Urological Emergencies Flashcards
Acute urinary retention
(Gradual or Sudden?) ____________
Sudden inability to micturate
Acute urinary retention is always painful
T/F
F
Invariably but not always painful
Painless Acute urinary retention are associated with ?
CNS pathology
Epidemiology of AUR
___% of all men in their 7th decade
___% of all men in their 8th decade
10
33
Chronic urinary retention is invariably (painful or painless?)
Painless
Acute on chronic retention can occur in ____,_____,______, etc
BPH
CA-P
strictures
Clinical evaluation of CUR patient
DRE is unreliable in ________
Full bladder
Problems of urethral catheterization
•risk of urethral _______, which can lead to _____ and _____
•increased risk of _______
•increased patient discomfort
Trauma; bleeding; strictures
UTIs
Management of urinary retention
_______ catheterization
__________ catheterization
Urethral
Suprapubic
Suprapubic catheterization
Can be :
-) _________ cystostomy
-) __________ cystostomy
Cystofix
Open
Suprapubic catheterization is the only reasonable option in ______ structures and acute _________
Tight; prostatitis
Problems of Suprapubic catheterization
- requires ____________
-potential risk of ———— in untrained hands
Higher level of training
Bowel injury
Advantages of Suprapubic catheterization
-)reduced risk of _____
-)improved ____________
-)no risk of __________ or _______
-)_____________ can be tried
UTI
patient comfort
urethral damage or stricture
trial of micturition
Complications After Relieve of Acute on Chronic Retention
Post obstructive diuresis
-output is >_____mls/hr for ____hours
-______ damage and impaired nephron’s ability to __________
-hypovolaemia, reduced electrolytes
200; 2
tubular; concentrate urine
Post obstructive diuresis
Risk factors
Increased _______, _________ , ______ kidney, post void volume > ______ .
Admit and offer IVF to correct fluid and electroyte imbalance.
Blood pressure
renal failure; solitary
IL
After relieve of acute on chronic retention, Most pts will exhibit diuress
T/F
F
Most pts will not exhibit diuress
Age Specific Haematuria
_______- 25 yrs
________- 30
_______-35
_______-45
_________- 50
Schistosomia
Trauma
UTI
Calculi
Tumors
CLINICAL FEATURES of hematuria
Pain - Painless haematuria highly suggestive of ____________.
Pain - _________,_______
malignant disease
Inflammation, stones
Hematuria :Duration
- Short hx - _______ ,________
-Long (months / years) - _______,________,___________ etc.
Tumor , acute infections
TB, Calculi, hydronephrosis
Most cases of gross haematuria are self limiting.
T/F
T
Treatment of hematuria
- Can patient empty bladder? - If not - _________ with __________
and flush to ________
If there’s Continued clot formation or significant haematuria, use a _________ catheter and start continuous ________.
catheterize
haematuric catheter
evacuate clot.
3 way Foley ; irrigation
Massive Haematuria - Haematuria
severe enough to threaten the patients with the risk of severe __________
hypovolaemia
Intractable Haematuria -______,_______ haematuria, which fails to respond to ___________ treatment.
Invariably from ________,_______, or _____
_________- main culprit
Severe, persistent
conservative
kidney or bladder or prostatic urethra
Bladder
Haematuria most times self limiting.
T/F
T
First episode of haematuria gives best chance of early diagnosis and cure of malignant disease.
T/F
T
Degree of haematuria correlates with severity of underlying problem in early cases.
F
It does not
_________ + ________ + ___________ = RCC.
Haematuria
Loin mass
loin pain
Painless haematuria - _________ disease
until proved otherwise.
Malignant
All patients (with few exceptions) having hematuria should have an
______ or _____ + ____________.
IVU
USS
cystoscopy
In Bladder injuries - _________ is mandatory.
catheterisation
If urethral injury suspected - Avoid
urethral catheterization because it can convert _________ into a —————
partial rupture
complete one.
In a normal Capacity bladder,
Sensation of Pain occurs when the volume exceeds
a. 150mls d. 400mls
b. 200mls C. 300mls e. 500mls
E
The drugs known to precipitate Acute Urinary Retention (AUR) include:
b. ___________
c. _________
d. _____________
e. ________
Diuretics
Prazosin
Alfuzosin
Probanthilin
Causes of Acute Urinary Retention (AUR) in women include:
a. ________
c. ______________ uterus
e. Psychogenic
Cystitis
Retroverted gravid
Likely causes of AUR include
a. Benign Prostatic hyperplasia (BPH)
b. Urethral stricture disease
c. Prostatic carcinoma
d. Bilateral ureteric stones
e. Tumors involving the bladder fundus.
A
B
C
Acute Urinary Retention can be defined as:
(a)Inability to pass urine despite the urge to void
b)Inability to pass urine despite the presence of a
full bladder.
c) Anuria
(d)Oliguria
(e)All of the above
B
The following drugs are known to precipitate AUR
a. Morphin
b. Probanthilin
c. Diuretics
d. Prazosin
e. Alfuzosin
B
C
D
E
Causes of AUR in women include
a. Cystitis
b. Urethral Stricture
c. Retroverted gravid uterus
d. Carbuncle
e. Psychogenic
A
B
C
AUR IS
(a)Commonly associated with CUR
(b) Always painful
(c) Usually of short duration of onset
(d)Almost invariably associated with a palpable bladder
(e)The commonest urologic disorder presenting to the emergency room.
C
Urethral stricture
• _______ age group
• Previous history of ______,______, or _______ – few weeks or ____ yrs before presentation
• Previous LUTS may be absent.
• Poor stream (improved or not improved?) by straining
• Post STI- ________ urethra and (short or long?)
• Post catheterisation strictures rising
•______/______ tests are mandatory
• Treatment is __________
Any
trauma,STI,instrumentation; 20
Improved
anterior; long
RUCG\MCUG
urethroplasty
TRAUMA
• Now a major cause of AUR
• Usually occurs in ____________
• AUR usually associated with ______ at external meatus
• AUR more common with _________ urethral trauma
• Pelvic fracture- ________ urethra
•saddle- ________ urethra
young male adults
blood ; posterior
posterior; anterior
•_________ attempt(s) at passage of a well lubricated urethral catheter permitted
A single
______________________ (SPC) is the safest
Suprapubic cystosomy
IMPORTANT MESSAGES
Avoid ______________
Always use an ____________________ gel.
suprapubic tap
anaesthetic lubricating
______________ is scientifically a better option than urethral catherization for an indwelling catheter
Suprapubic cystostomy
Always observe patient for at least ____________ after relieve of obstruction
few hours
IMPORTANT MESSAGES
____________ Antibiotics – Controversial
Replacement of Indwelling Catheter- ________-__________
Clean intermittent Catheterization.
Prophylactic
2-4 weeks-3months.
Commonest causes Of hematuria in Lagos – ______,______,______,_______,________
________ - rare
Tumors can arise at any age
Trauma, Tumors, BPH,Stones, SCD
Infection
Painless haematuria highly suggestive of ______________
Painful hematuria– ________,_________
malignant disease.
Inflammation, stones
Short history of hematuria- ______,_______
Long (months / years) history of hematuria – _______,________, hydronephrosis etc.
Tumor, acute infections
TB, Calculi
Haematuria in Renal trauma
• Can be absent in ______ of vascular pedicle
• When persistent and life threatening is an indication for _______ and _____
• .conservativeTx involves absolute _______ until urine is completely clear
• _________ injury is an indication for surgery
• .most injuries are _______ and _______
avulsion
CT and surgery
bed rest; Penetrating
blunt and minor
Prostatic origin of hematuria
• ______ commonest
• May be severe
• Will respond to __________
• Do __________ in non responsive cases
• Cystoscopic clot evacuation with Elliks evacuator
• Place for emergency _________ and _______________
Bph
bladder irrigation
Diathermy fulguration
prostatectomy
5 alpha reductase inhibitor
