Urological Emergencies Flashcards
main complication of BPH
acute retention
causes of acute urinary retention
prostate infection BPH bladder overdistension excessive fluid intake alcohol prostatic infarction
name the 2 types of acute retention
precipitated
spontaneous
what can cause precipitated urinary retention
non-prostate related surgery
catheterisation
anaesthesia
anticholinergic medication
Tx of acute retention
catheter if >1l in bladder
trial without catheter + tamsulosin if <1l residue in bladder
patient with uraemia, oedema, CCF, hypertension who presents with oliguria?
post obstructive diuresis
what is solute diuresis?
retained urea, Na and water + inability of kidney to concentrate urine
urine output over __ ml/hr is unusual in a patient who hasnt been drinking
200
Tx of post obstructive diuresis?
monitor fluids and UO
give IV fluids and Na replacement if not resolved within 2 days
pre surgical Tx of stones?
IM diclofenac if no renal failure +/- opiates
give tamsulosin if small stone too
differential for acute loin pain?
stones
AAA
if stone hasn’t passed in _ __ it is likely to require intervention
1 month
the ureters can be found in line with what bony structures?
transverse processes of the spine
if a patient with stones is very sick how should you treat them?
ureteric stent/stone fragmentation if no infection
percutaneous nephrostomy if infected hydronephrosis
painless frank haematuria makes you think…
bladder cancer
what type of catheter is used for clot retention?
3 way irrigating haematuria catheter
Ix for frank haematuria?
CT urogram
cystoscopy
causes of frank haematuria?
stones infection tumour BPH polycystic kidneys trauma coagulation deficiency
what 2 structures can be torted in the scrotum?
spermatic cord
appendix testis
main infectious conditions of the scrotum?
epididymitis
epididymo-orchitis
most common causes of epididymo-orchitis?
young men- STI
older men- catheter
of the 2 structures in the scrotum that can be torted, which is the most painful and severe?
spermatic cord
most common time for testicular torsion and why?
puberty as this is when testicular volume gets bigger
pain in scrotum waking teenage boy up from sleep; has nausea and vomiting…
testicular torsion
on examination the testicle is found where in testicular torsion?
lies high in the scrotum and is facing sideways
what is the onset of the pain in torsion?
sudden
where can pain refer in torsion?
lower abdoemn
there is loss of what reflex in torsion?
cremasteric reflex
Ix of torsion?
doppler USS
Tx of torsion?
fix it if get it in time
if dead remove
fix the other side
what sign can be found in early torsion?
blue dot sign (appendix testis is engorged with blood)
who gets epididymitis?
adults
pyrexial patient with urinary symptoms with increased blood flow on imaging and a swollen scrotum…
epididymitis
important things to ask in PMH for a suspected epididymitis?
UTI
urethritis
catheterisation
Ix for epididymitis?
doppler- INC blood flow
urine culture
chlamydia PCR
Tx of epididymitis?
analgesia
scrotal support
bed rest
ofloxacin 400mg/day for 2 weeks
antibiotic for epididymitis?
ofloxacin for 2 weeks
child presents with swollen scrotum without fever or tenderness, slightly itchy..
idiopathic scrotal oedema
what is paraphimosis?
painful swelling of the foreskin distal to a phimotic ring
what can cause a paraphimosis?
after foreskin is retracted for catherisation or cystoscopy and it isnt brought back to normal
Tx of paraphimosis
iced glove for 2hrs
puncture edematous skin
compress glans
dorsal slit
what condition is called “compartment syndrome of the penis”?
priapism
main signs and symptoms of priapism?
prolonged erection over 4hrs
painful and NO sexual arousal
causes of priapism?
erectile dysfuncton injecton trauma sickle cell anaemia neuro conditions idiopathic
main pathophysiology of priapism?
ischaemia of the penis due to vascular stasis and lack of venous outflow OR disrupted penile vasculature (non-ischaemic)
Ix of priapism?
aspirate blood- if it looks dark it could be ischaemic
colour duplex USS- minimal or absent flow in ischaemic, normal to high flow in non-ischaemic
Tx of ischaemic priapism?
aspiration +/- irrigation with saline
inject alpha blocker
insert shunt
Tx of non-ischaemic priapism?
observe, may resolve spontaneously
selective arterial embolisation
fournier’s gangrene is the penile form of what condition?
necrotising fasciitis
Tx of fournier’s gangrene
surgical debridement
antibiotics
predisposing factors to fournier’s gangrene?
infection around this area
diabetes
trauma
pathophysiology of fournier’s gangrene?
begins as cellulitis, then get swelling and crepitus of scrotum (looks dark purple)
Ix of fournier’s gangrene?
X ray or USS to confirm gas in tissue
causative organism of emphysematous pyelonephritis?
gas forming uropathogen eg e coli
who gets emphysematous pyelonephritis?
diabetics
associated symptom of emphysematous pyelo?
ureteric obstruction
diabetic man presents with obstruction, fever, vomiting and flank pain with gas on KUB imaging…
emphysematous pyelo
Ix of emphysematous pyelo?
KUB for gas
CT for extent of emphysema
Tx of emphysematous pyelo?
nephrectomy
findings on bloods in someone with a pyelonephric abscess?
high WCC
high creatinine
Ix of pyelonephric abscess?
bloods
CT
Tx of perinephric abscess?
antibiotics
percutaneous or surgical drainage
which kidney problem will present with a flank mass?
perinephric abscess
main test for frank haematuria
CT with contrast always
bladder injury is commonly associated with what problem?
pelvic fracture
main symptoms of a bladder injury?
subrapubic pain and tenderness
inability to void
guarding
diminished bowel sounds
there will be gross haematuria in bladder injury T or F
T
Ix of bladder injury
CT cystography
Tx of bladder injury?
large bore catheter
antibiotics
repeat cystogram in 14 days
if bad, needs surgery
a “flame shaped collection of contrast in the pelvis” is likely to be an intra or extraperitoneal injury?
extraperitoneal
the prostate is attached to what ligament?
puboprostatic ligaement
posterior urethral injury is often associated with fracture of what structure?
pubic rami
signs and symptoms of urethral injury?
blood at meatus cant urinate palpable full bladder high prostate haematoma
what is the haematoma from a urethral injury said to look like?
butterfly perineal haematoma
Tx of urethral injury?
suprapubic catheter
main cause of penile fracture
intercourse
man experiences popping sound followed by pain whilst having sex…
suspected penile fracture
main signs and symptoms of penile fracture
pain
discolouration
swelling
Ix of testicular injury?
USS
main symptoms of testicular injury?
pain and nausea
