urological emergencies Flashcards
what is acute urinary retention a complication of
BPH
what is acute urinary retention
inability to urinate with increasing pain
what can cause precipitated acute urinary retention
- non prostate related surgery
- catheterization or urethral instrumentation
- anaesthesia
- meds with sympathomimetic or anticholinergic effects
treatment for acute urinary retention
if painful with <1litre residue and normal serum electrolytes then trial without catheter
-alphablockers before TWOC improves chances of success
who usually gets post-obstructive diuresis
patients with chronic bladder outflow obstruction in association with uraemia, oedema, CCF, hypertension
what could acute loin pain be
urinary tract or AAA for example
what causes the loin pain in ureteric colic
prostaglandins released by ureter in response to obstruction
treatment for acute loin pain
NSAID +/- opiate
-alpha blocker for small stones that are expected to pass
indications to treat a ureteric colic urgently
- pain unrelieved
- pyrexia
- persistent nausea/vomiting
- renal impairment
urgent treatment of ureteric colic involves what?
- ureteric stent or stone fragmentation/removal if no infection
- percutaneous nephrostomy for infected hydronephrosis
treatment of clot retention causing frank haematuria
3 way irrigating haematuria catheter
investigation for frank haematuria
- CT urogram/USS
- cytoscopy
what things could cause acute scrotum
- torsion of spermatic cord
- torsion of appendix testis
- epididymitis
- inguinal hernia
- hydrocele
- trauma
- derm lesions
- inflammatory vasculitis
- tumour
symptoms of spermatic cord torsion
- sudden onset pain
- nausea/vomiting
- lower abdo pain
what is found on examination in spermatic cord torsion
- testis high in scrotum
- transverse lie
- absence of cremasteric reflex
if the testis are necrotic what do you do
remove them
presentation of torsion of appendage (penis)
- localised tenderness at upper pole
- blue dot sign
what can cause epididymitis
- UTI
- urethritis
- catheterisation
what is found on examination in epididymitis
- cremasteric reflex present
- pyuria
- swelling and increased blood flow on doppler
- send for urine culture and and chlamydia PCR
treatment for epididymitis
analgesia and scrotal support and bed rest
-ofloxacin 400mg/day for 14 days
what is paraphimosis
painful swelling of the foreskin distal to a phimotic ring
when does paraphimosis usually happen
after foreskin retracted for catheterization or cytoscopy and staff forget to put foreskin back in natural position
treatment for paraphimosis
iced glove
granulated sugar for 1-2 hours
multiple punctures in oedematous skin
what is priapism
prolonged unwanted erection (>4hrs)
not associated with s3xual arousal
causes of priapism
- intracorporeal injection for ED
- trauma
- haematologic dyscriasis
- neurological condition
- idiopathic
what are the two types of priapism
ischaemic and non-ischaemic
what is ischaemic priapism
Vascular stasis in penis and decreased venous outflow, a true compartment syndrome.
Corpora cavernosa are rigid and tender, penis often painful
what is non-ischaemic priapism
traumatic disruption of penile vasculature results in unregulated blood entry and filling of corpora
diagnosis of priapism
aspirate blood from corpus cavernosum
- dark blood means low flow ischaemic
- normal blood means non-ischaemic
colour duplex USS
- minimal flow in ischaemic
- normal to high flow in non-ischaemic
treatment of ischaemic priapism
aspiration +/- irrigation with saline
injection of alpha agonist
surgical shunt
treatment for non-ischaemic priapism
observe
selective arterial embolisation
fournier’s gangrene
form of necrotizing fasciitis occurring around the male genitalia
pre disposing factors for fournier’s gangrene
- diabetes
- local trauma
- periurethral extravastion
- perianal infection
presentation of fournier’s gangrene
- starts as cellulitis
- swelling and crepitus of scrotum, dark purple areas
- marked toxicity
investigation for fournier’s gangrene
plain x-ray or USS may confirm gas in tissues
treatment for fournier’s gangrene
antibiotics and surgical debridement
what is emphysematous pyelonephritis
An acute necrotizing parenchymal and perirenal infection caused by gas-forming uropathogens, usually E coli
what is emphysematous pyelonephritis usually associated with
diabetes and ureteric obstruction
symptoms of emphysematous pyelonephritis
fever
vomiting
flank pain
what usually causes a perinephric abscess
rupture of an acute cortical abscess into the perinephric space or from haematogenous seeding from sites of infection
diagnosis of perinephric abscess
- high WCC
- high serum creatinine
- pyuria
- CT
treatment fo perinephric abscess
antibiotics and percutaneous or surgical drainage
class 1 renal trauma
class II renal trauma
class III renal trauma
class IV renal trauma
class V renal trauma
different classes of renal trauma
indications for imaging in terms of haematuria
- Frank haematuria in adult
- Frank or occult haematuria in child
- Occult haematuria + (systolic <90mmHg at any point)
- Penetrating injury with any degree of haematuria
presentation of a bladder injury
- suprapubic tenderness
- lower abdo bruising
- guarding/rigidity
- diminished bowel sounds
diagnosis of extraperitoneal injury
flame-shaped collection of contrast in pelvis
what would urethral injury be like on examination
- blood at meatus
- inability to urinate
- palpably full bladder
- high riding prostate
- butterfly perineal haematoma
investigations for urethral injury
retrograde urethrogram
treatment for urethral injury
suprapubic catheter
presentation of a penile fracture
- cracking or popping sound
- pain
- rapid detumescence
- discolouration
- swelling
treatment for penile fracture
circumcision incision with degloving of penis to expose all 3 compartments
