Urological emergencies 2 Flashcards
What is torted in torsion of the appendage ?
The appendix testis
What are the typical presenting features of torsion of the appendage?
- Localised tenderness at upper pole
- “blue dot” sign
- May have similar features to torsion of the testis or not but the testis should be mobile and cremasteric reflex present
What is the treatment of torsion of the appendage?
Removal of the appendix testis as the patient will then recover more quickly
What is epididmyitis ?
- Inflammation of the epididymis characterised by scrotal pain and swelling
- Dysuria / pyrexia more common but still difficult to apart from torsion
What are the typical presenting features of epididymitis on exammination?
- Cremasteric reflex present
- Scrotal pain and swelling
What is the investigations are done to help diagnose epididmymitis ?
- Doppler US - shows swollen epididmyitis
- Send urine for culture + Chlamydia PCR
What is the treatment of epididmyitis ?
- If UTI likely (>35 and no new partner) ofloxacin 200mg bd or ciprofloxacin
- If STI likely (<35 or new partner in last 3mth) doxycycline
What is idiopathic scrotal oedema ?
Self-limiting swelling of the scrotum which is not sore
What is a paraphimosis ?
It is painful swelling of the foreskin which results in foreskin stuck behind the glans of the penis
What is the treatment of a paraphimosis ?
If ischaemia and necrosis present - then emergency surgery
If no ischaemia and necrosis present:
- 1st line = manual manipulation
- 2nd line = Puncture technique (puncturing the foreskin at mutiple locations to reduce the swelling
What is a priapism ?
Prolonged erection (> 4hrs), often painful and not associated with sexual arousal
What are the 2 different classes of priapism and explain each class?
Ischaemic and non-ischaemic
- Ischaemic is due to vascular stasis in penis and decreased venous outflow, a true compartment syndrome. Corpora cavernosa are rigid and tender, penis often painful
- Non-ischaemic - due to traumatic disruption of penile vasculature results in unregulated blood entry and filling of corpora.
What investigation is done to help distinguish between ischaemic and non-ischaemic priaprism and what does it show for the 2 different types ?
Colour duplex USS
- Ischaemic priaprism shows minimal or absent flow in cavernosal arteries in low-flow
- Non-ischaemic shows normal to high flow
What is the treatment of ischaemic priaprisms ?
- 1st line = Aspiration +/- irrigation
- Plus - Injection of alpha-agonist, e.g. phenylephrine
What is the treatment of non-ischaemic priaprisms?
1st line: observation
Patient preference for intervention:
- adjunct: Cavernosal artery embolisation
- adjunct: Surgery
How does Fournier’s gangrene typically present ?
- Intense genital pain and tenderness that is usually associated with edema of the overlying skin; pruritus may also be present
- Swelling + crepitus of scrotum, dark purple areas
