A 5-year-old boy presents with the fourth febrile urinary tract infection in the last 8 months. He undergoes a voiding cystourethrogram (VCUG) after current febrile UTI. The imaging reveals contrast reflux into the ureter, renal pelvis, and calyces without dilation. What grade of vesicoureteral reflux does this finding represent?
A 3-year-old girl presents with dysuria and fever. This is her third febrile urinary tract infection (UTI) in six months. Her parents report that she has been toilet trained but occasionally experiences urgency and accidents. Physical examination is unremarkable except for an anxious child. A renal ultrasound performed after the second UTI was normal. You suspect vesicoureteral reflux in this patient. Which diagnostic test is most appropriate to confirm a diagnosis of vesicoureteral reflux in this patient?
A 72-year-old patient undergoes a total hip replacement under spinal anesthesia. Patient was catheterized preoperatively and postoperatively develops urinary retention. Which of the following factors most likely contributed to his postoperative urinary retention?
A 40-year-old man undergoes knee arthroscopy. Postoperatively, he experiences difficulty voiding and discomfort. His history includes benign prostatic hyperplasia (BPH). Which of the following pre-existing conditions in this patient increases his risk for postoperative urinary retention?
A 50-year-old woman had a total abdominal hysterectomy performed. Several hours after the surgery, she has not urinated despite feeling the urge. An ultrasound confirms significant bladder volume. Which intervention would be most appropriate for managing this patient’s postoperative urinary retention?
A 65-year-old male undergoes an inguinal hernia repair under general anesthesia. Postoperatively, he complains of pain and has not voided since the procedure. His bladder is palpable and percusses to be full. Which of the following is the most likely cause of postoperative urinary retention in this patient?
A 60-year-old female undergoes pelvic surgery under general anesthesia. She has no history of urinary retention but is concerned about developing it postoperatively. The surgical team aims to minimize her risk of postoperative urinary retention (POUR). Which of the following is the best strategy to prevent POUR in this patient?
A 68-year-old male undergoes a 3-hour abdominal hernia repair under general anesthesia. Six hours after surgery, he complains of lower abdominal discomfort and has not urinated since the procedure. A bladder ultrasound shows 600 mL of retained urine. Which of the following is the most appropriate next step in managing this patient?
A 68-year-old male with a history of benign prostatic hyperplasia is admitted to the hospital for management of community-acquired pneumonia. On the third day of hospitalization, he develops sudden anuria. He has an indwelling urinary catheter in place. Which of the following is the most appropriate initial step in management?
A 55-year-old woman presents with flank pain, fever, and dysuria for the past 3 days. She has a history of recurrent urinary tract infections (UTIs) and type 2 diabetes mellitus. Physical examination reveals costovertebral angle tenderness on the right side. Urinalysis shows alkaline urine (pH 8.5), leukocyte esterase positive, and numerous white blood cells. A non-contrast CT scan reveals a staghorn calculus in the right renal pelvis. Which of the following is the most likely underlying pathophysiology?
