INI CET November 2025 - Urology Questions with Answers & Explanations

Note: The INI CET November 2025 exam was held on 9th November 2025 and was rated moderate in difficulty. The recall questions below are sourced from student recalls and review resources. Urology questions generally appear under the Surgery section. Full confirmed recall papers are available on Prepladder's previous papers page and DigiNerve's recall review.

Q1. Renal Stone Formation - Causes

1. Hyperoxaluria
2. Hypercalciuria
3. Hypercitraturia
4. Hyperuricosuria

✅ Answer: 3 - Hypercitraturia

• Spontaneous nucleation
• Crystal growth of calcium oxalate
• Agglomeration

• Renal tubular acidosis type I (distal RTA)
• Thiazide therapy (due to potassium wasting causing intracellular acidosis)
• Chronic diarrhoea
• Hypokalemia, fasting, hypomagnesemia, androgens, gluconeogenesis, acid-ash diet
• Urinary tract infection (bacteria consume urinary citrate)

• Smith and Tanagho's General Urology, 19th Ed, p.278

Q2. Urethral Injury - Straddle/Perineal Trauma

1. Wait and send him home
2. Immediate insertion of Foley's catheter
3. Suprapubic aspiration of urine
4. Wait for bladder to fill and urge to urinate

✅ Answer: 4 - Wait for bladder to fill and urge to urinate

• Blood at meatus = DO NOT insert Foley catheter blindly - this is the cardinal rule. Doing so can convert a partial tear into a complete tear or introduce infection.
• First investigation: Retrograde urethrogram (RUG) to define the injury extent before any catheter attempt.
• Since vitals are stable and bladder is not distended (not palpable), there is no immediate need for bladder drainage.
• The correct initial step is to wait until the patient feels the urge to urinate, and observe. If the patient voids normally, this suggests an incomplete or minor injury.
• If bladder is distended and patient cannot void, a suprapubic cystostomy (SPC) is the preferred method of bladder drainage - NOT blind urethral catheterisation.

• Schwartz's Principles of Surgery, 11th Ed, p.1793-1794

Q3. Testicular Swelling - Seminoma Management

1. FNAC
2. Scrotal orchidectomy
3. Inguinal orchidectomy
4. Biopsy

✅ Answer: 3 - Inguinal orchidectomy

• Painless testicular swelling in a young male = testicular tumour until proven otherwise.
• Elevated AFP (Alpha-fetoprotein) at 3000 U indicates a non-seminomatous germ cell tumour (NSGCT) - pure seminoma does NOT raise AFP.
• FNAC is absolutely contraindicated - risk of tumour seeding along the needle track, and may violate lymphatic drainage planes.
• Scrotal biopsy or scrotal incision is also contraindicated for the same reason (altered lymphatic drainage - scrotal drainage is to inguinal nodes, not para-aortic).
• The correct approach is radical inguinal orchidectomy - allows ligation of the spermatic cord at the internal inguinal ring before tumour manipulation.

Q4. Varicocele Surgery - Venous Drainage After Ligation

1. Cremasteric veins
2. Penile veins
3. Ectopic drainage in the iliac fossa
4. At the usual location

✅ Answer: 1 - Cremasteric veins

• Venous drainage from the testis is redirected through collateral channels - primarily the cremasteric veins (which drain into the inferior epigastric vein).
• This is why leaving the cremasteric artery/vein intact during surgery is an important technical consideration.
• The deferential veins (via the bladder/pelvic venous plexus) are a minor alternative collateral.
• If all channels are ligated, testicular atrophy or hydrocele can result.

Q5. Bladder Cancer

1. Renal cell carcinoma
2. Transitional cell carcinoma of bladder
3. Penile cancer
4. Urethral cancer

✅ Answer: 2 - Transitional cell carcinoma of bladder

• Bladder cancer occurs at an average age of 65 years with a 3:1 male to female ratio.
• Transitional cell carcinoma (TCC/urothelial carcinoma) is the most common histologic type (~90% of bladder cancers in Western countries).
• It ranks second to prostate adenocarcinoma as the most common male GU malignancy.
• Strong association with cigarette smoking (most important risk factor).
• Also associated with aniline dyes, aromatic amines (occupational exposure), cyclophosphamide, phenacetin abuse, and Schistosoma haematobium (causes squamous cell carcinoma in endemic areas).
• Diagnosis is confirmed by cystoscopy and biopsy.
• Morgan & Mikhail's Clinical Anesthesiology, 7th Ed

Q6. Renal Calculi - Citrate Therapy

1. Citrate promotes calcium oxalate crystallisation
2. Citrate acts as an inhibitor - it complexes with calcium and decreases crystal growth
3. Citrate increases monosodium urate levels in urine
4. Low citrate levels protect against stone formation

✅ Answer: 2

• Complexes with calcium in solution - reduces the free ionic calcium concentration and thus the activity product for calcium oxalate/calcium phosphate
• Decreases agglomeration of calcium oxalate crystals
• Decreases spontaneous nucleation and crystal growth
• Decreases monosodium urates that can adsorb inhibitors and facilitate heterogeneous nucleation

• Smith and Tanagho's General Urology, 19th Ed, p.278

Summary Table

Exam Resources

The INI CET Nov 2025 paper was rated moderate in difficulty. Urology questions typically number 3-5 out of 200, covered under Surgery. Common high-yield urology topics for INI CET include: urethral injuries, renal calculi, testicular tumours, BPH/LUTS, bladder cancer, and congenital anomalies (hypospadias, cryptorchidism).