Urologic Emergencies Flashcards
Renal Trauma
- dx
- tx
Dx
- CT with contrast for
- -blunt trauma w/gross hematuria or microhematuria with shock
- -penetrating trauma w/any hematuria
- -pediatric trauma
Tx
- managed conservatively: +/- stent, embolization, percutaneous drain or nephrostomy tube
- less than 10% are emergently operated on, but these are the indications to do so:
- -life threatening hemorrhage
- -continued bleeding
- -exploration for other injuries reveals expanding perirenal hematoma
- -repair or remove kidney
Penile Fracture
- cause
- dx
- tx
Cause
-blunt trauma to erect penis causing tear in tunica albigenia (aggressive intercourse, off target penetration)
Dx
-audible snap, sudden detumence, swelling, bruising
Tx
- conservative (nonoperative) can lead to: erectile dysfunction, curvature, painful erections
- Surgical: deglove penis, rule out urethral injury, close corporal tear
Testis Rupture
- cause
- PE findings
- Dx
- Tx
Cause
-blunt or penetrating trauma (straddle, saddle horn, bar fight)
PE
-scrotal swelling and echymosis
Dx
-scrotal US: loss of tunic continuity, internal echos, heterogenecity
Tx
- surgery to debride extruded tissue and close tunic
- if less than 3 days, can usually save the testis, if more than 3 days, 70% get orchiectomy
Bladder Rupture
- cause
- sx
- Intraperitoneal Dx, Tx
- Extraperitoneal DX, Tx
Cause
- usually blunt trauma (usually not penetrating trauma)
- 60% are extraperitoneal, 30% intra, 10% combined
Sx
- hematuria always present
- 90% of bladder ruptures have associated pelvic fractures, but 10% of pelvic fractures have associated bladder ruptures
Intraperitoneal: external blow, full bladder
Dx
-CT or cystogram (usually CT cystogram)
–will see contrast around bowel, contrast above superior acetabular line
Tx
-surgical repair
Extraperitoneal:blunt trauma with pelvic fracture
Dx
-CT or cystogram
–will see contrast limited to pelvis, perineum, or genitalia…starburst pattern of contrast below superior acetabular line
Tx
-catheter drainage (surgical repair if having surgery for other injury)
Urethral Disruption
- Cause
- Sx
- Dx
- Incomplete vs Complete: describe what you will see on imaging and tx for each
Cause
-blunt or penetrating trauma
Sx
- blood at meatus!***
- distended bladder (unable to void)
- genital swelling and hematoma
Dx
-RUG (retrograde Urethrogram)
Incomplete: Dx -RUG shows contrast extravasation but with contrast into bladder Tx -catheter drainage
Complete Dx -RUG shows contrast extravasation w/o contrast into bladder Tx -suprapubic tube with: --early primary realignment, or --delayed reconstruction
ACUTE Urinary Retention
- what
- cause
- dx
- tx
What
-sudden, unexpected, PAINFUL inability to void
Cause
-BPH, urethral stricture, blood clots, stone, drugs (antihistamines, narcotics), post op, overdistention
Dx
- US or CT
- will feel abd/pelvic mass on PE
Tx
- Urethral catheter (14 french coude tip) with lots of lube!
- suprapubic tube
- suprapubic aspiration
- watch for hematuria
- post obstructive diuresis uncommon with acute retention and normal Cr
Priapism
- What
- describe the types: Ischemic vs nonischemic
- what type is most common?
- tx
What
-painful, prolonged (more than 4 hours) erection
Ischemic
- low flow
- MC form***
- like compartment syndrome
- Cause: drugs (intracavernosal injections, cocaine), sickle cell disease, blood dyscrasias (leukemia), idiopathic
Nonischemic
- high flow due to AV fistula
- usually due to trauma
Tx
- Pharmacologic
- -inject phenylephrine (1mg every 10min)
- -flush with 1:100,000 epi solution
- surgical
- -winter shunt (he said hes tried this a few times and it has never worked)
- -Al Ghorab shunt (cut into glans, puncture cavernosum)
Acute Ureteral Obstruction
- Cause
- Sx
- Dx
Cause
-stones, clot, retroperitoneal fibrosis, surgical mishap, bladder outlet obstruction, malignancy
Sx
- flank/abd pain: colicky, cramping, unable to lay still, non-positional!
- pain radiation to groin
- nausea, vomiting
- UA (possible hematuria or pyuria)
Dx
-NONCONTRAST abd/pelvic CT
Acute Ureteral Obstruction
EMERGENT
-what classifies it as emergent?
-tx
NONEMERGENT
- what classifies it as nonemergent?
- tx
EMERGENT
- solitary kidney
- bilateral obstruction
- associated infection:fever/chill, high WBC, pyuria, bacteriuria, hypotension, tachycardia
Tx
- ureteral stent
- nephrostomy tube (provides reliable, unequivocal drainage)
- stone removal with ureteroscopy delayed til after infection is resolved
NONEMERGENT
- Pyuria without other evidence of infection
- hydropnephrosis
- perinephric fluid (urine)
- hematuria
- mildly increased Cr
Tx
- Toradol!!!!!!!!
- P.O. analgesia
- ? tamsulosin
**Stone size and location are not critical factors!
Fourniers Gangrene
- What
- risk factors
- dx
- tx
What
- Necrotizing infection of skin, fat, and fascia of genitalia and perineum
- synergistic infection with multiple aerobic and anerobic bugs
Risk Factors
- Obesity
- DM
- immunosuppression
- alcoholism
- malnutrition
Dx
- hx of pain, swelling, fever
- exam: fever, tachycardia, tachypnea, erythema, edema, crepitus, fluctuance, discoloration, purlulent drainage, FOUL ODOR
- Soft tissue gas (which is black) on Xray, CT, or US
Tx
- wide, aggressive debridement
- broad spectrum abx to cover GP, GN, and anerobes
- Post op wound care: repeat I and D, dressing changes, HBO, wound vac, skin grafts
Testis Torsion
- Describe the types: extravaginal vs intravaginal
- dx and tx of each
EXTRAVAGINAL
- neonate with swollen, discolored scrotum (hemorrhagic necrosis)
- nontender, firm testis with hydrocele
- cord twists above tunica vaginalis
- occurs in utero
- salvage is rare
Dx
-doppler US
Tx
-orchiectomy with contralateral fixation most common
INTRAVAGINAL
- usually in teenagers
- MC
- within tunica vaginalis
- acute scrotal and/or ipsilateral abd pain
- firm, tender, high riding testis with hydrocele and edema
- absent cremasteric reflex
Dx
-doppler US
Tx
- manual detorsion (rotate externally)
- immediate* exploration with detorsion and bilateral fixation
- orchiectomy for nonviable testis
