Emergencies

Question 1

Causes of acute urinary retention

Answer 1

Bladder outflow obstruction

• BPH
• Prostate cancer
• Stricture
• Stone
• Clot
• Pelvic organ prolapse
• Abscess

Contractility/ neurological

• Drugs
• Pain
• Cord compression
• MS
• Diabetes
• Post Op

Question 2

Treatment of urinary retention

Answer 2

Catheter

• Urethral/ suprapubic
• Monitor residual volume

Investigate/ treat cause
- Mid-stream culture
- Blood culture
- Antibiotics
- Analgesia
-

Question 3

Chronic retention

- Defintion

Answer 3

Painless inability to void
- Maybe acute on chronic insults

Urine> 1L in bladder

High pressure and low pressure types

Question 4

Acute urinary retention

- Definition

Answer 4

Painful inability to void, with <1L urine in the bladder.

Question 5

Features of high pressure chronic urinary retention

• Pain
• Continence
• Cr
• Ureter/ Kidneys

Answer 5

Painless

Raised Cr

Incontinence

Ureter +kidneys
- Hydroureter/ hydrpnephrosis

Question 6

Features of low pressure chronic urinary retention

• Pain
• Continence
• Cr
• Ureter/ Kidneys
• Treatment

Answer 6

Painless

Continence, dry

Normal Cr

Normal kidneys/ ureter

Management
- Treat the cause

Question 7

Management of high pressure chronic urinary retention

Answer 7

IV access + IV saline

Catheter
- Record residual volume

Blood- U+Es

Monitor output

Question 8

Haematuria

• Definition/ classifications
• Investigation
• Causes

Answer 8

Blood in urine, can be macroscopic or microscopic

Investigations

• Urine dip detects haem/ myoglobin/ porphyrins
• Microscopy detects microscopic

Causes

• Tumour (macroscopic> microscopic)
• Infection
• Trauma
• Stones

Question 9

Investigations for haematuria

Answer 9

Bloods

• FBC
• U&Es
• PSA
• Clotting
• Group and save

Urine

• Drip
• Microscopy
• Culture

Imagin

• US
• CT urogram: tvenous, arterial)
• KUB X ray

Question 10

Indications for admitting haematuria

Answer 10

Macroscopic and anaemia

Macroscopic and clot retention

Haemodynamically compromised

Question 11

Renal trauma

• Characteristics
• Associations

Answer 11

Occurs in roughly 8-10% abdominal trauma
- Most are blunt

Associated with abdominal visceral injury
- If isolated majority are minor

Question 12

Signs of renal trauma

Answer 12

Loin/ abdominal bruising

Loin tenderness

Loss of lion contour

Loin mass

Macroscopic haematuria/ clots

Question 13

Renal trauma

- Investigations

Answer 13

Conservative

• Bed rest
• antibiotics 5/7

Surgical
- Nephrectomy

Radiological
- Arterial embolisation

Question 14

Testicular torsion

• Definition
• Presentation
• Differentials

Answer 14

Testes twist around spermatic cord and can cause obstruction of the blood flow to testes

Presentation

• Scrotal, ischaemic pain
• Nausea and vomiting
• Low abdo pain
• High lying in scrotum

Differentials

• Torsion of hydatid of morgani
• Epididymitis
• Orchitis

Question 15

Management of testicular torsion

Answer 15

Surgical emergency
- Must be sorted within 4-6 hours

1. NBM and IV Acess
2. Analgesia, bloods
3. Surgery
   - Orchidectomy
   - Bilateral orchidopexy (suture testes to scrotum)

Question 16

Paraphimosis

• Definition
• Cause
• Managament

Answer 16

Foreskin is unable to be retracted
- May obstruct blood flow to glans of penis

Cause
- Catherisation

Management

• Gentle manula reduction
• Dundee method
• Surgical release (circumcision)

Question 17

Torted hydatid of morgagni

Answer 17

Remnant of the Mullerian duct

• Can present as testicular torsion when in torsion
• Presents with small blue dot.

Question 18

Drugs that cause urinary retention

Answer 18

Stress incontinence
- Duloxetine

Urgency
- Anti-muscarinic: tolterodine, imipramine

Question 19

Pyonephrosis

Answer 19

Infection of kidney collecting system.