Urology Nursing Guide — GCC Edition

Urinary Catheters

Indications & Sizing

Catheter Size	Clinical Use
12–14 Fr	Females, children, narrow urethra
14–16 Fr	Routine adult catheterisation
18–20 Fr	Post-TURP, haematuria, clot evacuation
22–24 Fr	Three-way irrigation catheter

Valid Indications: Urinary retention, perioperative (selected surgeries), hourly output monitoring in critically ill, haematuria irrigation, neurogenic bladder, sacral/perineal wound management.

Avoid: Catheterisation solely for nursing convenience or incontinence management — this is not a valid indication per HICPAC guidelines.

CAUTI Prevention Bundle

HICPAC

1. Daily indication review — document & remove promptly
2. Aseptic insertion — sterile technique at placement
3. Maintain closed drainage — never disconnect unnecessarily
4. Perineal hygiene — soap & water, meatal care twice daily
5. Dependent drainage — bag below bladder level at all times
6. Avoid routine irrigation — only if obstruction expected
7. Hand hygiene — before and after any catheter manipulation

Male Urethral Catheterisation — Step-by-Step Technique ▶

Obtain informed consent; explain procedure; ensure privacy and dignity.
Assemble sterile catheterisation pack, correct catheter size, sterile gloves, lignocaine gel 10–15 mL (anaesthetic/lubricant).
Position patient supine, expose only as needed. Place sterile drape.
Don sterile gloves. Cleanse glans and urethral meatus with normal saline (top-to-base strokes).
Hold penis at 90° to abdomen (stretches urethra). Instil lignocaine gel; wait 3–5 minutes for anaesthetic effect.
Insert catheter gently advancing ~20 cm until urine drains freely. Never force against resistance.
Inflate balloon with 10 mL sterile water only after confirming free urine flow. Gently retract catheter until resistance felt.
Return foreskin (prevent paraphimosis), connect to closed drainage bag.
Secure catheter to thigh with catheter holder — prevent traction injury.
Document: date, time, catheter size/type, residual volume, patient tolerance.

Key hazard: False passage risk in BPH/stricture. If resistance at external sphincter/prostate — do NOT force. Refer to urology for flexible cystoscopy-guided insertion.

Female Catheterisation

Use 12–14 Fr for routine, shorter catheter acceptable
Identify urethral meatus (anterior to vaginal opening)
Cleanse labia minora, urethral orifice with saline
Insert 5–7 cm; inflate only on urine return
Higher risk of misplacement into vagina — withdraw and re-attempt

Suprapubic Catheter Care

Inserted surgically through anterior abdominal wall into bladder
Site care: clean with saline, observe for leakage/skin excoriation
First change: no earlier than 4–6 weeks (tract formation)
Subsequent changes: every 4–12 weeks per manufacturer
Never remove if patient cannot void — risk of tract closure within hours
Urgent escalation: catheter displacement, urine leaking around site, inability to reinsert

Catheter Removal & TWOC (Trial Without Catheter)

Catheter Removal Protocol

Confirm indication for removal; document in notes.
Deflate balloon completely before removal — aspirate all water.
Remove smoothly; inspect catheter tip for integrity.
Measure residual if bladder scan possible before removal.

TWOC Protocol

Remove catheter in morning (allows monitoring all day).
Encourage oral fluids 1.5–2 L.
Patient should void within 6 hours; document time and volume.
Perform bladder scan post-void — residual >300 mL = failed TWOC.
Failed TWOC: re-catheterise; consider alpha-blocker (tamsulosin) and retry in 1–2 weeks.

Intermittent Self-Catheterisation (ISC) Teaching

Patient Teaching Points

Clean (not sterile) technique at home is acceptable
Frequency: 4–6 times per day (maximum residual 400–500 mL)
Hand washing essential before each procedure
Use water-based lubricant or hydrophilic catheter
Single-use catheters preferred; multi-use require rigorous cleaning
Bladder diary: record voided volumes and catheterised volumes

Indications for ISC

Neurogenic bladder (spinal cord injury, MS)
Post-void residual >300 mL persistent
Preference over long-term indwelling catheter
Post-prostatectomy overflow
Bladder dysfunction in spina bifida

ISC reduces CAUTI risk compared to indwelling catheters and preserves bladder compliance.

Lower Urinary Tract

Benign Prostatic Hyperplasia (BPH)

IPSS Score Assessment

Score	Severity	Action
0–7	Mild	Watchful waiting, lifestyle advice
8–19	Moderate	Medical therapy
20–35	Severe	Surgical consideration

Medical Management

Alpha-blockers (tamsulosin, alfuzosin): relax smooth muscle, rapid symptom relief; SE: postural hypotension, retrograde ejaculation
5-Alpha-reductase inhibitors (finasteride, dutasteride): shrink prostate over 3–6 months; SE: decreased libido, erectile dysfunction
Combination therapy: superior for large prostates or severe symptoms

TURP Nursing Care

Post-operative

Haematuria: Pink-red urine expected for 24–48 h; frank blood clots = concern
Bladder irrigation: Three-way catheter, continuous normal saline irrigation
Irrigation rate: Titrate to keep drainage light pink/clear (often 1–3 L/h initially)
Pain: Bladder spasms common — antispasmodics (oxybutynin), reassure patient
Catheter removal: Typically 24–48 h post-op if urine clear
Discharge advice: Avoid strenuous activity for 4 weeks, expect intermittent haematuria for 2–4 weeks

TUR Syndrome — Recognition and Management ▶

EMERGENCY: TUR Syndrome results from absorption of hypotonic irrigant (glycine) causing dilutional hyponatraemia. Risk increases with operative time >60 minutes and deep resections.

Clinical Features

Neurological: Confusion, restlessness, agitation, headache, visual disturbance
Cardiovascular: Bradycardia, hypertension (early), hypotension (late), ECG changes
GI: Nausea, vomiting, abdominal distension
Serum Na⁺ <125 mmol/L — seizures possible

Immediate Management

Stop irrigation immediately; inform surgeon/anaesthetist urgently.
Urgent serum electrolytes, FBC, serum osmolality.
Restrict fluids; insert urinary catheter to monitor output.
Furosemide IV if euvolaemic hyponatraemia.
Hypertonic saline (1.8–3%) if severe hyponatraemia (<120) or seizures — ICU setting only.
Correct sodium slowly: max 10 mmol/L in 24 h to prevent osmotic demyelination.
Continuous cardiac monitoring, neuro observations every 15 minutes.

Overactive Bladder (OAB)

Symptoms: Urgency ± urge incontinence, frequency (>8 voids/day), nocturia
Anticholinergics: Oxybutynin, solifenacin, tolterodine — dry mouth, constipation, urinary retention risk (especially elderly)
Beta-3 agonist: Mirabegron — fewer anticholinergic SE, caution in uncontrolled hypertension
PTNS (Posterior Tibial Nerve Stimulation): 12-week weekly outpatient course, needle near ankle
Sacral Neuromodulation (InterStim): implantable device for refractory OAB
First-line: Bladder training, pelvic floor exercises, fluid management

Urinary Incontinence Types

Type	Mechanism	Management
Stress	Increased abdominal pressure (cough/sneeze)	PFMT, mid-urethral sling
Urge	Detrusor overactivity	Bladder training, anticholinergics
Overflow	Incomplete bladder emptying	Catheterisation, treat obstruction
Functional	Physical/cognitive barrier to toilet	Prompted voiding, mobility aids
Mixed	Stress + urge combination	Combined approach

Pelvic floor physiotherapy is recommended as first-line for stress and mixed incontinence — at least 3 months supervised programme.

Upper Urinary Tract

Renal Colic — Ureteric Stone

Clinical Presentation

Sudden onset severe loin-to-groin pain — typically colicky, may be constant
Haematuria (macro or micro) — present in ~90%
Nausea, vomiting, restlessness (cannot find comfortable position)
Ipsilateral hydronephrosis if obstruction present

Investigations

CT KUB (non-contrast): Gold standard — sensitivity 97%, detects all stone types
Urine dipstick/MSU — haematuria, rule out infection
FBC, U&E, creatinine, CRP
Serum calcium, urate, phosphate (metabolic work-up for recurrent stones)

Acute Management

Diclofenac 75 mg IM (NSAID — superior analgesia, reduces ureteric oedema) — avoid if renal impairment/pregnancy
Morphine IV — if NSAIDs contraindicated or insufficient
Alpha-blocker (tamsulosin 0.4 mg) — medical expulsive therapy for distal stones ≤10 mm, increases passage rate
IV fluids if dehydrated; antiemetics
Urgent urology if: Infected obstructed kidney (sepsis), bilateral obstruction, solitary kidney, anuria

Nephrostomy Tube Care

Percutaneous tube draining renal pelvis directly through back.

Nursing Management

Drainage: Monitor volume, colour, turbidity every 4 hours; document output
Normal output: 50–200 mL/h depending on renal function and hydration
Flushing: Only if blocked and on prescription — 5–10 mL normal saline gently; never use force
Site care: Sterile dressing, change every 48–72 h or if soiled; check for skin excoriation
Securing: Loop tubing on skin surface, secure with adhesive dressing — prevent traction

Dislodgement: If tube comes out — cover site with sterile dressing. Do NOT reinsert. Contact urology immediately. Tract closes rapidly (within hours).

Red Flags

No drainage >2 hours (blocked vs. dislodged)
Sudden pain increase at site
Frank haematuria persisting >48 h post-procedure
Signs of infection: fever, purulent drainage, rigors

Ureteric Stent (JJ Stent / Double-J Stent)

Common Side Effects — Patient Education

Ureteric colic-like symptoms: Loin discomfort especially on voiding — normal, due to urine reflux up stent
Urinary frequency, urgency, dysuria, haematuria — common and expected
Suprapubic ache (bladder coil irritation)
Reassure: Symptoms resolve after stent removal

Stent Removal

Removed by flexible cystoscopy under local anaesthesia (outpatient)
Stent string (if present): can be removed in clinic without cystoscopy
Duration: typically 4–6 weeks; maximum 12 weeks before exchange (encrustation risk)
Stent forgotten: Encrustation, stone formation, obstruction — serious complication

Renal Biopsy Nursing Care

Pre-Procedure

Check INR (<1.3), platelets (>100), BP (<160/90)
Hold anticoagulants as directed; aspirin usually held 7 days
Group and save; consent obtained by doctor

Post-Procedure Monitoring

Bed rest for 4–6 hours post-procedure
BP and HR every 15 min × 1 h, then 30 min × 2 h, then hourly × 4 h
All urine observations — haematuria expected, gross haematuria = concern
Urinary output monitoring — haematoma can cause obstruction
Pain assessment — escalate if severe (haematoma, arteriovenous fistula)
Discharge if: BP stable, no gross haematuria, voiding normally, urine clearing

Serious complications: Significant haematoma requiring transfusion (~1–2%), AV fistula, need for embolisation or nephrectomy (<0.1%). Patient should not drive home; have responsible adult.

Hydronephrosis Monitoring

Grading (SFU/ESPU)

Grade	Findings
I	Slight renal pelvis dilatation only
II	Pelvis + few calyces
III	All calyces dilated, parenchyma normal
IV	Parenchymal thinning — significant obstruction

Nursing Considerations

Monitor renal function (creatinine, eGFR) regularly
Watch for obstruction signs: decreased urine output, rising creatinine
Bilateral hydronephrosis — emergency; may require catheterisation
Post-obstructive diuresis: large urine output after relief — risk of electrolyte imbalance and dehydration

Urology Oncology Nursing

Bladder Cancer — TURBT Nursing Care

Post-operative TURBT

Pink urine: Expected for 24–48 h; reassure patient
Three-way catheter if significant bleeding — continuous bladder irrigation
Monitor for clot retention — acute pain, no urine output despite irrigation
Discharge usually 24–48 h; haematuria may persist 1–2 weeks
Driving/heavy lifting: avoid 2–4 weeks
Cystoscopy surveillance: every 3 months year 1 (NMIBC)

Intravesical BCG Therapy

Live AttenuatedCytotoxic

Used for high-risk non-muscle-invasive bladder cancer
Preparation: Reconstitute in BSC; cytotoxic PPE (gloves, gown, mask, eye protection)
Instil via urethral catheter; patient retains for 2 hours, rotating positions
Void into toilet — disinfect with bleach for 6 hours post-instillation

BCG is a live bacteria — NOT cytotoxic in the traditional sense but requires cytotoxic handling precautions. Contraindicated in immunocompromised, active UTI, traumatic catheterisation, haematuria.

Intravesical BCG Safe Handling Protocol ▶

BCG contains live attenuated Mycobacterium bovis. Handle as cytotoxic AND as biohazard.

Preparation

Reconstitute in designated BCG preparation area or BSC if available.
Don double gloves, impermeable gown, surgical mask, eye protection.
Reconstitute with saline as per manufacturer — do not shake vigorously.
Transfer to 50 mL syringe; label clearly "BCG INTRAVESICAL".
Dispose of all reconstitution materials in cytotoxic waste.

Administration & Patient Safety

Confirm no UTI (recent MSU), no traumatic catheterisation, no frank haematuria.
Catheterise aseptically; drain bladder completely first.
Instil BCG by gravity (do not apply pressure).
Remove catheter; patient retains BCG for 2 hours rotating positions.
Void seated to prevent splashing; flush toilet twice with lid closed.
Household: hypochlorite bleach in toilet for 6 hours after each void.

Side Effects

Common: Cystitis symptoms, haematuria, flu-like symptoms for 24–48 h
BCG sepsis (rare, <1%): Fever >38.5°C persisting >24 h, systemic illness — EMERGENCY; rifampicin + isoniazid treatment, contact urology/ID
Contraindications if immunosuppressed: Risk of disseminated BCG infection

Prostate Cancer — Radical Prostatectomy

Post-operative Nursing

Urethral catheter: Remains for 7–14 days (anastomosis healing); strict no-kinking, document output hourly
Haematuria: Mild blood-staining expected; frank haematuria/clots = anastomotic bleeding, escalate
Continence recovery: Pelvic floor exercises from day 1; continence typically returns over 3–12 months; stress incontinence common initially
Erectile dysfunction: Common (nerve-sparing vs non-nerve-sparing); PDE5 inhibitors, vacuum device, penile rehabilitation programme — nurse-led discussion essential
PSA monitoring: Should be undetectable (<0.1 ng/mL) 6 weeks post-op; PSA rise = biochemical recurrence

Radical Cystectomy

Urinary Diversion Types

Type	Description	Nursing Key Points
Ileal conduit	Incontinent urostomy — most common	Stoma care, appliance management, mucus education
Neobladder	Continent orthotopic reservoir	ISC teaching, mucus management, night-time incontinence
Indiana pouch	Continent cutaneous diversion	ISC via stoma, no external bag

Stoma Nursing Post-Cystectomy

Urostomy output: immediately after surgery; mucus in effluent is normal (bowel segment)
Mucus education: patient must understand — expected, not infection
Appliance change 48–72 h post-op with stoma nurse
Peristomal skin assessment at each change

Nephrectomy Nursing Care

Open vs. Laparoscopic

Approach	Open	Laparoscopic
Incision	Flank/midline ~15–25 cm	3–4 small ports
Hospital stay	5–7 days	2–3 days
Return to activity	6–8 weeks	2–4 weeks
Blood loss	Higher	Less

Post-operative Monitoring

Hourly urine output — target >0.5 mL/kg/h (compensatory from remaining kidney)
Monitor contralateral renal function: creatinine, eGFR daily
Haemoglobin trend — significant flank bleed possible
Shoulder tip pain (laparoscopic) — referred diaphragmatic irritation from CO₂; position change, mobilisation
DVT prophylaxis: LMWH + compression stockings
Long-term: single kidney — avoid NSAIDs, maintain hydration, annual BP/eGFR check

Paediatric Urology Nursing

Hypospadias Repair

Byars FlapMAGPITIP Repair

Post-operative Catheter Care

Stenting catheter (silicone) typically remains for 7–10 days
Secured with penile dressing — do NOT remove or disturb until scheduled
Monitor for blockage: if no drainage >4 h, notify team
Avoid catheter tension; extra length coiled and secured to abdomen/thigh
Double nappy technique: inner nappy catches urine via catheter, outer nappy for faeces — prevents contamination

Wound & Dressing Care

Penile oedema and bruising: expected and normal — reassure parents
Dressing (Tegaderm/transparent film) change only by surgical team
No baths/swimming for 4–6 weeks; sponge bath only
Haematoma, purulent discharge, wound separation: escalate urgently
Return to school: typically 1 week post-discharge

Vesicoureteric Reflux (VUR)

Grading (International Classification)

Grade	Description
I	Reflux into ureter only (no dilatation)
II	Reflux to renal pelvis, no dilatation
III	Mild ureteric and pelvic dilatation
IV	Moderate dilatation, mild tortuosity
V	Gross dilatation, tortuosity, intrarenal reflux

Management

Antibiotic prophylaxis: Trimethoprim or nitrofurantoin low-dose nocte (Grade III-V or breakthrough UTIs)
DMSA scan: Detects renal scarring — prepare child (cannula, scan takes 3–4 h; imaging at 3–4 h after injection)
VCUG (Voiding Cystourethrogram): Bladder catheterised, contrast instilled, X-ray during voiding — prepare child/parents for catheterisation discomfort; clean technique
Surgical: Endoscopic (DEFLUX injection) or open ureteric reimplantation for high-grade or breakthrough UTIs

Undescended Testis — Orchidopexy

Pre-operative Considerations

Timing: 6–18 months of age (optimal fertility preservation)
Distinguish from retractile testis (cremasteric reflex) — examine in warm room
Bilateral undescended — check chromosomes/hormones; may present as DSD

Post-operative Care

Positioning: Scrotal support (supportive underwear for older children); no straddle toys for 2–4 weeks
Scrotal oedema and bruising: normal; ice pack (wrapped in cloth) for 24–48 h
Scrotal support: Encourages healing position, reduces haematoma
Monitor: haematoma formation (firming of scrotum), testicular loss if vascular compromise
No bathing for 48 h; sponge bath; avoid nappy friction
Long-term: annual testicular exam; testicular cancer screening in adulthood

Posterior Urethral Valves (PUV)

Neonatal Emergency: PUV causes severe bladder outlet obstruction in male neonates. Can present prenatally with bilateral hydronephrosis on scan.

Presentation

Weak urinary stream, dribbling, poor urine output in male neonate
Bilateral hydronephrosis, renal dysplasia on prenatal ultrasound
Respiratory distress (pulmonary hypoplasia from oligohydramnios)
Elevated creatinine/renal impairment

Acute & Long-term Nursing

Emergency: Urethral catheterisation (fine gauge 6Fr) to relieve obstruction — specialist only
Post-decompression diuresis: intensive fluid/electrolyte management
Definitive: cystoscopic valve ablation
Long-term bladder dysfunction: Non-compliant bladder, incontinence, CKD — lifelong follow-up; ISC may be required
Renal function surveillance: eGFR, BP, proteinuria annually

Nocturnal Enuresis

Assessment

Primary (never dry) vs secondary (was dry, now wet)
Monosymptomatic (night-time only) vs non-monosymptomatic (daytime symptoms)
Bladder diary: voiding frequency, volumes, accidents
Exclude: UTI, constipation, diabetes insipidus
Treat only from age 5–6 years

GCC School Considerations

School nurses in UAE/KSA/Qatar can play key role in identifying and supporting children
Cultural sensitivity: shame and stigma may delay presentation
Support parents with reassurance — common, treatable condition

Treatment

Treatment	Details
Enuresis alarm	First-line; moisture-triggered alarm; 12-week trial; 70% success rate; requires motivated family
Desmopressin	Synthetic ADH; oral/sublingual; restrict fluids 1 hour before to 8 h after dose — risk of hyponatraemia; temporary measure
Combination	Alarm + desmopressin for resistant cases
Oxybutynin	If overactive bladder component

Desmopressin: Restrict fluid intake — do not give if child has been drinking excessively. Risk of symptomatic hyponatraemia (seizures) if overhydrated.

GCC Context & Exam Preparation

Urolithiasis Epidemic in GCC

Highest Global Prevalence

Risk Factors Unique to GCC

Hot climate & dehydration: Concentrated urine year-round; inadequate fluid intake common
High protein diet: Meat-heavy diet increases uric acid and calcium oxalate stones
Hypercalciuria: Vitamin D deficiency supplements may increase calcium load; dietary calcium imbalance
Sedentary lifestyle: Increased in urbanised GCC populations
Genetic factors: Family history prevalent in Gulf populations
Recurrence rate: 50% within 5–10 years without prevention

Prevention Nursing Advice

Fluid intake: >2.5 L per day — urine should be pale yellow
Reduce sodium intake (<5 g/day) — reduces calciuria
Moderate animal protein (<0.8 g/kg/day)
Calcium: maintain normal dietary intake (do not restrict — paradoxically worsens oxalate stones)
Citrate-rich foods: lemon juice, citrus — inhibits stone crystallisation

GCC Nursing Regulatory Bodies

Country	Body	Urology Relevance
UAE (Dubai)	DHA (Dubai Health Authority)	DHA licensing, urology nursing competencies, CAUTI targets
UAE (Abu Dhabi)	DOH (Dept of Health)	DOH licensing exam, scope of practice documents
Saudi Arabia	SCFHS	Urology nursing certification, Saudi Commission for Health Specialties
Qatar	QCHP	Qatar Council for Healthcare Practitioners licensing
Bahrain	NHRA	National Health Regulatory Authority
Kuwait	MOH Kuwait	Ministry of Health licensing

SCFHS Urology Nursing Certification requires clinical hours in urology, specific competencies in catheter care, stoma management, and patient education documentation.

Islamic Considerations in Urology Nursing

Wudu (Ablution) & Urinary Catheter

Islamic ruling: A person with a urinary catheter who has no control over urine leakage falls under the ruling of "Ma'zur" (excused person)
Ma'zur status: may pray with their catheter/drainage bag in place; perform wudu before each prayer time
Urine draining continuously does not invalidate prayer — the condition is beyond control
Nursing role: Advise patient to consult their imam/scholar for personal religious guidance; provide factual information about catheter function

Prayer Validity

Patients may perform prayer with catheter and drainage bag
Position bag below waist during prayer — functional advice
Closed drainage system maintains appropriate hygienic conditions
Respect patient's need for prayer times — schedule procedures around Salah where possible

Ramadan: Hydration & Stone Prevention

High risk period: Prolonged daytime fasting without fluids increases urinary concentration and stone risk
Studies show increased renal colic presentations during Ramadan months in GCC
Nursing advice for stone-former patients during Ramadan:
Suhoor (pre-dawn): drink 2–3 large glasses of water
Iftar (sunset): begin with water/soup; aim to consume most of daily fluid allowance from Iftar to Suhoor
Target 2.5 L total fluid intake within permitted hours
Avoid excessive salt and protein at Iftar meals
If on stone prevention medication (potassium citrate, allopurinol) — timing adjustment with prescriber
Patients with nephrostomy/stent: Ensure adequate hydration; may need medical review regarding fasting safety

GCC CAUTI Improvement Initiatives

GCC hospitals participate in WHO patient safety goals; CAUTI is tracked as a key hospital-acquired infection metric
Dubai Health Authority and Joint Commission International (JCI) standards require catheter indication documented within 24 h
Many GCC tertiary centres have implemented "Catheter Nurse Champions" programmes — dedicated nurses auditing CAUTI bundles
CBAHI (Saudi Arabia) standards include CAUTI prevention bundle compliance as accreditation criterion
Target: CAUTI rate <1 per 1000 catheter-days (international benchmark)

Interactive Tool: CAUTI Risk Assessment & Prevention Bundle Checker

GCC Exam MCQs — DHA / DOH / SCFHS / QCHP Style

1. A male patient 4 hours post-TURP has dark red urine with clots and reports severe bladder spasms. The three-way catheter is draining poorly. What is the PRIORITY nursing action?

A. Increase oral fluid intake
B. Administer IV morphine for pain
C. Increase the rate of continuous bladder irrigation and perform catheter patency check
D. Remove catheter and reassess voiding

Answer: C. Increased irrigation rate clears clots, restores drainage and relieves spasm. Catheter removal post-TURP is contraindicated at this stage. Morphine may help pain but does not address the underlying obstruction.

2. Which of the following is a CONTRAINDICATION to instilling intravesical BCG therapy?

A. Pink-tinged urine post-TURBT 6 weeks ago
B. Patient is on immunosuppressive therapy for rheumatoid arthritis
C. Patient has mild haematuria-free microscopic haematuria on routine dip
D. Patient had a cold 2 weeks ago, now fully recovered

Answer: B. BCG is a live attenuated organism. Immunosuppression risks disseminated BCG infection, which is life-threatening. Other contraindications include active UTI, traumatic catheterisation, frank haematuria, and active TB.

3. A patient undergoing TURP develops confusion, bradycardia, nausea, and abdominal distension 60 minutes into the procedure. The most likely diagnosis and immediate priority is:

A. Pulmonary embolism — oxygen and anticoagulation
B. TUR syndrome — stop irrigation, urgent serum electrolytes, medical emergency management
C. Anaphylaxis — adrenaline IM
D. Hypoglycaemia — dextrose IV

Answer: B. TUR syndrome results from glycine irrigant absorption causing dilutional hyponatraemia. Hallmarks: neurological symptoms + bradycardia + GI symptoms during/after TURP. Immediate action: stop irrigation, check electrolytes, treat hyponatraemia cautiously.

4. In GCC countries, which factor most significantly contributes to the region's highest global prevalence of urolithiasis?

A. High dietary calcium intake
B. Hot climate leading to chronic dehydration and concentrated urine
C. High alcohol consumption
D. Fluoridated water supply

Answer: B. The combination of extreme heat, inadequate fluid replacement, and resulting chronic dehydration creates concentrated urine — the primary driver of stone formation in GCC. High protein diet and hypercalciuria are additional contributing factors.

5. A nephrostomy tube shows no drainage for 3 hours in a patient with a known ureteric obstruction. The tube was draining 150 mL/h previously. What is the FIRST nursing action?

A. Flush the nephrostomy with 50 mL normal saline
B. Check the tube for kinking, position, and visible dislodgement, then contact urology
C. Increase IV fluids to improve renal output
D. Document as normal variation and reassess in 2 hours

Answer: B. First assess mechanical causes (kinking, position, dislodgement) before any irrigation. Flushing a potentially dislodged nephrostomy risks injury. Urology must be notified promptly — a blocked nephrostomy in an obstructed kidney can cause sepsis.