Urological Emergencies Flashcards
Acute urinary retention can be a complication of:
BPH
Symptoms of urinary retention
Inability to urinate with inreasing pain
Precipitating factors of urinary retention
Surgery, Catheter, anaesthesia, meds
Treatment for urinary retention
Catheter
Uroselective alpha blocker (Tamsulosin) before TWOC if
Complication of acute urinary retention
Post-obstructive diuresis (chronic outflow obstruction with uraemia, oedema, HT, diuresis and inability to concentrate urine)
Haematuria
Treatment for post-obstructive diuresis
Monitor fluid output, should be less than 200ml/hour
Severe cases: IV fluids, Na replacement
Treatment of ureteric colic
NSAID
Opiate
Alpha blocker (Tamsulosin) for small stones
When is intervention required for a stone?
If stone hasn’t passed in 1 month = Stent, stone fragmentation, nephrostomy for hydronephrosis
Indications for stone surgery
Pain unrelieved
Fever
N+V persistent
High grade obstruction
Investigations for frank haematuria
CT urogram
Cystoscopy
Symptoms of torsion of spermatic cord
Sudden onset pain, refers to lower abdo
N+V
On examination of spermatic cord torsion
Testis high in scrotum, absence of cremasteric reflex
Acute hydrocele may obliterate landmarks
Investigations for spermatic cord torsion
Doppler US
Treatment for spermatic cord torsion
Exploration
Remove testes if necrotic
Fix contralateral side
Symptoms and signs of appendix testes torsion
Local tenderness at upper pole, blue dot sign
Mobile testes, cremasteric reflex present
Treatment for appendix testes torsion
Self-limiting
Symptoms and signs of epididymitis
Dysuria, pyuria, history of UTI/urethritis/catheter
Cremasteric reflex present
Investigations for epididymitis
Doppler US - swollen, increased blood flow
Urine culture
Chlamydia PCR
Treatmetn for epididymitis
Analgesia
Scrotal support
Bed rest
Ofloxacin 14 days
Symptoms and signs of idiopathic scrotal oedema
No fever, tenderness minimal
Pruritis
Self-limiting
Paraphimosis
Retraction and swelling of foreskin
Often happens after catheterisation and foreskin not returned to normal position
Treatment for paraphimosis
Iced glove Granulated sugar for 1-2 hours Punctures in oedematous skin Compression of glans and traction of foreskin Dorsal slit
Priapism
Prolonged erection >4 hours
Often painful, not associated with sexual arousal
Causes of priapism
Trauma
Intracorporeal injection for ED
Neurological conditions
Idiopathic
Ischaemic priapism
Veno-occlusive or low flow
Vascular stasis in penis and decreased venous outflow = compartment syndrome
Corpus cavernosa rigid and tender
Non-ischaemic priapism
Arterial or high flow
Unregulated blood entry and filling due to trauma
Fistula
Investigations for priapism
Aspirate blood (dark = low o2/high co2 = low flow/ischaemic). (normal = high flow/non-ischaemic)
Treatment of ischaemic priapism
Aspiration, irrigation with saline, alpha agonist injection, surgical shunt
>48-72 hours: unlikely to respond, prosthesis
Treatment of non-ishchaemic priapism
Observe - may resolve spontaneously
Arterial embolisation with non-permanent material
Fournier’s gangrene
Form of necrotising fasciitis in male genitalia
Symptoms of fournier’s gangrene
Starts as cellulitis: redness, swelling, pain, fever
Swelling and crepitus of scrotum, dark purple areas
Investigation of fournier’s gangrene
Plain xray or US to confirm gas
Treatment of fourniers
Debridement
Antibiotics
Emphysematous pyelonephritis
Acute necrotising parenchymal and perirenal infection caused by gas forming pathogens, e.g. E. coli
In diabetics or obstruction
Symptoms of emphysematous pyelonephritis
Fever, vomiting, flank pain
Investigations for emphysematous pyelonephritis
Xray (KUB), CT - show gas
Treatment of emphysematous pyelonephritis
Nephrectomy
Perinephric abscess
Usually results from rupture of acute cortical abscess into perinephric space OR haematogenous spread
Symptoms of perinephric abscess
Flank mass, may be fever
High WCC, pyuria, high serum creatinine
Investigations for perinephric abscess
CT
Treatment of perinephric abscess
Antibiotics
Percutaneous/surgical drainage
Types of renal trauma
I: haematoma
II: 1cm laceration
IV: laceration through cortex, medulla, collecting parts
V: shattered kidney, avulsion of hilum
Indications for kidney imaging
Frank haematuria in adult
Frank or ocult haematuria in child
Occult haematuria and shock
Penetrating injury with occult/frank haematuria
Investigations for renal trauma
CT with contrast
Treatmetn for renal trauma
Embolisation/angiography
Surgery
Bladder injury is commonly associated with:
pelvic fracture
Symptoms of bladder injury
Suprapubic/abdo pain, inability to void, lower abdo bruising, guarding, rigidity, diminished bowel sounds
Investigations for bladder injury
Retrograde urethrogram
CT cystography
Sign of extraperitoneal injury
Flame shaped collection of contrast in pelvis
Treatment of bladder injury
Large bore catheter, antibiotics, repeat cystogram 14 days
Immediate repair if intraperitoneal injury/#/penetrating injury
Posterior urethral injury assocatied with
Pubic ramus fracture
Signs of urethral injury
Blood at meatus, inability to urinate, palpable bladder, high riding prostate, butterfly perineal haematoma
Investigation of urethral injury
Retrograde urethrogram
Treatment for urethral injury
Suprapubic catheter
Delayed reconstruction after 3 months
Penile fracture
Happens during intercourse - buckling injury
Cracking/popping sound, pain, rapidly flacid, discolouration, swelling
Treatment of penile fracture
Exploration and repair
Circumcision incision, deglove penis to expose 3 compartments
Investigation for testicular injury
US
