Urological Emergencies Flashcards
What is acute urinary retention a complication of?
Benign prostatic hyperplasia
(very rare in women)
How does acute urinary retention present?
Inability to urinate
Pain
Distended bladder
How can acute urinary retention be caused?
Spontaneously
Precipitated (triggering event)
Which factors may precipitate acute urinary retention?
Non-prostate related surgery
Catheterisation or urethral instrumentation
Anaesthesia
Medications with sympathomimetic or anticholinergic effects
If a patient presents with <1 litres of retention what should be given if there is a trial without catheter?
Alpha blocker
What is the treatment for renal calculi?
NSAIDs (if no renal failure) +/- opiates
Alpha blockers may be given for stones which are expected to pass
Generally a patient with a renal calculus will require intervention if it has not passed within which time frame?
1 month
How are renal calculi best imaged?
Non-contrast CT
What are the indications to treat renal calculi urgenty?
Unrelieved pain
Pyrexia
Persistent nausea or vomiting
High grade obstruction
How are renal calculi removed?
Ureteric stent or stone fragmentation/removal if no infection
Percutaneous nephrostomy for infected hydronephrosis
What are the main causes for visible (frank) haematuria?
- Infection
- Stones
- Tumours
- Benign prostatic hyperplasia (BPH)
- Polycystic kidneys
- Trauma
- Coagulation/platelet deficiencies
What are the best investigations for visible haematuria?
CT urogram
Cytoscopy
Torsion of the spermatic cord generally occurs _____________
Torsion of the spermatic cord generally occurs spontaneously
Torsion of the spermatic cord is most common around with age?
Puberty
How does a torsion of the spermatic cord present?
- Testis high in scrotum
- Transverse position of testis
- Absence of cremasteric reflex
- Acute hydrocoele + oedema
- Red and inflamed
What is the best test for acute testicular torsion?
Doppler USS
In which instance must a testis be removed?
Necrotic damage
Why must the contralateral side be fixed in a testicular torsion?
Bell clapper deformity
What is a Bell clapper deformity?
A predisposing factor in testicular torsion in which the tunica vaginalis joins high on the spermatic cord, leaving the testis free to rotate
The blue dot sign is associated with which testicular pathology?
Torsion of testicular appendage
Which other condition is difficult to differentiate from testicular torsion?
Epididymitis
Epididymitis is _________ in children
Epididymitis is rare in children
Which clinical sign raises suspicion of epididymitis versus testicular torsion?
Pyuria
(and dysuria)
How can epididymitis be treated?
Analgesia + scrotal support, bed rest
Ofloxacin 400mg/day for 14 days
How does idiopathic scrotal oedema present?
Children
No fever
Itching
Minimal tenderness
What is paraphimosis?
Painful swelling of the foreskin distal to a phimotic ring
What is the treatment for paraphimosis?
- Iced glove
- Granulated sugar for 1-2hrs (draws out excess fluid to minimise swelling)
- Multiple punctures in oedematous skin
- Manual compression of glans with distal traction on oedematous foreskin
- Dorsal slit (when non-surgical methods fail)
What is priapism?
Prolonged erection (>4hrs) not associated with sexual arousal
What is a form of necrotizing fasciitis occurring about the male genitalia?
Fournier’s gangrene
How does Fournier’s gangrene normally begin initially?
As a cellulitis
From skin, urethra or rectal region
Which predisposing factors exist for Fournier’s gangrene?
Diabetes
Local trauma
Periurethral extravasation
Perianal infection
What is the appropriate treatment for Fournier’s gangrene?
Surgical debridement
Antibiotics
What is emphysematous pyelonephritis?
Acute necrotizing parenchymal and perirenal infection caused by gas-forming uropathogens, usually E coli
Which comorbidiy predisposes to emphysematous pyelonephritis?
Diabetes
Which clinical symptoms and signs indicate a diagnosis of emphysematous pyelonephritis?
Fever
Vomiting
Flank pain
Gas seen on KUB
CT
Which treatment is often required for emphysematous pyelonephritis?
Nephrectomy
How does a perinephric abscess typically form?
Rupture of acute cortical abscess into perinephric space
Haematogenous seeding from sites of infection
What are the clinical signs of a perinephric abscess?
Flank mass
High WCC
High serum creatinine
Pyuria
Insidious onset
What is the treatment for perinephric abscess?
Antibiotics and either percutaneous or surgical drainage
How many stages can renal trauma be classified?
5
How can renal trauma be imaged?
CT urogram
How are most renal bleeds due to trauma treated?
Embolisation and angiography
Which type of fracture is associated with bladder injury?
Pelvic
What are the two types of bladder trauma?
Intraperitoneal
Extraperitoneal
How is a bladder injury imaged?
CT cystography
What is posterior urethral injury usually associated with?
Fracture of the pubic rami
Which clinical signs are present which indicate a urethral injury?
Blood at meatus
Inability to urinate
Palpably full bladder
“High-riding” prostate
Butterfly perineal haematoma
What is the treatment for a urethral injury?
Suprapubic catheter
Delayed reconstruction (after 3 months)
When does a penile fracture typically occur?
Intercourse
(Penis slips out of vagina and strike pubis)
Which investigation can be used to assess testicular injuries?
USS
