Urological Trauma, Emergencies, and Scrotal Pathology — WACS Viva & Clinical Scenarios (Urology)

Exam-style urological trauma, emergencies, and scrotal pathology viva scenarios with examiner probes and model answers for ANAESTHESIA candidates.

Scenarios covered

• SCENARIO 1: A 24-year-old male is brought to the resuscitation bay following a motorcycle crash. He is tachycardic (HR 130 bpm), hypotensive (BP 80/45 mmHg), with gross haematuria and a pelvic binder in situ for an unstable pelvic fracture. Contrast CT reveals an American Association for the Surgery of Trauma (AAST) Grade IV renal laceration with active contrast extravasation and a retroperitoneal expanding haematoma. Describe your damage control resuscitation, haemodynamic targets, and anaesthetic strategy for immediate laparotomy.
• SCENARIO 2: A 14-year-old boy presents to the emergency room with severe, sudden-onset right testicular pain of 2.5 hours' duration, accompanied by vomiting. He ate a full meal 1 hour prior to presentation. Ultrasound confirms right testicular torsion with absent arterial flow. Outline your pre-operative assessment, timing of surgery, anaesthetic technique, airway management, and pain relief strategies.
• SCENARIO 3: A 56-year-old poorly controlled diabetic male presents in septic shock with foul-smelling necrotizing fasciitis of the scrotum, perineum, and lower abdominal wall (Fournier's gangrene). Blood glucose is 26 mmol/L, arterial pH 7.20, serum lactate 4.8 mmol/L, base deficit -10 mmol/L, and urine output is negligible. The surgical team demands immediate radical debridement. Detail your rapid resuscitation, airway management, intraoperative stability goals, and metabolic correction.
• SCENARIO 4: A 30-year-old male with sickle cell anaemia (HbSS) presents with severe, painful, non-ischaemic/ischaemic priapism lasting >18 hours. He is scheduled for emergency intracavernosal aspiration, sympathomimetic irrigation, and potential cavernospongiosal shunting. What are the specific pathophysiological concerns, anaesthetic technique options, and sickle cell crisis prevention protocols for this patient?