Injury to Ureters

Q) Management of ureteral injury at the time of Left Colectomy

A) Mobilization of the two ends of the ureter and anastomoses of the spatulated ends over a stent

Q) Which portion of the ureter is at chance of injury during hysterectomy

A) At the level of broad ligament where ureter passes under the uterine vascular pedicle in relation to the cervix

Q) What are the contraindications of using ileum as a ureteic implant

A) Impaired renal function (Creatinine more than 2mg%)

      Bladder outlet obstruction

    Impaired emptying of bladder

Renal Tumors

Q ) Is Wilm's tumor in older children associated with good or bad prognosis

A) Older patients have more aggresive tumor with bad prognosis

Q ) What is the most common site of metastasis for Wilm's tumor

A) Lungs

Q ) Would you do a biopsy to confirm a Wilm's tumor

A) Biopsy is not always indicated. If at all percutaneous biopsy should be done

Renal Tumors

Kidney Stones

Q What is the relation of obesity with renal stone formation

A Obesity causes changes in urine chemistry reflecting increased calcium, uric acid, sodium, and decreased citrate in the urine.

Calcium oxalate and uric acid stones are more common in obese. 

ph of the urine decreases in obese. This is because  insulin resistance at the cellular level results in hyperinsulinemia, which in turn causes defects in renal production of ammonia, lowering the pH of the urine.

Q How long should one wait before advising surgery for renal stones

A 1 month is the average time one should wait before advising surgery. After one month the rate of complications such as strictures develop

General Urology

Q How is Fournier's  gangrene treated. What is the mortality rate?

A. Fournier's gangrene is treated by prompt debridement , Broad spectrum antibiotics and surgical debridement. Mortality rate ranges from 6-20%

Q What is the most common organism associated with Fournier's gangrene

A Staphylococcus and Streptococci

   Now even gram negative organisms and anaerobes are being cultured

Q. Is orchidectomy needed in debridement of Fournier's gangrene

A.  No

Testis can be preserved because 

1. They have a separate blood supply

2. They can be placed in a pouch in the thigh