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urological emergencies Flashcards

1
Q

what is acute urinary retention ?

A

painful inability to void, with relief of pain following drainage of the bladder by catheterization

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2
Q

what is the aetiology of acute urinary retention ?

A 
BPH 
clot retention 
prostate cancer 
urethral stricture 
infection
inflammation 
infarction
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3
Q

what medications can cause acute urinary retention ?

A

anti-cholinergics

anti-histaminics

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4
Q

what is the management algorithm for AUR ?

A 
short history and exam 
catheterization 
DRE 
note residual volume 
Bloods U+E
watch out for diuresis
home with catheter and alpha blockers
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5
Q

what is post obstructive diuresis ?

A

abnormal prolonged polyuria which happens after the acute drainage and decompression of a distended bladder from urinary retention

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6
Q

what are the types of post obstructive diuresis ?

A

physiological

pathological

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7
Q

what are the causes for pathological post obstructive diuresis ?

A

ADH insensitivity

salt loss

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8
Q

what is the management in cases of post-obstructive diuresis ?

A
  1. admit the patient if the urine output is above 200 mls/hr
  2. if it is iso-osmolar , it will return to normal within 24 hrs
  3. if it is hyper-osmolar , then replace equal with NaCl
  4. if hypo-osmolar replace 1/2 of UO with dextrose saline and oral fluids
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9
Q

which of the osmolality results are associated with a high mortality ?

A

hyper-osmolar

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10
Q

what condition is associated with hypo-osmolar urine ?

A

ADH insensitivity

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11
Q

what additional measures must be taken with a patient that has hyper-osmolar urine ?

A

measure :
postural BP
serum and urine Na
4 times a day

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12
Q

what additional measures must be taken with a patient that has hypo-osmolar urine ?

A

daily weight measuring

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13
Q

what conditions are associated with painful hematuria ?

A 
UTI 
stones 
Retention 
Trauma 
Haemorrhagic cystitis 
papillary necrosis
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14
Q

what conditions are associated with painless hematuria ?

A 
TCC bladder 
renal cell carcinoma 
coagulation disorder 
ureteric tumors 
nephrological 
post exercise
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15
Q

if a patient present with both obstruction and a fever what does this patient have ?

A

sepsis

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16
Q

what are the differential diagnosis of acute scrotum?

A

torsion testis

acute epididymo-orchitis

17
Q

what is presentation of torsion testis ?

A

sudden testicular pain
tender testis
erythema and oedema of the scrotal wall
unilateral loss of cremasteric reflex
persistent pain despite elevation of the testis ( negative prehn’s sign)

18
Q

what is the presentation of acute epididymo-orchitis ?

A 
history of UTI 
acute onset 
dysuria 
leucocytes in urine 
testis is normally oriented
19
Q

what can be used in the treatment of acute epididymo-orchitis ?

A

doxycycline

doxycycline

20
Q

what is the aetiology of renal trauma ?

A

blunt
penetrating
iatrogenic

21
Q

what is the algorithm for the management of renal trauma ?

A 
CT urogram 
admit 
monitor vital signs
Analgesics 
Control BP 
Re-scan if unstable
22
Q

what are the types of bladder trauma ?

A

intraperitoneal

extra peritoneal

23
Q

what are the types of urethral trauma ?

A

anterior urethral trauma

posterior urethral trauma

24
Q

what is the management for urethral trauma ?

A

gently attempt catheterization
if it fails - ascending urethrogram

if that fails then an ascending urethrogram

25
Q

what is the most appropriate management whether the urethra is intact or damaged ?

A

intact - catheterization
if damaged attach a suprra pubic catheter

damaged - suprapubic catheter

26
Q

what is the protective factor of the testicles

A

tunica albuginea

27
Q

what is the gold standard investigation for the diagnosis of ureteric colics ?

A

non contrast CTUT

28
Q

what size stone would be an indication to admit a patient ?

A

a stone above 5

29
Q

what are the signs associated with urethral trauma ?

A

blood at the meatus
floating prostate sign
perineal bruising

30
Q

on examination of a patient with a penile fracture what is commonly observed ?

A

eggplant deformity
penile swelling

31
Q

what instructions must be given after repair of penile fractures ?

A

eliminate erections after surgery
no inteercourse for 6-12 weeks

32
Q

what is the aim of treatment in bilateral testicular injury vs in blunt testicular injury ?

A

bilateral injury - preserve as much functioning testicular tissue as possible

blunt injury - significant intratesticular hematoma should be drained

33
Q

old heavy smoker with painless hematuria ?

A

consider urologgical malignancy

WH (68 decks)

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