urological emergencies Flashcards by Sarah Gibb

what is acute urinary retention?

a complication of BPH
inability to urinate with increasing pain

can be caused by prostate infection, bladder overdistension, excess fluid intake, alcohol, prostatic infarction, an anaesthetic, anti muscarinic meds

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what is post obstructive diuresis?

often present in patients with chronic bladder outflow obstruction in association with uraemia, oedema, CCF and hypertension

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what can cause acute loin pain?

remember AAA
ureteric colic secondary to calculus- pain mediated by prostaglandins released by ureter in response to obstruction

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what is used for small kidney stones?

NSAIDs +/- opiates
alpha blockers (tamsulosin) for small stones expected to pass

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what are some indications for urgent kidney stone treatment?

pain unrelieved
pyrexia
persistant nausea/vomiting
renal impairment

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how are severe kidney stones treated?

ureteric stent for stone fragmentation/removal if no infection
percutaneous nephrostomy for infected hydronephrosis

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what can cause visible haematuria?

infection
stones
tumours (esp. bladder)
BPH
polycystic kidneys

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what is the referral pathway for macrohaematuria?

2 week wait
same day if- symptomatic anaemia, coag/platlet deficiency, peliv radiation cystitis

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what can cause an acute scrotum?

Torsion of spermatic cord
Torsion of appendix testis
Epididymitis / epididymo-orchitis
Inguinal hernia
Hydrocoele
Trauma / insect bite
Dermatological lesions
Inflammatory vasculitis
Tumour

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what are the features of testicular torsion?

most common at puberty/teenage
no known trigger
adolescents usually woken from sleep
sudden onset of pain, N+V, pain referral to lower abdo
O/E- testes high in scrotum, transverse lie, acute hydrocele

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when can irreparable damage occur in testicular torsion?

4 hrs after torsion

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what is the treatment for testicular torsion?

Prompt exploration. Irreversible ischaemic injury may begin as soon as 4hrs
3-point fixation with fine non-absorbable sutures
If testis necrotic then remove
MUST fix contralateral side (bell clapper deformity)

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what are the symptoms of appendage torsion?

Symptoms variable – may be insidious onset or identical to torsion of cord
If seen early, may have localised tenderness at upper pole and “blue dot” sign
Testis should be mobile and cremasteric reflex present

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how is torsion of appendage resolved?

spontaneously

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what are the features of epididymitis?

rare in children
May be difficult to distinguish from torsion
Dysuria / pyrexia more common
Hx of UTI, urethritis, catheterization/instrumentation

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what is seen O/E in epididymitis?

Cremasteric reflex present
Suspect if pyuria
Doppler – swollen epididymis, increased bloodflow
Send urine for culture + Chlamydia PCR

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how is epididymitis treated?

analgesia+scrotal support, bed rest
ofloxacin 400mg/day for 14 days

what are the features of idiopathic scrotal oedema?

Self-limiting, unknown cause, not usually associated with scrotal erythema
No fever, tenderness minimal but may be pruritis

what is paraphimosis?

surgical emergency
Painful swelling of the foreskin distal to a phimotic ring
Often happens after foreskin retracted for catheterization or cystoscopy and staff member forgets to replace it in its natural position

how is paraphimosis treated?

Under penile block Manual compression of glans with distal traction on oedematous foreskin
Dorsal slit

what is priapism?

Prolonged unwanted erection (> 4hrs), often painful and not associated with sexual arousal

what causes priapism?

Intracorporeal injection for ED, e.g. papaverine
Trauma (penile / perineal)
Haematologic dyscrasias e.g. sickle cell
Neurological conditions
Idiopathic

what are the features of non-ischaemic priapism?

Observe, may resolve spontaneously
Selective arterial embolization with non-permanent materials

what is the treatment of an ischaemic priapism?

Aspiration +/- irrigation with saline
Injection of alpha-agonist, e.g. phenylephrine 100-200ug every 5-10 mins up to max 1000ug
Surgical shunt
Ischaemic priapism > 48-72hrs unlikely to respond to intracavernosal treatment
For very delayed presentation, may even consider immediate placement of a penile prosthesis

what is fourniers gangrene?

A form of necrotizing fasciitis occurring about the male genitalia

what predisposes to fourniers gangrene?

diabetes, local trauma, periurethral extravasation, perianal infection

what are the features of fourniers gangrene?

cellulitis swelling and crepitus of scrotum, dark purple areas

what is the treatment for fourniers gangrene?

Antibiotics + surgical debridement Mortality 20%, higher in diabetics and alcoholics

what is emphysematous phylonephritis?

An acute necrotizing parenchymal and perirenal infection caused by gas-forming uropathogens, usually E coli

who is usually affected by emphysematous pyelonephritis?

diabetics

at are the symptoms of emphysematous pyelonephritis?

Often associated with ureteric obstruction Fever, vomiting, flank pain See gas on KUB CT defines extent of emphysematous process requires ITU support. If not settling needs nephrectomy

what are the features of a perinephric abcess?

Usually results from rupture of an acute cortical abscess into the perinephric space or from haematogenous seeding from sites of infection Insidious onset, approx 33% not pyrexial Flank mass in 50% High WCC, high serum creatinine, pyuria treated with abx

what is a class 1 renal trauma?

Haematoma, subcapsular, non-expanding, no parenchymal laceration

what are the features of a class 2 trauma?

Laceration <1cm parenchymal depth without urinary extravasation

what are the features of a class 3 trauma?

>1cm depth, no collecting system rupture or extravasation

what are the features of a class 4 trauma?

Laceration through cortex, medulla and collecting system Main arterial/venous injury with contained haemorrhage

what are the features of a class 5 trauma?

Shattered kidney Avulsion of hilum, devascularizing kidney

what are renal traumas imaged?

Frank haematuria in adult Frank or occult haematuria in child Occult haematuria + (systolic <90mmHg at any point) Penetrating injury with any degree of haematuria Ix – CT with contrast

how are blunt renal images treated?

98% of blunt renal injuries can be managed non-operatively with angiography/embolization Surgery - Persistent renal bleeding, expanding perirenal haematoma, pulsatile perirenal haematoma Urinary extravasation, non-viable tissue, incomplete staging (can do on-table IVU)

what are the features of a bladder injury?

commonly associated with a pelvic fracture suprapubic/abdo pain and inability to void lower abdo bruising, guarding/rigidity catheterisation needed treated with abx

what are the features of a penile fracture?

Typically happens during intercourse – buckling injury when penis slips out of vagina and strikes pubis Cracking or popping sound followed by pain, rapid detumescence, discolouration and swelling 20% incidence of urethral injury (frank haematuria/blood at meatus)