Obstructive Uropathy, Urosepsis, and Stone Disease — WACS Viva & Clinical Scenarios (Urology)

Exam-style obstructive uropathy, urosepsis, and stone disease viva scenarios with examiner probes and model answers for ANAESTHESIA candidates.

Scenarios covered

• SCENARIO 1: A 52-year-old female presents to the emergency department obtunded, febrile (39.2°C), hypotensive (BP 75/40 mmHg), tachycardic (HR 135 bpm), and oliguric. Abdominal ultrasound reveals severe right hydronephrosis with an obstructing 1.5 cm proximal ureteric calculus and debris in the renal pelvis. Arterial blood gas shows pH 7.18, lactate 5.4 mmol/L, and base excess -12 mmol/L. The urologist requests urgent cystoscopy and JJ stent insertion. What is your resuscitation and anaesthetic management plan?
• SCENARIO 2: A 60-year-old male with solitary functional right kidney presents with anuric AKI secondary to an impacted pelvic-ureteric stone. Serum potassium is 7.2 mmol/L with peaked T waves and widened QRS complexes on ECG. Serum creatinine is 680 micromol/L. Outline your immediate medical management of hyperkalaemia and your anaesthetic technique for emergency percutaneous nephrostomy placement.
• SCENARIO 3: A 48-year-old male has 3.5 litres of urine drained within the first 3 hours following relief of chronic high-pressure urinary retention. His blood pressure drops from 140/85 mmHg to 90/50 mmHg with marked postural dizziness. Explain the pathophysiology of post-obstructive diuresis, the distinction between physiological and pathological diuresis, and your fluid replacement strategy.
• SCENARIO 4: A 42-year-old male is scheduled for Extracorporeal Shock Wave Lithotripsy (ESWL) for a 1.2 cm upper pole renal calculus. Describe the physics of shock wave triggering, potential cardiovascular and renal complications, and your choice of anaesthetic technique/monitoring.