Bladder

Reflux involving the entire ureter and upper tract, dilated calices with sharp fornices is _____?
1. Grade II
2. Grade III
3. Grade IV
The pathophysiology of vesicoureteral reflux is complex. Is a short ureteral tunnel congenital or acquired?
1. Congenital
2. Acquired
If a child has VUR, what is the risk of an asymptomatic sibling having reflux?
1. Less than 5%
2. 10%
3. 25 Â– 30%
4. 50%
Neurovesicular dysfunction and periureteral diverticula result in _____, leading to vesicoureteral reflux?
1. Weak floor of the ureteral tunnel
2. Noncompliant roof of the ureteral tunnel
3. Obstruction of ureteral orifice
T or F: The central portion of the kidneys is more predisposed to pyelonephritic scarring.
1. True
2. False
Which is better for detecting renal parenchymal injury after acute pyelonephritis or chronic scarring?
1. CT scan
2. DMSA renogram
3. Equivalent
What is the chance of resolution for a patient with Grade 3 primary vesicoureteral reflux?
1. 20%
2. 40 - 50%
3. 65 - 70%
T or F: The chance of resolution for secondary VUR is independent of the Grade of reflux.
1. True
2. False
Nonoperatively managed VUR is followed by VCUG every _____?
1. 2 years
2. 1.5 years
3. 1 year
4. 6 months
What should be the ureteral tunnel length to ureteral diameter ratio of the reimplanted ureter?
1. 8:1
2. 5:1
3. 3:1
4. 1:1
T or F: Endoscopic subtrigonal injection has equivalent success rates compared to open surgical techniques for vesicoureteral reflux.
1. True
2. False
T or F: Ultrasound is usually obtained at 6 months for postoperative follow-up of VUR after reimplantation.
1. True
2. False
Which is NOT true regarding umbilical artery division during the extravesicular repair of VUR?
1. Avoid ureteral kinking
2. Allows adequate ureteral mobilization
3. Promotes collateral formation
Which repair has the highest incidence of suprahiatal obstruction?
1. Extravesical reimplant
2. Leadbetter-Politano reimplant
3. Cohen cross-trigonal reimplant
Which operation has the highest incidence of urinary retention?
1. Extravesical reimplant
2. Leadbetter-Politano reimplant
3. Cohen cross-trigonal reimplant
What is the most common reason for re-do reimplantation for ureterovesical obstruction?
1. Ischemia
2. Idiopathic scarring
3. Leak
4. Technical complication (orifice too small)
What is the incidence of bladder exstrophy?
1. 1 in 100,000
2. 1 in 30,000 Â– 40,000
3. 1 in 10,000
4. 1 in 1,000
When in gestation does bladder or cloacal exstrophy originate?
1. 2 Â– 4 weeks
2. 4 Â– 10 weeks
3. 12th week
4. 16 weeks
Classic bladder exstrophy results following rupture of the ___________?
1. Urogenital membrane
2. Transverse septum
3. Cloacal membrane
4. WhartonÂ’s membrane
Which of the following is not part of the spectrum of the exstrophy complex?
1. Female epispadias
2. Cloacal exstrophy
3. Diastasis pubis
4. Meningocele
T or F: Males outnumber females by a ratio of 4 to 1 in the incidence of bladder exstrophy.
1. True
2. False
What are the advantages of early neonatal reconstruction for bladder exstrophy?
1. More pliable bladder
2. More pliable pubic ring
3. Easier to perform osteotomy
4. Relatively sterile environment
Which is NOT associated with closure of the pelvic ring in exstrophy?
1. Stable closure of the bladder and abdominal wall
2. Reconstruction of the internal sphincter of the bladder
3. Penile shortening
4. Approximation of the corpora cavernosa
T or F: Approximation of the pubis during repair of bladder exstrophy occurs before tubularization of the neourethra.
1. True
2. False
How long should the lower extremities be placed in traction or immobilized after repair of exstrophy?
1. 2 Â– 4 days
2. 3 Â– 4 weeks
3. 2 Â– 4 months
At what age should continent bladder reconstruction be performed in exstrophy?
1. Newborn period
2. 6 months
3. 2 - 3 years
4. Preschool (4 Â– 5 years)
What reimplantation technique in exstrophy maximizes the potential for urethral lengthening during bladder neck reconstruction?
1. Extravesical reimplant
2. Leadbetter-Politano reimplant
3. Cohen cross-trigonal reimplant
Of the following complications, which are not commonly seen after bladder exstrophy repair?
1. Incontinence
2. Urolithiasis
3. Pyelonephritis
4. Hydronephrosis
What is the most common location for epispadias?
1. Balanic (in the glans)
2. Penile
3. Penopubic
What is the incidence of epispadias?
1. 1 in 100,000
2. 1 in 30,000 Â– 40,000
3. 1 in 10,000
4. 1 in 1,000
What is the incidence of cloacal exstrophy?
1. 1 in 500,000
2. 1 in 200,000
3. 1 in 100,000
4. 1 in 50,000
Cloacal exstrophy has all except ____?
1. Two lateral hemibladders
2. Proximal bowel orifice leading to the ileum
3. One or two other orifices representing the appendix and hindgut
4. S-I joint separation
What is done with the strip of mucosa in the midportion of cloacal exstrophy?
1. Excision in order to reapproximate bladder halves
2. Tubularize
3. Incorporate in bladder closure
4. Used as paraexstrophy flaps
How common are associated anomalies in patients with cloacal exstrophy?
1. 10%
2. 25%
3. 50%
4. Greater than 60%
Which is NOT part of the classic triad of prune belly syndrome?
1. Cryptorchidism
2. Ectatic upper and lower urinary tract
3. Infertility
4. Absent or deficient abdominal wall musculature
How frequent is prune belly syndrome?
1. 1 in 100,000
2. 1 in 50,000
3. 1 in 10,000
4. 1 in 1,000
T or F: Prune belly syndrome patients usually have a bladder outlet obstruction, causing dilated bladder and upper?
1. True
2. False
T or F: The kidney in patients with prune belly syndrome is abnormal in 90 percent of cases?
1. True
2. False
How common is a ureteral pelvic obstruction (UPJ) in prune belly syndrome?
1. Common
2. Uncommon
What portion of the ureter is usually involved when ureteral dilation is present in PBS?
1. Proximal one-third
2. Distal one-third
3. Middle one-third
T or F: The urinary bladder in patients with prune belly syndrome is typically small?
1. True
2. False
Are urachal remnants or cysts common in prune belly syndrome?
1. Infrequent
2. Frequent
Although infertility is present in 100% of males with PBS, the hormonal production of the testicle is ____?
1. High
2. Normal
3. Low
Which is NOT commonly seen in patients with prune belly syndrome?
1. Pseudovalves
2. Small verumontanum
3. Prostatic hyperplasia
4. Small or absent ejaculatory ducts
Which type (scaphoid or fusiform megalourethra) is associated with absence of the corpora cavernosa?
1. Scaphoid
2. Fusiform
3. Both
4. Neither
What musculoskeletal abnormalities are usually seen with PBS?
1. Absent limbs
2. Hip dislocation
3. Duchenne muscular dystrophy
4. Arthrogryposis
With regard to cryptorchidism in PBS, which of the following is true?
1. The cryptorchid testis is commonly found at the external ring
2. All patients with prune belly syndrome are sterile and impotent.
3. Retrograde ejaculation is common
4. Risk of testicular CA in PBS Greater than normal patients with UDT
T or F: Upper abdominal muscles are more poorly developed than the lower in patients with prune belly syndrome?
1. True
2. False
T or F: Most PBS patients have normal urodynamic studies and voiding pressures, and empty their bladders completely.
1. True
2. False
Why are patients with prune belly syndrome at higher risk for anesthetic complications during the neonatal period?
1. Associated psudeocholinesterase deficiency
2. Increased risk of malignant hyperthermia
3. Loss of potential for shivering thermogenesis
4. Increased risk of pulmonary complications
What is the limiting factor in survival in most patients with prune belly syndrome?
1. Associated cardiac disease
2. Respiratory insufficiency from absent or weak abdominal muscles
3. Renal failure
T or F: Urinary diversion should be performed in most infants with prune belly syndrome during the neonatal period.
1. True
2. False
At what age should abdominoplasty be considered in PBS?
1. Newborn
2. 1.5 Â– 2 years, often with orchiopexy
3. 1.5 Â– 2 years, without orchiopexy
What is the current survival for a patient with prune belly syndrome?
1. Normal
2. 90%
3. 70%
4. 50%
The outcome after antireflux procedures in a patient with PBS is _____ compared to healthy controls with VUR?
1. Similar
2. Worse
3. Better
Reduction cystoplasty for PBS is associated with a low or high incidence of recurrent bladder dilation?
1. Low
2. High

Bladder

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