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UROLOGY > UROLOGICAL EMERGENCIES > Flashcards

UROLOGICAL EMERGENCIES Flashcards

1
Q

What are the main urological emergencies?

A

Acute urinary retention

Renal colic

Testicular torsion

Paraphimosis

Priapism

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2
Q

Who is normally affected by acute urinary retention?

A

Elderly men

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3
Q

What are the four major categories of causes of acute urinary retention?

A

Obstructive

Inflammatory

Neurological

Over-distension - leading to bladder not contracting properly

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4
Q

What are the obstructive causes of urinary retention?

A

Mechanical obstruction:

BPH

Urethral stricture

Constipation

Pelvic mass

Dynamic obstruction:

Increase in smooth muscle tone due to postoperative pain and drugs

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5
Q

What are the inflammatory causes of acute urinary retention?

A

UTI

Prostatitis

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6
Q

What are the neurological causes of acute urinary retention?

A

Spinal cord injury

Multiple sclerosis

Pelvic surgery

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7
Q

What are some causes of over-distention of the bladder which can lead to the bladder no longer able to contract properly and hence lead to acute urinary retention?

A

Post-anaesthesia

High alcohol intake

Drugs:

  • ephedrine, pseudoephedrine
  • Antidepressants
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8
Q

What are the clinical features of acute urinary retention?

A

Central lower abdominal pain

Anuria

Palpable bladder

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9
Q

How do we treat acute retention?

A

Urgent urethral catheterisation

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10
Q

What must you do once urethral catheterisation of a patient with acute urinary retention has happened?

A

Record the urine drained in the first 10-15 minutes

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11
Q

What is the normal volume drained from the bladder through urethral catheterisation following acute urinary retention?

A

Less than 1 litre

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12
Q

If more than 1 litre is drained from someone with urinary retention, what might this indicated?

A

More chronic retention

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13
Q

How should you treat a patient with urinary retention in whom urethral catheterisation fails?

A

Admit urgently for consideration of a suprapubic catheter.

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14
Q

Once a patient who presents with acute urinary retention has been catheterised, what investigations and management should be done for them?

A

Renal function blood tests

Start alpha blocker

TWOC after 2-3 days of alpha blocker

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15
Q

How should a patient with acute urinary retention who fails a TWOC be managed?

A

Long-term catheter

OR

Prostatic surgery

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16
Q

What are the features of chronic urinary retention?

A

Build up of more than 1 litre

Less pain than acute

Nocturnal enuresis

Overflow incontinence

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17
Q

Is chronic or acute urinary retention more likely to cause abnormal renal function?

A

Chronic - in these cases immediate catheterisation is required

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18
Q

How do we treat chronic urinary retention?

A

Catheter

TWOC not appropriate management

Should undergo elective prostatic surgery or have long term catheter.

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19
Q

What is renal colic?

A

Pain caused by kidney stones

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20
Q

What are the clinical features of renal colic?

A

Severe sudden onset-pain

Starts in the flank

Radiates around the front to the groin and sometimes scrotum or labia

Nausea and vomiting

Visible haematuria

Unable to find a comfortable position and therefore appear restless

Often nil on examination

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21
Q

What is the cause of the pain in renal colic?

A

Dilatation, stretching and spasm caused by acute ureteral obstruction.

22
Q

What investigations should be done for someone who presents with signs and symptoms consistent with renal colic?

A

Urinalysis - blood (if not blood is found, strongly consider alternative diagnosis)

U&Es

Pregnancy test in women of childbearing age

Non-contract CT abdo-pelvis

23
Q

How do you treat a patient with renal colic?

A

Resuscitation with fluids

Anti-emetics

Analgesia (NSAIDs should be tried before opiate based)

If small enough wait for stone to pass.

If larger - number of option including endoscopic or surgical extraction, or shock wave treatment to break up stone.

24
Q

Below what size of kidney stone is there a 90% chance of spontaneously passing it?

A

4mm

25
Q

Above what size of kidney stone is there only a 20% chance of spontaneously passing it?

A

6mm

26
Q

What are the complications of kidney stones?

A

Obstructive renal failure

Severe pyelonephrtitis

27
Q

What is testicular torsion?

A

Twisting of the spermatic cord, which impedes blood flow to the testis and impairs venous drainage. This results in oedema, ischaemia and necrosis.

28
Q

What are the peak ages of incidence for testicular torsion?

A

1-2 years old

Late teenage years

Testicular torsion is very rare in the over 40s

29
Q

What is the most common cause of testicular torsion?

A

Malformed tunica vaginalis - bell-clapper deformity. The tunica vaginalis extends over the whole testis rather than just the upper pole.

30
Q

What are the clinical features of testicular torsion?

A

Pain

Very quick in onset

Previous episodes of pain indicating intermittent torsion

Swelling

Erythema

Testicle lying horizontally, sitting high in the scrotum

Absent cremasteric reflex

31
Q

What investigations should be done for someone who presents with signs and symptoms consistent with testicular torsion?

A

Urinalysis - normal

Colour flow Doppler USS - poor or absent blood flow

Remember that time is key to management of this, so if the diagnosis is highly likely then surgery should not be delayed for investigations.

32
Q

How is testicular torsion managed?

A

Testicle is detorted surgically and then fixed to the scrotal wall.

If testis is not salvageable, an orchidectomy is performed.

Other testicle should also be examined and fixed if bell-clapper deformity is bilateral.

33
Q

What percentage of testes will be salvaged if surgery is performed 8 hours after onset of pain?

A

65%

34
Q

What is paraphimosis?

A

Foreskin becomes fixed in the retracted position and cannot be reduced therefore constricting venous return from glans penis and resulting in swelling of glans.

35
Q

What is the condition known to precipitate paraphimosis?

A

Phimosis

36
Q

What is the most common cause of paraphimosis?

A

Iatrogenic - medical staff fail to replace the foreskin following urethral catheterisation.

37
Q

What are the complications of untreated paraphimosis?

A

Ulceration and necrotic changes in the preputial skin and glans penis.

38
Q

What are the management option for paraphimosis?

A

Adequate analgesia - may involve penile nerve block

Manual decompression should be tried first - reduce oedema enough to replace foreskin over glans

Dorsal slit in the preputial skin.

Formal circumcision is definitive management - usually performed after dorsal slit to allow oedema to decrease.

39
Q

What is priapism?

A

Penile erection persisting beyond or unrelated to sexual stimulation.

40
Q

What are the two types of priapism?

A

Low-flow or ischaemic

High-flow or non-ischaemic

41
Q

What is the aetiology of low flow priapism?

A

Decreased venous and lymphatic drainage of corpus cavernosae

42
Q

What is the aetiology of high flow priapism?

A

Unregulated arterial blood flow often related to trauma.

43
Q

What is the main complication of priapism?

A

Erectile dysfunction often as a result of thrombosis, further ischaemia and subsequent fibrosis

44
Q

What are the haematological causes of priapism?

A

Sickle cell disease

Leukaemia

Thrombophilia

45
Q

What are the neurological causes of priapism?

A

Spinal cord compression

46
Q

What are the drugs related causes of priapism?

A

Drugs for ED:

Intracavernosal papaverine

Intracavernosal prostaglandin E1

Intraurethral alprostadil

Other drugs:

Antihypertensives

Antipsychotics

Antidepressants

Alcohol and cocaine

47
Q

What are the causes of high-flow priapism?

A

Perineal or penile trauma (commonly straddle type injuries) producing a cavernosal artery laceration, subsequent arteriovenous fistula and thus unregulated arterial blood flow.

48
Q

How do you definitively distinguish between high-flow and low-flow priapism?

A

Penile blood gas aspirated from corpus cavernosum.

49
Q

How do we treat low-flow priapism?

A

Aspiration and irrigation of corpora

Intracavernosal injection of phenylephrine (required cardiac monitoring)

If unsuccessful - surgical shunt between corpora cavernosa and spongiosa

50
Q

How do we treat high-flow priapism?

A

This is less urgent

Normally cases can be observed prior to arteriography and selective embolisation with good functional outcomes.

UROLOGY (5 decks)

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