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Renal > Urological Emergencies > Flashcards

Urological Emergencies Flashcards

1
Q

What is acute urinary retention and what most commonly causes it?

A

Inability to urinate with increasing pain

A complication of BPH

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2
Q

What else can precipitate acute urinary retention?

A

Non-prostate related surgery
catheterization or urethral instrumentation
anaesthesia
medication with sympathomimetic or anti-cholinergic effects

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3
Q

What is the treatment for acute urinary retention?

A

Catherization

a Uroselective alphablocker (Alfuzosin) before treating with cathetar improves chance of voiding success

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4
Q

What is the most common cuase of lion pain?

A

Ureteric colic secondary to calculus

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5
Q

As the size of the calculus increases, what happens to the chance of it spontaneously passing?

A

Decreases

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6
Q

What is the definitive test for renal calculus?

A

Non-contrast CT scan “stone search”

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7
Q

What are the indications to treat a patient with renal calculus urgently?

A

Pain unrelieved
Pyrexia
Persistenct nause/vomiting
High grade obstruction

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8
Q

What are the treatment options for renal stones?

A
  • Internal ureteric stent
  • Stone fragemntation/ removal if no infection
  • Percutaneous nephrostomy tube for infected hydronephrosis
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9
Q

Give some causes of frank haematuria?

A 
Infection
Stones
Tumours
Benign prostatic hyperplasia (BPH)
Polycystic kidneys
Trauma
Coagulation/platelet deficiencies
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10
Q

If a patient comes in with frank haematuria then retention how should this be treated?

A

Large 3-way catheter

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11
Q

When is torsion of the spermatic cord most common?

A

At puberty

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12
Q

What clinical signs and symptoms are seen in torsion of the spermatic cord?

A 
Sudden onset of pain - may refer to lower abdomen 
Nause/ vomiting 
testes high in scrotum 
Testes lie transversely 
Absence of cremasteric reflex
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13
Q

What is the blue dot sign?

A

Black necrotic appendix testes from torsion of the appedage/appendix testes

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14
Q

In terms of blood flow, how does it differ in torsion from epididymitis?

A

Absent blood flow in torsion

Increased blood flow in epididymitis

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15
Q

What is epididymitis?

A

Inflammation of the epididymis

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16
Q

What treatment is given for epididymitis?

A

Analgesia + scrotal support, bed rest

Ofloxacin 400mg/day for 14 days

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17
Q

How does idiopathc scrotal oedema present?

A 
No scortal erythema 
No fever 
Tenderness minimal 
May be pruritis 
Self-limiting
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18
Q

What is paraphimosis?

A

Painful swelling of the foreskin distal to a phimotic ring

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19
Q

How does paraphimosis occur?

A

Often happens after foreskin retracted for catheterization or cystoscopy and staff member forgets to replace it in its natural position

20
Q

What is a priapism?

A

Prolonged erection (> 4hrs), often painful and not associated with sexual arousal

21
Q

What are the 2 classifications of priaprism? Are they treated the same?

A

Ischaemia
Non-ischaemic
No

22
Q

What is Founier’s gangrene? Where does it most commonly occur?

A

A form of necrotizing fasciitis occurring about the male genitalia
Most commonly arises from skin, urethra or rectal region

23
Q

What can predispose a patient to Fournier’s gangrene?

A

Diabetes
local trauma
periurethral extravasation
perianal infection

24
Q

What symptoms are seen in Fournier’s gangrene?

A

Starts all cellulitis (swolle, erythematous, tender)
Marked pain, fever, systemic toxicity.
Swelling and crepitus of scrotum, dark purple areas

25
Q

What treatment is required for Fournier’s gangrene?

A

Broad spectrum antibiotics (usually a mix of anaerobes and aerobes) and surgical debridement

26
Q

What si emphysematous pylenephritis?

A

An acute necrotizing parenchymal and perirenal infection caused by gas-forming uropathogens, usually E coli

27
Q

In who does emphysematous pylenephritis occur and how does it present?

A 
Diabetics 
fever 
vomiting 
flank pain 
Often associated with ureteric obstruction
28
Q

What imaging technique is used to define the extent of the emphysematous process?

A

CT

29
Q

Treatment of emphysematous pyleonephritis?

A

Nephrectomy

30
Q

How does a perinephric abscess occur?

A

Usually results from rupture of an acute cortical abscess into the perinephric space or from haematogenous seeding from sites of infection

31
Q

What are the indications for imaging in someone presenting with renal or urological problems?

A
  • 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
32
Q

Bladder injury is commonly assciated with what?

A

Pelvic fractures

33
Q

How does bladder injury present?

A

Suprapubic/abdominal pain + inability to void
Suprapubic tenderness lower abdominal bruising guarding/rigidity
diminished bowel sounds

34
Q

What is the main imaging technique for bladder injury?

A

CT cystography

35
Q

How is a bladder injury treated?

A

Large-bore catheter
Antibiotics
Repeat cystogram in 14 days

36
Q

If there is blood at the external urethral meatus what might this indicate?

A

The urethra is damaged

37
Q

Posterior urethral injury is fte associated with what?

A

Fracture of pubic rami

38
Q

On examination what may be seen in a urethral injury?

A 
Blood at meatus
Inability to urinate
Palpably full bladder
“High-riding” prostate (won't feel it)
Butterfly perineal haematoma
39
Q

What treatment is used for a urethral injury?

A

Subrapubic catheter

Delayed reconstruction after at least 3 months

40
Q

What imaging modality is used when there is suspected urethral injury?

A

Retrograde urethrogram

41
Q

How does a penil fracture usually occur?

A

during intercourse – buckling injury when penis slips out of vagina and strikes pubis

42
Q

What clinical signs are seen when a penis fractures?

A

Cracking or popping sound followed by pain, rapid detumescence, discolouration and swelling

43
Q

What treatment is required for penile fracture?

A

Prompt exploration and repair

Circumcision incision with degloving of penis to expose all 3 compartments

44
Q

What term is used to describe how a penis looks when it has been fractured?

A

egg-plant deformity

45
Q

How does injury to the testicles present?

A

Exquisite pain and nausea

Swelling and bruising variable

46
Q

Imaging technique used for testicular injury?

A

US - to assess integrity/ vascularity

47
Q

What treatment is required for a testicular injury?

A

Early exploration/repair improves testis salvage, reduces convalescence, better preserves fertility and hormonal function

Renal (9 decks)

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