Urological Emergencies Flashcards
what is acute retention usually a complication of?
BPH
2 types of acute urinary retention?
spontaneous and precipitated
acute retention treatment?
catheter
alpha blockers (-sin)
acute retention complications?
post obstructive diuresis and haematuria (rare)
acute loin pain is due to what?
urinary tract pathology or even AAA
ureteric colic secondary to calculus
acute loin pain treatment?
NSAID +/- opiate
alpha blocker
as size of stone increases, the chance of spontaneous passage __________
as size of stone increases, the chance of spontaneous passage DECREASES
investigation for stones?
non-contrast CT scan
indications of loin pain to treat urgently?
unrelieved pain
pyrexia
persistent N&V
high grade obstruction
urgent treatment of acute loin pain/stone?
ureteric stent or stone fragmentation
frank haematuria cause?
infection stones tumours BPH polycystic kidneys trauma coagulation/platelet deficiencies
investigations of frank haematuria?
CT urogram
frank haematuria treatment?
3-way catheter for clot
acute scrotum causes?
torsion of spermatic cord torsion of appendix testis epididymitis inguinal hernia hydroceles trauma dermatological lesions tumour
at what age is spermatic cord torsion cause?
teenage
investigation for torsion?
doppler USS
torsion treatment?
2 or 3 point fixation with non-absorbable sutures
MUST fix both sides
name the sign seen in torsion of the appendage
blue dot sign
is epididymitis common in children?
no
dysuria and pyrexia is common
epididymitis treatment?
analgesia and 14 days ofloxacin
what is paraphimosis?
painful swelling of foreskin distal to a phimotic ring
often happens after foreskin retracted for catheterization or cystoscopy and staff member forgets to replace it in its natural position
paraphimosis treatment?
ice and sugar
manual compression
dorsal slit
what is priapism?
prolonged erection
most common classification of priapism?
ischaemic
also get non-ischaemic
priapism treatment?
aspiration and irrigation with saline
alpha agonist injection
surgical shunt
non-ischaemic - observe
what is Fournier’s gangrene?
necrotizing fasciitis occurring about the male genitalia
predisposing factors for Fournier’s gangrene?
diabetes
alcoholic
trauma
infection
starts as cellulitis
Fournier’s gangrene investigation?
XR or USS for gas in tissues
Fournier’s gangrene treatment?
antibiotics and surgical debridement
what is emphysematous pyelonephritis?
an acute necrotizing parenchymal and perirenal infection caused by gas-forming uropathogens, usually E coli
who gets emphysematous pyelonephritis?
diabetics
emphysematous pyelonephritis treatment?
nephrectomy
perinephric abscess treatment?
antibiotics and surgical drainage
how many classifications are there in renal trauma?
5
I - haematoma II - laceration III - deeper laceration IV - laceration through all structure V - shattered kidney
imaging for bladder injury?
CT cystography
extra or intraperitoneal?
extraperitoneal bladder injury treatment?
large bone catheter
antibiotics
intraperitoneal bladder injury treatment?
laparotomy
fracture of pubic rami injures what structure?
posterior urethra
butterfly perineal haematoma is seen in what?
urethral injury
urethral injury investigation?
retrograde urethrogram
urethral injury treatment?
suprapubic catheter
delayed reconstruction
penile fracture treatment?
prompt exploration and repair
circumcision incision with degloving of penis to expose all 3 compartments
testicular injury investigation?
USS to assess integrity / vascularity
testicular injury treatment?
early exploration/repair improves testis salvage, reduces convalescence, better preserves fertility and hormonal function
indications for imaging?
frank haematuria
shock
penetrating injury
NOT blunt trauma
