urological emergencies Flashcards
what is acute urinary retention ?
painful inability to void, with relief of pain following drainage of the bladder by catheterization
what is the aetiology of acute urinary retention ?
BPH clot retention prostate cancer urethral stricture infection inflammation infarction
what medications can cause acute urinary retention ?
anti-cholinergics
anti-histaminics
what is the management algorithm for AUR ?
short history and exam catheterization DRE note residual volume Bloods U+E watch out for diuresis home with catheter and alpha blockers
what is post obstructive diuresis ?
abnormal prolonged polyuria which happens after the acute drainage and decompression of a distended bladder from urinary retention
what are the types of post obstructive diuresis ?
physiological
pathological
what are the causes for pathological post obstructive diuresis ?
ADH insensitivity
salt loss
what is the management in cases of post-obstructive diuresis ?
- admit the patient if the urine output is above 200 mls/hr
- if it is iso-osmolar , it will return to normal within 24 hrs
- if it is hyper-osmolar , then replace equal with NaCl
- if hypo-osmolar replace 1/2 of UO with dextrose saline and oral fluids
which of the osmolality results are associated with a high mortality ?
hyper-osmolar
what condition is associated with hypo-osmolar urine ?
ADH insensitivity
what additional measures must be taken with a patient that has hyper-osmolar urine ?
measure :
postural BP
serum and urine Na
4 times a day
what additional measures must be taken with a patient that has hypo-osmolar urine ?
daily weight measuring
what conditions are associated with painful hematuria ?
UTI stones Retention Trauma Haemorrhagic cystitis papillary necrosis
what conditions are associated with painless hematuria ?
TCC bladder renal cell carcinoma coagulation disorder ureteric tumors nephrological post exercise
if a patient present with both obstruction and a fever what does this patient have ?
sepsis
what are the differential diagnosis of acute scrotum?
torsion testis
acute epididymo-orchitis
what is presentation of torsion testis ?
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)
what is the presentation of acute epididymo-orchitis ?
history of UTI acute onset dysuria leucocytes in urine testis is normally oriented
what can be used in the treatment of acute epididymo-orchitis ?
doxycycline
doxycycline
what is the aetiology of renal trauma ?
blunt
penetrating
iatrogenic
what is the algorithm for the management of renal trauma ?
CT urogram admit monitor vital signs Analgesics Control BP Re-scan if unstable
what are the types of bladder trauma ?
intraperitoneal
extra peritoneal
what are the types of urethral trauma ?
anterior urethral trauma
posterior urethral trauma
what is the management for urethral trauma ?
gently attempt catheterization
if it fails - ascending urethrogram
if that fails then an ascending urethrogram
what is the most appropriate management whether the urethra is intact or damaged ?
intact - catheterization
if damaged attach a suprra pubic catheter
damaged - suprapubic catheter
what is the protective factor of the testicles
tunica albuginea
what is the gold standard investigation for the diagnosis of ureteric colics ?
non contrast CTUT
what size stone would be an indication to admit a patient ?
a stone above 5
what are the signs associated with urethral trauma ?
blood at the meatus
floating prostate sign
perineal bruising
on examination of a patient with a penile fracture what is commonly observed ?
eggplant deformity
penile swelling
what instructions must be given after repair of penile fractures ?
eliminate erections after surgery
no inteercourse for 6-12 weeks
what is the aim of treatment in bilateral testicular injury vs in blunt testicular injury ?
bilateral injury - preserve as much functioning testicular tissue as possible
blunt injury - significant intratesticular hematoma should be drained
old heavy smoker with painless hematuria ?
consider urologgical malignancy
