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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
What are the findings of an examination in a patient with epididymitis
Cremasteric reflex present | Swollen epididymis and increased blood flow on doppler
26
What is the treatment for epididymitis
Analgesia and scrotal support, bed rest | Ofloxacin 400mg/day for 14 days
27
What are some of the signs and symptoms of idiopathic scrotal oedema
Self limiting - unknown cause - not usually associated with scortal erythema no fever tenderness minimal may be pruritus
28
What are some of the signs Paraphimosis
Painful swelling of the foreskin distal to a phimotic ring
29
What are some of the causes of paraphimosis
Retraction of foreskin for catheterisation or cystoscopy and staff forget to replace it in its natural position
30
What is the treatment for paraphimosis
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
31
What is Priapism
Prolonged erection >4hours | Often painful and not associated with sexual arousal
32
What is the aetiology of priapism
``` Intracorporeal injection for ED Trauma (penile / perinea) Haematologic dyscrasias e.g. sickle cell Neurological conditions Idiopathic ```
33
What can cause true compartment syndrome of the penis
Vascular stasis in penis and decreased venous outflow
34
What is meant by ischaemic priapism
Veno-occlusive or low-flow priapism
35
What is meant by non-ischaemic priapism
Arterial or high flow priapism
36
What might traumatic disruption of penile vasculature result in
unregulated blood entry and filling of corpora
37
What might be seen on a colour duplex USS in 1 low flow and 2 high flow priapism
Minimal or absent flow in cavernosal arteries in low-flow | Normal to high flow in non-ischaemic priapism
38
Describe the appearance of aspirated blood from the corpus cavernosium in low flow priapism
Dark blood, low O2 and high CO2
39
Describe the appearance of aspirated blood from the corpus cavernosium in high flow priapism
Normal arterial blood in high flow
40
What is the treatment for ischaemic priapism with early presentation
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
What is the treatment for ischaemic priapism after 48-72 hours (late presentation)
It is unlikely to respond to intracavernosal treatment | Consider immediate placement of a penile prosthesis for very delayed presentation
42
What is the treatment for non-ischaemic priapism
Observe - may resolve spontaneously | Selective arterial embolisation with non-permanent materials
43
What is Fournier's gangrene
A form of necrotising fasciitis occurring about the male genitalia
44
Where does Fournier's gangrene most commonly arise
From skin, urethra or rectal region
45
What are predisposing factors to Fournier's gangrene
Diabetes local trauma periurethral extravasation perianal infection
46
What causes Fournier's gangrene
A mixture of aerobes / anaerobes
47
Describe the onset of Fournier's gangrene
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
What investigation may confirm las in tissues
Plain X-Ray or USS
49
What is the treatment for Fournier's gangrene
Antibiotics and surgical debridement
50
What is the prognosis for Fournier's gangrene
Mortality 20% but higher in diabetics and alcoholics
51
What is Emphysematous pyelonephritis
An acute necrotising parenchymal and peritoneal infection caused by gas-forming uropathogens, usually Ecoli
52
What patients are most likely to develop Emphysematous pyelonephritis
Diabetics
53
What is Emphysematous pyelonephritis associated with
ureteric obstruction
54
What ares one of the symptoms of Emphysematous pyelonephritis
fever, vomiting, flank pain
55
What investigation is most useful in Emphysematous pyelonephritis and what does it tell us
CT | Defines extent of emphysematous process
56
What is often the treatment for Emphysematous pyelonephritis
Nephrectomy
57
What does a perinephric abscess usually result from
rupture of an acute cortical abscess into the perinephric space or from haematogenous seeding from sites of infection
58
What would the blood results show in a patient with a perinephric abscess
High WCC High serum creatinine pyuria
59
What is the treatment for perinephric abscess
Antibiotics and percutaneous or surgical drainage
60
How can we classify renal trauma
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
What are some of the indications of imaging
Frank haematuria in an adult Frank or occult haematuria in child Occult haematuira + shock Penetrating injury with any degree of haematuria
62
What is the investigation of choice
CT with contrast
63
What is the treatment for blunt trauma kidney injuries
98% can be managed non-operatively | Angiography / embolisation
64
When is surgery required for kidney injuries
``` Persistent renal bleeding, expanding perirenal haematoma Pulsatile perirenal haematoma Urinary extravasation non-viable tissue incomplete staging (can do on table IVU) ```
65
What is a bladder injury commonly associate with
Pelvic fracture
66
What are some of the signs and symptoms of a bladder injury
``` Suprapubic / abdominal pain + inability to void Suprapubic tenderness lower abdominal bruising guarding/rigidity diminished bowel sounds ```
67
What should be performed if a catheter does not easily pass or if there is blood at the external meatus
A retrograde urethrogram as they may well have a urethral injury
68
What is the best imaging technique for a bladder injury
CT cystography
69
What is the treatment for a bladder injury
Large-bore catheter Antibiotics Repeat cystogram in 14 days
70
What are some indications for an immediate repair of a bladder injury
``` 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
What is a urethral injury often associated with
fracture of the pubic rami
72
What are some of the findings on examination of a urethral injury
``` Blood at meatus Inability to urinate Palpably full bladder High -riding prostate Butterfly perineal haematoma ```
73
What investigation is best for a urethral injury
Retrograde urethrogram
74
What is the treatment for a urethral injury
Suprapubic catheter | Delayed reconstruction after at least 3 months
75
How does a penile fracture usually arise
Typically during intercourse - buckling injury when penis slips out of vagina and strikes pubis
76
What is the normal presenting complaint of a patient with a penile fracture
Cracking or popping sound followed by pain, rapid detumescence, discolouration and swelling
77
What is the treatment for a penile fracture
Prompt exploration and repair | Circumcision incision with degloving of penis to expose all 3 compartments
78
How do testicular injuries usually present
Exquisite pain and nausea | swelling / bruising variable
79
What is the investigation of choice for a testicular injury
USS to assess integrity / vascularity
80
What is the treatment for a testicular injury
Early exploration / repair improves testis salvage, reduces convalescence, better preserves fertility and hormonal function

SM Renal (23 decks)

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