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Urology > Emergent Urological Conditions > Flashcards

Emergent Urological Conditions Flashcards

1
Q

What are the principle types of Urologic Emergencies?

A 
Testicular torsion (rupture, fracture, dislocation)
Priapism
Paraphimosis
Urinary obstruction
Fornier's Gangrene
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2
Q

What are the types of testicular torsion?

A

Intravaginal (cord twists within tunica vaginalis)

Extravaginal (Cord and tunica twist together, newborns)

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3
Q

What are the predisposing factors for testicular torsion?

A

Undescended testis

Bell clapper deformity

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4
Q

What is the typical age of testicular torsion?

A

12-18 years old but may occur at any age

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5
Q

How does testicular torsion present?

A

Acute onset of severe testicular pain.

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6
Q

What are the physical findings associated with testicular torsion?

A

Tender, firm, high riding testicle
Absent cremasteric reflex
Thick knotted spermatic cord
Pain not relieved by elevation of testicle

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7
Q

How is testicular torsion diagnosed?

A

clinically

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8
Q

What is the differential diagnosis for severe testicular pain?

A

Torsion (acute and abrupt in onset)

Epididymitis (more chronic and gradual)

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9
Q

What modalities my aid in the diagnosis of torsion?

A

Ultrasound may be used to check blood flow with doppler.

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10
Q

What is the treatment for Testicular torsion?

A

Immediate surgical exploration with with detorsion, and bilateral orchiopexy.

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11
Q

What is the timeframe of testicular torsion?

A

Most are viable if detorsed within 6 hours. Few are viable after 24 hours

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12
Q

What should you do for torsion if an operating room is not immediately available?

A

Attempt manual detorsion through the Scrotum. Follow that up with scheduled orchiopexy.

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13
Q

What is paraphimosis?

A

When the foreskin gets trapped behind the glans resulting in necrosis of the glans.

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14
Q

What should be done to treat paraphimosis?

A

Manual reduction –> dorsal slit –> emergent circumcision

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15
Q

What should be done before attempting to manually reduce a paraphimosis?

A

topical anesthetic, penile block, pain medication, or sedation.

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16
Q

What is the technique for manually reducing paraphimosis?

A

Squeeze out any edema

put index and forefinger on either side of the constricting skin, then push down with thumbs on glans.

17
Q

If there is cutaneous compromise during reduction of the phimosis/paraphimosis what complication may occur?

A

Fournier’s Gangrene

18
Q

How do you treat ureteral obstruction with sepsis?

A

Drain with nephrostomy tube, administer antibiotics, then relieve the obstruction after the infection has resolved.

19
Q

How do you manage high grade ureteral obstruction?

A

Place a ureteral stent, place a nephrostomy tube, remove the cause of the obstruction promptly.

20
Q

How do you manage bladder outlet obstruction with significant urinary retention?

A

Drain with catheter or SP tube.

21
Q

Why is ambiguous genitalia considered a urologic emergency?

A

Because conditions causing ambiguous genitalia can also cause fluid and electrolyte abnormalities

22
Q

What is post obstructive diuresis?

A

The polyuria that results from relieving complete obstruction of the urinary system.

23
Q

What are the pathophysiologic causes of post obstructive diuresis?

A 
Osmotic diuresis - accumulation of urea, most common
Physiologic - Release of fluid and Na
Neph DI - Impaired tubular concentrating
Impaired proximal tubule Na resorption
Circulating hormones - i.e. ANP
24
Q

What is the usual course of post obstructive diuresis?

A

post obstructive diuresis is usually self limiting and lasts for less than 48 hours

25
Q

What is the cause of post obstructive diuresis?

A

Impaired proximal tubular reabsorption of sodium causes salt diuresis

26
Q

What are the complications post obstructive diuresis > 48 hours?

A

hypovolemia
hyponatremia
hypokalemia
hypomagnesemia

27
Q

What tests should be ordered for post obstructive diuresis?

A

BUN/Cr

electrolytes (including Mg)

28
Q

What are the criteria for discharge for post obstructive diuresis?

A
  1. Short duration of symptoms
  2. No elevation in BUN/Cr
  3. No electrolyte abnormalities
  4. No change in mental status
  5. Patient can drink fluids
  6. Stable condition and vital signs

If patient does not meet any of the above criteria then admit

29
Q

How do you treat post obstructive diuresis?

A
  1. Increase oral intake
  2. If oral intake is inadequate give 1ml 1/2 NS for every mL lost
  3. Replace electrolytes as needed
  4. Be cautious of overhydrating.

Urology (6 decks)

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