urinary emergencies

Question 1

what are the types of acute urinary retention

Answer 1

precipitated = trigger event

spontaneous

Question 2

what are the causes of precipitated acute urinary retention

Answer 2

excessive fluid intake
infract/infection
surgery
medication 
benign prostatic hyperplasia

Question 3

what are the symptoms of acute urinary retention

Answer 3

inability to urinate

increasing pain

Question 4

what is the treatment of acute urinary retention

Answer 4

catheter

uroselective alpha blocker = tamsulosin, alfuzosin

Question 5

what is frank haematuria

Answer 5

visible blood in the urine

Question 6

what are the investigations of frank haematuria

Answer 6

CT urogram + contrast

cystoscopy

Question 7

what is the treatment of frank haematuria

Answer 7

3-way irrigating haematuria catheter

Question 8

what is torsion of the spermatic cord

Answer 8

testis and cord rotate around arterial supply causing ischaemia then death

Question 9

what is the cause of torsion of the spermatic cord

Answer 9

spontaneous = most common
trauma
athletic activity

Question 10

what are the symptoms of torsion of the spermatic cord

Answer 10

ACUTE
sudden onset of extreme pain
nausea/vomiting
bell clapper deformity

Question 11

what are the investigations of torsion of the spermatic cord

Answer 11

scrotal exam

US

Question 12

what would you expect to find on examination of the scrotum with torsion of the spermatic cord

Answer 12

testis high in scrotum

absence of cremasteric reflex

Question 13

what is the treatment of torsion of the spermatic cord

Answer 13

EMERGENCY SURGERY

Question 14

What is epididymitis, who is usually affected by this

Answer 14

inflammation of epididymis which is located at back of testis

children

Question 15

what are the symptoms of epididymitis

Answer 15

dysuria
pyrexia
history of UTI/catheterisation/urethritis

Question 16

what are the investigations of epididymitis

Answer 16

scrotal exam = cremasteric reflex present
US
urine culture
chlamydia swab for PCR

Question 17

what is the treatment of epididymitis

Answer 17

ofloxacin for 14 days

analgesia + bed rest

Question 18

what is paraphimosis

Answer 18

painful swelling of the foreskin distal to the phimotic ring

Question 19

what usually causes paraphimosis

Answer 19

foreskin retracted for procedure then not return to original position

Question 20

what is the treatment of paraphimosis

Answer 20

ice
granulated sugar (?)
pnctures
manual compression
dorsal slit

Question 21

what is priapism

Answer 21

prolonged erection (>4hrs) not associated with sexual arousal

Question 22

what are the causes of priapism

Answer 22

trauma
neurological condition
idiopathic
treatment of erectile dysfunction

Question 23

what are the types of priapism

Answer 23

ischaemic

non-ischaemic

Question 24

what is the investigation of priapism

Answer 24

US

Question 25

what is the treatment of priapism

Answer 25

ischaemic = aspirate blood ± irrigation with saline 
non-ischaemic = observe

Question 26

what is fournier’s gangrene

Answer 26

form of necrotising fasciitis in skin, urethra or genital region

Question 27

what are the symptoms of fournier’s gangrene

Answer 27

starts as cellulitis 
red, tender
very painful 
fever
swollen + crepitus of scrotum

Question 28

what is the investigation of fournier’s gangrene, what will it show

Answer 28

Xray
US

showing gas in tissue

Question 29

what is the treatment of fournier’s gangrene

Answer 29

surgical debridement + antibiotics

Question 30

what are the symptoms of penile fracture

Answer 30

crack or pop sound
pain
rapid detumescene, discolouration and swelling