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2 RENAL > Urological Emergencies > Flashcards

Urological Emergencies Flashcards

1
Q

what is acute urinary retention most commonly a complication of

A

benign prostatic hyperplasia

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2
Q

other causes of urinary retention

A 
infection 
bladder over distension 
excessive fluid intake 
alcohol 
prostatic infection 
non-protate related surgery 
cathertisation or recent instrumentation 
anaesthesia
medication
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3
Q

2 types of urinary retention

A

spontaneous

precipitated

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4
Q

treatment of urinary retention

A

catheter

give uroselective alpha blocker - improves chances of success without catheter

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5
Q

treatment for post-obstructive diuresis

A

monitor fluid balance and urine output

usually resolves in 48 hours but may need IV fluid and sodium replacement

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6
Q

what is post-obstructive diuresis

A

when you put a catheter in someone who has had chronic urinary retention and they pee out loads of salt and fluid

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7
Q

differential for loin pain

A

Ureteric colic - secondary to calculus
renal problems
other causes - AAA

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8
Q

treatment for renal calculus

A

NSAIDs +/- opiates

Alpha blocker - for small stones expected to pass

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9
Q

what percentage of <4mm stones have spontaneous passage

A

80%

4-6mm 59%
>6mm 21%

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10
Q

what are some indications to treat stones urgently

A

pain unrelieved
pyrexia
persistent nausea/vomiting
high-grade obstruction

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11
Q

urgent treatment for stones

A

uteric stent or stone fragmentation/removal if no infection

percutaneous nephrostomy for infected hydronephrosis

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12
Q

what causes haematuria

A 
infection 
stones 
tumour 
benign prostatic hyperplasia (if big) 
trauma 
polycystic kidneys 
coagulation/platelet deficiencies
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13
Q

what is the treatment for clot retention

A

3 way irrigating haematuria catheter

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14
Q

investigation for haematuria

A

CT urogram

Cystoscopy

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15
Q

what are the differentials fro acute scrotum

A 
Torsion of spermatic cord 
Torsion of appendix testes 
Epididymitis/epididymo-orchitis 
Inguinal hernia 
Hydrocoele 
Trauma/insect bite 
Dermatological lesions 
Inflammatory vasculitis 
Tumour
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16
Q

most common presentation of torsion of spermatic cord

A

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

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17
Q

signs of torsion of the spermatic cord

A

testis high in scrotum
transverse lie
absence of cremasteric reflex
acute hydrocele +oedema (may obliterate land marks)

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18
Q

investigations for torsion

A

Doppler USS

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19
Q

Management for torsion

A

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

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20
Q

symptoms or torsion of appendage

A

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

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21
Q

treatment for torsion of appendage

A

if diagnosis confirmed then will resolve spontaneously without surgery

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22
Q

what is epididymitis

A

inflammation of the epidymitis usually caused by infection

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23
Q

how do differentiate epididymitis from torsion

A

dysuria
pyrexia
past history of UTI, urethritis, cathertisation/instrumentation

can be due to STI

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24
Q

signs of epididymitis

A

cremasteric reflex present

suspect if pyuria

doppler shows swollen epididymis, increased blood flow

send urine for culture + chlamydia PCR

25
Q

treatment for epididymitis

A

analgesia + scrotal support
bed rest

ofloxacin 400mg/day for 14 days

26
Q

what is idiopathic scrotal oedema

A

self limiting oedema with unknown cause

may also have itch

27
Q

what is paraphimosis

A

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

28
Q

treatment for paraphismosis

A

iced glove
granulated sugar for 1-2 hours (draws out oedema)
manual compression of glands with distal traction on oedematous foreskin
dorsal slit

29
Q

what is priapism

A 
prolonged erection (>4 hours) 
often painful and not associated with arousal
30
Q

causes of priapism

A 
after intracorporeal injection for erectile deficiency 
trauma 
haematology dycrasias (sickle cell) 
neurological conditions 
idiopathic
31
Q

what are the 2 types of priapism

A

Ischaemic
ischaemia (venous-occlusive or low flow)

vascular stasis in penis and decreased venous flow - compartment syndrome

Non-ischaemic

32
Q

what is non-ischaemic priapism

A

traumatic disruption of penile vasculature resulting in unregulated blood entry and filling of corpora

33
Q

Investigations for ischaemic priapism

A

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

34
Q

treatment for ischaemic priapism

A

aspiration +/- irrigation with saline
injection of alpha agonist
surgical shunt

35
Q

treatment for non-ischaemic priapism

A

observe - may resolve spontaneously

selective arterial embolisation with non-permanent materials

36
Q

what is Fournier’s gangrene

A

form of necrotising fasciitis occurring about the male genetalia

37
Q

predisposing factors from Fournier’s gangrene

A

diabetes
local trauma
periurethral extravasation
perianal infection

38
Q

signs/symptoms of Fournier’s gangrene

A

starts as cellulitis

  • swollen
  • erythematus
  • tender

marked pain
fever
systemic toxicity

swelling + crepitus of scrotum - dark brown purple areas

39
Q

investigation for Fournier’s gangrene

A

x-ray or USS

40
Q

treatment for fourniers gangrene

A

antibiotics + Surgical debridement

mortality 20%

41
Q

what is emphysematous pyelonenephritis

A

an infective emergency where an acute necrotising parenchymal and perirenal infection caused by gas-forming uropathogens

42
Q

what group tends to get emphysematous pyelonephritis

A

diabetics

43
Q

signs/symptoms of emphysematous pyelonephritis

A

often ureteric obstruction association

fever
vomiting
flank pain

gas on KUB
CT shows extend of it

44
Q

treatment of emphysematous pyelonephritis

A

nephrectomy

45
Q

what is a perinephric abscess

A

results from rupture of acute cortical abscess into the perinephric space or from haematogenous seeing from sites of infection

46
Q

treatment for perinephric abscess

A

antibiotics + percutaneous or surgical drainage

47
Q

indications for imaging

A

frank haematuria in adult
occult haematuria in child
occult haematuria + shock
penetrating injury with any degree of haematuria

do CT with contrast

48
Q

what causes of haematuria need surgery

A

expanding perirenal haematoma

pulsatile perirenal haematoma

49
Q

what organ is commonly injured with pelvic fracture

A

bladder

50
Q

symptoms of bladder injury

A 
suprapubic/abdominal pain 
inability to void 
suprapubic tenderness 
lower abdomen bruising 
guarding/rigidity 
diminished bowel sounds
51
Q

treatment for bladder injury

A

catheterisation
if catheter does not pass easily do retrograde urethrogram (may have urethral injury)

antibiotics

repeat cystogram in 14 days

52
Q

what imaging do you do for bladder injury

A

imaging - CT cystography

53
Q

what gives a flame-shaped collection of contrast in pelvis

A

exztraperitoneal injury

54
Q

what injury is often associated with fracture of pubic rami

A

posterior urethra

55
Q

signs/symptoms of posterior urethra injury

A 
blood at meatus 
inability to urinate 
palpably full bladder 
'high riding' prostate 
butterfly perineal haematoma
56
Q

investigation for urethral injury

A

retrograde urethrogram

57
Q

treatment for urethral injury

A

suprapubic catheter

delayed reconstruction after at least 3 months

58
Q

what is penile fracture

A

bucking injury commonly occurs in intercourse when penis slips out of vagina and strikes pubis

2 RENAL (20 decks)

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