Urological emergencies 1 Flashcards
What is acute urinary retention ?
It is the inability to voluntarily pass urine
What are the symptoms/signs of acute urinary retention ?
- Inability to pass urine
- Increasing pain
- May see a palpable bladder
What is acute urinary retention usually due to and hence who does it most commonly affect ?
Most commonly affect men - due being commonly caused by BNH of the prostate
What is the treatment of acute urinary retention ?
1st line = Catheterisation
- If painful retention with < 1 litre residue and normal serum electrolytes then trial without catheter (TWOC) during same admission.
- prescribe a uroselective alphabocker (Alfuzosin, Tamsulosin) before TWOC improves chance of voiding success
What is post-obstructive diuresis ?
This is where copious amounts of salt and water are eliminated after the relief of a urinary tract obstruction (>200mls/hr)
What are the patients at risk of developing post-obstructive diuresis ?
Patients with chronic bladder outflow obstruction in association with:
- Uraemia
- Oedema
- CCF
- Hypertension
What is the treatment of post-obstructive diuresis ?
- Monitor fluid balance - match 50% of output as input with IVF or if the patient can manage then PO
- It usually resolves by itself in 24-48hrs
What is a potential cause of loin pain outwidth the urinary tract which you need to be aware of ?
Leaking AAA
What is ureteric colic (nephrolithiasis) due to ?
Stones in the urinary tract (kidneys or ureter)
What is the typical presentation of ureteric colic ?
- Acute severe loin pain +/- groin pain
- Nausea and vomiting due to pain
- urinary frequency/urgency
- haematuria
What scan is used to diagnose ureteric colic due to stones diagnosed ?
Non-constrast CT-KUB
What is the treatment of ureteric colic ?
Most stones will pass so:
1st line = hydration (to flush them out) and NSAID (diclofenac PR) + paracetamol +/- opiate and alpha-blocker (Tamsulosin) (depends if stone might pass) or buscopan
Tamsulosin helps to relax alpha-1 smooth muscle cells and in theory might help pass the stone but also reduces muscle spasm pain, if not giving tamsulosin then use buscopan.
What would indiacte the need for urgent treatment of ureteric colic ?
- Pain unrelieved
- Pyrexia
- Persistent nausea/vomiting
- High-grade obstruction (hydronephrosis)
What additional blood tests should you add on for everyone presenting with ureteric calculi ?
A calcium and urate allows you then to potential find a cause for stone formation and if needed start e.g. allopurinol or lower their calcium.
What is the treatment urgent treatment for severe cases of ureteric colic?
Severe cases include - presence of ureteric obstruction, renal developmental abnormality such as horseshoe kidney and previous renal transplant.
- No infection present - ureteric stent or stone fragmentation (Lithotripsy)/removal (nephrolithotomy)
- Infection also present alongside urteric obstruction - percutaneous nephrostomy needed
What are some of the causes of frank haematuria ? (macroscopic)
- Infection
- Stones
- Tumours
- Benign prostatic hyperplasia (BPH)
- Polycystic kidneys
- Trauma
- Coagulation/platelet deficiencies
What is the investigation done in patients presenting with frank haematuria ?
CT urogram + cystoscopy
Define what is meant by acute scrotum ?
Acute Scrotal Pain and Swelling +/- ischaemia
What are the main causes of acute scrotum ?
- Torsion of spermatic cord
- Torsion of appendix testis
- Epididymitis
What causes torsion of the testes (hint this is a bit of a trick question)?
Torsion of the spermatic cord
Who does torsion of the testes typically affect ?
Boys of pubertal age
What is the typical presentation of torsion of the testes ?
- Testicular pain +/- abdominal pain
- Scrotal swelling or oedema
- Scrotal erythema
- Reactive hydrocele
- High-riding fixed testicle
- Horizontal lie
- Absent cremasteric reflex
What investigation may be useful in diagnosing torsion of the testis ?
Doppler USS (don’t wait on this if you think it is torsion of testis, rush straight for surgery and exploration)
What is the treatment of torsion of the testis ?
- Emergency scrotal exploration
- Testis are then fixed (both sides) to prevent re-occurance
