Renal + Urology emergencies Flashcards
What is the criteria of malignant hypertension
Systolic pressure > 180
or Diastolic pressure > 120
+ signs of organ damage
Malignant hypertension can lead to
Acute renal failure
Papilloedema
Encephalopathy
Cardiac failure
Benign prostate hyperplasia can lead to
acute urinary retention - inability to urinate with increasing pain
Management of acute urinary retention
Catheter
What is testicular torsion
When the testicle rotates and twist the spermatic cord that brings blood to the scrotum -> ischaemia and necrosis
Which age group is most commonly affected by testicular torsion
10-30 years old, peak at 13-15
Symptoms of testicular torsion
Acute severe pain at groin and lower abdomen
Nausea, vomiting
Swollen tender testis
Testis higher than normal position
Cremasteric reflex is reduced
What is cremasteric reflex
Stroking / pinching medial thigh causes contraction of cremaster muscle which elevates the testis
What nerves are responsible for cremasteric reflex
genitofemoral nerve
How do you differentiate between testicular torsion and epididymitis
In testicular torsion, pain is not relieved by elevating the testis
Management of testicular torsion
Urgent surgical exploration - fix both testis
What is epididymo-orchitis
Infection of the epididymis (epididymitis) and testis
Common pathogens causing epididymo-orchitis
N. gonorrhoea
Chlamydia
E. coli
E. coli as a cause of epididymo-orchitis is more common in
Older adults with low-risk sexual history
STI as a cause of epididymo-orchitis is more common in
Younger adults <35
Symptoms of epididymo-orchitis
Acute sever testicular pain
May have history of dysuria and urethral discharge (sign of STI)
Warm, hot swollen testis
Pain RELIEVES on elevation of the testes
Management of epididymis-orchitis
If STI is the most likely cause - refer to local sexual health clinic -> ceftriaxone
If enteric organisms are the most likely cause -
1. send MSU
2. oral quinolone (ofloxacin)
What is priapism
Unwanted persistent penile erection > 4 hrs not associated to sexual arousal
2 types of causes of priapism
Ischaemic
Non-ischaemic
What is the ischaemic cause of priapism
Due to impaired vasorelaxation -> reduced vascular outflow -> congestion of blood in corpus cavernosum
What is corpus cavernosum
Spongy tissue of the penis that fills up with blood to cause erection
What is the non-ischaemic cause of priapism
due to high arterial inflow e.g. fistula formation
Which type of priapism is more urgent
Ischaemic cause of priapism - it is a compartment syndrome which can cause necrosis
What are the causes of priapism
Idiopathic
Sickle cell disease
Erectile dysfunction medication
Trauma
Drugs
What drugs can cause priapism
Anti-hypertensives
Anti-coagulants
Cocaine
Cannabis
Ecstasy
What are the erectile dysfunction medications that can cause priapism
intracavernosal papaverine
Sildenafil
PDE-5 inhibitors
Symptoms of priapism
Persistent erection > 4hrs
Pain at penis
May be non-painful -> suggests non-ischaemic
Investigations for priapism
Cavernosal blood gas analysis
Doppler / duplex USS - shows high/low blood flow
What may cavernosal blood gas analysis show for priapism
If ischaemic - pO2 and pH reduced, pCO2 increased
If non-ischaemic - normal
Management of ischaemic priapism
- Aspiration of blood + injection of saline
- intracavernosal injection of vasoconstrictive agent
- surgery
Why is injection of saline used in ischaemic priapism
To wash out viscous blood
What vasoconstrictive agent is used for priapism
alpha agonist - Phenylephrine
Management of non-ischaemic priapism
Observation, not a medical emergency
What is Fournier’s gangrene
necrotising facilities around the penis
type 1 necrotising fasciitis is most commonly caused by
mixed anaerobes and aerobes
type 2 necrotising fasciitis is most commonly caused by
Streptococcus pyogenes
which type of necrotising fasciitis is the most common
type 1 - common post-surgery in diabetics
Risk factors of necrotising fasciitis
Recent trauma/burns
Diabetes - use of SGLT2
IV drug use
Immunosuppression
Symptoms of Fournier gangrene
rapidly worsening cellulitis
swelling and crepitus of scrotum
dark purple areas - necrosis
Management of Fournier gangrene
Urgent surgical debridement
IV antibiotics
What is paraphimosis
Painful swelling of the foreskin, happens after foreskin retracted for catheterisation or cystoscopy and staff member forgets to replace it in its natural position
