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Renal and urology > Urological emergencies > Flashcards

Urological emergencies Flashcards

1
Q

How does acute urinary retention present?

A

Inability to urinate

Increasing pain

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2
Q

What condition is acute urinary retention a complication of?

A

Benign prostatic hyperplasia

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3
Q

What is the treatment for acute urinary retention?

A

Catheter

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4
Q

What are the indications for trial without catheter following catheterisation to treat acute urinary retention?

A

>1 litre residue

Normal serum electrolytes

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5
Q

What drug may be prescribed to try and improve success of trial without catheter following catherisation for acute urinary retention?

A

Alpha blocker - relaxes smooth muscle in the bladder wall

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6
Q

Why might haematuria occur following acute urinary retention?

A

Decompression of bladder may cause some bleeding

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7
Q

When is post-obstructive diuresis usually present?

A

In patients with chronic bladder outflow obstruction in association with uraemia, oedema, CCF, hypertension

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8
Q

What causes post-obstructive diuresis?

A

Solute diuresis (retained urea, sodium and water) and defect in concentrating ability of kidney

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9
Q

How should post-obstructive diuresis be managed?

A

Monitor fluid balance and beware if urine output > 200ml/hr

Usually resolves in 24-48hr but in severe cases may require IV fluid and sodium replacement

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10
Q

What differential for acute loin pain outwith the urinary tract should always be remembered?

A

AAA

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11
Q

What is the gold-standard investigation for looking at kidney stones?

A

Non-contrast CT

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12
Q

What causes the pain in ureteric obstruction by a renal stone?

A

Prostaglandin release in response to obstruction

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13
Q

What is the treatment for small kidney stones?

A

NSAIDs

Opiate

Alpha blocker (if expected to pass spontaneously)

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14
Q

What signs would indicate urgent treatment for renal calculi required?

A

Pain unrelieved

Pyrexia

Persistent nausea/vomiting

High-grade obstruction

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15
Q

What is the treatment for significant renal calculi?

A

Ureteric stent or stone fragmentation/removal if no infection

   Percutaneous nephrostomy for infected hydronephrosis: drain infected urine first, deal with stone later
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16
Q

What are the causes of frank haematuria?

A

Infection

Stones

Tumours

Benign prostatic hyperplasia (BPH)

Polycystic kidneys

Trauma

Coagulation/platelet deficiencies

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17
Q

What is the most common cause of haematuria?

A

Infection

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18
Q

What treatment should be used if a patient is passing clots followed by an inability to urinate?

A

3-way irrigating haematuria catheter to perform bladder washout and remove clots

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19
Q

When is torsion of spermatic cord most common?

A

Puberty

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20
Q

How does testicular torsion present?

A

Sudden onset pain

May be predisposed by previous episodes of self-limiting pain

May be nauseous

Referred pain to abdomen

Usually spontaneous, but can be brought on by trauma or sports

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21
Q

What is the treatment for testicular torsion?

A

2 or 3-point fixation with fine non-absorbable sutures

If testis necrotic then remove

MUST fix contralateral side (bell clapper deformity)

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22
Q

What imaging is used to investigate testicular torsion?

A

Doppler ultrasound

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23
Q

What signs on examination indicate testicular torsion?

A

Testis high in scrotum

Transverse lie

Absence of cremasteric reflex

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24
Q

Which testicular pathology is indicated by a ‘blue dot’ sign?

A

Testicular appendage torsion

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25
Q

What is epididymitis?

A

Inflammation of the epididymis at the back of the testicle

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26
Q

What symptoms are more likely to be present in epididymitis that would distinguish it from testicular torsion?

A

Dysuria

Fever

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27
Q

What may be in the history of a patient presenting with epididymitis?

A

UTI

Urethritis

Catheterization/instrumentation

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28
Q

What would be seen on examination and imaging with epididymitis?

A

Cremasteric reflex present

Pyuria

Doppler – swollen epididymis, increased bloodflow

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29
Q

What investigations should be sent off with epididymitis?

A

Urine for culture

PCR for chlamydia

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30
Q

What is the treatment for epididymitis?

A

Analgesia and scrotal support

Bed rest

Ofloxacin 400mg/day for 14 days

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31
Q

What is paraphimosis?

A

Painful swelling of the foreskin distal to a phimotic ring

32
Q

How does paraphimosis often occur?

A

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

33
Q

What is the treatment for paraphimosis?

A

Iced glove, granulated sugar for 1-2hrs, multiple punctures in oedematous skin

Manual compression of glans with distal traction on oedematous foreskin

Dorsal slit

34
Q

What is the diagnosis here?

A

Paraphimosis

35
Q

What is priapism?

A

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

36
Q

How can priapism be classed?

A

Ischaemic

Non-ischaemic

37
Q

What is the cause of ischaemic priapism?

A

Vascular stasis in penis and decreased venous outflow, a true compartment syndrome

38
Q

What signs on examination would indicate an ischaemic priapism?

A

Corpora cavernosa are rigid and tender, penis often painful

39
Q

What is the pathology in non-ischaemic priapism?

A

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

40
Q

How can priapism be diagnosed?

A

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
41
Q

How is non-ischaemic priapism treated?

A

Observe, may resolve spontaneously

Selective arterial embolization with non-permanent materials

42
Q

What is Fournier’s gangrene?

A

A form of necrotizing fasciitis occurring about the male genitalia

Most commonly arises from skin, urethra or rectal region

43
Q

What are some predisposing factors to Fournier’s gangrene?

A

Diabetes

Local trauma

Periurethral extravasation

Perianal infection

44
Q

How does Fournier’s gangrene present?

A

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

45
Q

What increases mortality in Fournier’s?

A

Mortality 20% increased in alcoholics and diabetics

46
Q

What is the treatment for Fournier’s?

A

Antibiotics and surgical debridement

47
Q

What is emphysematous pyelonephritis?

A

An acute necrotizing parenchymal and perirenal infection caused by gas-forming uropathogens

48
Q

What is the most common causative organism in emphysematous pyelonephritis?

A

E. Coli

49
Q

In which patients does emphysematous pyelonephritis usually occur?

A

Diabetic patients

Associated with ureteric obstruction

50
Q

How does emphysematous pyelonephritis present?

A

Fever

Vomiting

Flank pain

51
Q

What signs on imaging would indicate emphysematous pyelonephritis?

A

Gas on Xray

CT to see extent of emphysematous process

52
Q

How is emphysematous pyelonephritis usually treated?

A

Nephrectomy

53
Q

How does a perinephric abscess occur?

A

From rupture of an acute cortical abscess into the perinephric space

From haematogenous seeding from sites of infection

54
Q

How does perinephric abscess present?

A

Insidious onset, approx 33% not pyrexial

Flank mass in 50%

Pyruria

55
Q

What blood tests are raised in perinephric abscess?

A

White cell count

Serum createnine

56
Q

What imaging is used in perinephric abscess?

A

CT

57
Q

What is the treatment for perinephric abscess?

A

Antibiotics and percutaneous or surgical drainage

58
Q

What is class 1 renal trauma?

A

Haematoma:

Subcapsular

Non-expanding

No parenchymal laceration

59
Q

What is class 2 renal trauma?

A

Laceration <1cm parenchymal depth without urinary extravasation

60
Q

What is class 3 renal trauma?

A

>1cm depth, no collecting system rupture or extravasation

61
Q

What is class 4 renal trauma?

A

Laceration through cortex, medulla and collecting system

Main arterial/venous injury with contained haemorrhage

62
Q

What is class 5 renal trauma?

A

Shattered kidney

Avulsion of hilum, devascularizing kidney

63
Q

What are the indications for renal imaging following trauma?

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

64
Q

What imaging is used to view the kidneys following trauma?

A

Contrast CT

65
Q

What fracture is bladder injury commonly associated with?

A

Pelvic fracture

66
Q

How does bladder injury present?

A

Suprapubic/abdominal pain

Inability to void

Suprapubic tenderness

Lower abdominal bruising

Guarding/rigidity

Diminished bowel sounds

67
Q

What sign on imaging indicates extraperitoneal injury?

A

Flame-shaped collection of contrast in pelvis

68
Q

What would indicate urethral injury?

A

Blood at external urethral meatus

Catheter doesn’t pass easily

69
Q

What is the treatment for extraperitoneal injury?

A

Large-bore catheter

Antibiotics

Repeat cystogram in 14 days

70
Q

What fracture is a posterior urethral injury associated with?

A

Fracture of pubic rami

71
Q

What would indicate a posterior urethral injury on examination?

A

Blood at meatus

Inability to urinate

Palpably full bladder

“High-riding” prostate

Butterfly perineal haematoma

72
Q

What imaging is used to investigate posterior urethral injury?

A

Retrograde urethrogram

73
Q

What is the treatment for posterior urethral injury?

A

Suprapubic catheter

Delayed reconstruction after at least 3 months

74
Q

How does testicular injury present?

A

Exquisite pain

Nausea

Swelling / bruising variable

75
Q

What imaging is used to investigate testicular injury?

A

Ultrasound to assess integrity/vascularity

76
Q

What is the treatment for testicular injury?

A

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

Renal and urology (11 decks)

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