Prometric Exam Questions for Urology Specialists 2026: 15 Practice MCQs with Answers and Rationale for the URO5931 Paper

The urology specialist paper (URO5931) is written for the urology registrar: the stone that must be drained tonight, the painful testicle that must go to theatre now, the PSA that needs a biopsy pathway, the haematuria that needs cystoscopy, and the chronic management of prostate enlargement and incontinence. Stone disease is unusually common in the Gulf's hot climate, and the paper reflects it. It is usually 100 to 150 single-best-answer questions in 2.5 to 3 hours, with a pass mark of about 60%.

The fifteen questions below follow that blueprint. Allow about 70 seconds each and read every rationale.

For titles and the route, read the urologist guide. For timed papers use the Urology specialist bank, about 2,000 questions.

Stones and obstruction

Question 1

A 40-year-old has renal colic, a temperature of 39 °C, rigors and a CT showing a 7 mm obstructing proximal ureteric stone with hydronephrosis. The management is:

1. Analgesia and medical expulsive therapy at home
2. Urgent decompression of the infected obstructed kidney by ureteric stent or percutaneous nephrostomy, with intravenous antibiotics and resuscitation; definitive stone treatment is deferred until sepsis has resolved
3. Immediate ureteroscopy and laser
4. Extracorporeal shock wave lithotripsy today

Answer: B. An obstructed infected kidney is a urological emergency; manipulating the stone during sepsis risks septic shock. Drain first, treat the stone later.

Question 2

A patient has an uncomplicated 5 mm distal ureteric stone with controlled pain and no infection. The appropriate first-line management is:

1. Immediate percutaneous nephrolithotomy
2. Medical expulsive therapy with an alpha blocker such as tamsulosin, analgesia, hydration and follow-up imaging, with intervention if the stone has not passed in about four weeks or pain is uncontrolled
3. Open ureterolithotomy
4. Nephrectomy

Answer: B. Most stones under 5 to 6 mm pass spontaneously; alpha blockers help distal stones. Ureteroscopy is first line for larger or non-passing distal stones.

Question 3

A patient who has had three calcium oxalate stones in five years asks how to prevent recurrence. The strongest evidence-based advice is:

1. Restrict all calcium in the diet
2. Increase fluid intake to produce more than 2 to 2.5 L of urine a day, normal dietary calcium, reduced sodium and animal protein, limited oxalate-rich foods, and metabolic evaluation with thiazide or citrate therapy if indicated
3. Vitamin C supplements
4. No preventive measures exist

Answer: B. Calcium restriction increases oxalate absorption and stone risk. In Gulf heat, hydration advice is the single most important measure.

Prostate

Question 4

A 68-year-old has bothersome lower urinary tract symptoms with an IPSS of 20, a 50 mL prostate on ultrasound, a PSA of 2.5 ng/mL and no retention. First-line drug therapy is:

1. Antibiotics for a month
2. An alpha blocker for symptom relief, with a 5-alpha-reductase inhibitor added for prostates over about 30 to 40 mL to reduce progression and retention risk
3. Immediate transurethral resection
4. Anticholinergics alone

Answer: B. Combination therapy is indicated for larger glands. Surgery is for retention, recurrent infection, stones, haematuria, renal impairment or failed medical therapy.

Question 5

A 62-year-old has a PSA of 8 ng/mL and a firm nodule on digital rectal examination. The next step is:

1. Repeat PSA in a year
2. Multiparametric MRI of the prostate followed by targeted and systematic biopsy, with staging if cancer is confirmed, and risk-stratified treatment ranging from active surveillance to radical prostatectomy or radiotherapy
3. Start androgen deprivation immediately
4. Transurethral resection for diagnosis

Answer: B. MRI-first pathways reduce unnecessary biopsies and improve detection of significant cancer. Low-risk disease is managed with surveillance.

Question 6

A man with metastatic prostate cancer on an LHRH agonist develops back pain, leg weakness and urinary retention. The management is:

1. Increase the LHRH agonist dose
2. High-dose dexamethasone and urgent MRI of the whole spine for metastatic spinal cord compression, with radiotherapy or surgery within 24 hours, and a catheter for retention
3. Physiotherapy
4. Oral analgesia only

Answer: B. Cord compression is an oncological emergency; neurological outcome depends on speed of treatment.

Haematuria and urothelial cancer

Question 7

A 60-year-old smoker has a single episode of painless visible haematuria. The appropriate work-up is:

1. Antibiotics and reassurance
2. Urgent referral for flexible cystoscopy and upper tract imaging (CT urography), because visible haematuria in a smoker is urothelial cancer until proven otherwise
3. Repeat urinalysis in three months
4. Ultrasound only

Answer: B. About one in five patients with visible haematuria over 60 has a malignancy; a negative dipstick after an episode does not cancel the referral.

Question 8

Transurethral resection shows a high-grade T1 bladder tumour with carcinoma in situ. The appropriate management is:

1. Observation with annual cystoscopy
2. Repeat resection to exclude muscle invasion, then intravesical BCG induction and maintenance, with cystectomy considered for BCG failure
3. Immediate chemotherapy alone
4. Partial cystectomy

Answer: B. High-risk non-muscle-invasive disease is treated with BCG; muscle-invasive disease needs radical cystectomy or chemoradiotherapy.

Kidney and testis

Question 9

An incidental 3 cm enhancing solid renal mass is found on CT in a 55-year-old with normal contralateral kidney function. The management is:

1. Percutaneous biopsy in every case before any decision
2. Partial nephrectomy (nephron-sparing surgery) where technically feasible, with active surveillance or ablation for small masses in poor surgical candidates
3. Radical nephrectomy for all masses
4. Chemotherapy

Answer: B. Nephron-sparing surgery preserves renal function with equivalent cancer outcomes for T1 tumours. Biopsy is selective.

Question 10

A 16-year-old has sudden severe unilateral testicular pain for 3 hours with a high-riding tender testis and absent cremasteric reflex. The management is:

1. Ultrasound and review tomorrow
2. Immediate surgical exploration for testicular torsion, with detorsion and bilateral orchidopexy, ideally within 6 hours of onset; imaging must not delay surgery when the diagnosis is clinically likely
3. Antibiotics for epididymitis
4. Analgesia and observation

Answer: B. Testicular salvage falls sharply after six hours. Epididymitis presents more gradually with fever and a positive Prehn's sign.

Question 11

A 28-year-old has a painless testicular mass; ultrasound shows a solid intratesticular lesion and tumour markers show a raised AFP and hCG. The next step is:

1. Transscrotal biopsy
2. Radical inguinal orchidectomy, with CT staging and sperm banking offered beforehand, and adjuvant treatment by histology and stage
3. Chemotherapy without surgery
4. Observation

Answer: B. Scrotal biopsy risks tumour seeding. Raised AFP indicates a non-seminomatous element.

Infection, incontinence and paediatrics

Question 12

A 30-year-old woman has her fourth culture-proven cystitis in a year, with a normal ultrasound and no structural cause. Management options include:

1. Long-term high-dose fluoroquinolones
2. Behavioural advice, vaginal oestrogen if postmenopausal, non-antibiotic prophylaxis such as methenamine or D-mannose where supported, and low-dose or post-coital antibiotic prophylaxis for a limited period if infections continue
3. Cystectomy
4. Nothing can be done

Answer: B. Antimicrobial stewardship favours non-antibiotic measures first; fluoroquinolones are reserved because of resistance and adverse effects.

Question 13

A 50-year-old woman leaks urine when coughing and exercising, with no urgency. After failed pelvic floor training, the surgical option with the best evidence is:

1. Anticholinergic medication
2. A mid-urethral sling or autologous fascial sling, or urethral bulking agents for selected patients, after urodynamic assessment where indicated
3. Bladder augmentation
4. Botulinum toxin injection

Answer: B. Stress incontinence is treated with pelvic floor training first, then surgery; anticholinergics and botulinum toxin are for overactive bladder.

Question 14

A newborn boy has an undescended left testis at birth. The appropriate plan is:

1. Immediate orchidopexy in the first week
2. Re-examine at about 3 to 6 months; if still undescended, orchidopexy between 6 and 12 to 18 months of age to reduce infertility and malignancy risk
3. Hormone therapy only
4. Observation until puberty

Answer: B. Many testes descend by three months. Early orchidopexy improves fertility; bilateral impalpable testes need endocrine and genetic evaluation.

Question 15

A 75-year-old man presents with a painful, distended bladder and no urine for 12 hours after a cold remedy. Immediate management is:

1. Oral alpha blocker and wait
2. Urethral catheterisation (or suprapubic if urethral fails), recording the residual volume, monitoring for post-obstructive diuresis, starting an alpha blocker, and arranging a trial without catheter
3. Intravenous diuretics
4. Immediate prostatectomy

Answer: B. Acute retention is relieved first; anticholinergic cold remedies are a classic precipitant in men with BPH.

How to use these questions

• Learn the emergencies as sequences: infected obstructed kidney, torsion, cord compression, retention, Fournier's gangrene.
• Know the cancer pathways for prostate, bladder, kidney and testis, including what not to do (scrotal biopsy, TURP for diagnosis).
• Cover stones in depth, including prevention, because the Gulf climate makes them a major workload.
• Practise under time in the Urology bank with the error-log method.

Nephrologists have their own guide (nephrology guide). Other specialty banks are listed in specialty question banks for doctors. When you hold eligibility, join the doctor talent pool.

Frequently asked questions

How many questions are in the urology Prometric exam?

Usually 100 to 150 in 2.5 to 3 hours. Your eligibility notice states the exact format.

What is the pass mark?

About 60% for the specialist paper, scaled at some authorities, and higher for consultant titles.

Does the paper include paediatric urology and andrology?

Yes, at the level of diagnosis, timing of referral and principles of treatment.

Can an MCh or FRCS Urol holder skip the exam?

Sometimes, depending on the authority's recognition list; see the exemptions guide.

Are these real exam questions?

No. They are original practice questions written to the published blueprint. Real exam content is confidential.