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Renal > Urological Emergencies > Flashcards

Urological Emergencies Flashcards

1
Q

how does acute urinary retention present?

A

inability to urinate with increasing pain

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2
Q

what common condition can cause acute urinary retention?

A

BPH

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3
Q

what can acute urinary retention be separated in to?

A

spontaneous and precipitated

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4
Q

when would acute urinary retention be precipitated?

A
  • non-prostate related surgery
  • catheterization
  • anaesthesia
  • medication with sympathomimetric or anticholinergeric effects
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5
Q

when should trial without catheter be used in acute urinary retention?

A

if painful retention with

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6
Q

what can be prescribed to improve chance of successful voiding before trial without catheter in acute urinary retention?

A

prescribing a uroselective alphablocker

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7
Q

examples of uroselective alpha-blocker?

A

Tamsulosin, alfuzosin

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8
Q

in what patients does post-obstructive diuresis often present in?

A

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

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9
Q

what is the diuresis due to in post-obstructive diuresis?

A

due to solute diuresis (retained urea, sodium and water) and defect in concentrating ability of kidney

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10
Q

in post-obstructive diuresis what should you make sure urine output doesnt exceed?

A

> 200 ml/hr

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11
Q

how long does post-obstructive diuresis take to resolve?

A

24-48 hours

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12
Q

what treatment may be required in post-obstructive diuresis in a severe case?

A

IV fluid and sodium replacement

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13
Q

most common cause for ureteric colic?

A

calculus

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14
Q

what mediates the pain in ureteric colic?

A

release of prostaglandins by ureter in response to obstruction

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15
Q

for a small stone, what is the treatment?

A

NSAIDS +/- opiate
alpha-blocker
stone expected to pass

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16
Q

what is the chance of a stone

A

80%

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17
Q

what is the chance of a stone 4-6mm spontaneously passing?

A

59%

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18
Q

what is the chance of a stone > 6mm spontaneously passing?

A

21%

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19
Q

intervention is likely required if a ureteric stone hasnt passed within what time length?

A

a month

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20
Q

what is the best diagnostic investigation when investigating renal calculus ?

A

non-contrast CT

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21
Q

what are the indications that a renal calculus needs to be treated urgently?

A
  • pain unrelieved
  • pyrexia
  • persistent nausea/vomitting
  • high-grade obstruction
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22
Q

how is a renal stone managed surgically in the absence of infection ?

A

ureteric stent or stone fragmentation/removal

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23
Q

how is a renal stone managed surgically if there is an infected hydronephrosis?

A

percutaneous nephrostomy for infected hydronephrosis

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24
Q

at what age is torsion of the spermatic cord most common?

A

at puberty

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25
Q

how does torsion of the spermatic cord present?

A

sudden onset of pain, may be nausea/vomitting, lower abdo pain

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26
Q

what can precipitate a torsion of the spermatic cord?

A

trauma or athletic activity

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27
Q

what will you find on examintion of the teste in a torsion of the spermatic cord?

A
  • testis high in scrotum
  • testis lying transversely
  • absence of cremasteric reflex
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28
Q

what is the managment of a torsion of the spermatic cord?

A

urgent surgical exploration.

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29
Q

what happens if a torsion of spermatic cord is not recognised/treated?

A

irreversible ischaemic injury begins as soon as 4hrs

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30
Q

how may a torsion of appendage present and appear on examintion?

A
  • symptoms variable - may be insidious onset or same as torsion of cord.
  • ma have localised tenderness at upper pole and blue dot sign
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31
Q

is the cremasteric reflex present in torsion of appendage?

A

yes

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32
Q

managment of torsion of appendage?

A

will resolve spontaneously without surgery

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33
Q

presentation of epididymitis?

A

similar to torsion. dysuria/pyrexia more common.

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34
Q

is the cremateric reflex present in epididymitis?

A

reflex present

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35
Q

what can been seen in a doppler of epididymitis?

A

swollen epididymis, increased bloodflow

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36
Q

what tests should be done in suspected epididymitis?

A

send urine for culture and chlamydia PCR

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37
Q

what can precipitate epididymitis?

A

history of UTI, urethritis, catheterization/instrumentation

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38
Q

conservative management of epididymitis?

A
  • analgesia, scrotal support, bed rest
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39
Q

medical managment of epididymitis?

A
  • ofloxacin 400mg/day for 14 days
40
Q

is idiopathic scrotal oedema usually associated with erythema?

A

no

41
Q

what would you expect on examination of idiopathic scrotal odema?

A

odema around scrotum, no eythema, no fever, minimal tenderness

42
Q

how is idiopathic scrotal oedema managed?

A

it is self-limiting

43
Q

what is paraphimosis?

A

painful swelling of the foreskin distal to a phimotic ring

44
Q

when does paraphimosis usually occur?

A

often happens after foreskin is retracted for catheterization or cystoscopy and staff member forgets to pull foreskin back into its natural position

45
Q

what is priapism?

A

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

46
Q

aetiology of priapism?

A
  • intracorporeal injection
  • trauma
  • haematologic dyscasias
  • neurological condition
  • idiopathic
47
Q

classifications of priapism?

A

ischaemic and non-ischaemic

48
Q

how does an ischaemic priapism occur?

A

veno-occlusion or low flow leading to vascular stasis

49
Q

how do corpora cavernosa feel?

A

rigid and tender

50
Q

how does a non-ischaemic priapism occur?

A

traumatic disruption of penile vasculature resulting in unregulated blood entry and filling of corpora

51
Q

in non-ischaemic priapism what allows blood to by-pass the normal helicine arteriolar bed?

A

fistula formation between the cavernous artery and lacunar spaces

52
Q

how is priapism diagnosed?

A

aspirate blood from corpus cavernosum

53
Q

what is the profile of the blood aspirated in an ischaemic priapism?

A

dark, low oxygen, high carbon dioxide

54
Q

what is the profile of the blood aspirated in a non-ischaemic priapism?

A

normal arterial blood

55
Q

treatment of ischaemic priapism?

A

aspiration +/- irrigation with saline. injection of alpha-antagonist 100-200 ug every 5-10 mins up to a max of 1000ug- if not resolved : surgical stunt

56
Q

how is ischaemic priapism treated?

A

observe, may resolve spontaneously. selective arterial embolization with non-permanent materials

57
Q

after how many hours of ischaemic priapism will it be unlikely to be helped by intracavernosal treatment?

A

more than 48-72 hours

58
Q

for delayed presentation of ischaemic priapism, what could be considered?

A

immediate placement of a penile prosthesis

59
Q

what is Fournier’s gangrene?

A

a form a necrotizing fasciitis occurring about the male genitalia.

60
Q

where does Fournier’s gangrene most commonly arise from in the male genitalia?

A

skin, urethra or rectal region

61
Q

what are the predisposing factors of Fourneir’s gangrene?

A
  • diabetes
  • local trauma
  • periurethral extravasation
  • perianal infection
62
Q

organisms causing Fourniers gangrene?

A

usually a mixture of aerobes and anaerobes

63
Q

what is the presentation of Fourniers gangrene?

A
  • start as cellulitis: swollen, erythematous, tender, pain, fever, systemic upset
64
Q

what can be seen on examination of Fourniers gangrene?

A

-swollen, eythematous, tender, marked pain, fever. crepitus of scrotum, dark purple areas.

65
Q

what investigations can be used to confirm gas in the tissues in Fournier’s gangrene?

A

plain x-ray and USS

66
Q

managment of Fournier’s gangrene?

A

surgical debridement and antibiotics

67
Q

what is emphysematous pyelonephritis?

A

an acute necrotizing parenchymal and perirenal infection

68
Q

what pathogen usually causes emphysematous pyelonephritis?

A

E.coli

69
Q

what disease is associated with emphysematous pyelonephritis?

A

diabetes

70
Q

what problem is associated with emphysematous pyelonephritis?

A

ureteric obstruction

71
Q

how does emphysematous pyelonephritis present?

A

fever, vomitting, flank pain

72
Q

what scan is used to define the extend of the emphysematous process in emphysematous pyelonephritis?

A

CT

73
Q

what is often required to treat emphysematous pyelonephritis?

A

nephrectomy

74
Q

what does a perinephric abscess usually result from?

A

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

75
Q

approx what percentage of patients with perinerphric absess are not pyrexial?

A

33%

76
Q

in what percent of patients with a perinephric abscess is there a flank mass?

A

in 50%

77
Q

what test results would be expected in peinephric abscess?

A

high WCC, high serum creatinine, pyuria

78
Q

management of perinephric abscess?

A

antibiotics and percutaneous or surgical drainage

79
Q

in renal trauma, what is a type I classification?

A
  • haematoma, subcapsular, non-expanding, no parenchymal laceration
80
Q

type II classification in renal trauma?

A

laceration

81
Q

type III classification in renal trauma?

A

> 1cm depth, no collecting system rupture or extravasation

82
Q

type IV classification in renal trauma?

A

laceration through cortex, medulla and collecting system. main arterial/venous injury with contained haemorrhage

83
Q

type V classification in renal trauma?

A

shattered kidney, avulsion of hilium, devascularized kidney

84
Q

what type of fracture is commonly associated with bladder injury?

A

pelvic fracture

85
Q

what is posterior urethral injury often associated with?

A

fracture of pubic rami

86
Q

what fixes the posterior urethra in place?

A

fixed at urogenital diaphragm and puboprostatic ligaments

87
Q

what part of the of the posterior urethra is most vulnerable to injury?

A

bulbomembranous junction

88
Q

what will you find on examination in urethral injury?

A
  • blood at meatus
  • inability to urinate
  • palpably full bladder
  • high riding prostate
  • butterfly perineal haematoma
89
Q

investigation for urethral injury?

A

retrograde urethrogram

90
Q

management of urethral injury?

A
  • suprapubic catheter

- delayed reconstruction after at least 3 months

91
Q

when does a penile fracture typically happen?

A

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

92
Q

what is experienced when a penile fracture occurs?

A

cracking or popping sound followed by pain, discolouration and swelling

93
Q

what is there a 20% incidence of in penile fractures?

A

urethral injury

94
Q

management of penile fracture?

A

prompt exploration and repair. circumcision incision with degloving of penis to expose all 3 compartments

95
Q

how does testicular injury usually present?

A

exquisite pain and nausea

96
Q

what investigation is done in testicular injury?

A

USS to assess integrity/vascularity

97
Q

managment of testicular injury?

A

early exploration/repair

Renal (10 decks)

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