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Y4: Acute surgery > Urological emergencies > Flashcards

Urological emergencies Flashcards

1
Q

Clinical features of Acute urinary retention?

A
  • Suprapubic tenderness
  • Palpable bladder
    • Dull to percuss
  • Large prostate on PR
  • <1 L drained on catheterisation
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2
Q

Investigations into Acute urinary retention (AUR)?

A
  • Blood: FBC, U&Es, PSA (before DRE)
  • Urine: dip, MC&S
  • Imaging:
    • US: bladder volume, hydronephrosis
    • Pelvic x-ray
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3
Q

What are the steps in the management of AUR?

A
  • Conservative
  • Catheterise
  • TURP
    • Transurethral resection of prostate
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4
Q

Describe the conservative management of AUR?

A
  • Analgesia
  • Privacy
  • Walking
  • Running water or hot bath
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5
Q

Describe catheterisation process in AUR?

A
  • Insert catheter
    • +/- gentamicin cover
  • Hourly urine output and replace: post-obstruction diuresis
  • Tamulosin: reduces risk of recatherisation after retention
  • Trial without catheter after 24-72 hours
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6
Q

Describe the use of Tamulosin in acute urinary retention?

A
  • Alpha blocker
  • Relaxes muscle in the prostate and bladder neck
  • Makes urination easier
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7
Q

Describe the indications for the use of TURP in AUR?

A
  • Failed trial without catheter
  • Impaired renal function
  • Elective procedure
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8
Q

Alternatives if patients become void after TURP?

A
  • Suprapubic catheterisation
    • Reduced UTIs, maintain sexual function
    • Requires skills for replacement
  • Clean intermittent self-catheterisation
    • Alternative to indwelling catheter
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9
Q

Name some causes of false haematuria?

A
  • Beetroot
  • Rifampicin
  • Vaginal bleed
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10
Q

Describe the management of testicular torsion?

A
  • Surgical emergency (12 hours to save testes)
  • Analgesia + Nil by mouth
  • Manual detorsion may be attempted in first 6 hours
  • Surgery:
    • Consent for possible orchidectomy
    • Bilateral orchidopexy: suture testes to scrotum
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11
Q

What is priapism?

A
  • Prolonged, painful erection > 4hrs not associated with arousal
  • Failure of blood to drain from penis after erection onset
  • Due to venous sludging corpora cavernosum
  • If untreated: Scarring / ED
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12
Q

Causes of priapism?

A
  • Haematological:
    • Sickle cell disease
    • Leukaemia
  • Sildenafil
  • Injections for treating ED
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13
Q

Management of priapism?

A
  • Aspiration
  • Intracavernosal injections of phenylephrine
  • If this fails:
    • Creation of a venous shunt within 6-12 hours
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14
Q

Describe paraphimosis?

A
  • Uncircumcised males develop inflammation in the foreskin
  • Foreskin retracts and cannot be returned to its normal position, trapping the blood flow and causing the glans to swell
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15
Q

Causes of paraphimosis?

A
  • Infection
  • Poor hygiene
  • Trauma
  • Recurrent catheterisation
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16
Q

Management of paraphimosis?

A
  • Reduce oedema of glans:
    • Mechanical compression
    • Puncture technique
    • Dorsal slit
17
Q

Difference between paraphimosis and phimosis?

A
  • Phimosis
    • Foreskin cannot be retracted
  • Paraphimosis
    • Foreskin becomes inflamed causing oedema and sweliing of the glans
18
Q

What is Fournier’s gangrene?

A
  • Gangrenous infection of the genitalia
  • Severe pain to the penis or scrotum
  • Fever, rigors
  • 50% mortality
19
Q

Associations of fournier’s gangrene?

A
  • Diabetes
  • Immunosuppression
  • Steroid use
  • Alcohol abuse
20
Q

Describe the management of Fournier’s gangrene?

A
  • Surgical debridement of necrotic tissue
  • Broad spectrum antibiotics
  • Hyperbaric oxygen therapy
    • Ambient pressure and breathing 100% oxygen
    • Inhibition of anaerobic growth
    • Increased fibroblast production and angiogenesis
    • Hypoxia reduces effects of vancomycin and ciprofloxacin
  • May require reconstruction
21
Q

Describe Peyronie’s disease?

A
  • Hard fibrous plaque in the wall of the corpus cavernosum
    • Causes curvature of the penis
  • Possibly related to trauma with the formation of scar tissue
  • Present with deformity and pain during intercourse
22
Q

Describe the management of Peyronie’s disease?

A
  • Cortisone injections
  • Radiotherapy
  • Excision of the plaque and replacement with a dermal patch graft
23
Q

Describe testicular torsion?

A
  • Torsion of the spermatic cord around the testes
    • Results in strangulation of the blood supply
  • Associated with abnormal tunica vaginalis or spermatic cord
24
Q

Presentation of testicular torsion?

A

Teenager with sudden onset testicular pain and swelling

25
Q

Pathophysiology of testicular torsion?

A
  • Initiated by a spasm of the cremaster
  • The cremaster inserts spirally into the cord which causes the rotation

Y4: Acute surgery (9 decks)

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