Urological Emergencies Flashcards
destrusor sphincter dysnergia
distrubance of coordination of detrusor contraction and external sphincter opening
posterior urethral valve
- obstructing membrane over the posterior urethra as a result of abnormal utero development
- the most common cause of bladder outlet obstruction in males
what can hypoxia in utero do to the kidneys
cause ischemia and scarring, elading to pelvi-ureteric stenosis
what does prolonged bladder obstruction do to the bladder
- causes the detrusor muscle to hypertrophy - trabeculation
- eventually diverticulum form
other complications of bladder obstruction
- renal failure - hydronephrosis
- atonic bladder - detrusor muscle hypofunction
- recurrent UTI
- overflow incontinence
management of urethral stricture
- optical urethrotomy (incision of urethra)
- anastomtotic urethroplasty
management of phimosis
circumcision or dorsal slit
management of bladder stones
- cystolitholapaxy
- (fragmentation of stone through US/laser waves)
how much does the bladder normalyl contain
around 600ml
what type of medication can precipitate acute urinary retention
- medication with sympathomimetic or anti-cholingeric effects (oxybutynin, tolterodine)
treatment of acute urinary retention
- catheter and start an alpha-blocker (e.g. alfuzosin, tamsulosin) before the catheter is removed for at least 2 days in
TWOC in acute urinary retention
- may be started on the same admission if there is <1l residue and normal serum electrolytes
- prescribe an alpha blocker with it to increase voiding success
post obstructive diuresis
Polyuric state in which copious amounts of salt and water are eliminated after the relief of a urinary tract obstruction - osmotic diuresis
management of post obstructive diuresis
- monitor fluid balance and beware of hypovolaemia if urine output is >200ml/hour
- may require IV fluid and sodium replacement
how long does post obstructive diuresis usually last for
usually resolves in 24-48 hours
obstructive uropathy
- The blockage of urinary flow, which may affect one or both of the kidneys. If only one kidney is affected, urinary output may be unchanged and serum creatinine can be normal
- When kidney function is affected, termed obstructive nephropathy
hydronephrosis
- Hydronephrosis refers to the dilation of the renal pelvis and can be present with/out obstruction
what can follow hydronephrosis
2y infection often folows stasis, pyonephrosis (pus collects in the renal pelvis)
what is an important DD in acute loin pain
AAA
describe renal colic pain
- Renal colic is a severe waxing and waning loin pain radiating to the groin or thigh e.g. with nausea and vomiting.
- patient is classically rolling about the bed
what is the pain of renal colic due to
stretching of the smooth muscle
investigation of renal stone
- KUB X ray first line
- Lacks specificity (e.g. uterine fibroids, arteriolar calcification may show up), and sensitivity (small/radiolucent calculi are not shown)
- Spiral non-contrast CT
- Definitive test to confirm
- Occasionally struggles to distinguish between small pelvic calculi and phleboliths when there are no 2y signs to help e.g. hydronephrosis
describe how the size of stones determines whether they are likely to pass spontaneously
- <4mm: 80%
- 4-6mm: 59%
- >6mm: 21%
indications for urgent treatment of acute loin pain
- Pain unrelieved
- Pyrexia
- Presence of infection and obstruction
- Bilateral obstructing stones
- Persistent nausea/vomiting
- High-grade obstruction
name some common sites for ureter blockage due to stones
- pelviureteric junction
- pelvic brim
- ureter crossing common iliac artery
- vesicoureteric junction
where do the ureters run in relation to the spine
along transverse processes