GU emergencies Flashcards
1
Q
what is the most common urologic emergency
A
- acute urinary retention
2
Q
acute urinary retention
A
- inability to voluntarily pass urine
- either acute or chronic
- men > women
3
Q
when does the brain normally signal to void?
A
- 200-300 cc of urine
4
Q
common drug causes of acute urinary retention
A
- narcotics
- diphenhydramine
- pseudoephedrine
- oxybutynin/detrol- anticholinergics for OAB
- ETOH ingestion
- anesthesia
5
Q
common causes of acute urinary retention in men
A
- BPH/ prostatitis
- carcinoma of prostate
- urethral stricture
- prostatic abscess
6
Q
common causes of acute urinary retention in women
A
- pelvic prolapse
- urethral stricture
- urethral diverticulum
- post op
- pelvic mass
7
Q
common causes of acute urinary retention in general
A
- clot retention
- drugs
- pain
- nerve damage
8
Q
acute urinary retention treatment
A
- urethral catheterization
- suprapubic cath if foley cath cannot be placed
- send urine for UA and culture
- check serum Cr to r/o serious obstructive uropathy
- ALL pts need f/u with urology in 3-7 days for voiding trial
- treat underlying cause
9
Q
post obstructive diuresis
A
- excessive loss of water and salt in urine after urinary obstruction is relieved
- usually occurs within 24 hours
- results in dehydration, electrolyte imbalance, hypovolemic shock, death
10
Q
pts at risk of post obstructive diuresis
A
- renal insufficiency
- heart failure
- evidence of volume overload
- CNS depression
11
Q
treatment for post obstructive diuresis
A
- monitor serum and urine electrolytes
- monitor urine osmolality
- if urine Na > 40, suggests renal tubular injury
- measure strict ins and outs
- IVF 75% of cc/hour rate of diuresis
- ok to eat and drink
- likely need longer time before attempted voiding trial
12
Q
what are alpha 1 blockers used for
A
- BPH
- incomplete bladder emptying
- acute urinary retention
- generally relax smooth muscle of GU sys within 72 hours
13
Q
ADRs of alpha 1 blockers
A
- dizziness
- orthostatic hypotension
- tamsulosin has higher risk ejaculatory dysfunction
- terazosin and doxazosin interact with ED meds
14
Q
5 alpha reductase inhibitors
A
- shrink size of prostate over a 6 mo period
- no indication in acute urinary retention
- reduces need for prostate surgery
- reduce PSA levels by 50%- caution if monitoring levels
- finasteride* and dutasteride
15
Q
ADRs of 5 alpha reductase inhibitors
A
- reduced sex drive
- difficulty with erection or ejaculation
- sx of depression
- sx not super common
16
Q
nephrolithiasis
A
- presence of crystalline stones in GU sys
- almost always originate in kidney then travel down ureter and bladder
17
Q
risk factors for nephrolithiasis
A
- previous stones
- male gender
- high protein
- high salt
- obese
18
Q
work up for nephrolithiasis
A
- labs
- KUB xray- cant dx uric acid stones
- renal US- not sensitive for ureteral stones
- gold std= CT without contrast
- IV pyelograms and spot urine for cystine not often used
19
Q
pain for ureteropelvic junction stone
A
- mild to severe deep flank pain
- without radiation to groin
20
Q
pain for ureteral stone
A
- abrupt onset colicky pain in flank and ipsilateral lower abdomen
- may radiate to testicles/ vulvar area
- nausea
21
Q
pain for mid ureteral stone
A
- pain radiates anteriorly
- on right may mimic appendicitis
- on left may mimic diverticultis
22
Q
pain for distal ureter and ureterovesicular junction stones
A
- pain radiates to groin
- may have cystitis sx
23
Q
types of stones
A
- calcium oxalate
- uric acid
- struvite stones (staghorn calculi)
24
Q
calcium oxalate stones
A
- most common
- risk factors= dehydration, hypercalciuria, hyperoxaluria
25
uric acid stones
- highly acidic urine- pH< 5.5
- persistent metabolic acidosis
- hyperuricemia leading to hperuricosuria
26
struvite stones
- aka staghorn calculi
- due to bacteria proteus
- usually found after recurrent UTI from proteus infections
27
conservative therapy for stones
- attempt to shorten duration of time to pass stone
- alpha blockers
- analgesics
- LOTS of fluids- 2L per day
- strain urine and send stone for analysis
- if pt has UTI then treat with abx
28
types of intervetions for stones
- dissolve uric acid stones with potassium citrate
- extracorporeal shock wave lithotripsy (ESWL)
- ureteroscopy and laser lithotripsy
- percutaneous nephrolithotripsy
29
extracorporeal shock wave lithotripsy
- for stones < 3 cm
- shock wave sent through flank breaks up stones
- pass stone fragments
30
ureteroscopy and laser lithotripsy
- cystoscopy into ureter
- break up stone with laser
- extract pieces and place stent
- usually for stones in middle of ureter
31
percutaneous nephrolithotripsy
- for large kidney staghorn calculi
| - direct entry into kidney at CVA
32
who needs urgent intervention for kidney stones
- stone with urinary obstruction
- si of infection/ sepsis
- renal deterioration
- bilat hydronephrosis
- intractable nausea and vomiting
- pain refractory to analgesics
- stone in solitary kidney
33
what stones have the highest morbidity and mortality?
- urinary tract obstruction + upper urinary infection
34
management of stones with signs of infection or bilat obstruction
- STAT urology consult
- NPO, IVF, pain meds
- urology does cystoscopy and ureteroscopy to place stent
- **DO NOT want to break up stone- will release bacteria and worsen sx
35
preventing future kidney stones
- increase fluid intake
- low salt diet
- moderate animal protein
- moderate calcium
- increase dietary citrate
- 2 tbsp pure lemon juice a day
36
fournier's gangrene
- polymicrobial necrotizing fasciitis of perineum and genitalia
- 10X more common in men
- risk in diabetics/ immunocomp
- high mortality rates
37
GU exam findings for fournier's gangrene
- erythema that extends towards bilat inner thighs
- edematous scrotum
- tender
- odor
- necrosis on penile shaft and scrotum
- no active drainage
38
etiology of fournier's gangrene
- mucosal breakdown in urethra or colon
- perineal or genital skin infx
- urethral stricture
- trauma
- iatrogenic
- paraphimosis
- septic abortion
- STI
39
how many organisms do you usually find for fournier's gangrene
- usually at least 3
40
diagnosis of fournier's gangrene
- clinical dx
- need surgical consult STAT
- 100% mortality if tx with abx only
- imaging may be needed in atypical presentation
41
treatment for fournier's gangrene
- debridement- avg of 3.5 surgical interventions per pt
- hemodynamic stabilization with IVF
- abx- zosyn + vanco + clinda
- plastics consult
42
urological emergencies
- testicular torsion
- priapism
- paraphimosis
- penile fx
- bilateral hydronephrosis
- acute urinary retention
- fournier's gangrene
43
testicular torsion
- twisting of spermatic cord -> venous occulsion and engorgement
- usually 720 degrees of twisting
- common in young men and kids
44
sx of testicular torsion
- rapid onset severe pain from trauma, physical activity, or nothing
- 12-24 hours whole scrotum appears as confluent mass
- afebrile
- no voiding sx
- normal UA and WBC
45
PE for testicular torsion
- high riding testicle
- absent cremasteric reflex
- get US to confirm dx
46
treatment for testicular torsion
- urology consult- vascular emergency
| - good prognosis if treated within 4-6 hours of pain
47
paraphimosis
- foreskin of uncircumcised male becomes retracted behind glans penis
- venous and lymphatic outflow obstructed -> necrosis, gangrene, autoamputation
48
treatment for paraphimosis
- pain control
- topical lidocaine
- NO epi
- urology consult for manual reduction
