Urologic Emergencies

Question 1

Renal Trauma Indications for surgical intervention

Answer 1

Life threatening hemorrhage
Continued bleeding
Exploration for other injuries reveals expanding perirenal hematoma
Repair or remove kidney

Question 2

Urethral Disruption

Answer 2

Blunt or penetrating trauma
Blood at meatus !
Distended bladder;  unable to void
Genital swelling and hematoma
Diagnosis by RUG (Retrograde Urethrogram)

Question 3

Acute Urinary Retention

Answer 3

Sudden, unexpected, painful inability to void
Abd / pelvic mass on exam, US or CT
Caused by BPH, urethral stricture, stones, blood clots
Tx. with urethral catheter

Question 4

Priapism Causes

Answer 4

Drugs (intracavernosal injections, trazadone** , cocaine, PDE5 inhibitors
Sickle Cell Disease
Blood dyscrasias (leukemia)
Idiopathic (30-50%)

Question 5

Priapism - Treatment

Answer 5

Inject Phenylephrine .5 – 1mg q 10 min
Flush with 1:100,000 epinephrine solution
Surgical: Winter shunt, Al Ghorab shunt

Question 6

Emergent Urethral Obstruction

Answer 6

Solitary kidney
Bilateral obstructin
Associated infection:
Fever/chills
High WBC
Pyuria, bacteruria
Hypotension, tachycardia
*Stone size and location are not critical factors

Question 7

Non-emergent Urethral Obstruction

Answer 7

Pyuria without other evidence of infection (pos. nitrites, bacteruria, etc)
Hydronephrosis
Perinephric fluid (urine)
Hematuria
Mildly increased Cr

Question 8

Fournier’s Gangrene Risk factors

Answer 8

Obesity
Diabetes Mellitus
Immunosupressoin
Alcoholism
Malnutrition

Question 9

Extravaginal Testicular Torsion

Answer 9

Neonate with swollen, discolored scrotum (hemorrhagic necrosis)
Nontender, firm testis with hydrocele
Cord twists above tunica vaginalis
Presumed to occur in utero
Salvage is rare

Question 10

Intravaginal Testicular Torsion

Answer 10

Typically in adolescents
More common
Within tunica vaginalis
Acute scrotal and/or ipsilateral abd pain
Firm, tender, high riding testis w/ hydrocele and edema
Absent cremasteric reflex