Urological emergencies

Question 1

70 year old man, pain and distended abdomen, unable to pass urine. Diagnosis?

Answer 1

acute urinary retention

Question 2

What are the differentials for acute urinary retention

Answer 2

obstructive
infections
pharmacological
trauma

Question 3

List three obstructive causes of acute urinary retention

Answer 3

BPH, prostate cancer, urethral stenosis, faecal impaction

Question 4

List two infectious causes of acute urinary retention

Answer 4

lyme’s disease, cystitis

Question 5

List two classes of drugs that can cause acute urinary retention

Answer 5

antidepressants, anticholinergics

Question 6

List two investigations for acute urinary retention

Answer 6

post void bladder scan
catheterised specimen of urine
USS
routine bloods

Question 7

What is the management of acute urinary retention?

Answer 7

catheter
terazosin
abx- infection

Question 8

Which drug can be used in BPH for acute urinary retention?

Answer 8

terazosin

Question 9

What is TWOC?

Answer 9

trial without catheter, trial period to dertermine whether you can pass urine without it

Question 10

What is the time period for TWOC?

Answer 10

24-48hr

Question 11

Three differentials for acute scrotum?

Answer 11

testicular torsion
orchitis/epidydimitis
hydrocele (doesn’t cause pain)
Torsion of Hydatid of morgagni

Question 12

Cremasteric reflex present, palpable blue dot appearance on scrotum. Diagnosis?

Answer 12

torsion of hydatid of morgagni

Question 13

What is a positive cremasteric reflex?

Answer 13

This reflex is elicited by lightly stroking or poking the superior and medial (inner) part of the thigh—regardless of the direction of stroke.v The normal response is an immediate contraction of the cremaster muscle that pulls up the testis ipsilaterally

Question 14

In which condition is cremasteric reflex lost?

Answer 14

testicular torsion

Question 15

What is prehn’s sign?

Answer 15

It is performed by lifting the scrotum and assessing the consequent changes in pain. A positive Prehn’s sign indicates relief of pain upon elevation of the scrotum and is associated with epididymitis

Question 16

What is the management of testicular torsion?

Answer 16

surgical input immediately

Question 17

Define testicular torsion anatomically

Answer 17

twisting of spermatic cord with tunica vaginalis

Question 18

List three risk factors for testicular torsion

Answer 18

12-25
undescended testes
FH
Bell clapper deformity

Question 19

What is the status of cremaster and prehn’s tests in testicular torsion?

Answer 19

cremaster: absent

prehn’s: negative

Question 20

What is the status of cremasteric and prehn’s reflexes in epidiymitis?

Answer 20

cremasteric present

prehn’s: positive

Question 21

What is an enteric cause of epidydimits

Answer 21

e.coli

klebsiella

Question 22

What is a non-enteric infective cause of epididymitis?

Answer 22

gonorrhoea
chalmydia
STIs most common causes of epididymitis

Question 23

What is the salvageable window in testicular torsion?

Answer 23

<6 hr!