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Urological Emergencies Flashcards

1
Q

Acute urinary retention can be a complication of:

A

BPH

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2
Q

Symptoms of urinary retention

A

Inability to urinate with inreasing pain

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3
Q

Precipitating factors of urinary retention

A

Surgery, Catheter, anaesthesia, meds

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4
Q

Treatment for urinary retention

A

Catheter

Uroselective alpha blocker (Tamsulosin) before TWOC if

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5
Q

Complication of acute urinary retention

A

Post-obstructive diuresis (chronic outflow obstruction with uraemia, oedema, HT, diuresis and inability to concentrate urine)
Haematuria

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6
Q

Treatment for post-obstructive diuresis

A

Monitor fluid output, should be less than 200ml/hour

Severe cases: IV fluids, Na replacement

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7
Q

Treatment of ureteric colic

A

NSAID
Opiate
Alpha blocker (Tamsulosin) for small stones

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8
Q

When is intervention required for a stone?

A

If stone hasn’t passed in 1 month = Stent, stone fragmentation, nephrostomy for hydronephrosis

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9
Q

Indications for stone surgery

A

Pain unrelieved
Fever
N+V persistent
High grade obstruction

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10
Q

Investigations for frank haematuria

A

CT urogram

Cystoscopy

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11
Q

Symptoms of torsion of spermatic cord

A

Sudden onset pain, refers to lower abdo

N+V

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12
Q

On examination of spermatic cord torsion

A

Testis high in scrotum, absence of cremasteric reflex

Acute hydrocele may obliterate landmarks

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13
Q

Investigations for spermatic cord torsion

A

Doppler US

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14
Q

Treatment for spermatic cord torsion

A

Exploration
Remove testes if necrotic
Fix contralateral side

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15
Q

Symptoms and signs of appendix testes torsion

A

Local tenderness at upper pole, blue dot sign

Mobile testes, cremasteric reflex present

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16
Q

Treatment for appendix testes torsion

A

Self-limiting

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17
Q

Symptoms and signs of epididymitis

A

Dysuria, pyuria, history of UTI/urethritis/catheter

Cremasteric reflex present

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18
Q

Investigations for epididymitis

A

Doppler US - swollen, increased blood flow
Urine culture
Chlamydia PCR

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19
Q

Treatmetn for epididymitis

A

Analgesia
Scrotal support
Bed rest
Ofloxacin 14 days

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20
Q

Symptoms and signs of idiopathic scrotal oedema

A

No fever, tenderness minimal
Pruritis
Self-limiting

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21
Q

Paraphimosis

A

Retraction and swelling of foreskin

Often happens after catheterisation and foreskin not returned to normal position

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22
Q

Treatment for paraphimosis

A 
Iced glove
Granulated sugar for 1-2 hours
Punctures in oedematous skin
Compression of glans and traction of foreskin
Dorsal slit
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23
Q

Priapism

A

Prolonged erection >4 hours

Often painful, not associated with sexual arousal

24
Q

Causes of priapism

A

Trauma
Intracorporeal injection for ED
Neurological conditions
Idiopathic

25
Ischaemic priapism
Veno-occlusive or low flow Vascular stasis in penis and decreased venous outflow = compartment syndrome Corpus cavernosa rigid and tender
26
Non-ischaemic priapism
Arterial or high flow Unregulated blood entry and filling due to trauma Fistula
27
Investigations for priapism
Aspirate blood (dark = low o2/high co2 = low flow/ischaemic). (normal = high flow/non-ischaemic)
28
Treatment of ischaemic priapism
Aspiration, irrigation with saline, alpha agonist injection, surgical shunt >48-72 hours: unlikely to respond, prosthesis
29
Treatment of non-ishchaemic priapism
Observe - may resolve spontaneously | Arterial embolisation with non-permanent material
30
Fournier's gangrene
Form of necrotising fasciitis in male genitalia
31
Symptoms of fournier's gangrene
Starts as cellulitis: redness, swelling, pain, fever | Swelling and crepitus of scrotum, dark purple areas
32
Investigation of fournier's gangrene
Plain xray or US to confirm gas
33
Treatment of fourniers
Debridement | Antibiotics
34
Emphysematous pyelonephritis
Acute necrotising parenchymal and perirenal infection caused by gas forming pathogens, e.g. E. coli In diabetics or obstruction
35
Symptoms of emphysematous pyelonephritis
Fever, vomiting, flank pain
36
Investigations for emphysematous pyelonephritis
Xray (KUB), CT - show gas
37
Treatment of emphysematous pyelonephritis
Nephrectomy
38
Perinephric abscess
Usually results from rupture of acute cortical abscess into perinephric space OR haematogenous spread
39
Symptoms of perinephric abscess
Flank mass, may be fever | High WCC, pyuria, high serum creatinine
40
Investigations for perinephric abscess
CT
41
Treatment of perinephric abscess
Antibiotics | Percutaneous/surgical drainage
42
Types of renal trauma
I: haematoma II: 1cm laceration IV: laceration through cortex, medulla, collecting parts V: shattered kidney, avulsion of hilum
43
Indications for kidney imaging
Frank haematuria in adult Frank or ocult haematuria in child Occult haematuria and shock Penetrating injury with occult/frank haematuria
44
Investigations for renal trauma
CT with contrast
45
Treatmetn for renal trauma
Embolisation/angiography | Surgery
46
Bladder injury is commonly associated with:
pelvic fracture
47
Symptoms of bladder injury
Suprapubic/abdo pain, inability to void, lower abdo bruising, guarding, rigidity, diminished bowel sounds
48
Investigations for bladder injury
Retrograde urethrogram | CT cystography
49
Sign of extraperitoneal injury
Flame shaped collection of contrast in pelvis
50
Treatment of bladder injury
Large bore catheter, antibiotics, repeat cystogram 14 days | Immediate repair if intraperitoneal injury/#/penetrating injury
51
Posterior urethral injury assocatied with
Pubic ramus fracture
52
Signs of urethral injury
Blood at meatus, inability to urinate, palpable bladder, high riding prostate, butterfly perineal haematoma
53
Investigation of urethral injury
Retrograde urethrogram
54
Treatment for urethral injury
Suprapubic catheter | Delayed reconstruction after 3 months
55
Penile fracture
Happens during intercourse - buckling injury | Cracking/popping sound, pain, rapidly flacid, discolouration, swelling
56
Treatment of penile fracture
Exploration and repair | Circumcision incision, deglove penis to expose 3 compartments
57
Investigation for testicular injury
US

Renal (19 decks)

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