Urological emergencies Flashcards
What can cause acute urinary retention?
Prostate infection
Bladder overdilation
In who is acute urinary retention common?
Men with BPH
What are the two types of acute urinary retention?
Spontaneous
Precipitated
What can precipitate acute urinary retention?
Catheterisation
Instrumentation
Anaesthesia
What clinical signs can be seen in acute urinary retention?
Full, palpable bladder
How is acute urinary retention solved?
If less than 1 litre then try alpha blocker.
If not, then catheterise.
What drugs can be given for calculi?
NSAIDs and opiate for pain
Alpha blocker to pass small stones
At what point will stones that have not been passed require investigation?
After 1 month
What imaging modality is used to view calculi?
CT
No contrast!
What presentation of calculi needs urgent treatment?
Pyrexia
Persistent n&v
High grade obstruction
What are some options of treating kidney stones?
Extracorporeal shock wave lithotripsy
Ureteric stent
If haematuria presents, what imaging would you use?
CT urogram with contrast
Cystoscopy
What can haematuria be a sign of?
Trauma Infection Stones Tumour BPH
What investigation is done for the acute scrotum?
Doppler USS
What is the blue dot sign?
Torsion of testicular appendage
What may be seen on examination of spermatic cord torsion?
Testis high in scrotum
Transverse lie
Absence of cremasteric reflex
What is the cremasteric reflex?
When inner thigh is lightly stroked the the testis should ascend due to contraction of cremaster muscles
How can testicular appendage torsion and spermatic cord torsion be differentiated?
Cremaster reflex present in appendage torsion
Testis are mobile
How is testicular appendage torsion fixed?
Will resolve spontaneously
What are the symptoms of epididymitis?
Pyrexia
Hydrocoele
What causes epidiymitis?
Chlamydia
UTI
On examination what is seen with epididymitis?
Cremaster reflex present
Doppler shows swollen epididymis
What investigations should be done for epididymitis?
Urine culture
Chlamydia PCR
What is the treatment for epididymitis?
Analgesia
Rest
Ofloxacin
What is paraphimosis?
Swelling of foreskin distal to the phimotic ring
When does paraphimosis occur?
When foreskin retracted and not replaced
What is the treatment for paraphimosis?
Iced glove
Granulated sugar
Manual replacement of foreskin
What is priapism?
Prolonged erection (>4hrs), not associated with sexual arousal
What might cause a priapism?
trauma
intracorporeal injection
sickle cell
How can priapism be classified?
Ischaemic
Non-ischaemic
What is ischaemic priapism?
Vascular stasis in penis and decreased venous outflow
What is non-ischaemic priapism?
Due to trauma to penile vascularisation
What is the treatment for non-ischaemic priapism?
May resolve spontaneously
What is the treatment for ischaemic priapism?
Aspiration
Injection of alpha-agonist
What is Fournier’s gangrene?
Necrotising fasciitis around male genitalia
What pre-disposes to Fournier’s gangrene?
Diabetes
Trauma
Perianal infection
What does Fournier’s gangrene look like?
Swollen, erythematous, tender, painful, systemic toxicity.
What investigations are needed for Fournier’s gangrene?
Plain X ray to confirm gas in tissues
What is the treatment for Fournier’s?
Abx
Surgical debridement
What is emphysematous pyelonephritis?
Necrotising infection of renal parenchyma by E Coli
In who does emphysematous pyelonephritis occur?
Diabetics
What symptoms may be present with emphysematous pyelonephritis?
Fever
Vomiting
Flank pain
Ureteric obstruction
What investigations are done for emphysematous pyelonephritis?
KUB shows gas
CT shows extent
What is the treatment for emphysematous pyelonephritis?
Nephrectomy
How many classifications of renal trauma are there?
5
If there is a laceration through the collecting system what classification of trauma is present?
4
If there is a laceration of less than 1cm what classification of renal trauma is present?
2
What symptoms point towards a bladder trauma?
Suprapubic pain
Inability to void
Guarding
Diminished bowel sounds
What investigation must be done if blood at external meatus?
Retrograde urethrogram
What is likely to happen with a pelvic fracture?
Bladder trauma
Urethral damage
What is a butterfly haematoma?
Blood spread to anus in a symmetrical pattern
Sign of urethral injury
What are the possible consequences of penile fracture?
ED
Permanent curvature
Pain during intercourse
