urological emergencies Flashcards
what usually causes acute urinary retention?
complication of BPH
types of acute urinary retention?
spontaneous
precipitated
what can cause precipitating AUR?
non-prostate related surgery catheterization urethral instrumentation anaesthesia medication with anticholinergic effect (reduces bladder contraction)
how is AUR managed?
put in a catheter (usually in urethra, or suprapubic if cant get it into urethra)
management without catheter?
if retension with <1L residue and normal serum electrolytes then trial without catheter
prescribe a uroselective alphablocker (alfuzosin) before the trial without catheter (improves change of voiding success)
how does post-obstructive diuresis present and how is it managed?
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non urological causes of loin pain?
AAA
what usually causes acute loin pain?
ureteric colic due to calculus
- pain mediated by release of prostaglandins by ureter in response to obstruction
how is acute loin pain managed?
NSAIDs +/- opiates
alpha blocker for small stones expected ot pass
chance of spontaneous passage of stones?
<4mm = 80% 4-6 = 59 >6 = 21
how long do you give for stones to pass before making plans to remove them?
1 month
indications for urgent removal of kidney stones?
pain unrelieved
pyrexia (infection)
persistent nausea/vomiting
high grade obstruction
how can stones be removed?
ureteric stent or stone fragmentation/removal if no infection
percutaneous nephrostomy for infected hydronephrosis
causes of frank haematuria?
infection (common) stones tumours benign prostatic hyperplasia polycystic kidneys trauma coagulation/platelet deficiencies
how is clot retention (blockage of ureters due to clot) managed?
3 way irrigating haematuria catheter
how is frank haematuria investigated?
CT urogram + cystoscopy
causes of acute scrotum?
torsion of spermatic cord/appendix testis epididymis/epididymo-orchitis inguinal hernia hydrocele trauma/insect bites dermatological lesions inflammatory vasculitis tumour
typical story of torsion of spermatic cord?
teenage boy
can occur with trauma/athletic activity
usually spontaneous
often woken from sleep with sudden onset severe pain
may have has previous episodes of self limiting pain
may have nausea/vomiting
pain can refer to lower abdomen
examination findings of torsion of spermatic cord?
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how is torsion of spermatic cord investigated?
Doppler US
how is torsion of spermatic cord managed?
2 or 3 point fixation with non-absorbable sutures
if testis is necrotic then remove
must fix contralateral side incase it happens to other side (correct bell clapper deformity)
how does torsion of appendage present?
may be insidious onset or identical to cord torsion but usually less severe
may have localised tenderness at upper pole and “blue dot” sign if seen early
testis should be mobile and cremasteric reflex present