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ABU Pediatric Urology study materials
ABU Pediatric Urology study resources

ABU Pediatric Urology practice questions

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Question 1Pediatric Urologic Oncology

What is the most common malignant renal tumor in children?

  1. Clear cell sarcoma of the kidney
  2. Renal cell carcinoma
  3. Mesoblastic nephroma
  4. Wilms tumor Correct answer.

Explanation

Wilms tumor (nephroblastoma) accounts for the large majority of pediatric renal malignancies, peaking between ages 2 and 5 years. Renal cell carcinoma is far less common in children, and the other entities are rare.

Question 2Pediatric Urologic Oncology

A 3-year-old presents with an asymptomatic abdominal mass. Which imaging study is the standard initial modality to evaluate a suspected renal mass in a child?

  1. Bone scan
  2. Intravenous pyelogram
  3. Abdominal ultrasound Correct answer.
  4. Upper gastrointestinal series

Explanation

Ultrasound is noninvasive, avoids radiation, and reliably distinguishes a renal mass from other abdominal masses, making it the first-line study. Cross-sectional imaging follows for staging.

Question 3Pediatric Urologic Oncology

Which congenital syndrome carries the highest risk of developing Wilms tumor and warrants regular screening?

  1. Turner syndrome
  2. Klinefelter syndrome
  3. WAGR syndrome Correct answer.
  4. Marfan syndrome

Explanation

WAGR (Wilms tumor, aniridia, genitourinary anomalies, retardation) results from WT1 deletion and confers a high Wilms tumor risk, prompting surveillance imaging. The other syndromes are not associated with Wilms tumor.

Question 4Pediatric Urologic Oncology

What is the most common presentation of a child with a Wilms tumor?

  1. Hypertension with seizures
  2. Painless abdominal mass Correct answer.
  3. Fever of unknown origin
  4. Frank hematuria

Explanation

Most children present with an asymptomatic, enlarging abdominal mass discovered by a caregiver. Hematuria and hypertension occur but are less common.

Question 5Pediatric Urologic Oncology

Which pediatric testicular tumor is the most common prepubertal germ cell tumor?

  1. Choriocarcinoma
  2. Seminoma
  3. Yolk sac tumor Correct answer.
  4. Embryonal carcinoma

Explanation

Yolk sac (endodermal sinus) tumor is the most common prepubertal malignant testicular germ cell tumor, typically presenting with an elevated alpha-fetoprotein. Seminoma and the other nonseminomatous tumors predominate after puberty.

Question 6Pediatric Urologic Oncology

A 2-year-old boy has a firm, painless scrotal swelling. Which serum marker is most useful in evaluating a suspected yolk sac tumor?

  1. Carcinoembryonic antigen
  2. Lactate dehydrogenase
  3. Beta-hCG
  4. Alpha-fetoprotein Correct answer.

Explanation

Yolk sac tumors characteristically secrete alpha-fetoprotein, making it the key tumor marker for diagnosis and monitoring. Beta-hCG is more associated with choriocarcinoma and some other germ cell tumors.

Question 7Pediatric Urologic Oncology

A 4-year-old boy presents with a painless left scrotal mass. Ultrasound shows a solid intratesticular lesion. What is the appropriate next step in management?

  1. Transscrotal biopsy
  2. Radical inguinal orchiectomy Correct answer.
  3. Scrotal aspiration
  4. Observation with repeat ultrasound in 6 months

Explanation

A solid intratesticular mass in a child is presumed malignant and managed with radical inguinal orchiectomy via an inguinal approach. Transscrotal biopsy or aspiration risks tumor seeding and alters lymphatic drainage.

Question 8Pediatric Urologic Oncology

In a child with a suspected Wilms tumor, which feature at presentation most strongly suggests a need for preoperative chemotherapy rather than immediate nephrectomy in a North American setting?

  1. Tumor diameter of 4 cm
  2. Age of 6 years
  3. Bilateral renal involvement Correct answer.
  4. Mild hypertension

Explanation

Bilateral disease requires preoperative chemotherapy to preserve renal parenchyma and reduce the extent of resection. In North America, unilateral tumors are typically resected upfront, whereas bilateral disease is treated with neoadjuvant therapy.

Question 9Pediatric Urologic Oncology

A 1-year-old with a Wilms tumor is found to have tumor thrombus extending into the inferior vena cava. What is the most appropriate management consideration?

  1. Immediate nephrectomy without vascular assessment
  2. Radiation therapy alone
  3. Preoperative chemotherapy to shrink the thrombus before resection Correct answer.
  4. Observation only

Explanation

Intravascular tumor thrombus, especially caval extension, is often treated with preoperative chemotherapy to reduce thrombus burden and facilitate safer resection. Careful vascular imaging and surgical planning are essential.

Question 10Pediatric Urologic Oncology

A 5-year-old with a right-sided Wilms tumor undergoes nephrectomy. Which histologic feature is associated with a worse prognosis and may warrant more intensive therapy?

  1. Favorable histology
  2. Anaplasia Correct answer.
  3. Nephrogenic rests
  4. Capsular fibrous band

Explanation

Anaplasia (especially diffuse anaplasia) identifies a high-risk subset of Wilms tumors with poorer outcomes and requires intensified therapy. Favorable histology and nephrogenic rests do not carry this adverse prognostic weight.

Question 11Pediatric Urologic Oncology

A 2-year-old with a Wilms tumor has pulmonary metastases. Which treatment modality is most appropriate in addition to systemic chemotherapy?

  1. Partial nephrectomy
  2. Bone marrow transplant
  3. Observation
  4. Pulmonary irradiation Correct answer.

Explanation

Pulmonary metastases from Wilms tumor are typically managed with whole-lung irradiation combined with chemotherapy. This improves disease control in metastatic disease.

Question 12Pediatric Urologic Oncology

Which pediatric renal tumor is most strongly associated with a history of neuroblastoma or its treatment and requires surveillance?

  1. Clear cell sarcoma
  2. Rhabdoid tumor
  3. Wilms tumor
  4. Renal cell carcinoma Correct answer.

Explanation

Survivors of neuroblastoma, particularly after radiation, have an increased risk of secondary renal cell carcinoma and require long-term surveillance. Wilms tumor and the other entities are not the classic secondary renal malignancy in this context.

Question 13Pediatric Urologic Oncology

A 3-year-old has an abdominal mass and is found to have a renal tumor with a rhabdoid histology. Which feature best characterizes malignant rhabdoid tumor of the kidney?

  1. Association with aniridia
  2. Benign behavior requiring no therapy
  3. Predominantly bilateral presentation
  4. Highly aggressive behavior with poor prognosis Correct answer.

Explanation

Malignant rhabdoid tumor of the kidney is highly aggressive with a poor prognosis and often presents with metastases. It is not associated with aniridia and is usually unilateral.

Question 14Pediatric Urologic Oncology

Which of the following is the most common paratesticular tumor in children?

  1. Lipoma
  2. Rhabdomyosarcoma Correct answer.
  3. Fibroma
  4. Leiomyoma

Explanation

Rhabdomyosarcoma is the most common paratesticular malignancy in children and adolescents. Benign tumors such as lipoma are less common as a group.

Question 15Pediatric Urologic Oncology

A 6-year-old boy has a painless paratesticular mass. Imaging suggests rhabdomyosarcoma. What is the appropriate initial surgical approach?

  1. Transscrotal excision
  2. Scrotal biopsy only
  3. Observation
  4. Radical inguinal orchiectomy with high cord ligation Correct answer.

Explanation

Paratesticular rhabdomyosarcoma is managed with radical inguinal orchiectomy and high ligation of the spermatic cord, often followed by chemotherapy. Transscrotal approaches risk local recurrence and alter lymphatic drainage.

Question 16Pediatric Urologic Oncology

Which statement best reflects the role of nephron-sparing surgery in pediatric renal tumors?

  1. It is contraindicated in all pediatric renal tumors
  2. It is only used for metastatic disease
  3. It is preferred in bilateral disease and in children with a solitary kidney to preserve renal function Correct answer.
  4. It always requires postoperative dialysis

Explanation

Nephron-sparing surgery is favored when preservation of renal parenchyma is critical, such as bilateral tumors or a solitary kidney. It is not contraindicated in all cases, and dialysis is not routinely required.

Question 17Pediatric Urologic Oncology

A 5-year-old with a Wilms tumor has a tumor that ruptures preoperatively. What is the main concern that alters staging and management?

  1. Tumor spill leading to upstaging and need for abdominal radiation Correct answer.
  2. Development of aniridia
  3. Loss of alpha-fetoprotein elevation
  4. Regression to benign histology

Explanation

Preoperative or intraoperative tumor rupture causes spillage, upstages the tumor, and typically requires abdominal radiation in addition to chemotherapy. It does not cause aniridia or histologic regression.

Question 18Pediatric Urologic Oncology

In a child with a suspected renal mass, which combination of findings most suggests a benign mesoblastic nephroma rather than Wilms tumor?

  1. Elevated alpha-fetoprotein
  2. Presentation at age 8 years with hematuria
  3. Bilateral tumors with aniridia
  4. Presentation in early infancy with a solid renal mass Correct answer.

Explanation

Congenital mesoblastic nephroma typically presents in the first few months of life as a solid renal mass and is generally benign. Wilms tumor usually presents later, and aniridia suggests WAGR.

Question 19Pediatric Urologic Oncology

A 7-year-old with a history of Wilms tumor treated with abdominal radiation and doxorubicin presents years later. Which long-term complication should be specifically monitored?

  1. Development of aniridia
  2. Loss of alpha-fetoprotein production
  3. Immediate renal failure requiring dialysis
  4. Cardiomyopathy and secondary malignancy Correct answer.

Explanation

Doxorubicin is cardiotoxic and abdominal radiation increases the risk of secondary malignancies, so survivors require long-term cardiac and oncologic surveillance. These therapies do not cause aniridia or immediate dialysis dependence.

Question 20Pediatric Urologic Oncology

Which feature distinguishes a stage I from a stage II Wilms tumor in the staging system commonly used?

  1. Presence versus absence of aniridia
  2. Complete resection with intact capsule versus tumor extension beyond the kidney but completely resected Correct answer.
  3. Elevated versus normal alpha-fetoprotein
  4. Bilateral versus unilateral disease

Explanation

Stage I denotes a tumor completely resected with an intact capsule, whereas stage II involves tumor extending beyond the kidney but still completely resected. Aniridia and alpha-fetoprotein are not staging criteria.

Question 21Congenital and Acquired Genitourinary Anomalies

A 2-day-old boy has a ventral urethral meatus located on the penoscrotal junction with a ventrally tethered, curved penis. Which term best describes the penile curvature?

  1. Phimosis
  2. Webbed penis
  3. Paraphimosis
  4. Chordee Correct answer.

Explanation

Chordee is ventral curvature of the penis, typically associated with hypospadias and tethering of the ventral shaft tissue. Phimosis and paraphimosis concern the foreskin, and a webbed penis is a penoscrotal configuration rather than curvature.

Question 22Congenital and Acquired Genitourinary Anomalies

In a newborn with hypospadias, which of the following should be avoided until the anomaly has been fully assessed?

  1. Routine circumcision Correct answer.
  2. Renal ultrasonography
  3. Documentation of meatal position
  4. Physical examination of the scrotum

Explanation

The preputial skin may be needed for urethral reconstruction, so circumcision is deferred in hypospadias until evaluation is complete. Examination, documentation, and imaging are appropriate parts of assessment.

Question 23Congenital and Acquired Genitourinary Anomalies

A newborn boy has an undescended testis palpable in the inguinal canal. What is the most appropriate initial management?

  1. Hormonal therapy with hCG
  2. Immediate inguinal exploration
  3. Observation with re-examination Correct answer.
  4. Scrotal orchiopexy at birth

Explanation

Many undescended testes descend spontaneously in the first months of life, so initial observation with serial examination is standard. Surgery is generally recommended if the testis remains undescended by around 6 months of age.

Question 24Congenital and Acquired Genitourinary Anomalies

Which finding on newborn examination is most characteristic of a classic bladder exstrophy?

  1. Exposed bladder mucosa on the lower abdominal wall Correct answer.
  2. Palpable abdominal mass with hematuria
  3. Bilateral nonpalpable testes with normal abdominal wall
  4. Urinary stream from a perineal opening

Explanation

In bladder exstrophy the bladder is open and exposed on the lower abdominal wall because of a midline closure defect. This is distinct from other anomalies of the lower urinary tract.

Question 25Congenital and Acquired Genitourinary Anomalies

A term newborn boy has a urethral meatus on the dorsal surface of the glans. What is the correct term for this anomaly?

  1. Megameatus
  2. Epispadias Correct answer.
  3. Hypospadias
  4. Urethral duplication

Explanation

Epispadias is a dorsal urethral opening, in contrast to hypospadias, which is ventral. It exists on a spectrum from glanular to penopubic and may accompany exstrophy.

Question 26Congenital and Acquired Genitourinary Anomalies

A newborn girl has a single perineal opening with ambiguous genitalia. Which evaluation step is most important initially?

  1. Routine urine culture
  2. Immediate cystoscopy
  3. Observation until puberty
  4. Assessment for a disorder of sex development Correct answer.

Explanation

Ambiguous genitalia with a single opening raises concern for a disorder of sex development and warrants prompt structured evaluation. This includes examination, karyotype, and metabolic assessment.

Question 27Congenital and Acquired Genitourinary Anomalies

Which physical finding is most consistent with a simple hydrocele in an infant?

  1. Transilluminating scrotal swelling that does not extend above the inguinal ring Correct answer.
  2. A painful, tender scrotum with absent cremasteric reflex
  3. Scrotal swelling that reduces with pressure and extends into the canal
  4. A firm, nontransilluminating scrotal mass

Explanation

A simple hydrocele transilluminates and is confined to the scrotum, indicating fluid around the testis. Extension above the ring or reducibility suggests a communicating hydrocele or hernia.

Question 28Congenital and Acquired Genitourinary Anomalies

A 6-year-old boy presents with sudden severe testicular pain, nausea, and a high-riding testis with a transverse lie. What is the most appropriate next step?

  1. Immediate surgical exploration Correct answer.
  2. Scrotal ultrasonography with Doppler
  3. Antibiotic therapy
  4. Observation with re-examination in 24 hours

Explanation

Acute scrotum with features suggesting torsion is a surgical emergency; prompt exploration preserves the testis. Imaging must not delay surgery when torsion is strongly suspected.

Question 29Congenital and Acquired Genitourinary Anomalies

A 9-year-old boy has a painless scrotal swelling that transilluminates and has been present since infancy without change in size. What is the most likely diagnosis?

  1. Varicocele
  2. Noncommunicating hydrocele Correct answer.
  3. Inguinal hernia
  4. Testicular tumor

Explanation

A noncommunicating hydrocele persists as a fluid collection without connection to the peritoneum and typically transilluminates. Hernias usually vary with activity, varicoceles are worm-like and left-sided, and tumors are solid.

Question 30Congenital and Acquired Genitourinary Anomalies

A 4-year-old boy has a retractile testis that can be brought into the scrotum manually and stays there. What is the appropriate management?

  1. Orchiopexy
  2. Observation Correct answer.
  3. hCG therapy
  4. Orchiectomy

Explanation

A retractile testis is normally descended and can be manipulated into the scrotum; it usually resolves as the child grows and does not require surgery. Surgery is reserved for a truly undescended testis.

Question 31Congenital and Acquired Genitourinary Anomalies

A newborn girl is noted to have a duplicated collecting system with an upper-pole ureter that inserts below the bladder. What is the most likely clinical presentation?

  1. Acute urinary retention
  2. Recurrent abdominal pain with a palpable mass
  3. Continuous urinary incontinence despite normal voiding Correct answer.
  4. Hematuria with hypertension

Explanation

An ectopic ureter from the upper pole typically inserts distal to the bladder sphincter, causing continuous incontinence in girls. The lower-pole ureter in a duplicated system more often inserts intravesically and may be associated with reflux.

Question 32Congenital and Acquired Genitourinary Anomalies

A boy has a urethral meatus located on the ventral glans with a normal ventral shaft and no curvature. Which hypospadias grade does this represent?

  1. Glanular Correct answer.
  2. Penoscrotal
  3. Perineal
  4. Penile

Explanation

Glanular hypospadias is the mildest form, with the meatus on the glans and typically no chordee. More proximal locations (penile, penoscrotal, perineal) are associated with greater curvature and complexity.

Question 33Congenital and Acquired Genitourinary Anomalies

Which condition is most strongly associated with unilateral renal agenesis in a newborn?

  1. Contralateral vesicoureteral reflux Correct answer.
  2. Bladder exstrophy
  3. Bilateral cryptorchidism
  4. Posterior urethral valves

Explanation

Children with unilateral renal agenesis have a high incidence of contralateral anomalies, especially vesicoureteral reflux, and warrant evaluation of the solitary kidney. This guides surveillance and counseling.

Question 34Congenital and Acquired Genitourinary Anomalies

A newborn boy has a dilated bladder, bilateral hydronephrosis, and a thick-walled bladder on ultrasound. Which diagnosis should be suspected?

  1. Neurogenic bladder
  2. Ureteropelvic junction obstruction
  3. Prune-belly syndrome
  4. Posterior urethral valves Correct answer.

Explanation

Posterior urethral valves cause bladder outlet obstruction, leading to a thick-walled bladder and bilateral upper tract dilation in boys. Early diagnosis and valve ablation are important to preserve renal function.

Question 35Congenital and Acquired Genitourinary Anomalies

A 5-year-old girl has recurrent urinary tract infections and ultrasound shows a duplicated kidney with the upper pole hydronephrotic. What complication of ectopic ureter is most likely?

  1. Ureterocele causing obstruction Correct answer.
  2. Urethral stricture
  3. Vesicoureteral reflux into the upper pole
  4. Renal artery stenosis

Explanation

An ectopic upper-pole ureter commonly ends in a ureterocele, which can obstruct and cause hydronephrosis and infection. Reflux more typically affects the lower pole in duplication.

Question 36Congenital and Acquired Genitourinary Anomalies

A 3-year-old boy has a ventral penile curvature with a meatus at the penoscrotal junction and a bifid scrotum. Which of the following is the most important consideration before repair?

  1. Performing immediate circumcision
  2. Starting antibiotic prophylaxis for life
  3. Assessing for associated anomalies such as cryptorchidism or DSD Correct answer.
  4. Reassuring the family that no intervention is needed

Explanation

Proximal hypospadias with bifid scrotum may be associated with cryptorchidism or a disorder of sex development, so evaluation precedes reconstruction. Circumcision is deferred because the foreskin may be used in repair.

Question 37Congenital and Acquired Genitourinary Anomalies

Which statement about the embryology of the ureter and kidney best explains the association between renal agenesis and an absent ipsilateral ureter?

  1. The cloaca gives rise to the renal pelvis
  2. The mesonephric duct forms the collecting system independently of the kidney
  3. The allantois becomes the ureter
  4. The ureteric bud induces metanephric differentiation and its failure leads to agenesis Correct answer.

Explanation

The ureteric bud outgrowth from the mesonephric duct induces the metanephric blastema to form the kidney; failure of this interaction can result in renal agenesis with an absent ureter. This explains the coupled development of kidney and ureter.

Question 38Congenital and Acquired Genitourinary Anomalies

A 7-year-old boy has a left-sided varicocele that does not decompress when supine. What is the most important next step?

  1. Scrotal support and NSAIDs
  2. Immediate varicocelectomy without imaging
  3. Reassurance only
  4. Imaging to evaluate for a retroperitoneal mass Correct answer.

Explanation

A varicocele that persists when supine, especially on the right or in a young child, raises concern for a retroperitoneal tumor obstructing the gonadal vein. Imaging of the abdomen and retroperitoneum is indicated.

Question 39Congenital and Acquired Genitourinary Anomalies

A newborn girl has a cystic pelvic mass and a single perineal opening; examination shows a cloacal anomaly. Which structure is most commonly affected in cloacal malformation?

  1. The renal artery only
  2. The gonads only
  3. The confluence of rectum, vagina, and urethra Correct answer.
  4. The ureterovesical junction only

Explanation

Cloacal malformation is a persistent common channel into which the rectum, vagina, and urethra converge. It is a complex anomaly requiring multidisciplinary reconstruction.

Question 40Congenital and Acquired Genitourinary Anomalies

A boy is diagnosed with a unilateral undescended testis at 9 months of age. What is the recommended management?

  1. Continued observation until puberty
  2. Orchiectomy
  3. Orchiopexy Correct answer.
  4. hCG therapy

Explanation

Orchiopexy is recommended for a testis that remains undescended beyond about 6 months of age to preserve fertility potential and enable surveillance. Delay increases the risk of impaired spermatogenesis and malignancy.

Question 41Congenital and Acquired Genitourinary Anomalies

A 2-year-old boy has a high scrotal testis that cannot be brought into the scrotum and is associated with an inguinal hernia. Which management is most appropriate?

  1. hCG therapy
  2. Orchiopexy with hernia repair Correct answer.
  3. Observation for spontaneous descent
  4. Ultrasound surveillance only

Explanation

An undescended testis with an associated hernia requires surgical repair with orchiopexy. Spontaneous descent is unlikely at this age, and hormonal therapy is not standard.

Question 42Congenital and Acquired Genitourinary Anomalies

A newborn boy has a large, thin-walled scrotal swelling that transilluminates and communicates with the abdomen, changing in size with crying. What is the most likely diagnosis?

  1. Varicocele
  2. Communicating hydrocele Correct answer.
  3. Spermatocele
  4. Simple hydrocele

Explanation

A communicating hydrocele has a patent processus vaginalis, so fluid moves between abdomen and scrotum and the size varies with intra-abdominal pressure. Simple hydroceles do not change with crying.

Question 43Congenital and Acquired Genitourinary Anomalies

Which of the following best describes the embryologic defect in hypospadias?

  1. Incomplete fusion of the urethral folds Correct answer.
  2. Premature closure of the urethral plate
  3. Defective descent of the testis
  4. Failure of the urogenital sinus to form the bladder

Explanation

Hypospadias results from incomplete fusion of the urethral folds, leaving the meatus on the ventral shaft. This also explains the associated ventral deficiency of the prepuce.

Question 44Congenital and Acquired Genitourinary Anomalies

A 1-year-old boy has bilateral nonpalpable testes and a normal 46,XY karyotype. Which diagnostic step is most appropriate next?

  1. Laparoscopy to locate the testes Correct answer.
  2. hCG stimulation only
  3. Scrotal ultrasound
  4. Observation until age 5

Explanation

Bilateral nonpalpable testes warrant laparoscopy to locate intra-abdominal testes and guide management, especially given the risk of malignancy and infertility. Ultrasound is unreliable for nonpalpable testes.

Question 45Congenital and Acquired Genitourinary Anomalies

A 4-year-old girl has a ureterocele associated with a duplicated system and recurrent infections. What is the primary goal of initial management?

  1. Immediate nephrectomy
  2. Urethral dilation
  3. Long-term observation without intervention
  4. Relieve obstruction and prevent infection while preserving renal function Correct answer.

Explanation

The initial aim is to relieve obstruction and prevent infection while preserving renal function, often with endoscopic incision or decompression. Nephrectomy is reserved for a nonfunctioning moiety.

Question 46Congenital and Acquired Genitourinary Anomalies

A 2-day-old boy is noted to have a dorsal hooded foreskin with the urethral meatus visible on the ventral surface of the penis. The ventral foreskin is deficient. What is the most likely diagnosis?

  1. Phimosis
  2. Paraphimosis
  3. Hypospadias Correct answer.
  4. Epispadias

Explanation

Hypospadias results from incomplete fusion of the urethral folds, leading to a ventral meatus and a dorsal hooded foreskin from incomplete preputial development. Epispadias involves a dorsal meatus and is part of the exstrophy-epispadias complex. Phimosis and paraphimosis are acquired conditions of the foreskin, not congenital urethral malposition.

Question 47Congenital and Acquired Genitourinary Anomalies

A 5-year-old boy is diagnosed with a left varicocele. It is grade 3 and does not decompress when he lies supine. What is the most appropriate next step in management?

  1. Immediate surgical ligation of the spermatic vein
  2. Ultrasound of the abdomen and retroperitoneum Correct answer.
  3. Reassurance and observation
  4. Antibiotic therapy for epididymitis

Explanation

A varicocele that does not decompress in the supine position raises concern for a retroperitoneal mass obstructing the gonadal vein, so imaging of the abdomen and retroperitoneum is indicated. Observation or immediate ligation would delay diagnosis of a possible tumor. Antibiotics are irrelevant because there is no evidence of infection.

Question 48Congenital and Acquired Genitourinary Anomalies

A 6-month-old girl has a history of recurrent urinary tract infections. Voiding cystourethrogram shows a grade IV vesicoureteral reflux on the right. Which initial management is most appropriate?

  1. Endoscopic injection of bulking agent
  2. Immediate ureteral reimplantation
  3. Prophylactic antibiotics and observation Correct answer.
  4. Clean intermittent catheterization

Explanation

High-grade vesicoureteral reflux in infants is often managed initially with continuous antibiotic prophylaxis and observation because many cases resolve spontaneously. Surgical intervention is reserved for breakthrough infections or persistent high-grade reflux. Clean intermittent catheterization is not indicated unless there is bladder dysfunction.

Question 49Congenital and Acquired Genitourinary Anomalies

A 3-year-old boy presents with a painful, swollen scrotum. Examination reveals a tender, high-riding testis with an absent cremasteric reflex. Doppler ultrasound shows decreased blood flow to the testis. What is the most appropriate immediate management?

  1. Observation with repeat ultrasound in 24 hours
  2. Manual detorsion followed by elective orchiopexy
  3. Antibiotics for epididymitis
  4. Scrotal exploration Correct answer.

Explanation

Testicular torsion is a surgical emergency; prompt scrotal exploration with detorsion and bilateral orchiopexy is required to salvage the testis. Manual detorsion can be attempted but should not delay surgery. Antibiotics and observation are inappropriate for torsion.

Question 50Congenital and Acquired Genitourinary Anomalies

A 2-year-old boy is diagnosed with a right inguinal hernia and a right undescended testis that is palpable in the inguinal canal. What is the most appropriate surgical management?

  1. Herniotomy alone
  2. Observation until age 5
  3. Herniotomy and orchiopexy Correct answer.
  4. Orchiopexy alone

Explanation

An undescended testis associated with an inguinal hernia should be treated with simultaneous hernia repair and orchiopexy to prevent incarceration and preserve testicular function. Herniotomy alone leaves the testis undescended. Observation is not recommended beyond 6–12 months of age.