Urological emergencies Flashcards
Hematuria in these situations is usually characterized by circular erythrocytes and absence of proteinuria and casts.
surgical/urological nonglomerular causes
A patient in the ER received a urine culture/cytology, renal US and flexible cystoscopy. What was his most likely presenting symptom?
hematuria
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
ureteric or renal colic
Imaging that can identify other non-stone causes of flank pain, is quick, and doesn’t require contrast
helical CT
What is the management of ureteric stones smaller than 5mm?
opiates and hydration
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?
ESWL or percutaneous nephrolithotomy
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
acute urinary retention
Initial management options for acute urinary retention
urethral catheterization or suprapubic catheter
Patient presents with distended bladder that isn’t painful, urinary dribbling, overflow incontinence, and a palpable lower suprapubic mass
chronic urinary retention
What is chronic urinary retention associated with?
reduced renal function or upper tract dilatation
What happens if the bladder of a patient with chronic urinary retention is drained to quickly?
sudden decompression causing hematuria
Most common cause of an acute scrotum
epididymitis
How soon does irreversible ischemic injury to the testicular parenchyma begin with intravaginal testicular torsion?
4 hrs
How can you differentiate between testicular torsion and epididymitis?
absent cremasteric reflex in testicular torsion
During surgical exploration of testicular torsion what should be done to preserve both affected and unaffected testes?
affected testis places in dartos pouch (suture fixation) and unaffected testis fixed to prevent subsequent torsion
Patient presents with dysuria, fever, epidiymal tenderness or massively swollen hemiscrotum with abscence of landmarks. cremasteric reflex present
epididymo-orchitis
Should be avoided with epididymo-orchitis
urethral instrumentation
Type of priapism due to hematological disease, malignant infiltration of the corpora cavernosa with malignant disease, or drugs.
Painful and most common type.
ischemic (veno-occlusive, low flow)
Type of priapism to perineal trauma, which creates an arteriovenous fistula. Painless
non-ischemic (arterial, high flow)
What is it important to warn all patients with priapism of?
possibility of impotence
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
IVU
Imaging study of choice for renal injury. Accurate, rapid, and images other intra-abdominal structures
Contrast-enhanced CT
How is a traumatic kidney injury managed that doesn’t have persistent bleeeding, an expanding hematoma, or pulsitile perirenal hematoma?
conservative (IV fluids and abx) follow-up ultrasound/CT
the peritoneum overlying the bladder, has been breached along with the wall of the bladder, allowing urine to escape into the peritoneal cavity.
intraperitoneal perforation
