Paediatric and Reconstructive Urological Surgery — WACS Viva & Clinical Scenarios (Urology)

Exam-style paediatric and reconstructive urological surgery viva scenarios with examiner probes and model answers for ANAESTHESIA candidates.

Scenarios covered

• SCENARIO 1: A 3-month-old male infant weighing 4.5 kg presents with poor feeding, lethargy, failure to thrive, and a palpable bladder. Investigations reveal posterior urethral valves, serum creatinine 180 micromol/L, potassium 5.6 mmol/L, and bilateral severe hydroureteronephrosis. He is scheduled for cystoscopy and endoscopic valve ablation. Detail your preoperative optimization, anaesthetic management, temperature regulation, and intraoperative fluid strategy.
• SCENARIO 2: An 18-month-old boy weighing 11 kg is scheduled for a proximal hypospadias repair with chordee release. Describe your plan for general anaesthesia, airway device selection, caudal epidural block technique (including dose and volume calculation of local anaesthetic and adjuvants), and strategies to avoid emergence delirium and postoperative erection.
• SCENARIO 3: A 3-year-old girl weighing 14 kg presents with a massive left abdominal mass confirmed as Wilms' tumour extending close to the inferior vena cava. She is scheduled for open radical nephrectomy. During dissection, sudden massive haemorrhage occurs from the renal vein. Describe your rapid vascular access setup, massive transfusion activation in a paediatric patient, and resuscitation strategy.
• SCENARIO 4: A 28-year-old male is scheduled for a 5-hour complex anterior urethroplasty with buccal mucosal graft harvest under general anaesthesia in the exaggerated lithotomy position. What are your specific anaesthetic considerations regarding airway sharing, patient positioning, prevention of compartment syndrome and nerve injuries, and postoperative pain control?