Urological emergencies

Question 1

Hematuria in these situations is usually characterized by circular erythrocytes and absence of proteinuria and casts.

Answer 1

surgical/urological nonglomerular causes

Question 2

A patient in the ER received a urine culture/cytology, renal US and flexible cystoscopy. What was his most likely presenting symptom?

Answer 2

hematuria

Question 3

Most common urologic emergency and a cause of the acute abdomen. Characterized by sudden onset of severe flank pain with N/V due to passage of renal stone

Answer 3

ureteric or renal colic

Question 4

Imaging that can identify other non-stone causes of flank pain, is quick, and doesn’t require contrast

Answer 4

helical CT

Question 5

What is the management of ureteric stones smaller than 5mm?

Answer 5

opiates and hydration

Question 6

What are the definitive treatment options for a ureteric stone that is either associated w/fever, unresponsive to analgesics, impairing renal fxn, or has caused obstruction > 4wks?

Answer 6

ESWL or percutaneous nephrolithotomy

Question 7

Painful inability to void, with relief of pain following drainage of the bladder by catheterization due to either increased urethral resistance, low bladder pressure, or interruption of the innervations of the bladder

Answer 7

acute urinary retention

Question 8

Initial management options for acute urinary retention

Answer 8

urethral catheterization or suprapubic catheter

Question 9

Patient presents with distended bladder that isn’t painful, urinary dribbling, overflow incontinence, and a palpable lower suprapubic mass

Answer 9

chronic urinary retention

Question 10

What is chronic urinary retention associated with?

Answer 10

reduced renal function or upper tract dilatation

Question 11

What happens if the bladder of a patient with chronic urinary retention is drained to quickly?

Answer 11

sudden decompression causing hematuria

Question 12

Most common cause of an acute scrotum

Answer 12

epididymitis

Question 13

How soon does irreversible ischemic injury to the testicular parenchyma begin with intravaginal testicular torsion?

Answer 13

4 hrs

Question 14

How can you differentiate between testicular torsion and epididymitis?

Answer 14

absent cremasteric reflex in testicular torsion

Question 15

During surgical exploration of testicular torsion what should be done to preserve both affected and unaffected testes?

Answer 15

affected testis places in dartos pouch (suture fixation) and unaffected testis fixed to prevent subsequent torsion

Question 16

Patient presents with dysuria, fever, epidiymal tenderness or massively swollen hemiscrotum with abscence of landmarks. cremasteric reflex present

Answer 16

epididymo-orchitis

Question 17

Should be avoided with epididymo-orchitis

Answer 17

urethral instrumentation

Question 18

Type of priapism due to hematological disease, malignant infiltration of the corpora cavernosa with malignant disease, or drugs.
Painful and most common type.

Answer 18

ischemic (veno-occlusive, low flow)

Question 19

Type of priapism to perineal trauma, which creates an arteriovenous fistula. Painless

Answer 19

non-ischemic (arterial, high flow)

Question 20

What is it important to warn all patients with priapism of?

Answer 20

possibility of impotence

Question 21

Done to evaluate renal injuries if patient is transferred immediately to the operating theatre without having had a CT scan and a retroperitoneal hematoma is found

Answer 21

IVU

Question 22

Imaging study of choice for renal injury. Accurate, rapid, and images other intra-abdominal structures

Answer 22

Contrast-enhanced CT

Question 23

How is a traumatic kidney injury managed that doesn’t have persistent bleeeding, an expanding hematoma, or pulsitile perirenal hematoma?

Answer 23

conservative (IV fluids and abx) follow-up ultrasound/CT

Question 24

the peritoneum overlying the bladder, has been breached along with the wall of the bladder, allowing urine to escape into the peritoneal cavity.

Answer 24

intraperitoneal perforation

Question 25

the peritoneum is intact
and urine escapes into the space around the bladder, but not into
the peritoneal cavity

Answer 25

extraperitoneal perforation

Question 26

Classic triad of symptoms and signs that are suggestive of a bladder rupture

Answer 26

suprapubic pain and tenderness, difficulty or inability in passing urine, and hematuria

Question 27

Why are bladder perforations repaired openly?

Answer 27

unlikely to heal spontaneously, large defects, leakage causes peritonitis, and associated other organ injury

Question 28

The majority a result of a straddle injury in boys or men. Can also be due to direct injuries to the penis, penile fracture, injuries by GSW, inflation of balloon catheter

Answer 28

anterior urethral injuries

Question 29

Patient presents with blood at end of penis, difficulty passing urine, frank hematuria, and penile swelling. What should you use to establish the diagnosis?

Answer 29

retrograde urethrography

Question 30

Management of a contusion anterior urethral injury

Answer 30

small-gauge urethral catheter for one week

Question 31

Management of partial rupture of anterior urethra

Answer 31

suprapubic urinary diversion for one week. No catheterization

Question 32

Management of complete rupture of anterior urethra

Answer 32

patient is unstable: a suprapubic catheter.

patient is stable: the urethra may either be immediately repaired or a suprapubic catheter

Question 33

Management of a penetrating anterior urethral injury

Answer 33

surgical debridement and repair

Question 34

What do the great majority of posterior urethral injuries occur in association with?

Answer 34

pelvic fractures

Question 35

Symptoms and signs include blood at the meatus, gross hematuria, and perineal or scrotal bruising.
High-riding prostate

Answer 35

posterior urethral injury

Question 36

Describe the different classifications of posterior urethral injuries

Answer 36

type 1 (rare)- stretch injury w/intact urethra. 2-partial tear. 3- complete tear

Question 37

In women, what is the most common urethral injury associated with pelvic fracture?

Answer 37

partial rupture at the anterior position

Question 38

Treatment of type 1 and type 2 urethral tears

Answer 38

stenting with a urethral catheter.

Question 39

What is a patient at risk for who has a type 3 urethral tear?

Answer 39

urethral stricture, urinary incontinence, and erectile dysfunction (ED)