Urological Emergencies Flashcards
What is acute urinary retention?
Sudden inability to pass urine (over period of hours)
What are the causes of acute urinary retention?
Obstructive:
Prostatic (BPH or CA)
Urethral strictures,
Cystocele,
Calculi
Constipation
Drugs:
Anticholinergics,
Antihistamines
Opioids
Benzodiazepines
Neurological:
Cauda equina syndrome
MS
Explain the presentation of acute urinary retention
- Inability to pass urine,
- Lower abdominal discomfort,
- Pain and distress
- Acute confusion
- Signs = Palpable distended bladder, lower abdo tenderness
What are the investigations for acute urinary retention?
- Urinalysis and culture,
- UEs for AKI
- FBC and CRP
- Bladder scan - volume over 300 cc confirms diagnosis
What are the complications of acute urinary retention?
UTI due to stagnant urine, electrolyte imbalance, post-decompression haematuria, pathological diuresis and renal failure
What are causes of transient non visible haematuria?
UTIs,
Menstruation,
Vigorous exercise
Sexual intercourse
What are causes of persistent non-visible haematuria?
Cancer (bladder, renal or prostatic)
Stones
BPH
Prostatitis
Urethritis (eg, chlamydia)
Renal causes: IgA nephropathy
Name some traumatic causes of haematuria
Injury to renal tract,
Blunt injury to kidneys,
Ureter trauma
Bladder trauma (RTA or pelvic fractures)
What are some infectious causes of haematuria?
TB
UTIs
Chlamydia
What are some malignant causes of haematuria?
Renal cell carcinoma (painful or painless),
Bladder cancers (painless),
Prostatic cancers
Penile cancers
What are some renal diseases which can cause haematuria?
Glomerulonephritis,
Renal stones (often microscopic)
What are some drug causes of haematuria?
- Aminoglycosides,
- Chemotherapy,
- Nsaids, penicillin, Anticoagulants
What are the investigations for haematuria?
- Assess renal function and look for ACR and PCR
- Urgent referral for those over 45 with unexplained visible haematuria or visible haematuria that persists after UTI treatment.
- Non-urgent referral for those over 60 with recurrent/persistent unexplained UTIs
- Manage in primary care for those under 40 with non-visible haematuria with normal renal function and no proteinuria and normotensive
What is testicular torsion?
Twisting of the spermatic cord which can result in testicular ischaemia and necrosis. Peak incidence between 13-15 years old)
What are features of testicular torsion?
- Sudden onset pain with referral to lower abdomen.
- Nausea and vomiting
- Swollen, painful testicle which is retracted upwards
- Cremasteric reflex is lost.
- Elevation doesn’t ease the pain (Prehn’s sign)
