Urological emergencies Flashcards
Clinical features of Acute urinary retention?
- Suprapubic tenderness
- Palpable bladder
- Dull to percuss
- Large prostate on PR
- <1 L drained on catheterisation
Investigations into Acute urinary retention (AUR)?
- Blood: FBC, U&Es, PSA (before DRE)
- Urine: dip, MC&S
- Imaging:
- US: bladder volume, hydronephrosis
- Pelvic x-ray
What are the steps in the management of AUR?
- Conservative
- Catheterise
- TURP
- Transurethral resection of prostate
Describe the conservative management of AUR?
- Analgesia
- Privacy
- Walking
- Running water or hot bath
Describe catheterisation process in AUR?
- 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
Describe the use of Tamulosin in acute urinary retention?
- Alpha blocker
- Relaxes muscle in the prostate and bladder neck
- Makes urination easier
Describe the indications for the use of TURP in AUR?
- Failed trial without catheter
- Impaired renal function
- Elective procedure
Alternatives if patients become void after TURP?
- Suprapubic catheterisation
- Reduced UTIs, maintain sexual function
- Requires skills for replacement
- Clean intermittent self-catheterisation
- Alternative to indwelling catheter
Name some causes of false haematuria?
- Beetroot
- Rifampicin
- Vaginal bleed
Describe the management of testicular torsion?
- 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
What is priapism?
- 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
Causes of priapism?
- Haematological:
- Sickle cell disease
- Leukaemia
- Sildenafil
- Injections for treating ED
Management of priapism?
- Aspiration
- Intracavernosal injections of phenylephrine
- If this fails:
- Creation of a venous shunt within 6-12 hours
Describe paraphimosis?
- 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
Causes of paraphimosis?
- Infection
- Poor hygiene
- Trauma
- Recurrent catheterisation
Management of paraphimosis?
- Reduce oedema of glans:
- Mechanical compression
- Puncture technique
- Dorsal slit
Difference between paraphimosis and phimosis?
- Phimosis
- Foreskin cannot be retracted
- Paraphimosis
- Foreskin becomes inflamed causing oedema and sweliing of the glans
What is Fournier’s gangrene?
- Gangrenous infection of the genitalia
- Severe pain to the penis or scrotum
- Fever, rigors
- 50% mortality
Associations of fournier’s gangrene?
- Diabetes
- Immunosuppression
- Steroid use
- Alcohol abuse
Describe the management of Fournier’s gangrene?
- 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
Describe Peyronie’s disease?
- 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
Describe the management of Peyronie’s disease?
- Cortisone injections
- Radiotherapy
- Excision of the plaque and replacement with a dermal patch graft
Describe testicular torsion?
- Torsion of the spermatic cord around the testes
- Results in strangulation of the blood supply
- Associated with abnormal tunica vaginalis or spermatic cord
Presentation of testicular torsion?
Teenager with sudden onset testicular pain and swelling
Pathophysiology of testicular torsion?
- Initiated by a spasm of the cremaster
- The cremaster inserts spirally into the cord which causes the rotation
