Urological emergencies Flashcards
A man presents with an inability to urinate and increasing abdominal pain.
Acute urinary retention
How do you manage acute urinary retention?
Immediate catheterisation
What drug could you prescribe before removal of the catheter, after acute urinary retention?
Alpha blocker
A patient presents with acute pain going from his loin to his groin. What is the most likely diagnosis?
Renal calculus
What is the treatment for renal colic due to a small calculus?
NSAID +/- opiate Alpha blocker (tamsulosin) for small stones that are expected to pass.
Why would you want to know if a renal stone was radio opaque or radio lucent?
For effective follow up .
If a stone hasn’t passed in …… then it is unlikely to and will probably need intervention.
1 month
A patient presents with severe unremmiting loin pain radiating to his groin. He is pyrexic and vomiting. What do you do?
Likely to a large renal calculus.
Ureteric stent or stone fragmentation/removal
How would you treat an infected hydronephrosis?
Percutaneous nephrostomy
How do you treat frank haematuria with cot retention
3 way irrigating haematuria catherter
How would you investigate a patient with frank haematuria.
CT urogram + cystoscopy
A teenage boy presents with severe pain in his testicles. He said it came on suddenly.
Torsion of the spermatic cord.
What investigation may be useful in a suspected testicular torison?
Doppler ultrasound scan
How do you treat testicular torsion?
Surgical treatment. 2 or 3 point fixation with fine non absorbale sutures.
A teenage boy presents with testicular pain that has got worse over the last day. The tenderness is worst at the upper pole. The testes are mobile and the cremateric reflex is present.
Torsion of the appendage
What is the treatment of a torsion of the appendage?
Diagnosis confirmed it is not testicular torsion. It will resolve spontaneously without surgery.
Describe the cremasteric reflex.
Stroking the superior and medial part of the thigh with the 3rd finger regardless of the direction of stroke results in an immediate contraction of the cremaster muscle that pulls up the ipsilateral testis.
A 25 year old man presents with severe testicular pain and dysuria. The cremasteric reflex is present but urine dipstick reveals pyuria.
Epidymitis
What investigations should be ordered if you suspect epidymitis?
Doppler scan (swollen epididymis with increased blood flow) Send urine for culture and chlamydia screen.
What is the treatment for epididymitis?
Analgesia, scrotal support and bed rest.
Ofloxacin 400mg/day for 14 days.