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renal > urological emergencies > Flashcards

urological emergencies Flashcards

1
Q

what events can cause precipitated acute urinary retention?

A

non-prostate related surgery, catheterisation or urethral instrumentation, anaesthesia, medication with sympathomimetic or anticholinergic effects

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2
Q

what is post-obstructive diuresis?

A

Diuresis due to solute diuresis (retained urea, sodium and water) + defect in concentrating ability of kidney
Often present in patients with chronic bladder outflow obstruction in association with uraemia, oedema, CCF, hypertension

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3
Q

what is the management of post-obstructive diuresis?

A

Monitor fluid balance and beware if urine output > 200ml/hr. Usually resolves in 24-48hr but in severe cases may require IV fluid and sodium replacement

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4
Q

what is it important to rule out in a patient presenting with acute loin pain?

A

AAA

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5
Q

how long should you wait to see if a renal stone passes itself before intervening?

A

1 month
(unless there is extreme pain, renal impairment or infection)

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6
Q

what is the most common cause of spermatic cord torsion?

A

spontaneous - adolescent suddenly woken in their sleep with severe pain

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7
Q

what is the management of spermatic cord torsion?

A
  • Prompt exploration. Irreversible ischaemic injury may begin as soon as 4hrs
  • 2 or 3-point fixation with fine non-absorbable sutures
  • If testis necrotic then remove
  • MUST fix contralateral side (bell clapper deformity)
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8
Q

what is epididymitis?

A

Inflammation of the testis and epididymis secondary to infection

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9
Q

what are the investigations for epididymitis?

A

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

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10
Q

what is the management for epididymitis?

A

Analgesia + scrotal support, bed rest
Ofloxacin 400mg/day for 14 days

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11
Q

what is paraphimosis?

A

Painful swelling of the foreskin distal to a phimotic ring
foreskin stuck back

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12
Q

what is a cause of paraphimosis in hospital?

A

after foreskin retracted for catheterization or cystoscopy and staff member forgets to replace it in its natural position

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13
Q

what is the management of paraphimosis?

A
  • Under penile block, manual compression of glans with distal traction on oedematous skin
  • If fails - dorsal slit
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14
Q

what is priapism?

A

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

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15
Q

what can cause priapism?

A
  • Intracorporeal injection for ED, e.g. papaverine
  • Trauma (penile / perineal)
  • Haematologic dyscrasias e.g. sickle cell
  • Neurological conditions
  • Idiopathic
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16
Q

what is ischaemic priapism?

A

(veno-occlusive or low-flow).
Vascular stasis in penis and decreased venous outflow, a true compartment syndrome.
Corpora cavernosa are rigid and tender, penis often painful

17
Q

what is non ischaemic priapism?

A

arterial or high flow
Traumatic disruption of penile vasculature results in unregulated blood entry and filling of corpora.
Fistula formation between cavernous artery and lacunar spaces allows blood to by-pass the normal helicine arteriolar bed

18
Q

what is the treatment of ischaemic priapism?

A

Aspiration +/- irrigation with saline
injection of alpha-agonist, e.g. phenylephrine 100-200ug every 5-10 mins up to max 1000ug
Surgical shunt

in delayed presentation (>48 hours) can consider penile prosthesis

19
Q

what is the treatment of non-ischaemic priapism?

A

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

20
Q

what is fournier’s gangrene?

A

A form of necrotizing fasciitis occurring about the male genitalia
Most commonly arises from skin, urethra or rectal region

21
Q

what are predisposing factors for fournier’s gangrene?

A

diabetes, local trauma, periurethral extravasation, perianal infection

22
Q

what is the presentation of fournier’s gangrene?

A

Starts as cellulitis – swollen, erythematous, tender. Marked pain, fever, systemic toxicity
Swelling + crepitus of scrotum, dark purple areas
Often marked toxicity out of proportion to the local findings

23
Q

what is the treatment of fournier’s gangrene?

A

Plain X-ray or USS may confirm gas in tissues
Antibiotics + surgical debridement
Mortality 20%, higher in diabetics and alcoholics

24
Q

what is emphysematous pyelonephritis?

A

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

25
Q

what is the presentation of emphysematous pyelonephritis?

A

Often associated with ureteric obstruction
Fever, vomiting, flank pain
See gas on KUB

26
Q

what causes a perinephric abscess?

A

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

27
Q

what are the classifications of renal trauma?

A

Classification:
I Haematoma, subcapsular, non-expanding, no parenchymal laceration

II Laceration <1cm parenchymal depth without urinary extravasation

III >1cm depth, no collecting system rupture or extravasation

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

V Shattered kidney
Avulsion of hilum, devascularizing kidney

28
Q

what are indications for imaging in renal injury?

A

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

do CT with contrast

29
Q

what is the presentation of bladder injury?

A

Suprapubic/abdominal pain + inability to void
Suprapubic tenderness, lower abdominal bruising, guarding/rigidity, diminished bowel sounds

30
Q

what are indications for immediate repair of bladder injury?

A

Intraperitoneal injury
Penetrating injury
Inadequate drainage or clots in urine
Bladder neck injury
Rectal or vaginal injury
Open pelvic fracture
Pelvic fracture requiring open reduction/fixation
Patients undergoing laparotomy for other reasons
Bone fragments projecting into bladder

otherwise - catheter + antibiotics

31
Q

what is the presentation of urethral injury?

A

Blood at meatus
Inability to urinate
Palpably full bladder
“High-riding” prostate
Butterfly perineal haematoma
often associated with fracture of pubic rami

32
Q

what are the investigations and management of urethral injury?

A

retrograde urethrogram

suprapubic catheter, delayed reconstruction after at least 3 months

33
Q

describe penile fracture

A

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)

34
Q

what is the management of penile fracture?

A

Prompt exploration and repair
Circumcision incision with degloving of penis to expose all 3 compartments

renal (23 decks)

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