Urological Emergencies

Question 1

Acute urinary retention is an emergency. True/False? List some symptoms of urinary retention

Answer 1

True
Unable to urinate
Increasing pain
Haematuria

Question 2

List some causes of acute urinary retention

Answer 2

Benign prostatic hyperplasia
Prostatitis
Bladder overdistention

Question 3

How is acute urinary retention managed?

Answer 3

Catheterisation (<1l residue and normal Es = TWOC)
(suprapubic or urethral depending if blockage or not)
Fluids
Uroselective alpha-blocker (alfuzosin, tamsulosin)

Question 4

What are the main causes of acute colicky loin pain?

Answer 4

Calculus - pain mediated by prostaglandins in ureter in response to obstruction
Pyelonephritis - upper UT infection
Abdominal aortic aneurysm

Question 5

How is acute ureteric colic managed?

Answer 5

NSAID with/without opiate
Fluids
Alpha-blocker (alfuzosin, tamsulosin)
If stone not passed in 1 month, surgery

Question 6

What investigations are done for frank haematuria?

Answer 6

CT urogram (non-contrast) if >50 and UUT problem
Cystoscopy in <50 and >50 with LUT problem

Question 7

Irreversible ischaemic injury may occur in acute scrotum as early as 4hrs. True/False?
List the main causes of acute scrotum

Answer 7

True
Need prompt intervention

Torsion of spermatic cord
Torsion of appendix testis
Epididymitis
STI

Question 8

The cremasteric reflex is not present in either testicular torsion or epidydimitis. Which one?

Answer 8

Present in epidydimitis

Not present in testicular torsion

Question 9

What is paraphimosis?

Answer 9

Painful swelling of foreskin distal to a phimotic ring

Usually occurs after catheterisation/ cytoscopy

Question 10

What is priapism?

Answer 10

Prolonged erection, usually longer than 4 hours

Question 11

If priapism is ischaemic, what are the symptoms and how is it treated?

Answer 11

Rigid corpus cavernosa
Tender and painful penis
Vascular stasis

Aspiration of blood from corpus cavernosum and saline irrigation
Colour duplex US (shows minimal flow)
Injection of alpha-agonist (phenylephrine)
Surgical shunt

Question 12

What is Fournier’s gangrene? What are the signs?

Answer 12

Form of necrotising fasciitis in the male genital region
Commonly found in diabetes
Swelling and crepitus of scrotum (dark purple areas)

Question 13

List side effects of alpha blockers used in urinary retention

Answer 13

Postural hypotension

Retrograde ejaculation

Question 14

State the main complication of acute urinary retenion

Answer 14

Post-obstructive diuresis (loss of salt and water in the urine following correction of obstruction + defect in urine concentrating ability)
Typically self-limiting in 24-48 hours

Question 15

List risk factors contributing to an increased risk of stones

Answer 15

Hyperparathyroidism
FHx
PMHx stones/ UTI
Dehydration 
Obesity

Question 16

List the main types of urological calculi

Answer 16

Calcium oxaloacetate
Calcium phosphate
Urate
Magnesium phosphate
Stravum

Question 17

List examinations and investigations used in the diagnosis of acute loin pain

Answer 17

Abdominal exam
External genitalia exam (testicular torsion)

Bloods (FBC, U+Es)
1st line imaging = CT KUB (KUB XR)
US (hydronephrosis)

Question 18

Torsion of the spermatic cord is most common in…

Answer 18

Pubertal teenage boys

Question 19

Outline the aetiology of torsion of spermatic cord

Answer 19

Trauma
Activity
Spontaneous (woken from sleep)

Question 20

List symptoms present in torsion of spermatic cord

Answer 20

Sudden pain +/- referral to lower abdomen
Worse on movement
Nausea and vomiting
Low grade pyrexia

Question 21

List investigation and management used in torsion of spermatic cord

Answer 21

Doppler US
2 or 3 point fixation with suture
Removal of necrotic ‘painless’ testis
Fix contralateral side (bell clapper deformity - horizontal testis in young men)

Question 22

What is the characteristic early sign of torsion of appendages?

Answer 22

Blue dot sign

Question 23

Torsion of appendages requires surgery to fix. True/ False?

Answer 23

False

Usually resolves spontaneously without surgery

Question 24

List distinguishing features of epididymitis that differ from testicular torsion

Answer 24

Dysuria
High grade pyrexia
Pyuria

Question 25

List risk factors for epididymitis

Answer 25

Hx of UTI

Hx of catheterisation

Question 26

List investigation and management used in epididymitis

Answer 26

Doppler US
Urinalysis
Chlamydia PCR/ STI screen

Analgesia
Scrotal support
Ofloxacin 400mg for 14 days

Question 27

State the main management option for paraphimosis

Answer 27

Dorsal slit

Circumcision

Question 28

How is Fournier’s gangrene diagnosed and treated?

Answer 28

Plain XR or US showing gas

Antibiotics and surgical debridement

Question 29

What is the first line imaging for renal trauma?

Answer 29

Contrast CT

Question 30

What is the first line imaging and management for bladder trauma?

Answer 30

CT cystography

Catheter and antibiotics

Question 31

What is the characteristic sign of urethral injury?

Answer 31

Butterfly perineal haematoma

Question 32

What is the first line imaging and management for urethral trauma?

Answer 32

Retrograde urethrogram
Suprapubic catheter
Reconstruction after 3 months

Question 33

What is the first line imaging for testicular trauma?

Answer 33

US

Question 34

What is the most common aetiology of penile fracture?

Answer 34

Buckling injury (penis hits the pubis) during intercourse

Question 35

How is penile fracture managed?

Answer 35

Circumcision incision (degloving of penis)

Question 36

What is the first line imaging in suspected renal stones? What is the definitive test?

Answer 36

KUB XR

Non-contrast enhanced CT (MRI in pregnancy)

Question 37

What is CT contrast-induced nephropathy? How is it managed?

Answer 37

Impaired renal function 3 days following CT contrast

1l saline before and after procedure