2: Urological emergencies Flashcards
What is the most common urological emergency presenting to A&E?
Acute urine retention
What are the symptoms of acute urine retention?
No urine output
Increasing bladder pain - midline, suprapubic
Abdominal mass
What commonly causes acute urine retention in men?
Benign prostatic hyperplasia
Apart from BPH, what are some other causes of acute urine retention?
Prostate infection
Prostate infarction
Excessive fluid intake - think alcohol
Acute urine retention is either ___ or ___.
spontaneous , precipitated
What are some events which can precipitate acute urine retention?
Surgery
Catheterisation
Anaesthesia
Sympathomimemetic / anticholinergic medication
How is acute urine retention treated?
Catheter
What can be prescribed along with a catheter to treat acute urine retention?
Alpha blocker
What are some consequences following treated acute urine retention?
Post-obstructive diuresis (risk of dehydration)
Haematuria
What is a common renal cause of loin pain?
Renal calculus causing ureteric colic
How is the pain of ureteric colic managed?
NSAID - diclofenac, inhibits prostaglandins which mediate ureteric pain
Opiate analgesia if NSAIDs not effective
What drug can be prescribed to encourage the passing of small renal calculi?
Alpha blocker
If a renal calculus is large, how is it likely to be treated?
Surgery
ureteric stent, stone removal
What imaging method is gold standard for finding renal stones?
CT scan +/- contrast
What signs and symptoms would encourage you to intervene to remove a renal stone?
Unrelieved pain
Fever and other signs of infection and sepsis
N&V
Haematuria is a common presentation - what investigation is used to find the cause?
CT urogram
Cystoscopy
What special type of catheter is used to treat frank haematuria?
3-way irrigated catheter
helps to break up clots
What is a presentation caused by twisting of the spermatic cord?
Testicular torsion
What usually causes testicular torison?
Which group is it common in?
Spontaneous
Adolescent boys
Where is pain felt in testicular torsion?
Scrotum
may radiate to lower abdomen
How is suspected testicular torison investigated?
Doppler USS
How is testicular torsion treated?
Surgically, within 4-6 hours of onset
What must be done if the testis is black on exploration?
Remove it
What sign is produced by torsion of the appendix testis?
Blue dot sign
What infectious disease presents like testicular torsion?
How do you tell the difference?
Epididimytis
Signs of infection, history of infectio,n, pyuria cremasteric reflex PRESENT
How is suspected epididimytis investigated?
Urine culture
Chlamydia PCR
How is epididimytis treated?
If confirmed to be an STI: oral doxycycline
If confirmed to be a UTI: oral oxfloxacin or ciprofloxacin
What is a common cause of scrotal tenderness and pruritus in children which self-resolves?
Idiopathic scrotal oedema
What is painful swelling of the foreskin called?
Paraphimosis
How is paraphimosis (painful swelling of the foreskin) treated?
Attempt to reduce swelling to move foreskin back over glans:
iced glove, punctures, compression, dorsal slit
What is priapism?
Prolonged erection (> 4hrs)
painful
not associated with arousal
I mean how likely is it that priapism will come up in exams
How is priapism investigated?
Blood sample from corpus cavernosum
USS
How is priapism treated?
Aspirate and irrigate with saline
Alpha agonist
Surgical shunt
What is Fournier’s gangrene?
Necrotising fasciitis of male genitalia
How is Fournier’s gangrene treated?
Surgical debridement
Antibiotics
What is the mortality rate of Fournier’s gangrene?
20%
What organism commonly causes pyelonephritis?
E. coli
emphysematous pyelonephritis
emergency form of “” with assoc gas
How is emphyematous pyelonephritis treated?
Nephrectomy
What is a perinephric abscess?
How is it investigated?
How is it treated?
Collection of pus in kidney, mass, symptoms of infection
CT scan
Antibiotics and drainage
Renal trauma is ___ depending on its severity.
graded
How does renal trauma tend to present?
Haematuria
or obvious on examination
How is renal trauma investigated?
CT with contrast
How is 98% of renal trauma managed?
Non-operatively
otherwise surgery
Which type of fracture can cause bladder trauma?
Pelvic fracture
What are the symptoms of bladder trauma?
Suprapubic pain
Urine retention
Haematuria
How is bladder trauma investigated?
CT cystography
What is a sign of bladder trauma on CT cystography with contrast?
Flame shape
How is bladder trauma treated?
Catheterise
Antibiotics
Repeat CT cystography in 2 weeks
Urethral trauma often presents with a distinctive ___-shaped haematoma in the perineum.
How is it managed?
butterfly haematoma
suprapubic catheter then reconstruction
