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EAU, Chapter 2 MCQs

EAU · MBBS / Medicine · 17 practice questions

1. Immediately after TURB for a low-risk Ta tumour, the surgeon notes the resection bed is clean, but the patient had visible bleeding requiring continuous bladder irrigation. What is the most appropriate next step regarding adjuvant therapy?

  1. AAdminister chemotherapy but reduce fluid intake to maintain concentration
  2. BOmit the single immediate chemotherapy instillation
  3. CDelay TURB follow-up and start BCG instead
  4. DProceed with immediate intravesical chemotherapy as scheduled
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B. Omit the single immediate chemotherapy instillation A single immediate instillation of chemotherapy should be omitted in any case of overt or suspected bladder perforation or bleeding requiring bladder irrigation, as stated in the technical recommendations. Proceeding with chemotherapy in this setting risks systemic absorption and complications. BCG is not indicated as a substitute here, and reducing fluid intake pertains to drug concentration, not to management of active bleeding.

2. A 58-year-old man undergoes TURB for a solitary, primary, 2 cm papillary bladder tumour. Histology reveals TaG1 (low-grade) urothelial carcinoma with no CIS. There is no perforation and no bleeding requiring irrigation. What is the most appropriate adjuvant treatment?

  1. AOne immediate instillation of intravesical chemotherapy after TURB
  2. BOne-year full-dose BCG treatment with induction and maintenance
  3. CRadical cystectomy
  4. DIntravesical full-dose BCG instillations for one to three years
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A. One immediate instillation of intravesical chemotherapy after TURB This tumour meets the low-risk definition (primary, solitary, TaG1, <3cm, no CIS), for which one immediate instillation of intravesical chemotherapy after TURB is recommended. Full-dose BCG for one year is used for intermediate-risk tumours; BCG for one to three years or cystectomy is reserved for high-risk/highest-risk tumours, none of which apply here.

3. A ureteral tumour on imaging shows invasion beyond the muscularis into the periureteric fat, without involvement of adjacent organs. According to the 2017 TNM classification for upper urinary tract urothelial carcinoma, what is the correct T stage?

  1. AT2
  2. BT3
  3. CT1
  4. DT4
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B. T3 For ureteral tumours, invasion beyond the muscularis into periureteric fat is classified as T3; this differs from renal pelvis tumours where T3 involves invasion into peripelvic fat or renal parenchyma. T1 is subepithelial connective tissue invasion, T2 is muscularis invasion only, and T4 requires invasion of adjacent organs or through the kidney into perinephric fat, none of which match this description.

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