Urological Emergencies Flashcards
what is acute urinary retention?
the inability to urinate with increasing pain
what is acute urinary retention a possible complication of?
benign prostate hyperplasia
what are the two possible causes of acute urinary retention?
spontaneous
precipitated by an event
what is the management for acute urinary retention?
catheter insertion
what investigations are done for frank haematuria?
CT urogram
cystoscopy
when is testicular torsion most common?
puberty
how does testicular torsion present?
sudden onset pain
nausea
vomiting
pain referral to lower abdomen
what is seen on examination of testicular torsion?
testes high in the scrotum
absent cremasteric reflex
what investigation may be done for testicular torsion?
doppler USS
how can epididymitis present?
dysuria
pyrexia
history of UTI or catheter
what is seen on examination of epididymitis?
cremasteric reflex present
what investigations are done for epididymitis?
doppler
urine culture + chlamydia PCR
what is the management for epididymitis?
analgesia
scrotal support
ofloxacin for 14 days
how is idiopathic scrotal oedema managed?
self limiting
what causes idiopathic scrotal oedema?
unknown
what is paraphimosis?
painful swelling of the foreskin distal to a phimotic ring
what is a common cause of paraphimosis?
foreskin retracted for catheterisation etc. and not replaced in its natural position
what is priapism?
prolonged unwanted erection for over four hours
often painful
what are four possible causes of priapism?
trauma
haematological diseases
neurological conditions
idiopathic
what are the two types of priapism?
ischaemic
non ischaemic
what are other names for ischaemic priapism?
veno occlusive
low flow
what is the pathophysiology behind ischaemic priapism?
vascular stasis and decreased venous outflow in the penis
how does ischaemic priapism present?
corpus cavernosum rigid and tender
often painful
what is the pathophysiology behind non ischaemic priapism?
traumatic disruption of vasculature causes unregulated blood entry
what two investigations are done for priapism?
aspirate blood from the corpus cavernosum
doppler USS
what is seen on aspiration in ischaemic priapism?
dark blood
low oxygen, high CO2
what is seen on aspiration in non ischaemic priapism?
normal arterial blood
what is seen on doppler in ischaemic priapism?
minimal/absent blood flow
what is seen on doppler in non ischaemic priapism?
normal/high flow
what is the management for ischaemic priapism?
aspiration
injections of alpha agonists
surgery - shunt
what is the management for non ischaemic priapism?
observe - often resolves spontaneously
selective embolisation
what is fournier’s gangrene?
a form of necrotising fasciitis occurring around the male genitalia
what are four risk factors for fournier’s gangrene?
diabetes
trauma
periurethral extravasation
perianal infection
what is seen on examination of fournier’s gangrene?
swelling
crepitus
dark purple areas
what is the treatment for fournier’s gangrene?
antibiotics
surgical debridement
what increases mortality in fournier’s gangrene?
diabetes
alcoholism
what is emphysematous pyelonephritis?
acute necrotising perirenal infection
what is the most common cause of emphysematous pyelonephritis?
e coli
what are the main risk factors for emphysematous pyelonephritis?
diabetes
ureteric obstruction
how does emphysematous pyelonephritis present?
fever
vomiting
flank pain
what is the investigation of choice for emphysematous pyelonephritis?
CT
how is emphysematous pyelonephritis managed?
ICU admission
nephrectomy if it doesnt settle
what causes a perinephric abscess?
rupture of cortical abscess
haematogenous spread of infection
what investigation should be done for a perinephric abscess?
CT scan
how is a perinephric abscess managed?
antibiotics
drainage
what investigation is done for renal trauma?
CT with contrast
what is bladder injury commonly associated with?
pelvic fractures
