Urological Emergencies Flashcards
Name urological emergencies?
- Torsion
- Priapism
- Paraphymosis
- Urinary obstruction
- Trauma
Tyepes of testicular torsion?
- Intravaginal at puberty
- the spermatic cord is twisted within the tunica vaginalis
- commonly associated with bell-clapper deformity - Extravaginal neonatal period
- concomitant twisting of the testicle, spermatic cord and tunica vaginalis
Risk factors for testicular torsion?
- Bell clapper deformity
- congenital malformation in which the tunica vaginalis attaches high on the spermatic cord
- characterized by increased testicular mobility and associated with intravaginal testicular torsion - Undescended testis
Epidemiology of testicular torsion?
peak incidence
1. neonatal period: first 30 days of life
2. puberty : 10 - 14 years
- 12 - 18 (post pubertal)
Clinical features of testicular torsion?
- Acute, severe testicular pain
- Hx of intermittent pain
- No urinary symptoms.
- P/E: tender, firm, high riding, horizontal lie testis
- Absent cremasteric reflex,
- Negative prehn’s / lifting test
- Epididymis not posterior to testis
Diagnosis of testicular torsion?
Based on clinical suspicion
- Never radiological
- don’t delay treatment to perform investigations
Ddx of testicular torsion?
- Epididymorchitis
- Torsion of testicular appendage
Surgery for testicular torsion?
Immediate surgical management
1. Scrotal exploration
2. detorsion
3. assess for viability
4. orchidopexy or orchidectomy
- Fix contralateral testis
What is priapism?
Persistent painful erection in the absence of sexual stimulation, beyond 4 hrs
Types of priapism?
- Low flow (ischaemic) vs High flow (non ischaemic)
- Stuttering (intermittent priapism)
Pathophysiology of priapism?
- Decreased venous outflow and increased pressure in corpora carvenosa.
- Stasis leads to hypoxia, acidosis and then prolonged painful erection
Clinical presentation of priapism?
Prolonged erection > 4hrs
- Painful for ischaemic
What do you see on PE of priapism?
- Fully erect corpora carvenosa
- Dark blood aspirated from corpora in ischaemic
- Bright in high flow
Risk factors for priapism?
- Sickle cell trait or disease
- Malignant filtration of corpora
- Total parenteral nutrition
- Medications for erectile dysfunction
- Spinal or general anaethesia
Treatment of priapism?
- Low flow is an emergency
- Aim is detumescence, preservation of erectile function and prevention of future episodes
- Iv hydration (sickle cell)
- Corpora aspiration and irrigation
- Phenylephrine injections
- Shunt surgery +/- penile prosthesis
Prevention of priapism?
- Sickle cell
- Transfuse to keep Hb >10g/dl
- Avoid sickling factors
- clod, hypoxia, dehydration,
What is paraphymosis?
Foreskin stuck behind glans
- Needs emergency reduction
Prevention of paraphymosis?
always reduce the foreskin after urethral catheterisation
Treatment for paraphymosis?
Approach under LA
Dundee techniques
Or dorsal slit
What is fourniers gangrene?
- Polymicrobial necrotising fascitis of perineum
- Always spreads superfical to the colle’s fascia
Risk factors for Fourniers gangrene?
urethral stictures,
Treatment of Fourniers gangrene?
Iv fluid rescuscitation
Antibiotics
Emergency Debridment
Types of urinary obstruction and how to treat them?
- Ureteral obstruction with sepsis
- Drain using nephrostomy
- antibiotics - High grade ureteral obstruction
- Nephrostomy to prevent renal damage - BOO with retention
- Urethral Catheter or SPC
What is the cause of bladder trauma?
Trauma in a full bladder patient, usually after drinking
