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MBBS 3: Surgery > Urological Emergencies > Flashcards

Urological Emergencies Flashcards

1
Q

Name urological emergencies?

A
  1. Torsion
  2. Priapism
  3. Paraphymosis
  4. Urinary obstruction
  5. Trauma
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2
Q

Tyepes of testicular torsion?

A
  1. Intravaginal at puberty
    - the spermatic cord is twisted within the tunica vaginalis
    - commonly associated with bell-clapper deformity
  2. Extravaginal neonatal period
    - concomitant twisting of the testicle, spermatic cord and tunica vaginalis
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3
Q

Risk factors for testicular torsion?

A
  1. 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
  2. Undescended testis
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4
Q

Epidemiology of testicular torsion?

A

peak incidence
1. neonatal period: first 30 days of life
2. puberty : 10 - 14 years
- 12 - 18 (post pubertal)

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5
Q

Clinical features of testicular torsion?

A
  1. Acute, severe testicular pain
  2. Hx of intermittent pain
  3. No urinary symptoms.
  4. P/E: tender, firm, high riding, horizontal lie testis
  5. Absent cremasteric reflex,
  6. Negative prehn’s / lifting test
  7. Epididymis not posterior to testis
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6
Q

Diagnosis of testicular torsion?

A

Based on clinical suspicion
- Never radiological
- don’t delay treatment to perform investigations

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7
Q

Ddx of testicular torsion?

A
  1. Epididymorchitis
  2. Torsion of testicular appendage
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8
Q

Surgery for testicular torsion?

A

Immediate surgical management
1. Scrotal exploration
2. detorsion
3. assess for viability
4. orchidopexy or orchidectomy
- Fix contralateral testis

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9
Q

What is priapism?

A

Persistent painful erection in the absence of sexual stimulation, beyond 4 hrs

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10
Q

Types of priapism?

A
  1. Low flow (ischaemic) vs High flow (non ischaemic)
  2. Stuttering (intermittent priapism)
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11
Q

Pathophysiology of priapism?

A
  • Decreased venous outflow and increased pressure in corpora carvenosa.
  • Stasis leads to hypoxia, acidosis and then prolonged painful erection
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12
Q

Clinical presentation of priapism?

A

Prolonged erection > 4hrs
- Painful for ischaemic

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13
Q

What do you see on PE of priapism?

A
  1. Fully erect corpora carvenosa
  2. Dark blood aspirated from corpora in ischaemic
  3. Bright in high flow
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14
Q

Risk factors for priapism?

A
  1. Sickle cell trait or disease
  2. Malignant filtration of corpora
  3. Total parenteral nutrition
  4. Medications for erectile dysfunction
  5. Spinal or general anaethesia
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15
Q

Treatment of priapism?

A
  1. Low flow is an emergency
  2. Aim is detumescence, preservation of erectile function and prevention of future episodes
  3. Iv hydration (sickle cell)
  4. Corpora aspiration and irrigation
  5. Phenylephrine injections
  6. Shunt surgery +/- penile prosthesis
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16
Q

Prevention of priapism?

A
  1. Sickle cell
  2. Transfuse to keep Hb >10g/dl
  3. Avoid sickling factors
    - clod, hypoxia, dehydration,
17
Q

What is paraphymosis?

A

Foreskin stuck behind glans
- Needs emergency reduction

18
Q

Prevention of paraphymosis?

A

always reduce the foreskin after urethral catheterisation

19
Q

Treatment for paraphymosis?

A

Approach under LA
Dundee techniques
Or dorsal slit

20
Q

What is fourniers gangrene?

A
  • Polymicrobial necrotising fascitis of perineum
  • Always spreads superfical to the colle’s fascia
21
Q

Risk factors for Fourniers gangrene?

A

urethral stictures,

22
Q

Treatment of Fourniers gangrene?

A

Iv fluid rescuscitation
Antibiotics
Emergency Debridment

23
Q

Types of urinary obstruction and how to treat them?

A
  1. Ureteral obstruction with sepsis
    - Drain using nephrostomy
    - antibiotics
  2. High grade ureteral obstruction
    - Nephrostomy to prevent renal damage
  3. BOO with retention
    - Urethral Catheter or SPC
24
Q

What is the cause of bladder trauma?

A

Trauma in a full bladder patient, usually after drinking

25
Q

Clinical presentation of bladder trauma?

A

Triad of:
1. suprapubic pain
2. inability to pass urine
3. suprapubic distention

26
Q

Types of bladder trauma?

A

Intra vs extraperitoneal

27
Q

Management of bladder trauma?

A

Do cystogram
1. intraperitoneal
- explore
2. extraperitoneal
- Urethral catheter for 10-14days

28
Q

What is urethral trauma?

A

Indicated by blood at external meatus

29
Q

Management of urethral trauma?

A

Don’t put urethral catheter
SPC if retention

30
Q

What is a penile fracture?

A
  • Caused by forceful bending of an erect penis
  • Penis classically has an “egg plant deformity

MBBS 3: Surgery (42 decks)

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