Surgery teaching (Urology) Flashcards
types of urinary retention
Acute
Chronic
Acute on chronic
High pressure
Low pressure
acute retention
- Painful
- Precipitant – alcohol XS, anaesthetic, UTI
chronic retention
Painless, large volume – neurological cause, previous pelvic surgery
Acute-on-chronic
- Painful, may be high pressure – check U&Es and upper tracts
- DO NOT TWOC, DISCUSS WITH UROLOGY
High pressure vs low pressure
- High pressure – bilateral hydronephrosis, AKI – not safe
- Low pressure – relatively safe, long-term complications
which catheter to use
1) Length- can choose between male and female - only difference is length (lots of Drs use males in females - longer)
2) Width - go big at least 16Fr, 14Fr if not available
what does Fr mean (catheter)
Fr= French = width = unit
what is this?
suprapubic catheter
what is this?
Paraphimosis
define paraphimosis
a common urologic emergency that occurs in uncircumcised males when the foreskin becomes trapped behind the corona of the glans penis. T
how to fix paraphimosis
1) Lots of instagel
2) Analgesia
2) Hold the penis tightly and try and retract the phimotic ring over the oedematous foreskin
3) if this doesnt work- get dissolved sugar water and put on gauze - osmosis
purpose of three way cathether
can flush catheter e.g. if blood clot
priapism
a disorder in which the penis maintains a prolonged, rigid erection in the absence of appropriate stimulation. Definitions vary regarding duration, but any erection lasting four hours or longer is generally considered priapism.
causes of priapism
**Non-ischaemic causes **are typically caused following penile or perineal trauma or spinal cord injury, whereby damage to the vasculature creates an arterial-sinusoidal shunt within the corpus cavernosum
Ischaemic causes include:
- Iatrogenic – Intracavernosal drug therapy* (for impotence), such as papaverine or alprostadil
- Sickle cell disease
- Other haematological disorders, such as leukaemia or thalassaemia
- Pelvic malignancy (rare)
management of priapism
1) Corporeal aspiration
2) Intracavernosal injection of a sympathomimetic agent, such as phenylephrine, may be trialled.
3) Surgical Management
If these manoeuvres are ineffective, a prompt surgical shunt between the corpus cavernosa and glans is fashioned.
renal failure can be
pre-renal
renal
post-renal
get a bladder scan
risk factors for prostate cancer
- older
- family history
- anabolic steroids
- taller
- afrocaribean
screening for prostate cancer
NO
The screening of asymptomatic men for prostate cancer is a controversial topic. To date, there is no national prostate cancer screening programme in many Western countries.
Other factors which icrease PSA
- DRE
- vigorous exercise
- surgery
- infection
investigations for prostate cancer
1) PSA
2) DRE
3) Multiparametric prostate MRI
4) Transperineal biopsy
stones management summary
Non-contrast CT
* Less than 5mm and intra-renal – no action needed
* All ureteric stones (or renal pelvis) – call Urology
* If larger than 5mm and renal – in hours consider Urology referral
causes of scrotal swellings
Hydrocele
Hernia
Testicular cancer
Epididymal cysts
