Urology Prometric exam questions with answers

1. Question 1Basic Sciences and Basics of Urologic Surgeryeasy

   A 35-year-old man has right loin-to-groin pain from a 4 mm ureteric stone. At which site is the ureter narrowest and a stone most likely to lodge?

   1. APelviureteric junction
   2. BVesicoureteric junction
   3. CWhere it crosses the iliac vessels
   4. DWhere it passes beneath the gonadal vessels
   Show answer and explanation▾

   Answer: B. Vesicoureteric junction

   The three classic sites of ureteric narrowing are the pelviureteric junction, the crossing of the iliac vessels at the pelvic brim and the vesicoureteric junction, and the VUJ is the narrowest, making it the commonest site of stone impaction. The pelviureteric junction often obstructs larger stones but is wider than the VUJ. The gonadal vessel crossing is not a recognised point of constriction.

2. Question 2Infections and Inflammatory Conditions of the Genitourinary Tractmedium

   Four patients have a urine culture growing more than 10^5 CFU/mL of Escherichia coli without urinary symptoms. Which patient should receive antibiotic treatment?

   1. AA 78-year-old woman in a nursing home with dementia
   2. BA 55-year-old woman with well-controlled type 2 diabetes
   3. CA 40-year-old man with a long-term urethral catheter
   4. DA 68-year-old man scheduled for transurethral resection of the prostate
   Show answer and explanation▾

   Answer: D. A 68-year-old man scheduled for transurethral resection of the prostate

   Asymptomatic bacteriuria should be screened for and treated before urological procedures that breach the mucosa, such as TURP, because of the high risk of postoperative bacteraemia and sepsis; treatment is also indicated in pregnancy. In older or institutionalised adults, people with diabetes and catheterised patients, treatment does not improve outcomes and promotes antimicrobial resistance and Clostridioides difficile infection. Catheter-associated bacteriuria is managed with catheter care unless symptomatic.

3. Question 3Urolithiasis and Obstructive Uropathyeasy

   A 48-year-old woman has fever of 39.2 degrees C, rigors, right loin pain and hypotension responding to fluids. CT shows a 9 mm obstructing proximal ureteric stone with hydronephrosis. Blood cultures are taken and antibiotics started. What is the most appropriate next step?

   1. AUrgent decompression with a ureteric stent or nephrostomy
   2. BEmergency ureteroscopy and laser lithotripsy
   3. CExtracorporeal shock wave lithotripsy within 24 hours
   4. DMedical expulsive therapy with tamsulosin
   Show answer and explanation▾

   Answer: A. Urgent decompression with a ureteric stent or nephrostomy

   An obstructed, infected kidney is a urological emergency, and urgent drainage by retrograde ureteric stent or percutaneous nephrostomy, together with antibiotics, is required; both methods are effective. Definitive stone treatment should be delayed until the sepsis has resolved because stone manipulation during active infection risks worsening sepsis. Medical expulsive therapy is inappropriate in the presence of infection and obstruction.

4. Question 4Urolithiasis and Obstructive Uropathymedium

   A 58-year-old obese man with type 2 diabetes and gout has a 14 mm renal pelvis stone that is not visible on a plain radiograph. Non-contrast CT shows an attenuation of about 400 HU. Urine pH is 5.0 and renal function is normal. What is the most appropriate first-line treatment?

   1. APercutaneous nephrolithotomy
   2. BFluoroscopically guided shock wave lithotripsy
   3. COral alkalinisation with potassium citrate for chemolysis
   4. DA thiazide diuretic and low-calcium diet
   Show answer and explanation▾

   Answer: C. Oral alkalinisation with potassium citrate for chemolysis

   A radiolucent stone with low CT attenuation in a patient with metabolic syndrome, gout and persistently acidic urine is likely to be uric acid, which can be dissolved by oral chemolysis: alkalinising the urine with potassium citrate (or sodium bicarbonate) to the recommended target pH, with high fluid intake and allopurinol if there is hyperuricosuria. Shock wave lithotripsy is difficult to target with fluoroscopy because the stone is radiolucent, and PCNL is unnecessary as first-line. Thiazides and calcium restriction are not relevant to uric acid stones.

5. Question 5Neurourology, Voiding Dysfunction, Incontinence and Female Urologyhard

   A 32-year-old man with a complete T4 spinal cord injury is undergoing urodynamic studies. During bladder filling he develops a pounding headache, facial flushing, sweating above the level of injury and a blood pressure of 210/115 mmHg with a heart rate of 50/min. What is the most appropriate immediate action?

   1. AGive intravenous atropine for the bradycardia
   2. BStop filling, empty the bladder and sit him upright
   3. CContinue the study to complete the pressure-flow assessment
   4. DLie him flat and give intravenous fluid
   Show answer and explanation▾

   Answer: B. Stop filling, empty the bladder and sit him upright

   Autonomic dysreflexia occurs with spinal cord lesions at or above T6 when a noxious stimulus below the level, most often bladder distension, triggers unopposed sympathetic outflow. The immediate actions are to remove the stimulus by stopping filling and draining the bladder, sit the patient upright and loosen tight clothing; if systolic pressure remains around 150 mmHg or more, a rapid-acting antihypertensive such as nifedipine or a nitrate is given. Bradycardia is a reflex response that resolves as blood pressure falls, so atropine is not the treatment.

6. Question 6Neurourology, Voiding Dysfunction, Incontinence and Female Urologyhard

   Three weeks after total abdominal hysterectomy, a 46-year-old woman has continuous vaginal leakage of urine in addition to normal voiding. A three-swab tampon test is performed after oral phenazopyridine and bladder instillation of methylene blue. The uppermost swab is stained orange, and none of the swabs is blue. What is the most likely diagnosis?

   1. AVesicovaginal fistula
   2. BUrethrovaginal fistula
   3. CStress urinary incontinence
   4. DUreterovaginal fistula
   Show answer and explanation▾

   Answer: D. Ureterovaginal fistula

   Phenazopyridine colours all urine from the kidneys orange, whereas methylene blue marks only bladder urine. Orange staining of the uppermost swab without blue means urine reaches the vaginal vault directly from a ureter, indicating a ureterovaginal fistula, a recognised complication of hysterectomy; normal voiding continues because the other kidney drains into the bladder. Blue staining of the upper swab would indicate a vesicovaginal fistula, and blue on the lowest swab suggests a urethrovaginal fistula or urethral leakage.

7. Question 7Genitourinary Trauma and Reconstructive Urologyeasy

   A 30-year-old man heard a cracking sound during vigorous intercourse, followed by immediate detumescence, pain and a large purple swelling of the penis that deviates to one side. He is voiding normally with no blood at the meatus. What is the most appropriate management?

   1. AIce packs, analgesia and review in 1 week
   2. BA compression bandage and oral antibiotics
   3. CUrgent surgical exploration and repair of the tunica albuginea
   4. DElective penile ultrasound in 6 weeks
   Show answer and explanation▾

   Answer: C. Urgent surgical exploration and repair of the tunica albuginea

   This is a penile fracture, a rupture of the tunica albuginea of the corpus cavernosum, and early surgical exploration and repair reduces erectile dysfunction, curvature and painful erections compared with conservative management. Urethral injury must be suspected if there is blood at the meatus or difficulty voiding, and assessed during repair. Conservative or delayed management is associated with more long-term complications.

8. Question 8Prostate: Benign Prostatic Hyperplasia and Prostate Cancermedium

   A 68-year-old man has bothersome lower urinary tract symptoms with an IPSS of 19. Transrectal ultrasound estimates prostate volume at 70 mL, PSA is 3.2 ng/mL and post-void residual is 60 mL. Urinalysis and renal function are normal. Which medical therapy best reduces his risk of symptom progression, urinary retention and need for surgery?

   1. AAn alpha-blocker combined with a 5-alpha-reductase inhibitor
   2. BAn alpha-blocker alone
   3. CAn antimuscarinic alone
   4. DA phosphodiesterase-5 inhibitor alone
   Show answer and explanation▾

   Answer: A. An alpha-blocker combined with a 5-alpha-reductase inhibitor

   In men with moderate-to-severe LUTS and an enlarged prostate (over about 40 mL) or raised PSA, combining an alpha-blocker with a 5-alpha-reductase inhibitor is superior to either drug alone in reducing clinical progression, acute urinary retention and the need for surgery. Alpha-blockers relieve symptoms quickly but do not shrink the prostate or reduce long-term retention risk. Antimuscarinics and PDE5 inhibitors improve storage symptoms or LUTS but do not alter disease progression.

9. Question 9Prostate: Benign Prostatic Hyperplasia and Prostate Cancerhard

   A 64-year-old man has taken dutasteride for 18 months. His PSA was 4.2 ng/mL before starting, fell to a nadir of 2.0 ng/mL at 9 months and is now 2.9 ng/mL on two consecutive measurements. Digital rectal examination is unchanged. How should this result be interpreted?

   1. ANormal, as the value remains below 4.0 ng/mL
   2. BConcerning, as a confirmed rise from the nadir warrants evaluation for prostate cancer
   3. CNormal, as PSA on dutasteride should be halved before interpretation
   4. DConcerning only once PSA exceeds the pretreatment value of 4.2 ng/mL
   Show answer and explanation▾

   Answer: B. Concerning, as a confirmed rise from the nadir warrants evaluation for prostate cancer

   5-alpha-reductase inhibitors lower PSA by about 50% after 6 to 12 months, so the measured value should be doubled for comparison with standard reference ranges. A confirmed rise from the on-treatment nadir is suspicious for prostate cancer, because cancer-derived PSA is less suppressed, and warrants further evaluation such as prostate MRI. Interpreting the raw value against the usual threshold, or waiting until it exceeds the baseline, would delay diagnosis.

10. Question 10Kidney and Adrenal Tumoursmedium

    A healthy 55-year-old woman has an incidentally discovered 3.2 cm enhancing solid mass in the lower pole of the right kidney. The contralateral kidney is normal, eGFR is 85 mL/min/1.73 m2 and staging shows no metastases. Which treatment is preferred?

    1. ARadical nephrectomy
    2. BActive surveillance with imaging every 6 months
    3. CSystemic tyrosine kinase inhibitor therapy
    4. DPartial nephrectomy
    Show answer and explanation▾

    Answer: D. Partial nephrectomy

    For a clinical T1a renal mass (4 cm or less), partial nephrectomy is preferred when technically feasible, because oncological outcomes match radical nephrectomy while renal function is preserved, reducing the risk of chronic kidney disease and its cardiovascular consequences. Thermal ablation and active surveillance are alternatives mainly for older or comorbid patients. Systemic therapy has no role in localised disease.

11. Question 11Bladder Cancer, Urothelial, Testicular and Penile Malignancymedium

    A 32-year-old man undergoes right radical inguinal orchidectomy for a 2.5 cm pure seminoma without lymphovascular or rete testis invasion. Post-orchidectomy tumour markers are normal and CT of the chest, abdomen and pelvis is normal (stage IA). He is reliable and keen to avoid unnecessary treatment. What is the preferred management?

    1. AActive surveillance
    2. BTwo cycles of BEP chemotherapy
    3. CRetroperitoneal lymph node dissection
    4. DRoutine adjuvant para-aortic radiotherapy
    Show answer and explanation▾

    Answer: A. Active surveillance

    For stage I seminoma, surveillance is the preferred option in reliable patients because relapse rates are low and nearly all relapses are cured with salvage treatment, sparing most men unnecessary therapy. Single-dose carboplatin is an alternative for those wishing to reduce relapse risk, while adjuvant radiotherapy is now rarely used because of second malignancy risk. BEP chemotherapy and retroperitoneal lymph node dissection are not standard for stage I seminoma.

12. Question 12Renal Failure, Renovascular Disease and Transplantationhard

    Five weeks after a deceased-donor kidney transplant, a 50-year-old man has rising creatinine and mild graft hydronephrosis. Ultrasound shows a 9 cm perigraft fluid collection, which is aspirated for analysis. Which result would indicate a urinoma rather than a lymphocele?

    1. AFluid creatinine similar to serum creatinine
    2. BA high fluid triglyceride concentration
    3. CFluid creatinine several times higher than serum creatinine
    4. DLymphocyte predominance on fluid cytology
    Show answer and explanation▾

    Answer: C. Fluid creatinine several times higher than serum creatinine

    Urine has a much higher creatinine concentration than plasma, so fluid creatinine several times the serum value identifies a urinoma from a urinary leak, usually at the ureteroneocystostomy. A lymphocele, the commonest perigraft collection at this stage, contains lymph with a creatinine similar to serum and lymphocyte predominance. Symptomatic lymphoceles are treated by drainage with sclerotherapy or laparoscopic peritoneal fenestration, whereas urinomas need urinary diversion and often ureteric revision.

13. Question 13Andrology, Male Infertility and Sexual Medicinemedium

    A 28-year-old man with sickle cell disease has had a painful, rigid erection for 6 hours. The glans is soft and the corpora are rigid. Corporal blood aspirate is dark, with pH 7.10, pO2 3 kPa (22 mmHg) and pCO2 9 kPa (68 mmHg). Which is the most appropriate first intervention?

    1. AImmediate penile prosthesis insertion
    2. BCorporal aspiration with irrigation, then intracavernosal phenylephrine if needed
    3. CSelective arterial embolisation
    4. DOral pseudoephedrine, ice packs and observation
    Show answer and explanation▾

    Answer: B. Corporal aspiration with irrigation, then intracavernosal phenylephrine if needed

    Acidosis, hypoxia and hypercapnia on corporal blood gas confirm ischaemic (low-flow) priapism, a compartment syndrome that needs urgent decompression by corporal aspiration with or without saline irrigation, followed by intracavernosal phenylephrine if detumescence is not achieved. In sickle cell disease, hydration, oxygen and haematology input are given alongside but must not delay penile intervention. Embolisation is used for non-ischaemic high-flow priapism, and prosthesis insertion is reserved for refractory prolonged cases.

14. Question 14Paediatric Urologymedium

    A 7-month-old boy, born at term, has a right testis that is palpable in the inguinal canal but cannot be brought into the scrotum; the left testis is normally descended. What is the most appropriate management?

    1. AUltrasound to confirm testicular position before referral
    2. BHormonal therapy with hCG to induce descent
    3. CReview at 3 years of age, as late descent is common
    4. DReferral for orchidopexy, ideally completed by 18 months of age
    Show answer and explanation▾

    Answer: D. Referral for orchidopexy, ideally completed by 18 months of age

    Spontaneous descent after about 6 months of corrected age is unlikely, so boys with an undescended testis should be referred for orchidopexy, which guidelines recommend completing by 12 to 18 months of age to optimise fertility potential and allow examination for later malignancy. Ultrasound before referral is not recommended because it rarely changes management and cannot reliably locate non-palpable testes. Hormonal therapy has low success rates and is not recommended to induce descent.

15. Question 15Patient Safety, Professionalism, Ethics, Communication and Evidence-Based Urologyeasy

    A screening programme reports that men whose prostate cancer was detected by PSA screening survive on average 3 years longer after diagnosis than men diagnosed with symptoms, yet prostate cancer mortality in the screened population is unchanged. Which bias best explains the apparent survival benefit?

    1. ARecall bias
    2. BAttrition bias
    3. CLead-time bias
    4. DObserver bias
    Show answer and explanation▾

    Answer: C. Lead-time bias

    Lead-time bias occurs when screening advances the time of diagnosis without changing the time of death, so survival measured from diagnosis appears longer even though screening has no effect on outcome. This is why population mortality in randomised trials, rather than survival from diagnosis, is the appropriate endpoint for screening. Length-time bias and overdiagnosis are related screening biases, whereas recall, attrition and observer bias concern data collection and follow-up.

Last reviewed September 2026. Questions are original and written to the published exam blueprint; they are not taken from any real paper.