Endourological Procedures and Transurethral Resection Syndromes — WACS Viva & Clinical Scenarios (Urology)

Exam-style endourological procedures and transurethral resection syndromes viva scenarios with examiner probes and model answers for ANAESTHESIA candidates.

Scenarios covered

• SCENARIO 1: A 74-year-old male with long-standing hypertension and ischaemic heart disease undergoes monopolar TURP under subarachnoid block. At 65 minutes into the resection, he becomes confused, complains of chest tightness, develops visual haziness, nausea, and his blood pressure rises from 130/80 mmHg to 195/110 mmHg with a heart rate of 42 beats per minute. What is your immediate diagnostic evaluation and step-by-step anaesthetic management?
• SCENARIO 2: A 68-year-old male is scheduled for TURBT of a large lateral wall bladder mass under spinal anaesthesia. During the resection, a sudden violent adductor jerk occurs, leading to intense suprapubic and shoulder-tip pain, abdominal rigidity, and hypotension. How do you assess, resuscitate, and manage this perioperative complication?
• SCENARIO 3: A 55-year-old female undergoes left-sided PCNL in the prone position under general anaesthesia. Forty-five minutes after tract dilatation and high-pressure irrigation, the ventilator alarms for peak airway pressures rising from 18 to 36 cmH₂O, SpO₂ drops from 99% to 88% on FiO₂ 0.5, and end-tidal CO₂ drops sharply with progressive hypotension. Outline your diagnostic algorithm and management plan.
• SCENARIO 4: A 72-year-old male with chronic urinary retention and baseline serum creatinine of 210 micromol/L presents for elective TURP. Discuss your choice of anaesthesia, perioperative fluid strategy, and the physiological rationale for the sensory block height required for this procedure.