Urinary problems

Question 1

What occurs in testicular torsion?

Answer 1

-Testicle rotates, twisting the spermatic cord that brings blood to the scrotum
-Typically occurs in children and young adults
-Undescended testes are particularly at risk

Question 2

How does testicular torsion present?

Answer 2

-Sudden, severe pain
-May radiate to lower abdomen
-Vomiting
SIGNS
-Red, tender, swollen testis
-Retracted upwards
-Opposite testis may be seen to lie horizontally
-Absent cremasteric reflex
-Pain not eased by elevation

Question 3

How should you manage testicular torsion?

Answer 3

-Urgent referral for surgery
-Often both need fixing

Question 4

How is acute urinary retention defined?

Answer 4

-Someone suddenly unable to pass urine, commonly occurs in men >60

Question 5

What is the possible aetiology of acute urinary retention?

Answer 5

-BPH
-Obstruction
-Constipation
-Anticholinergics, TCAs, opioids, Benzos, antihistamines
-UTI
-Post-op / post-partum

Question 6

How does acute urinary retention present?

Answer 6

-Inability to pass urine
-Pain (lower abdo, if chronic usually painless)
-May present with overflow incontinence (incomplete emptying, chronic)

Question 7

How should you investigate AUR?

Answer 7

-Rectal, neuro, pelvic exam
-Urinalysis and culture
-U+Es, creatinine (kidney injury)
-FBC+CRP (infection)
-USS

Question 8

How should you manage AUR?

Answer 8

-Decompression via catheterisation
-Treat cause
-Refer to gynae/neuro if necessary