Urological Emergencies Flashcards
Acute urinary retention is an emergency. True/False? List some symptoms of urinary retention
True
Unable to urinate
Increasing pain
Haematuria
List some causes of acute urinary retention
Benign prostatic hyperplasia
Prostatitis
Bladder overdistention
How is acute urinary retention managed?
Catheterisation (<1l residue and normal Es = TWOC)
(suprapubic or urethral depending if blockage or not)
Fluids
Uroselective alpha-blocker (alfuzosin, tamsulosin)
What are the main causes of acute colicky loin pain?
Calculus - pain mediated by prostaglandins in ureter in response to obstruction
Pyelonephritis - upper UT infection
Abdominal aortic aneurysm
How is acute ureteric colic managed?
NSAID with/without opiate
Fluids
Alpha-blocker (alfuzosin, tamsulosin)
If stone not passed in 1 month, surgery
What investigations are done for frank haematuria?
CT urogram (non-contrast) if >50 and UUT problem Cystoscopy in <50 and >50 with LUT problem
Irreversible ischaemic injury may occur in acute scrotum as early as 4hrs. True/False?
List the main causes of acute scrotum
True
Need prompt intervention
Torsion of spermatic cord
Torsion of appendix testis
Epididymitis
STI
The cremasteric reflex is not present in either testicular torsion or epidydimitis. Which one?
Present in epidydimitis
Not present in testicular torsion
What is paraphimosis?
Painful swelling of foreskin distal to a phimotic ring
Usually occurs after catheterisation/ cytoscopy
What is priapism?
Prolonged erection, usually longer than 4 hours
If priapism is ischaemic, what are the symptoms and how is it treated?
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
What is Fournier’s gangrene? What are the signs?
Form of necrotising fasciitis in the male genital region
Commonly found in diabetes
Swelling and crepitus of scrotum (dark purple areas)
List side effects of alpha blockers used in urinary retention
Postural hypotension
Retrograde ejaculation
State the main complication of acute urinary retenion
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
List risk factors contributing to an increased risk of stones
Hyperparathyroidism FHx PMHx stones/ UTI Dehydration Obesity
List the main types of urological calculi
Calcium oxaloacetate Calcium phosphate Urate Magnesium phosphate Stravum
List examinations and investigations used in the diagnosis of acute loin pain
Abdominal exam
External genitalia exam (testicular torsion)
Bloods (FBC, U+Es)
1st line imaging = CT KUB (KUB XR)
US (hydronephrosis)
Torsion of the spermatic cord is most common in…
Pubertal teenage boys
Outline the aetiology of torsion of spermatic cord
Trauma
Activity
Spontaneous (woken from sleep)
List symptoms present in torsion of spermatic cord
Sudden pain +/- referral to lower abdomen
Worse on movement
Nausea and vomiting
Low grade pyrexia
List investigation and management used in torsion of spermatic cord
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)
What is the characteristic early sign of torsion of appendages?
Blue dot sign
Torsion of appendages requires surgery to fix. True/ False?
False
Usually resolves spontaneously without surgery
List distinguishing features of epididymitis that differ from testicular torsion
Dysuria
High grade pyrexia
Pyuria
