Major Uro-Oncological and Open Pelvic/Retroperitoneal Surgery — WACS Viva & Clinical Scenarios (Urology)

Exam-style major uro-oncological and open pelvic/retroperitoneal surgery viva scenarios with examiner probes and model answers for ANAESTHESIA candidates.

Scenarios covered

• SCENARIO 1: A 64-year-old male with muscle-invasive bladder cancer and baseline anaemia (haemoglobin 8.8 g/dL) is scheduled for radical cystectomy and ileal conduit diversion. The estimated operative time is 6 hours. Describe your anaesthetic plan, including invasive monitoring, fluid management strategy, temperature preservation, and post-operative pain management.
• SCENARIO 2: A 58-year-old female presents with a 12 cm right renal mass and a Level III tumour thrombus extending into the retrohepatic inferior vena cava. She is scheduled for right radical nephrectomy and IVC thrombectomy. Detail your preoperative risk stratification, intraoperative vascular access setup, and management of haemodynamic collapse during caval manipulation and cross-clamping.
• SCENARIO 3: A 69-year-old male with moderate COPD and ischemic heart disease is undergoing laparoscopic radical prostatectomy. Thirty minutes after peritoneal insufflation and steep 30-degree Trendelenburg positioning, peak airway pressure increases to 38 cmH₂O, PaCO₂ rises to 56 mmHg despite hyperventilation, and facial/conjunctival oedema is noted. How do you manage this clinical situation?
• SCENARIO 4: A 45-year-old male with a right adrenal mass presents with episodic palpitations, severe hypertension (220/120 mmHg), and diaphoresis, confirmed to have a phaeochromocytoma. He is scheduled for open adrenalectomy. Outline your preoperative pharmacological optimization, intraoperative anaesthetic technique, and management of acute hypotension following tumour vein ligation.