Urological emergencies

Question 1

What is acute urinary retention most commonly a complication of?

Answer 1

Benign prostatic hyperplasia

Question 2

How can the chances of success of trial without catheter can be improved?

Answer 2

Treatment with an alpha-blocker 24 hours prior (e.g. tamsulosin)

Question 3

What is the most common cause of acute loin pain?

Answer 3

Ureteric stone

Question 4

How is a ureteric stone treated?

Answer 4

NSAID +/- opiate

Tamsulosin can help stone pass into bladder

Surgery if hasnt passed in a month

Question 5

What is the definitive investigation for ureteric stones?

Answer 5

non-contrast CT

Question 6

How is a ureteric stone treated surgically?

Answer 6

Ureteric stent if no infection

Percutaneous nephrostomy for infected hydronephrosis

Question 7

What is the most common cause of haematuria?

Answer 7

Cystitis (usually seen in the community rather than hospital)

Question 8

Bleeding then retention- how should this be treated?

Answer 8

Haematuria three-way catheter

Question 9

When is torsion of the spermatic cord most common?

Answer 9

Adolescence

Question 10

What is the “blue dot “ sign?

Answer 10

Black necrotic appendis testis

Question 11

What might be the consequence if the foreskin is not restored to its original position after catheterization?

Answer 11

Paraphimosis- painful swelling of the foreskin behind the glans penis

Question 12

What is priapism?

Answer 12

Prolonged erection (more than 4 hours)

Question 13

What causes priapism?

Answer 13

Decreased venous outflow causing ischaemia

Question 14

How is priapism treated?

Answer 14

Aspirate blood

Injection of alpha-agonist

Surgical shunt

Question 15

What is Fournier’s gangrene?

Answer 15

Necrotizing fasciitis of the male genitalia

Question 16

How does epidydmitis present?

Answer 16

Painful swollen scrotum (not usually in adolescents)

Usually with a history of UTI/instrumentation/catheter

Sometimes dysuria/pyrexia

Question 17

What is a potential complication of acute urinary retention (after the catheter has been inserted)?

Answer 17

Post-obstructive diuresis- need to maintain fluids and monitor input/output

Question 18

How is paraphimosis treated?

Answer 18

Iced glove, granulated sugar, multiple punctures in foreskin

Glans compression and distal traction of the foreskin

Question 19

How can most renal trauma be managed?

Answer 19

Embolization

Question 20

What is emphysematous pyelonephritis and how is it treated?

Answer 20

Acute peri-renal infection caused by gas-forming organisms such as E. coli

Usually requires nephrectomy

Question 21

Which group of patients does emphysematous pyelonephritis usually occur in?

Answer 21

Diabetics

Question 22

What specific injury is bladder trauma frequently associated with?

Answer 22

Pelvic fractures

Question 23

What does blood at the external urethral meatus often indicate?

Answer 23

Urethral injury