Urological Emergencies Flashcards
what is the treatment of Acute Urinary retention?
if under 1 litre is retained prescribe a uroselective alphabocker (Alfuzosin, Tamsulosin)
If large volumes cathaterize but be wary of post-obstructive diuresis. Will need fluid and salt replacement if fluid loss is over 200ml/hout
what diagnosis outwith the urinary tract should be considered for loin pain?
AAA
what is the treatment of renal stones of under 4mm?
NSAID +/- opiate
alpha-blocker (Tamsulosin) for small stones that are expected to pass
what are the indications for urgent treatment of renal stones?
How are they managed?
Pain unrelieved
Pyrexia
Persistent nausea/vomiting
High-grade obstruction
Rx – ureteric stent or stone fragmentation/removal if no infection
percutaneous nephrostomy for infected hydronephrosis
List causes of Frank Haematuria
Infection
Stones
Tumours
Benign prostatic hyperplasia (BPH)
Polycystic kidneys
Trauma
Coagulation/platelet deficiencies
what are the investigations for clot retention?
what is the treatment?
Ix – CT urogram + cystoscopy
use a 3-way irrigating haematuria catheter (toflush out blood clots)
what is the presentation of testicular torsion?
Most common at puberty
Can occur with trauma or athletic activity but usually spontaneous. Adolescent often woken from sleep
Usually sudden onset of pain, sometimes previous episodes of self-limiting pain
May be nausea/vomiting
May be referral of pain to lower abdomen
what would you find on an examination of testicular torsion?
testis high in scrotum
transverse lie
absence of cremasteric reflex
Acute hydrocoele + oedema may obliterate landmarks
what are the investigations and treatment of testicular torsion?
Ix – Doppler USS sometimes helpful
Rx – Prompt exploration. Irreversible ischaemic injury may begin as soon as 4hrs
2 or 3-point fixation with fine non-absorbable sutures
If testis necrotic then remove
MUST fix contralateral side (bell clapper deformity)
What is the diagnosis and treatment for torsion of the appendage?
Symptoms variable – may be insidious onset or identical to torsion of cord
If seen early, may have localised tenderness at upper pole and “blue dot” sign
Testis should be mobile and cremasteric reflex present
If diagnosis confirmed then will resolve spontaneously without surgery
what is the presentation of epididymitis?
May be difficult to distinguish from torsion
Dysuria / pyrexia more common
Pyuria
Hx of UTI, urethritis, catheterization/instrumentation
what are the investigations and treatment of epididymitis?
Doppler – swollen epididymis, increased bloodflow
Send urine for culture + Chlamydia PCR
Rx Analgesia + scrotal support, bed rest
Ofloxacin 400mg/day for 14 days
what’s the treatment of paraphimosis
Iced glove, granulated sugar for 1-2hrs, multiple punctures in oedematous skin
Manual compression of glans with distal traction on oedematous foreskin
Dorsal slit
what are the 2 classifications of priapism?
Ischaemic (veno-occlusive or low-flow).
Vascular stasis in penis and decreased venous outflow, a true compartment syndrome.
Corpora cavernosa are rigid and tender, penis often painful
Non-ischaemic (arterial or high-flow)
Traumatic disruption of penile vasculature results in unregulated blood entry and filling of corpora.
Fistula formation between cavernous artery and lacunar spaces allows blood to by-pass the normal helicine arteriolar bed
how do you differentiate between the 2 types of priapism?
Aspirate blood from corpus cavernosum – dark blood, low O2 , high CO2 in low-flow
- normal arterial blood in high-flow
Colour duplex USS - minimal or absent flow in cavernosal arteries in low-flow
normal to high flow in non-ischaemic priapism
what is the presentation and treatment of Fournier’s Gangrene?
Starts as cellulitis – swollen, erythematous, tender. Marked pain, fever, systemic toxicity
Swelling + crepitus of scrotum, dark purple areas
Often marked toxicity out of proportion to the local findings
Plain X-ray or USS may confirm gas in tissues
Rx – Antibiotics + surgical debridement
Mortality 20%, higher in diabetics and alcoholics
what are the classifications of renal trauma?
I Haematoma, subcapsular, non-expanding, no parenchymal laceration
II Laceration <1cm parenchymal depth without urinary extravasation
III >1cm depth, no collecting system rupture or extravasation
IV Laceration through cortex, medulla and collecting system
Main arterial/venous injury with contained haemorrhage
V Shattered kidney
Avulsion of hilum, devascularizing kidney
what is the classic presentation and treatment of a penile fracture?
Typically happens during intercourse – buckling injury when penis slips out of vagina and strikes pubis
Cracking or popping sound followed by pain, rapid detumescence, discolouration and swelling
20% incidence of urethral injury (frank haematuria/blood at meatus)
Rx Prompt exploration and repair
Circumcision incision with degloving of penis to expose all 3 compartments
