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Urology > Urologic Emergencies > Flashcards

Urologic Emergencies Flashcards

1
Q

Top 10 Urologic Emergencies

A 
Renal trauma
Penile fracture
Testis rupture
Bladder rupture
Urethral disruption
Acute urinary retention
Priapism
Acute ureteral obstruction
Fournier's Gangrene
Testis torsion
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2
Q

When should you use a CT with contrast for renal trauma?

A

Blunt trauma with gross hematuria or micro-hematuria with chock
Penetrating trauma with hematuria
Pediatric trauma with micro-hematuria

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3
Q

Management of Renal Trauma

A

Most managed conservatively
+/- stent
+/- embolization
+/- percutaneous drain or nephrostomy tube

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4
Q

Indications for Surgical Intervention

A

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

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5
Q

Causes of Penile Fracture

A 
Aggressive intercourse
Off target penetration
Masturbation
Falling out of bed
Scored lover
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6
Q

Diagnosis of Penile Fracture

A

Audible snap
Sudden detumesce
Swelling
Bruising

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7
Q

Conservative Management of Penile Fracture

A

Erectile dysfunction
Curvature
Painful erections

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8
Q

Surgical Treatment of Penile Fracture

A

Deglove penis
Rule out urethral injury
Close corporal tear

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9
Q

Causes of Testis Rupture

A 
Blunt or penetrating trauma
Straddle
Saddle horn
Bar fight
Kick
Drug deal gone bad
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10
Q

Exam for Testis Rupture

A

Scrotal swelling

Echymosis

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11
Q

Testis Rupture & Scrotal Ultrasound

A

Loss of tunic continuity
Internal echos
Heterogenecity

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12
Q

Management of Testis Rupture

A

Surgery to debride extruded tissue & close tunic
Early: salvage
late: orchiectomy

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13
Q

Bladder Rupture

A 
Blunt >> Penetrating
60% extraperitoneal
30% intraperitoneal
10% combined
Hematuria always present
90% have pelvic fractures
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14
Q

Causes of Intraperitoneal Bladder Rupture

A

External blow, full bladder

MVA

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15
Q

Diagnosing Intraperitoneal Bladder Rupture

A

CT or Cystogram

Contrast around bowel & above superior acetabular line

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16
Q

Management of Intraperitoneal Bladder Rupture

A

Surgical repair

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17
Q

Causes of Extraperitoneal

A

Blunt trauma with pelvic fracture

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18
Q

Diagnosing Extraperitoneal Bladder Rupture

A

CT or cystogram
Contrast limited to pelvis, perineum, or genitalia
Starburst pattern of contrast below superior acetabular line

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19
Q

Management of Extraperitoneal Bladder Rupture

A

Catheter drainage

Surgical repair IF repairing something else

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20
Q

Cause Urethral Disruption

A

Blunt or penetrating trauma

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21
Q

Signs/Symptoms of Urethral Disruption

A

Blood at meatus
Distended bladder
Genital swelling & hematoma

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22
Q

Diagnosis of Urethral Disruption

A

Retrograde Urethrogram (RUG)

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23
Q

Incomplete Urethral Disruption Diagnosis

A

RUG shows contrast extravasation but with contrast into bladder

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24
Q

Management of incomplete Urethral Disruption

A

Catheter drainage

25
Q

Complete Urethral Disruption Diagnosis

A

RUG shows contrast extravasation without contrast into bladder

26
Q

Management of Complete Urethral Disruption

A

Suprapubic tube with early primary realignment or delayed reconstruction

27
Q

Define Acute Urinary Retention

A

Sudden, unexpected, painful inability to void

28
Q

Causes of Acute Urinary Retention

A 
PBH
Urethral stricture
Blood clots in urethra
Stone in urethra
Drugs: antihistamines, narcotics, alpha adrenergics
Post op
Overdistension
29
Q

Management of Acute Urinary Retention

A 
Urethral catheter
Suprapubic tube
Suprapubic aspiration
Watch for hematuria
Post obstructive diuresis uncommon
30
Q

Define Priapism

A

Painful, prolonged (>4 hours) erection

31
Q

Ischemic Priapism

A

Low flow, most common
Compartment syndrome
Multiple causes

32
Q

Causes of Ischemic Priapism

A

Drugs: intracavernosal injections, trazadone, cocaine, PDE5 inhibitors
Sickle cell disease
Blood dycrasias (leukemia)
Idiopathic

33
Q

Non Ischemic Priapism

A

High flow due to AV fistula

Usually due to trauma

34
Q

Treatment of Priapism

A

Phenylephrine + 1:100,000 epinephrine solution

Surgical: Winter & Al Ghorab shunt

35
Q

Diagnosis of Acute Ureteral Obstruction

A 
Flank and/or abdominal pain: colicky, cramping
Pain radiating to groin
N/V
UA
Noncontrast abdominal/pelvic CT
36
Q

UA in Acute Ureteral Obstruction

A

Hematuria
Pyre with epithelial
Without nitrites
Bacteria suggests contamination

37
Q

Etiologies of Acute Ureteral Obstruction

A 
Stones
Clot
Retroperineal fibrosis
Surgical mishap
Bladder outlet obstruction
Malignancy: ureter, RP nodes, adjacent organs
38
Q

Emergent Acute Ureteral Obstruction

A

Solitary kidney
Bilateral obstruction
Association infection: fever, chills, high WBC, pyuria, bacteria, hypotension, tachycardia

39
Q

Non-Emergent Acute Ureteral Obstruction

A 
Pyuria without other evidence of infection
Hydronephrosis
Perinephric fluid (urine)
Hematuria
Mildly increased creatinine
40
Q

Emergent Management of Acute Ureteral Obstruction

A

Ureteral stent
Nephostomy tube
Stone removal with ureteroscopy (no infection present)

41
Q

Ureteral stent

A

Requires surgery, anesthesia
Convenient but painful
Flomax reduces symptoms

42
Q

Nephrostomy Tube

A

Provides reliable, unequivocal drainage
More comfortable
Invasive & inconvenient

43
Q

Non-emergent Management of Acute Ureteral Obstruction

A

Toradol: IM
P.O analgesia
Tamsulosin: dilates ureter to help pass the stones

44
Q

Define Fournier’s Gangrene

A

Necrotizing infection of skin, fat & fascia of genitalia & perineum

45
Q

Mortality with Fournier’s Gangrene

A

20-30%

46
Q

Risk Factors for Fournier’s Gangrene

A 
Obesity
DM
Immunosuppression
Alcoholism
Malnutrition
47
Q

Diagnosis of Fournier’s Gangrene

A 
Pain
Swelling
Fever
Musculoskeletal changes
Tachycardia
Tachypnea
Erythema
Edema
Crepitus
Fluctuance
Discoloration
Purulent drainage
Foul odor
X-ray, CT or US
48
Q

Treatment of Fournier’s Gangrene

A

Wide, aggressive debridement
Broad spectrum antibiotics to cover anaerobes
Post-op wound care

49
Q

Post-op Wound Care with Fournier’s Gangrene

A 
Repeat debridement
Dressing changes
Wound vac
Skin grafts, flaps
HBO
50
Q

Extravaginal Testis Torsion

A 
Neonate with swollen, discolored scrotum
Nontender, firm testis with hydrocele
Cord twists above tunica vaginalis
Presumed to occur in utero
Salvage is rare
51
Q

Intravaginal Testis Torsion

A

Adolescents
More common
Within tunica vaginalis
Acute scrotal and/or ipsilateral abdominal pain
Firm, tender, high riding testis with hydrocele & edema
Absent cremasteric reflex

52
Q

Differential Diagnosis of Testis Torsion

A

Torsion of testis appendage
Epididymitis
Incarcerated hernia

53
Q

Distinguishing Torsion of Testis Appendage

A

Blue dog sign
Tender, firm nodule
Normal US

54
Q

Distinguishing Epididymitis

A

Doppler US: normal testis flow, increased epididymal flow

55
Q

Distinguishing Incarcerated Hernia

A

Bowel sounds in scrotum

Gas in scrotum on US or x-ray

56
Q

Intravaginal Testicular Torsion Doppler Scrotal Ultrasound

A

Absence of flow is 90% sensitive, 99% specific

57
Q

Treatment of Intravaginal Testicular Torsion

A

Manual detorsion
Immediate exploration with detorsion & bilateral fixation
Orchiectomy for non-viable testis

58
Q

Extravaginal Testicular Torsions Treatment

A

Orchiectomy with contralateral fixation

Urology (12 decks)

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