renal and urological emergencies Flashcards
what is acute urinary retention a common complication of
BPH
why can anticholinergic drugs cause urinary retention
inhibit parasympathetic activity on detrusor muscle and its inhibitory effects on the bladder sphincters
management of acute urinary retention
catheterisation
what happens in testicular torsion
testicle twists around the spermatic cord leading to obstruction of blood flow to the testicle
who typically presents with testicular torsion
teenage boys
what is a predisposing factor for testicular torsion
bell clapper deformity - testes aren’t attached properly to the tunica vaginalis
clinical presentation of testicular torsion
sudden pain - woken up from sleep !!
N+V associated, pyrexia and redness of overlying area
2 clinical signs of testicular torsion
reduced or absent cremasteric reflex
testis may be higher than normal
what is the cremasteric reflex
gentle pinching or stroking of the medial thigh causes elevation of the ipsilateral testicle
name some risk factors for testicular torsion
family history, previous history, undescended testes
surgical correction of undescended testes
bilateral orchiopexy
what is epididymo-orchitis
inflammation of the epididymis and testes
most common cause of epididymo-orchitis in young males
STIs
most common cause of epididymo-orchitis in patients over 35
e.coli from GI tract
classic finding of epididymo-orchitis
alleviation of pain upon elevation of the testes
management of epididymo-orchitis in patients over 35
ofloxacin and analgesia
what is paraphimosis
inability to replace foreskin to its original position after its been retracted
what is phimosis
foreskin is too tight to be retracted over the glans of the penis
what can often precede paraphimosis
catheterisation or cystoscopy
staff member forgets to replace it to its natural position
management of paraphimosis
manual compression
dorsal slit if needed
what is priapism
prolonged unwanted erection
what are the 2 main categories of priapism
ischaemic (low-flow) and non-ischaemic (high-flow)
what is the most common type of priapism
ischaemic
what causes ischaemic priapism
lack of venous drainage from the corpus cavernosa
what conditions are ischaemic priapism linked to
sickle cell, malignancy
what is the most common cause of non-ischaemic priapism
trauma
pathophysiology of non-ischaemic priapism
unregulated cavernous arterial inflow
what syndrome is ischaemic priapism an example of
compartment syndrome !!
investigation of priapism and positive result
aspirate blood from corpus cavernosum + do ABG
ischaemic: low O2, high CO2
non-ischaemic: normal arterial blood
management pathway of priapism
aspiration + irrigation with saline
injection of phenylephrine or adrenaline
surgical shunt
what is fournier’s gangrene
rapidly progressive necrotising fasciitis of the perineum
name some predisposing factors for fournier’s gangrene
diabetes, local trauma, perianal infection
what diagnostic test can be used to confirm fournier’s gangrene
imaging to see if any evidence of gas in soft tissues
what is a perinephric abscess
collection of pus due to a bacterial infection in the perinephric fat and fascia surrounding the kidney
diagnostic imaging in suspected perinephric abscess
CT
clinical presentation of a perinephric abscess
fevers, night sweats and psoas irritation causing an antalgic gait
what is a bladder injury commonly associated with
pelvic fracture
name some renal indications for a CT with contrast
frank haematuria
occult haematuria in a child
haematuria and really low BP
haematuria following penetrating injury
imaging used in suspected bladder injury
CT cystogram
where along the urethra is most vulnerable to trauma
bulbomembranous junction
investigation to assess urethral injury
retrograde urethrogram
most common situation for a penile fracture
intercourse
clinical presentation of a penile fracture
cracking/popping sound, followed by pain, rapid detumescence
imaging of choice for testicular injury
ultrasound
