Summary of Answers

Q1 - Urethral Injuries (30 marks) ✅

• Classification: Posterior (PFUI with pelvic fracture) vs. Anterior (straddle/bulbar); Goldman grading
• Etiology: Pelvic fractures, straddle injury, iatrogenic catheterization
• Clinical features: Classic triad (blood at meatus, retention, butterfly hematoma), high-riding prostate
• Investigations: RUG (gold standard), CT pelvis, cystoscopy
• Management: SPT (AUA preferred), single blind catheter attempt, endoscopic realignment, delayed urethroplasty (3-6 months); complications - stricture (45-100%), ED (~50%)

Q2 - Carcinoma Bladder (20 marks) ✅

• Types: TCC (90-95%), SCC, Adenocarcinoma; NMIBC vs. MIBC staging
• Etiopathology: Tobacco (most important), aromatic amines, schistosomiasis (SCC), cyclophosphamide, radiation; molecular pathways (FGFR3 vs. TP53/RB1)
• Clinical features: Painless hematuria (cardinal), irritative symptoms, ureteric obstruction
• Investigations: Urine cytology, CTU, Cystoscopy + TURBT (gold standard)
• Management: TURBT + intravesical BCG/mitomycin for NMIBC; radical cystectomy + neoadjuvant chemo for MIBC; immunotherapy (pembrolizumab) for metastatic disease

Q3 - Splenomegaly + Laparoscopic Splenectomy (20 marks) ✅

• Causes: Infective (malaria, kala-azar), hematological (ITP, spherocytosis, thalassemia, CML), congestive (portal hypertension), storage disorders (Gaucher's)
• Laparoscopic splenectomy: Indications, contraindications, pre-op vaccinations, step-by-step technique (lateral decubitus, vascular stapler at hilum, endo-bag extraction), complications (OPSI, hemorrhage, pancreatic injury, thrombocytosis)

Q4(1) - Impotence (10 marks) ✅

• Causes: Psychogenic, vasculogenic (most common organic), neurogenic, endocrine, drug-induced
• Management: Lifestyle → psychotherapy → PDE5 inhibitors (sildenafil/tadalafil) → VED/ICI → penile prosthesis
• Recent trends: LiESWT, PRP, stem cell therapy, gene therapy, robotic nerve-sparing surgery

Q4(2) - Breast Reconstruction (10 marks) ✅

• Implant-based: tissue expander + implant (most common), direct implant
• Autologous flaps: LD flap (pedicled), TRAM (pedicled), DIEP (gold standard free flap), SIEA, GAP, TUG, PAP
• Adjuncts: fat grafting, nipple-areola tattooing, oncoplastic techniques

Q4(3) - Psoas Abscess (10 marks) ✅

• Etiopathology: Primary (hematogenous - S. aureus) vs. Secondary (Pott's disease in developing countries; Crohn's disease in developed world)
• Tracking along psoas to femoral triangle; "cold abscess" in TB
• Investigations: CT scan (gold standard), MRI for spinal TB, AFB/IGRA
• Management: ATT/antibiotics + CT-guided percutaneous drainage (first-line) → surgical drainage if failed; treat underlying cause