1. Which of the following method/s is/are believed to have the lowest risk for stone retropulsion during ureteroscopic lithotripsy?

Α. Ballistic Lithotripsy

Β. Ultrasounds (U/S)

C. Electrohydraulic waves

D. Holmium: YAG laser

Ε. C and D


2. Which of the following methods can achieve the most satisfactory ureteral orifice dilatation during ureteroscopy? 

Α. Balloon - dilator

Β. Plastic ureteral dilators

C. Dual-lumen ureteral catheter

D.  Α and  Β

Ε.   Α, Β and C


3. What guidewire will you choose to bypass an impacted ureteral stone? 

Α. Straight-tip  PTFE guidewire

Β. J-type tip PTFE  guidewire

C. Hydrophilic guidewire with straight or slightly curved tip

D. Amplatz super stiff guidewire

Ε. Bentson super stiff guidewire with a J-type tip


4. Which of the following methods can achieve the final dilatation of the percutaneous tract during percutaneous nephrolithotripsy?

Α. Balloon-dilator

Β. Plastic Amplatz dilators

C. Metallic Alken dilators

D. Only Α and Β are used today

Ε.  Α, Β and C


5. The use of ureteral access sheath during ureteroscopic lithotripsy secures:

Α. continuous and easy access to the ureter

Β. low intrarenal pressures

C. the potential of removing large stones (>1cm) without the need of their fragmentation

D.  Α and Β

Ε.  Α, Β and C  


6. Which of the following techniques is NOT USED for removing a calcified self-retaining ureteral catheter? 

Α. Extracorporeal lithotripsy

Β. Ureterolithotripsy

C. Open uretero-cystotomy

D. Watchful waiting while exerting mild traction on the catheter tip having pulled it to the outer urethral orifice

Ε. C and D


7. One week after extracorporeal lithotripsy of a renal stone, a steinstrasse is formed at the lower segment of the ureter.  The patient complains about strong colic-like pain in the ipsilateral lumbar region that responds only a little to analgesics. Which therapeutic method will you choose next?

Α. Placement of percutaneous nephrostomy and watchful waiting 

Β. Ureteroscopic lithotripsy

C. Extracorporeal lithotripsy of the steinstrasse

D. All the above are acceptable therapeutic options

Ε. Only Β and C have therapeutic value in the specific case


8. In an asymptomatic patient with a stone in the upper ureteral segment (maximum diameter 0,8cm) and mild (first grade) dilatation of the ipsilateral pyelocalyceal system, which therapeutic option will you choose once the conservative treatment (watchful waiting) has failed?

Α. Percutaneous (descending) ureteroscopy

Β. Extracorporeal in situ lithotripsy

C. Extracorporeal lithotripsy using the 'push-back' technique 

D. Placement of percutaneous nephrostomy and extracorporeal lithotripsy

Ε. Laparoscopic ureterolithotomy


9. Which is considered today the method of choice for the treatment of staghorn calculi (coral stones)?

Α. Monotherapy with extracorporeal lithotripsy

Β. Percutaneous Nephrolithotomy + extracorporeal lithotripsy

C. Anatrophic nephrolithotomy

D. Pyelolithotomy in combination with nephrolithotomies

E. Flexible ureteronephroscopic lithotripsy


10. Which is the treatment of choice for a uric acid stone (maximum diameter 2cm) lodged in the renal pelvis ?

Α. Percutaneous nephrolithotripsy

Β. Extracorporeal lithotripsy

C. Alkalization of urine

D. Laparoscopic pyelolithotomy

Ε. Open pyelolithotomy


11. The best approach for a symptomatic posterior calyceal diverticulum complicated with lithiasis is:

Α. Watchful waiting

Β.  Extracorporeal lithotripsy

C. Open surgery

D. Percutaneous nephrolithotomy (PCNL) - puncturing directly into the diverticulum and removing the stone

Ε. None of the above


12. Following ureteroscopy, a stent must be placed:

A. if there is ureter perforation

B. if the stone that was removed was impacted with a large concomitant oedema

C. if dilatation of the ureteral orifice with a balloon has preceded 

D.  in cases Α and Β

Ε. in cases Α, Β and C


13. The flexible ureteroscope is usually inserted into the ureter .....:

Α. alongside (adjacent to) a guidewire

Β. through a ureteroscopic access sheath

C. directly, as it happens with the the semi-flexible ureteroscope

D. Α and Β

Ε. Α, Β and C


14. Which of the following statement/s about the semi-flexible ureteroscope is/are true?

Α. It provides better visual field than the flexible ureteroscope.

Β. It is easier to handle.

C. It is the insturment-of-choice for removing stones lodged in the upper segment and ureteropelvic junction 

D. Α and Β

Ε. Α, Β and C


15. What type of guidewire will you use to bypass an impacted ureteral stone in the midline of the ureter?

Α. Simple PTFE guidewire 0,038 inch 

B. Super stiff Amplatz guidewire 0,038 inch

C. Hydrophilic Terumo Glidewire 0,038 inch 

D. Simple PTFE guidewire 0,038 inch with J-type tip

Ε. Nitinol guidewire 0,018 inch


16. Which of the following statements about flexible ureteroscopes is FALSE?

Α. Inserting instruments (e.g. grasping basket) through the working channel reduces the bending angle of the ureteroscope tip.

Β. The flexible ureteroscope is particularly fragile and has limited life duration. 

C. Inserting instruments through the working lumen reduces the flow of lavage fluid; that is why it is recommended to use a special device to increase fluid pressure.

D.The flexible ureteroscope can be combined only with two types of endoscopic lithotripsy: laser and electrohydraulic-wave lithotripsy 

Ε. In modern instruments, the maximum bending angle of the tip does not exceed 120 degrees. 


17. Which of the following statements about the anatomic position of kidneys and percutaneous procedures is/are TRUE?

Α. When the patient is in the prone position, the angle formed by the posterior renal calyces and the imaginary axis transversing the spine is about 30o.  

Β. A part of the upper renal pole at the posterior-lateral aspect of the kidney, is covered by the liver on the right and by the splene on the left. 

C. The posterior calyces are usually projected distally from the anterior calyces.

D.  Α, Β and C

Ε.  Α and Β


18. Which of the following statements about ureteroscopy is true?

Α. The good design of a procedure does not have to do only with a good detailed medical history, clinical examination and imaging methods, but it also requires the appropriate consumables and instruments. 

Β. Proper equipment and maintenance of a large stock of materials is essential (as long as the economic situtation allows for it). 

C. Learning as many techniques as possible is essential.

D. When treating the upper urinary tract, it takes a lot of patience, technique flexibility and gentle manipulations. 

Ε. All the above


19. Which extraction/ grasping basket is the most appropriate to use?

Α. Tipless/ zerotip basket, allowing for stone retrieval even when there is not enough space behind (e.g. calyceal stone manipulations).

Β. Endoscopic extraction basket either of the classical type or of  the flexible and long type, facilitating access behind an impacted stone

C. 3-wire grasping basket, which can be released from a stone if required  

D. Multiple-wire or even double- wire grasping basket, capable of retrieving stone fragments while dilating a narrow ureter around the stone.

Ε. Basket of 'kink-resistant' material, specially designed to resist to crushings and comminutions by various lithotripters; also capable of dilating the ureter, when deploying within the lumen.   

F. Grasping devices, such as «tri sept» or «graspit», allowing for immediate stone extraction even when there is no space behind comminuted concrements in the case of an impacted stone (commonly occurring with the ballistic lithotripter) or a stone lodged too close or projecting onto the ureteral orifice. 

G. Baskets with flexible tip and small diameter, that do not limit bending of flexible instruments, do not reduce lavage flow and ensure a good visual field. 

Η. Baskets with satisfactory diameter, strong and durable enough to be guided even through a 'difficult' ureter.

I. All the above should be available and used according to the case. 


20. Which of the following statements about ureteroscopes is true?

Α. Large-diameter instruments  (>8,5 Fr) , for they are:

- reliable

- strong and durable,  advancing more easily through the ureter  without the need of excessive tip-bending  and without loss of visual field. 

- large working channel

- big  visual field

- economical thanks to the higher endoscopic reliability and the potential of using strong and durable multiple-use instruments in the large working channel

Β. Small-diameter instruments (< 8 Fr), which

- rarely require ureteral dilatation

- are less traumatic and do not require «stenting» of the ureter

- are flexible and guided by wires

C. Flexible ureteroscopes of small diameter and big length, capable of accessing the whole urinary drainage system .

D. All the above types of ureterscopes should be available in a well-organized Endourology Department. 


21. Which of the following is an absolute contra-indication for performing endoscopic procedures in the upper urinary tract?

Α. Pathological obesity

Β. Prostatic hypertrophy

C. Pregnancy

D. Anticoagulant therapy

Ε. Active urinary tract infection

F. All the above


22. Which is the most appropriate therapeutic option for a patient with solitary stone 1,5cm in diameter lodged in the renal pelvis?

Α. pyelolithotomy

Β. ureteroscopy and lithotripsy with Ho:YAG laser

C. SWL and placement of ureteral stent


Ε. SWL in situ


23. Patient with congenital soliltary kidney presents staghorn calculi (coral stones) branching in the lower and middle calyx. There is mild hydronephrosis, while renal function is slightly affected. Which is the most appropriate therapeutic option?  


Β. Close monitoring with regular ultrasound screening, serum creatinine and general urine tests. 

C. ESWL with placement of ureteral stent

D. Percutaneous nephrostomy followed by PNL

Ε. Anatrophic Nephrolithotomy


24. Patient presents a stone, 0,8 in diameter, at the upper left ureter and concomitant hydronephrosis. Which is the indicated treatment?

Α. ESWL in situ

Β. ESWL with placement of ureteral stent

C. Administration of Tamsulosin and 1-month monitoring


Ε. Placement of ureteral stent and URS 1 week later


25. Extracorporeal lithotripsy is NOT a treatment of choice in:

Α. renal stones with maximum diameter >2cm

Β.  ureteral stones <1cm

C. renal stones composed of calcium monohydrate and dihydrate oxalate with maximum diameter of 1,5cm

D. stones in the lower calyx with maximum diameter <1cm 

Ε. stones of the upper ureteral segment


26. Which of the following statements about staghorn renal calculi (coral stones) is true?

Α.  ESWL as monotherapy is the treatment of choice.

Β. ESWL should be the primary therapeutic step and other methods (e.g. percutaneous lithotripsy) should follow as supplementary treatment. 

C. Open surgery is the treatment of choice.

D. Flexible ureteronephroscopy with the use of holmium:YAG laser is the most modern and effective therapeutic method for this type of stones. 

Ε. Percutaneous lithotripsy is the primary therapeutic choice, with supplementary use of ESWL wherever needed. 


27.What is the main indication for open ureterolithotomy?

Α. Upper ureteral stone > 1cm

Β. MIddle ureteral stone > 1 cm

C. Lower ureteral stone > 1 cm

D. Ureteral stone resistant to extracorporeal lithotripsy

Ε. None


28. Patient with sizeable complicated staghorn calculus (coral stone) presents considerable residual stone load after sandwich-PNL session.  What is the most appropriate therapeutic option?

Α. Open nephrolithotomy

Β. Flexible nephroscopy

C. Flexible uretero-nephroscopy

D. Monitoring

Ε. Nephrectomy


29. Woman 140kg in weight presents a renal pelvic stone of 4cm. What treatment will you follow?

Α. ESWL in situ

Β. Administration of α-blocker


D. Pyelolithotomy

Ε. Chemolysis


30. According to international data, the number of open procedures performed for the treatment of urolithiasis is:

Α. 1-5%

Β. 5-10%

C. 10-15%

D. 15-20%

Ε. >20%


31.  In percutaneous nephrolithotripsy, the initial puncture of the complicated posterior calyx  should be conducted with the tap needle in such a position that it forms an angle with the vertical body axis about:

Α. 10ο

Β. 30ο

C. 50ο

D. 60ο

Ε. 70ο


Correct answers


1 D

9 Β

17 Ε

25 Α

2 Ε

10 C

18 Ε

26 Ε

3 C

11 D

19 I

27 Ε

4 Ε

12 Ε

20 Ε

28 Α

5 D

13 D

21 Ε

29 D

6 D

14 D

22 Ε

30 Α

7 D

15 C

23 C

31 Β

8 Β

16 Ε

24 Α