Urological Emergencies Flashcards
Complication of BPH
Inability to urinate with increasing pain
Acute urinary retention
What could cause acute urinary retention?
Surgery Catheterisation Urethral instrumentation Anaesthesia Medication
Treatment for acute urinary retention
Catheter
If painful retention with
Management of post-obstructive diuresis
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
Treatment for acute loin pain (e.g. caused by calculus)
NSAID +/- opiate
Alpha-blocker (Tamsulosin)
Indications to treat urgently:
- pain unrelieved
- pyrexia
- persistent nausea/vomitting
- high grade obstruction
If this is the case then ureteric stent or stone fragmentation/removal if no infection
-PERCUTANEOUS NEPHROSTOMY for infected hydronephrosis
Treatment for clot
3-way irrigating haematuria catheter
Investigations for frank haematuria
CT urogram and cystoscopy
Usually sudden onset of pain, sometimes previous episodes of self-limiting pain
May be nausea/vomiting
May be referral of pain to lower abdomen
Torsion of spermatic cord
-testis high in scrotum
transverse lie (lying -transversely instead of up and down)
-absence of cremasteric reflex
Torsion of spermatic cord
Absence of which reflex in torsion of spermatic cord?
Absence of cremasteric reflex
Blue dot sign
Torsion of appendage
Symtpoms of torsion of appendage
Symptoms variable –> may be identical to torsion of cord or insidious onset
May have tenderness at upper pole and “blue dot sign”
Testis should be mobile and CREMASTERIC reflex present
Epididymitis
Rare in children
May be difficult to distinguish from torsion
Dysuria / pyrexia more common
Hx of UTI, urethritis, catheterization/instrumentation
What should you suspect if pyuria and presentation similar to torsion
Epididymitis
Cremasteric reflex present
Suspect if pyuria
Doppler – swollen epididymis, increased bloodflow
Send urine for culture + Chlamydia PCR
Epididymitis
What would doppler show in epididymitis?
Swollen spididymis and increased blood flow
What investigations should you ask for if epididymis suspected?
Urine for culture and CHLAMYDIA PCR
Treatment for epididymitis
Ofloxacin 400mg/day for 14 days
Idiopathic scrotal oedema
Self-limiting, unknown cause, not usually associated with scrotal erythema
No fever, tenderness minimal but may be pruritis
Often happens after foreskin retracted for catheterization or cystoscopy and staff member forgets to replace it in its natural position
Paraphimosis
Painful swelling of the foreskin distal to phimotic ring
Paraphimosis
Treatment for 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
Priapsim
Prolonged erection (>4 hrs) often painful and not associated with sexual arousal
Classification of priapism
Ischaemic (low flow)
Non-ischaemic (high flow)
Differentiate by aspirating 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
