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SM Renal > Urological Emergencies > Flashcards

Urological Emergencies Flashcards

1
Q

What is acute urinary retention a complication of

A

BPH

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2
Q

What is acute urinary retention

A

Inability to urinate with increasing pain

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3
Q

What are some of the causes of acute urinary retention

A 
Prostate infection
bladder overdistension
excessive fluid intake 
alcohol
prostatic infarction
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4
Q

What is meant by precipitated urinary retention

A

Triggering event- non prostate related surgery, catheterisation or urethral instrumentation
anaesthesia
medication with sympathomimetic or anticholinergic effects

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5
Q

What is the treatment for a person in acute urinary retention

A

Prescribe a uroselective alpha blocker (Alfuzosin, Tamsulosin) before inserting a catheter

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6
Q

What patients may develop post-obstructive diuresis

A

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

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7
Q

How does ureteric colic arise

A

Pain mediated by prostaglandins released by ureter in response to obstruction

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8
Q

What are some indications to treat ureteric colic urgently

A

Pain unrelieved
Pyrexia
Persisitent nausea/ vomiting
High grade obstruction

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9
Q

What is the treatment for renal colic if urgent treatment is required

A

Ureteric stent or stone fragmentation/ removal if no infection
Percutaneous nephrostomy for infected hydronephrosis

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10
Q

What can cause frank haematuria

A 
Infection
stones 
tumours 
BPH
Polycystic kidneys 
trauma
coagulation / platelet deficiencies
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11
Q

What investigations should be carried out for frank haematuria

A

CT urogram and cystoscopy

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12
Q

What should be used for clot retention

A

A 3 way irrigating haematuria catheter

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13
Q

What are some causes of acute scrotum issues

A 
Torsion of speramtic cord
Torsion of appendix testis 
Epididymitis / epidiymo-orchitis 
Inguinal hernia 
Hydroceoele 
Trauma / insect bite 
Dermatological lesions 
Inflammatory vasculitis 
Tumour
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14
Q

What age are most patients who present with torsion of the spermatic cord

A

Mostly in puberty

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15
Q

What are some causes of torsion of the spermatic cord

A

Trauma

Athletic activity but usually spontaneous

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16
Q

What are some signs and symptoms of torsion of the spermatic cord

A

Sudden onset of pain
May be nausea/ vomiting
referred pain to lower abdomen

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17
Q

What are some findings on examination of a patient with spermatic cord

A

Absence of the cremasteric reflex
transverse lie
testis high in scrotum

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18
Q

What investigation is sometimes useful for torsion of the spermatic cord

A

Doppler USS

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19
Q

What is the treatment for testicular torsion

A

Irreversible ischaemic injury may occur as soon as 4 hours therefore we need to act FAST.
2 or 3 point fixation with fine non-absorbable sutures
if testis is necrotic - must be removed
MUST fix contralateral side (bell clapper deformity)

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20
Q

What might be seen if caught early in a torsion of appendage

A

Blue dot sign

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21
Q

What reflex should be present in an appendage torsion

A

Cremasteric reflex

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22
Q

What is the treatment for torsion of appendage

A

Nothing - will resolve spontaneously

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23
Q

What is epididymitis sometimes difficult to distinguish from

A

Torsion

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24
Q

What is more commonly seen in epididymitis

A

Dysuria / pyrexia

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25
Q

What are the findings of an examination in a patient with epididymitis

A

Cremasteric reflex present

Swollen epididymis and increased blood flow on doppler

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26
Q

What is the treatment for epididymitis

A

Analgesia and scrotal support, bed rest

Ofloxacin 400mg/day for 14 days

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27
Q

What are some of the signs and symptoms of idiopathic scrotal oedema

A

Self limiting - unknown cause - not usually associated with scortal erythema
no fever
tenderness minimal
may be pruritus

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28
Q

What are some of the signs Paraphimosis

A

Painful swelling of the foreskin distal to a phimotic ring

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29
Q

What are some of the causes of paraphimosis

A

Retraction of foreskin for catheterisation or cystoscopy and staff forget to replace it in its natural position

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30
Q

What is the treatment for paraphimosis

A

Iced glove, granulated surfer for 1-2 hours
multiple punctures in oedematous skin
manual compression of glans with distal traction on oedematous foreskin
Dorsal slit

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31
Q

What is Priapism

A

Prolonged erection >4hours

Often painful and not associated with sexual arousal

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32
Q

What is the aetiology of priapism

A 
Intracorporeal injection for ED 
Trauma (penile / perinea)
Haematologic dyscrasias e.g. sickle cell
Neurological conditions 
Idiopathic
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33
Q

What can cause true compartment syndrome of the penis

A

Vascular stasis in penis and decreased venous outflow

34
Q

What is meant by ischaemic priapism

A

Veno-occlusive or low-flow priapism

35
Q

What is meant by non-ischaemic priapism

A

Arterial or high flow priapism

36
Q

What might traumatic disruption of penile vasculature result in

A

unregulated blood entry and filling of corpora

37
Q

What might be seen on a colour duplex USS in 1 low flow and 2 high flow priapism

A

Minimal or absent flow in cavernosal arteries in low-flow

Normal to high flow in non-ischaemic priapism

38
Q

Describe the appearance of aspirated blood from the corpus cavernosium in low flow priapism

A

Dark blood, low O2 and high CO2

39
Q

Describe the appearance of aspirated blood from the corpus cavernosium in high flow priapism

A

Normal arterial blood in high flow

40
Q

What is the treatment for ischaemic priapism with early presentation

A

Aspiration +/- irrigation with saline
Injection of alpha-agonist e.g. phenylephrine 100-200g every 5-10 mins up to a max of 1000g
Surgical Shunt

41
Q

What is the treatment for ischaemic priapism after 48-72 hours (late presentation)

A

It is unlikely to respond to intracavernosal treatment

Consider immediate placement of a penile prosthesis for very delayed presentation

42
Q

What is the treatment for non-ischaemic priapism

A

Observe - may resolve spontaneously

Selective arterial embolisation with non-permanent materials

43
Q

What is Fournier’s gangrene

A

A form of necrotising fasciitis occurring about the male genitalia

44
Q

Where does Fournier’s gangrene most commonly arise

A

From skin, urethra or rectal region

45
Q

What are predisposing factors to Fournier’s gangrene

A

Diabetes
local trauma
periurethral extravasation
perianal infection

46
Q

What causes Fournier’s gangrene

A

A mixture of aerobes / anaerobes

47
Q

Describe the onset of Fournier’s gangrene

A

Starts as cellulitis - swollen erythematous, tender
Marked pain, fever, systemic toxicity
Swelling and crepitus of scrotum, dark purple areas
Often marked toxicity out of proportion to the local findings

48
Q

What investigation may confirm las in tissues

A

Plain X-Ray or USS

49
Q

What is the treatment for Fournier’s gangrene

A

Antibiotics and surgical debridement

50
Q

What is the prognosis for Fournier’s gangrene

A

Mortality 20% but higher in diabetics and alcoholics

51
Q

What is Emphysematous pyelonephritis

A

An acute necrotising parenchymal and peritoneal infection caused by gas-forming uropathogens, usually Ecoli

52
Q

What patients are most likely to develop Emphysematous pyelonephritis

A

Diabetics

53
Q

What is Emphysematous pyelonephritis associated with

A

ureteric obstruction

54
Q

What ares one of the symptoms of Emphysematous pyelonephritis

A

fever, vomiting, flank pain

55
Q

What investigation is most useful in Emphysematous pyelonephritis and what does it tell us

A

CT

Defines extent of emphysematous process

56
Q

What is often the treatment for Emphysematous pyelonephritis

A

Nephrectomy

57
Q

What does a perinephric abscess usually result from

A

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

58
Q

What would the blood results show in a patient with a perinephric abscess

A

High WCC
High serum creatinine
pyuria

59
Q

What is the treatment for perinephric abscess

A

Antibiotics and percutaneous or surgical drainage

60
Q

How can we classify renal trauma

A

1: Hameatoma, subcapsular, non-expanding, no parenchymal laceration
2: Laceration 1cm depth, no collecting system rupture or extravasation
4: Laceration through cortex, medulla and collecting system. Main arterial / venous injury with contained haemorrhage
5: Shattered kidney. Avulsion of hilum, devascularising kidney

61
Q

What are some of the indications of imaging

A

Frank haematuria in an adult
Frank or occult haematuria in child
Occult haematuira + shock
Penetrating injury with any degree of haematuria

62
Q

What is the investigation of choice

A

CT with contrast

63
Q

What is the treatment for blunt trauma kidney injuries

A

98% can be managed non-operatively

Angiography / embolisation

64
Q

When is surgery required for kidney injuries

A 
Persistent renal bleeding, expanding perirenal haematoma
Pulsatile perirenal haematoma 
Urinary extravasation 
non-viable tissue 
incomplete staging (can do on table IVU)
65
Q

What is a bladder injury commonly associate with

A

Pelvic fracture

66
Q

What are some of the signs and symptoms of a bladder injury

A 
Suprapubic / abdominal pain + inability to void 
Suprapubic tenderness
lower abdominal bruising 
guarding/rigidity 
diminished bowel sounds
67
Q

What should be performed if a catheter does not easily pass or if there is blood at the external meatus

A

A retrograde urethrogram as they may well have a urethral injury

68
Q

What is the best imaging technique for a bladder injury

A

CT cystography

69
Q

What is the treatment for a bladder injury

A

Large-bore catheter
Antibiotics
Repeat cystogram in 14 days

70
Q

What are some indications for an immediate repair of a bladder injury

A 
Intraperitoneal injury 
penetrating injury 
Inadequate drainage or clots in urine 
Bladder neck injury 
Rectal or vaginal injury 
Open pelvic fracture 
Pelvic fracture requiring open reduction/ fixation
Patients undergoing laparotomy for other reasons 
Bone fragments projecting into bladder
71
Q

What is a urethral injury often associated with

A

fracture of the pubic rami

72
Q

What are some of the findings on examination of a urethral injury

A 
Blood at meatus 
Inability to urinate 
Palpably full bladder 
High -riding prostate 
Butterfly perineal haematoma
73
Q

What investigation is best for a urethral injury

A

Retrograde urethrogram

74
Q

What is the treatment for a urethral injury

A

Suprapubic catheter

Delayed reconstruction after at least 3 months

75
Q

How does a penile fracture usually arise

A

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

76
Q

What is the normal presenting complaint of a patient with a penile fracture

A

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

77
Q

What is the treatment for a penile fracture

A

Prompt exploration and repair

Circumcision incision with degloving of penis to expose all 3 compartments

78
Q

How do testicular injuries usually present

A

Exquisite pain and nausea

swelling / bruising variable

79
Q

What is the investigation of choice for a testicular injury

A

USS to assess integrity / vascularity

80
Q

What is the treatment for a testicular injury

A

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

SM Renal (23 decks)

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