Urological emergencies 3

Question 1

What is the typical presenting features of a perinephric abscess ?

Answer 1

• Insidious onset, approx 33% not pyrexial
• Flank mass in 50%
• High WCC, high serum creatinine, pyuria (pus in urine)

Question 2

What is the treatment of a perinephric abscess ?

Answer 2

Antibiotics + percutaneous or surgical drainage

Question 3

How is a perinephric abscess diagnosed ?

Answer 3

CT scan

Question 4

How is renal trauma classified ?

Answer 4

From grade I to V (I being best)

Question 5

Grade the following classifications of renal trauma:

• Laceration through cortex, medulla and collecting system, Main arterial/venous injury with contained haemorrhage
• Laceration <1cm parenchymal depth without urinary extravasation
• Haematoma, subcapsular, non-expanding, no parenchymal laceration
• Shattered kidney. Avulsion of hilum, devascularizing kidney
• >1cm depth, no collecting system rupture or extravasation

Answer 5

1. Grade I - Haematoma, subcapsular, non-expanding, no parenchymal laceration
2. Grade II - Laceration <1cm parenchymal depth without urinary extravasation
3. Grade III - >1cm depth, no collecting system rupture or extravasation
4. Grade IV - Laceration through cortex, medulla and collecting system, Main arterial/venous injury with contained haemorrhage
5. Grade V -Shattered kidney. Avulsion of hilum, devascularizing kidney

Question 6

What are the indications for imaging of the kidneys following renal truama ?

Answer 6

• Frank haematuria in adult
• Frank or occult haematuria in child
• Occult haematuria + shock (systolic <90mmHg at any point)
• Penetrating injury with any degree of haematuria

Question 7

What is the investigation done to image the kidneys following renal trauma, if indicated ?

Answer 7

CT scan with contrast

Question 8

What is the treatment for blunt injuries to the kidneys ?

Answer 8

• Almost all - Managed non-operatively - angiography/embolization
• Surgery - If e.g. persistent bleeding, expanding perirenal haematoma, pulsatile perirenal haematoma

Question 9

What trauma injury often causes injury to the bladder ?

Answer 9

Pelvic fractures

Question 10

What are the typical presenting features of bladder injuries ?

Answer 10

• Suprapubic/abdominal pain + inability to void
• On catheterization – gross haematuria

Question 11

What investigation is done to assess bladder injuries ?

Answer 11

CT cystography

Question 12

What is the treatment for bladder injuries ?

Answer 12

• Large-bore catheter
• Antibiotics
• Repeat cystogram in 14 days

Question 13

What injury often cause urethral injuries as well ?

Answer 13

Pubic rami fractures

Question 14

What are the features which would suggest a urethral injury ?

Answer 14

• Blood at meatus
• Inability to urinate
• Palpably full bladder
• “High-riding” prostate
• Butterfly perineal haematoma

Question 15

What investigation is done to assess urethral injuries ?

Answer 15

Retrograde urethrogram

Question 16

What is the treatment of urethral injuries ?

Answer 16

• Suprapubic catheter
• Delayed reconstruction after at least 3 months

Question 17

Describe the typical history (how do they often occur) of the penile fracture

Answer 17

• Typically happens during intercourse
• Cracking or popping sound followed by pain, discoloration and swelling

Question 18

What is the treatment of penile fractures ?

Answer 18

• Prompt exploration and repair
• Circumcision incision with degloving of penis to expose all 3 compartments to find the injury

Question 19

Following testicular injury what investigation can be done to assess the testis ?

Answer 19

USS to assess integrity / vascularity

Question 20

What is the treatment of testicular injuries ?

Answer 20

Early exploration/repair