Urological Emergencies Flashcards
what is acute urinary retention most commonly a complication of
benign prostatic hyperplasia
other causes of urinary retention
infection bladder over distension excessive fluid intake alcohol prostatic infection non-protate related surgery cathertisation or recent instrumentation anaesthesia medication
2 types of urinary retention
spontaneous
precipitated
treatment of urinary retention
catheter
give uroselective alpha blocker - improves chances of success without catheter
treatment for post-obstructive diuresis
monitor fluid balance and urine output
usually resolves in 48 hours but may need IV fluid and sodium replacement
what is post-obstructive diuresis
when you put a catheter in someone who has had chronic urinary retention and they pee out loads of salt and fluid
differential for loin pain
Ureteric colic - secondary to calculus
renal problems
other causes - AAA
treatment for renal calculus
NSAIDs +/- opiates
Alpha blocker - for small stones expected to pass
what percentage of <4mm stones have spontaneous passage
80%
4-6mm 59%
>6mm 21%
what are some indications to treat stones urgently
pain unrelieved
pyrexia
persistent nausea/vomiting
high-grade obstruction
urgent treatment for stones
uteric stent or stone fragmentation/removal if no infection
percutaneous nephrostomy for infected hydronephrosis
what causes haematuria
infection stones tumour benign prostatic hyperplasia (if big) trauma polycystic kidneys coagulation/platelet deficiencies
what is the treatment for clot retention
3 way irrigating haematuria catheter
investigation for haematuria
CT urogram
Cystoscopy
what are the differentials fro acute scrotum
Torsion of spermatic cord Torsion of appendix testes Epididymitis/epididymo-orchitis Inguinal hernia Hydrocoele Trauma/insect bite Dermatological lesions Inflammatory vasculitis Tumour
most common presentation of torsion of spermatic cord
teenager find severe pain in testes - often woken from sleep
Sudden onset pain - sometimes have previous episodes of self limiting pain
usually spontaneous but can occur with trauma or athletic activity
signs of torsion of the spermatic cord
testis high in scrotum
transverse lie
absence of cremasteric reflex
acute hydrocele +oedema (may obliterate land marks)
investigations for torsion
Doppler USS
Management for torsion
prompt exploration - irreversible ischaemic injury can occur as soon as 4 hours
2 or 3 point fixation with nine non-absorbable sutures
if testes necrotic then remove
MUST fix other side - to stop the same thing happening again
symptoms or torsion of appendage
can be insidious onset or present the same as cord torsion
if seen early may have localised tenderness at upper pole and ‘blue dot’ sign
testis should be mobile and cremasteric reflex present
treatment for torsion of appendage
if diagnosis confirmed then will resolve spontaneously without surgery
what is epididymitis
inflammation of the epidymitis usually caused by infection
how do differentiate epididymitis from torsion
dysuria
pyrexia
past history of UTI, urethritis, cathertisation/instrumentation
can be due to STI
signs of epididymitis
cremasteric reflex present
suspect if pyuria
doppler shows swollen epididymis, increased blood flow
send urine for culture + chlamydia PCR
treatment for epididymitis
analgesia + scrotal support
bed rest
ofloxacin 400mg/day for 14 days
what is idiopathic scrotal oedema
self limiting oedema with unknown cause
may also have itch
what is paraphimosis
painful swelling of the foreskin distal to phimotic ring
often happens after forskin retracted for cathertisation or cystoscopy and doesn’t go back to natural position
treatment for paraphismosis
iced glove
granulated sugar for 1-2 hours (draws out oedema)
manual compression of glands with distal traction on oedematous foreskin
dorsal slit
what is priapism
prolonged erection (>4 hours) often painful and not associated with arousal
causes of priapism
after intracorporeal injection for erectile deficiency trauma haematology dycrasias (sickle cell) neurological conditions idiopathic
what are the 2 types of priapism
Ischaemic
ischaemia (venous-occlusive or low flow)
vascular stasis in penis and decreased venous flow - compartment syndrome
Non-ischaemic
what is non-ischaemic priapism
traumatic disruption of penile vasculature resulting in unregulated blood entry and filling of corpora
Investigations for ischaemic priapism
aspirate blood from corpus cavernous (if low flow flow theres dark blood, normal in high flow)
USS - minimal or absent flow (low flow)
normal -high glow in non-ischaemic priapism
treatment for ischaemic priapism
aspiration +/- irrigation with saline
injection of alpha agonist
surgical shunt
treatment for non-ischaemic priapism
observe - may resolve spontaneously
selective arterial embolisation with non-permanent materials
what is Fournier’s gangrene
form of necrotising fasciitis occurring about the male genetalia
predisposing factors from Fournier’s gangrene
diabetes
local trauma
periurethral extravasation
perianal infection
signs/symptoms of Fournier’s gangrene
starts as cellulitis
- swollen
- erythematus
- tender
marked pain
fever
systemic toxicity
swelling + crepitus of scrotum - dark brown purple areas
investigation for Fournier’s gangrene
x-ray or USS
treatment for fourniers gangrene
antibiotics + Surgical debridement
mortality 20%
what is emphysematous pyelonenephritis
an infective emergency where an acute necrotising parenchymal and perirenal infection caused by gas-forming uropathogens
what group tends to get emphysematous pyelonephritis
diabetics
signs/symptoms of emphysematous pyelonephritis
often ureteric obstruction association
fever
vomiting
flank pain
gas on KUB
CT shows extend of it
treatment of emphysematous pyelonephritis
nephrectomy
what is a perinephric abscess
results from rupture of acute cortical abscess into the perinephric space or from haematogenous seeing from sites of infection
treatment for perinephric abscess
antibiotics + percutaneous or surgical drainage
indications for imaging
frank haematuria in adult
occult haematuria in child
occult haematuria + shock
penetrating injury with any degree of haematuria
do CT with contrast
what causes of haematuria need surgery
expanding perirenal haematoma
pulsatile perirenal haematoma
what organ is commonly injured with pelvic fracture
bladder
symptoms of bladder injury
suprapubic/abdominal pain inability to void suprapubic tenderness lower abdomen bruising guarding/rigidity diminished bowel sounds
treatment for bladder injury
catheterisation
if catheter does not pass easily do retrograde urethrogram (may have urethral injury)
antibiotics
repeat cystogram in 14 days
what imaging do you do for bladder injury
imaging - CT cystography
what gives a flame-shaped collection of contrast in pelvis
exztraperitoneal injury
what injury is often associated with fracture of pubic rami
posterior urethra
signs/symptoms of posterior urethra injury
blood at meatus inability to urinate palpably full bladder 'high riding' prostate butterfly perineal haematoma
investigation for urethral injury
retrograde urethrogram
treatment for urethral injury
suprapubic catheter
delayed reconstruction after at least 3 months
what is penile fracture
bucking injury commonly occurs in intercourse when penis slips out of vagina and strikes pubis
