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The Renal System > Urological Emergencies > Flashcards

Urological Emergencies Flashcards

1
Q

What is acute urinary retention a complication of?

A

Benign prostatic hyperplasia

(very rare in women)

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2
Q

How does acute urinary retention present?

A

Inability to urinate

Pain

Distended bladder

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3
Q

How can acute urinary retention be caused?

A

Spontaneously

Precipitated (triggering event)

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4
Q

Which factors may precipitate acute urinary retention?

A

Non-prostate related surgery

Catheterisation or urethral instrumentation

Anaesthesia

Medications with sympathomimetic or anticholinergic effects

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5
Q

If a patient presents with <1 litres of retention what should be given if there is a trial without catheter?

A

Alpha blocker

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6
Q

What is the treatment for renal calculi?

A

NSAIDs (if no renal failure) +/- opiates

Alpha blockers may be given for stones which are expected to pass

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7
Q

Generally a patient with a renal calculus will require intervention if it has not passed within which time frame?

A

1 month

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8
Q

How are renal calculi best imaged?

A

Non-contrast CT

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9
Q

What are the indications to treat renal calculi urgenty?

A

Unrelieved pain

Pyrexia

Persistent nausea or vomiting

High grade obstruction

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10
Q

How are renal calculi removed?

A

Ureteric stent or stone fragmentation/removal if no infection

Percutaneous nephrostomy for infected hydronephrosis

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11
Q

What are the main causes for visible (frank) haematuria?

A
  1. Infection
  2. Stones
  3. Tumours
  4. Benign prostatic hyperplasia (BPH)
  5. Polycystic kidneys
  6. Trauma
  7. Coagulation/platelet deficiencies
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12
Q

What are the best investigations for visible haematuria?

A

CT urogram

Cytoscopy

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13
Q

Torsion of the spermatic cord generally occurs _____________

A

Torsion of the spermatic cord generally occurs spontaneously

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14
Q

Torsion of the spermatic cord is most common around with age?

A

Puberty

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15
Q

How does a torsion of the spermatic cord present?

A
  1. Testis high in scrotum
  2. Transverse position of testis
  3. Absence of cremasteric reflex
  4. Acute hydrocoele + oedema
  5. Red and inflamed
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16
Q

What is the best test for acute testicular torsion?

A

Doppler USS

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17
Q

In which instance must a testis be removed?

A

Necrotic damage

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18
Q

Why must the contralateral side be fixed in a testicular torsion?

A

Bell clapper deformity

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19
Q

What is a Bell clapper deformity?

A

A predisposing factor in testicular torsion in which the tunica vaginalis joins high on the spermatic cord, leaving the testis free to rotate

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20
Q

The blue dot sign is associated with which testicular pathology?

A

Torsion of testicular appendage

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21
Q

Which other condition is difficult to differentiate from testicular torsion?

A

Epididymitis

22
Q

Epididymitis is _________ in children

A

Epididymitis is rare in children

23
Q

Which clinical sign raises suspicion of epididymitis versus testicular torsion?

A

Pyuria

(and dysuria)

24
Q

How can epididymitis be treated?

A

Analgesia + scrotal support, bed rest

Ofloxacin 400mg/day for 14 days

25
Q

How does idiopathic scrotal oedema present?

A

Children

No fever

Itching

Minimal tenderness

26
Q

What is paraphimosis?

A

Painful swelling of the foreskin distal to a phimotic ring

27
Q

What is the treatment for paraphimosis?

A
  1. Iced glove
  2. Granulated sugar for 1-2hrs (draws out excess fluid to minimise swelling)
  3. Multiple punctures in oedematous skin
  4. Manual compression of glans with distal traction on oedematous foreskin
  5. Dorsal slit (when non-surgical methods fail)
28
Q

What is priapism?

A

Prolonged erection (>4hrs) not associated with sexual arousal

29
Q

What is a form of necrotizing fasciitis occurring about the male genitalia?

A

Fournier’s gangrene

30
Q

How does Fournier’s gangrene normally begin initially?

A

As a cellulitis

From skin, urethra or rectal region

31
Q

Which predisposing factors exist for Fournier’s gangrene?

A

Diabetes

Local trauma

Periurethral extravasation

Perianal infection

32
Q

What is the appropriate treatment for Fournier’s gangrene?

A

Surgical debridement

Antibiotics

33
Q

What is emphysematous pyelonephritis?

A

Acute necrotizing parenchymal and perirenal infection caused by gas-forming uropathogens, usually E coli

34
Q

Which comorbidiy predisposes to emphysematous pyelonephritis?

A

Diabetes

35
Q

Which clinical symptoms and signs indicate a diagnosis of emphysematous pyelonephritis?

A

Fever

Vomiting

Flank pain

Gas seen on KUB

CT

36
Q

Which treatment is often required for emphysematous pyelonephritis?

A

Nephrectomy

37
Q

How does a perinephric abscess typically form?

A

Rupture of acute cortical abscess into perinephric space

Haematogenous seeding from sites of infection

38
Q

What are the clinical signs of a perinephric abscess?

A

Flank mass

High WCC

High serum creatinine

Pyuria

Insidious onset

39
Q

What is the treatment for perinephric abscess?

A

Antibiotics and either percutaneous or surgical drainage

40
Q

How many stages can renal trauma be classified?

A

5

41
Q

How can renal trauma be imaged?

A

CT urogram

42
Q

How are most renal bleeds due to trauma treated?

A

Embolisation and angiography

43
Q

Which type of fracture is associated with bladder injury?

A

Pelvic

44
Q

What are the two types of bladder trauma?

A

Intraperitoneal

Extraperitoneal

45
Q

How is a bladder injury imaged?

A

CT cystography

46
Q

What is posterior urethral injury usually associated with?

A

Fracture of the pubic rami

47
Q

Which clinical signs are present which indicate a urethral injury?

A

Blood at meatus

Inability to urinate

Palpably full bladder

“High-riding” prostate

Butterfly perineal haematoma

48
Q

What is the treatment for a urethral injury?

A

Suprapubic catheter

Delayed reconstruction (after 3 months)

49
Q

When does a penile fracture typically occur?

A

Intercourse

(Penis slips out of vagina and strike pubis)

50
Q

Which investigation can be used to assess testicular injuries?

A

USS

The Renal System (37 decks)

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