. Open testicular biopsy

C. Microsurgical testis biopsy

D. Microsurgical sperm cell collection from the lumen of the epididymal head

Ε. Fine-needle puncture from the epididymal tail

9. Male patient with non-obstructive azoospermia and normal karyotype presents total
microdeletions of the AZFa region and left varicocele. What treatment would you
recommend?

Α. Repair of the left varicocele.

Β. Bilateral spermatic vein ligation

C. Left testicular biopsy for identifying spermatozoa

D. Right testicular biopsy for identifying spermatozoa

Ε. None of the above methods

10. Which of the following statements is true?

Α. Androgens play an important role in the first phase of the testicular descending process.

Β. Androgens play an important role in the second phase of the testicular descending
process.

C. Androgens play no role in the testicular descending process.

D. The second phase of the testicular descending process takes place due to oestrogen action.

11. Cryopreservation of spermatozoa means:

Α. Preservation of spermatozoa at -80​ο​C

Β. Preservation of spermatozoa at -120​ο​C

C. Preservation of spermatozoa at -196​ο​C

D. Preservation of spermatozoa at -0​ο​C

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12. Which of the below agents has/have a negative effect on spermatogenesis?

A. Κetoconazole

Β. Spironolactone

C. Κolhikin

D. Estrogens

Ε. All the above

13. Spermatogenesis can be inhibited, if a male presented feverish disease:

Α. 1 year before

Β. the last 7 days

C. the last 6 months

D. There is absolutely no correlation.

14. When the man aims at conceiving, it is better to ejaculate during his female partner's
productive phase:

Α. every two days

Β. on a daily basis

C. when ovulation has been confirmed

15. Prostagladines are produced by the same male accessory reproductive gland that
secretes also:

Α. citric acid

Β. fructose

C. glucosidase

D. Zink

16. In non-mosaic Klinefelter's syndrome with left varicocele, it makes sense to:

Α. repair the varicocele

Β.repair the varicocele and perform therapeutic testis biopsy

C. perform therapeutic testis biopsy only

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17. Every man with azoospermia should:

Α. undergo karyotype screening, as long as there is absence of spermatic duct on the left

Β. undergo karyotype screening, as long as there is absence of spermatic duct bilaterally

C. undergo karyotype screening, as long as the primary testicular lesion has been
diagnosed

D. undergo karyotype screening, only if there are microdeletions of the Y-chromosome

18. Seminovesiculography is:

Α. an essential examination that should be done in all azoospermic patients

Β. an essential examination that should be done in all patients with non-obstructive azoospermia

C an essential examination that should be done to diagnose obstructive azoospermia

D. an essential examination that should be done only before the surgical procedure for
restoring patency of reproductive ducts

19. An azoospermic male patient with intratubular in situ neoplasia:

Α. will never develop testicular tumor

Β. is very unlikely to develop testicular tumor

C. will surely develop invasive testicular tumor, as long as he lives enough

20. In a patient with obstructive azoospermia and normal FSH levels participating in an
assisted-reproduction program, the method of choice for collecting male gametes is:

Α. Fine-needle aspiration of testicular cells

Β. Open testicular biopsy

C. Microsurgical testis biopsy

D. Microsurgical sperm cell collection from the lumen of the epididymal head

Ε. Fine-needle puncture from the epididymal tail

21. Male patient (30-year old fertile wife) with 13.000.000 spermatozoa/ mΙ, 10%
quantitative motility of spermatozoa and 28% spermatozoa with normal morphology
(according to WHO) is diagnosed with left varicocele (normal hormone levels). Which
therapy should the Expert follow so that the couple can achieve gestation?

Α. Collecting spermatozoa from seminal fluid with masturbation and then in-vitro fertilization (IVF)
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Β. Administration of R-FSH and R-LH

C. Varicocele sclerotherapy

D. Surgical repair of varicocele

22. Which surgical method for varicocele repair is the most appropriate?

Α. Palomo

Β. Ivanissevich

C. Laparoscopic

D. Robotic

Ε. Subinguinal microsurgical varicose repair

23. For patients who presented biochemical relapse after radical prostatectomy, which of
the following factors are related more to local relapse rather than with remote metastasis?

Α. First measurable PSA value 6 months after surgery, Gleason score​>​7, pathological stage Τ3

Β. Age below 70 at the time of relapse, first measurable PSA value < 2 ng/ml, Gleason score ​<​5

C. Histological absence of seminal vesicles and lymph-nodes, Gleason score ​<​5, first
measurable PSA value one year after surgery, PSA doubling-time (PSADT) >6 months

D. Pathological stage Τ2, Gleason score 8 to 10, negative bone scintigram

Ε. First measurable PSA value 4 months after surgery, negative biopsy of prostatic bed, PSA
doubling-time (PSADT) <3 months

Chronic Pelvic Pain

1. What is the main characteristic element of the Pelvic Pain Syndrome?

Α. Pain, pressure or discomfort localized in the pelvis.

Β. Pain, pressure or discomfort related to bladder filling, relieved with urination.

C. Pain, pressure or discomfort related to the bladder.

D. None of the above.

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2. Which of the following conditions occur/s in the pelvic pain syndrome more frequently
than in the general population?

Α. Allergies and autoimmune diseases

Β. Crohn's disease

C. Sjogren's syndrome

D. Fibromyalgia

Ε. All the above.

3. The various Pelvic Pain Syndrome types are classified based on:

Α. cystoscopic findings with hydrodilation, morphological elements from bladder biopsies and
localization of pain.

Β. cystoscopic findings with hydrodilation, morphological elements from bladder

biopsies.

C. cystoscopic findings and symptoms.

D. cystoscopic findings with hydrodilation, symptoms and urodynamic findings.

4. Which of the following is NOT a 2nd-line treatment in the Pelvic Pain Syndrome?

Α. Analgesics

Β. Αntidepressants

C. Αntihistamines

D. Botulinum toxin Α

Ε. Pentosan Polysulfate Sodium (Na-PPS)

5. Pelvic Pain Syndrome: Transurethral Resection, Cautery or Laser are applied mainly:

Α. after relapse of BCG

Β. in the Bladder Pain Syndrome, type 3X

C. in every type of Bladder Pain Syndrome

D. in none of the above cases

6. In the lower urinary tract, the pain is characterized as 'chronic', when lasting at least:

Α. 1 month
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Β. 2 months

C. 3 months

D 6 months

Ε. 9 months

7. In the Chronic Pelvic Pain Syndrome (CPPS):

Α. pain may be caused by tumor in the minor pelvis.

Β. microbes are cultivated in 15% of cases.

C. differentiation between ΙΙΙΑ and ΙΙΙΒ has no clinical or therapeutic significance.

D. administration of corticosteroids

Ε. Endometriosis is not an etiological factor.

8. In the therapeutic treatment of chronic prostatic pain (prostatodynia), the following has
no documented indication:

Α. COX2 inhibitors

Β. Phytotherapy

C. Supportive care and acupuncture

D. α-inhibitors

Ε. Quinolones

9. All conditions below are mentioned as causes of chronic testicular pain APART FROM:

Α. Spermatocele

Β. Inguinal hernia

C. Constipation

D. Irritable bowel syndrome

Ε. Urethral stricture

10. Which of the following statements is FALSE?

Α. Gabapentin and Pregabalin are substances acting on pain signal transmission and are used
in the Chronic Pelvic Pain Syndrome (CPPS).

Β. Prostatic Pain Syndrome (PPS) and Bladder Pain Syndrome (BPS) are etiologically
interconnected.
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C. Sexually-transmitted diseases may lead to chronic orchialgia (testicular pain).

D. In the treatment of CPPS, intraprostatic injections of lidocaine and Botulinum toxin A have
been tried.

Ε. Scrotal ultrasound has high diagnostic value in identifying the cause of chronic scrotal
pain.