Urological emergencies Flashcards
What is acute urinary retention most commonly a complication of?
Benign prostatic hyperplasia
How can the chances of success of trial without catheter can be improved?
Treatment with an alpha-blocker 24 hours prior (e.g. tamsulosin)
What is the most common cause of acute loin pain?
Ureteric stone
How is a ureteric stone treated?
NSAID +/- opiate
Tamsulosin can help stone pass into bladder
Surgery if hasnt passed in a month
What is the definitive investigation for ureteric stones?
non-contrast CT
How is a ureteric stone treated surgically?
Ureteric stent if no infection
Percutaneous nephrostomy for infected hydronephrosis
What is the most common cause of haematuria?
Cystitis (usually seen in the community rather than hospital)
Bleeding then retention- how should this be treated?
Haematuria three-way catheter
When is torsion of the spermatic cord most common?
Adolescence
What is the “blue dot “ sign?
Black necrotic appendis testis
What might be the consequence if the foreskin is not restored to its original position after catheterization?
Paraphimosis- painful swelling of the foreskin behind the glans penis
What is priapism?
Prolonged erection (more than 4 hours)
What causes priapism?
Decreased venous outflow causing ischaemia
How is priapism treated?
Aspirate blood
Injection of alpha-agonist
Surgical shunt
What is Fournier’s gangrene?
Necrotizing fasciitis of the male genitalia
How does epidydmitis present?
Painful swollen scrotum (not usually in adolescents)
Usually with a history of UTI/instrumentation/catheter
Sometimes dysuria/pyrexia
What is a potential complication of acute urinary retention (after the catheter has been inserted)?
Post-obstructive diuresis- need to maintain fluids and monitor input/output
How is paraphimosis treated?
Iced glove, granulated sugar, multiple punctures in foreskin
Glans compression and distal traction of the foreskin
How can most renal trauma be managed?
Embolization
What is emphysematous pyelonephritis and how is it treated?
Acute peri-renal infection caused by gas-forming organisms such as E. coli
Usually requires nephrectomy
Which group of patients does emphysematous pyelonephritis usually occur in?
Diabetics
What specific injury is bladder trauma frequently associated with?
Pelvic fractures
What does blood at the external urethral meatus often indicate?
Urethral injury
