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Renal > Urological Emergencies > Flashcards

Urological Emergencies Flashcards

1
Q

What is a common complication of BPH?

A

Acute Urinary Retention

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2
Q

What causes acute urinary retention?

A

Infection, overdistention, excessive fluid intake, alcohol, infarction

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3
Q

State factors that can precipitate acute urinary retention

A
  • non-prostate related surgery
  • catheterisation
  • urethral instrumentation
  • anaesthesia
  • medication (anticholinergic/sympathomimetic)
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4
Q

How is acute urinary retention treated?

A

Catheter

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5
Q

In what circumstances can a catheter be removed in patients with previous acute urinary retention?

A

If <1 litre and normal electrolytes, can trial without a catheter but must prescribe a uroselective alpha blocker first

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6
Q

Name a uroselective alpha blocker

A

Tamulosin

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7
Q

What is post-obstructive diuresis?

A

Chronic obstruction associated with oedema, uraemia, hypertension - as a result of solute diuresis and defect in concentrating ability

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8
Q

How is post-obstructive diuresis treated?

A

Monitor fluid balance and it usually resolves in 24-48hours

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9
Q

What is the main concern in acute loin pain?

A

AAA

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10
Q

What is acute loin pain often due to?

A

Ureter colic secondary to calculus

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11
Q

How does the ureter respond to obstruction?

A

Releases prostaglandins which causes pain

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12
Q

State the relationship between size of stone and likelihood of passage

A

<4mm - 80%
4-6mm - 59%
>6mm - 21%

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13
Q

How is a stone treated?

A

NSAID +/- opiate

Alpha blocker if the stone is small and expected to pass

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14
Q

After how long will intervention be required for a stone?

A

1 month

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15
Q

What symptoms associated with loin pain signify treatment is urgent?

A

Pyrexia, pain unrelieved, persistent nausea/vomitting, high grade obstruction

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16
Q

How can a stone be removed?

A

Stent, surgical removal or nephrostomy for infected hydronephrosis

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17
Q

State the potential causes of frank haematuria

A

Infection, stones, tumours, BPH, polycystic kidneys, trauma, coagulation/platelet deficiencies (blood clot)

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18
Q

What investigations are done on a patient with frank haematuria?

A

CT urogram and cystoscopy

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19
Q

How is clot retention treated?

A

A 3 way irrigating haematuria catheter

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20
Q

State the causes of acute scrotum?

A 
Torsion of spermatic cord/appendix testis
Epididymitis 
Inguinal hernia 
Hydrocele 
Trauma 
Vasculitis 
Tumour
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21
Q

Describe the presentation of spermatic cord torsion

A

Most common in puberty, can occur during sport or spontaneously (sleep), sudden onset pain, nausea/vomiting

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22
Q

On examination what will be found in spermatic cord torsion?

A

Testes will be high in scrotum and may lie transverse, absent cremasteric reflex

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23
Q

What investigations are carried out in suspected torsion?

A

Doppler USS

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24
Q

How is spermatic cord torsion treated?

A

2-3 point fixation, remove if necrotic, fix bell clapper deformity if present on other side

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25
Q

Describe torsion of appendage

A

Variable symptoms and may have blue dot, cremasteric reflex will be present and testis mobile - should resolve spontaneously without surgery

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26
Q

What is epididymitis caused by?

A

UTI or STI

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27
Q

How does epididymitis present?

A

Dysuria/pyrexia
History of UTI
Urethritis
Post catheterisation/instrumentation

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28
Q

What investigation can be done in epidiymitis?

A

Doppler - will show swelling and increased blood flow

Urine culture & chlamydia PCR

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29
Q

How is epididymitis treated?

A

Analgesia, scrotal support and ofloxacin (14 days)

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30
Q

Describe idiopathic scrotal oedema

A

Self limiting, minimal tenderness may be itchy

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31
Q

What is the name given to swelling of the foreskin distal to the phimotic ring?

A

Paraphimosis

32
Q

What causes paraphimosis?

A

Retraction for catheterisation/cystoscopy

33
Q

How is paraphimosis treated?

A

Iced glove
Granulated sugar
Manual compression
Multiple punctures/slit if other options fail

34
Q

State the term used to describe a prolonged erection

A

Priapism

35
Q

After how long is an erection considered pathological?

A

4 hours

36
Q

What causes priapism?

A 
ED injection 
Trauma 
Sickle cell 
Neurological conditions 
Idiopathic 
Atherosclerosis
37
Q

What are the two types of priapism?

A

Ischaemic

Non-ischemic

38
Q

Describe ischaemic priapism

A

Low flow, leads to vascular stasis and decreased venous outflow - compartment syndrome

39
Q

Describe non-ischaemic priapism

A

High flow, traumatic disruption to vasculature leads to unregulated blood entry and filling of corpora, fistula formation allows blood to by-pass arteriolar bed

40
Q

What investigations are carried out in priapism?

A

Blood aspirate, duplex colour USS

41
Q

How can ischaemic priapism be treated?

A

Aspiration and irrigation with saline
Injection of alpha agonist
Surgical shunt

42
Q

How is non-ischaemic priapism treated?

A

May resolve spontaneously if not arterial embolisation of damaged vessel

43
Q

What is the name given to necrotising fasciitis that arises from the skin/urethra/rectal region?

A

Fournier’s Gangrene

44
Q

What are the risk factors for Fournier’s gangrene?

A

Diabetes
Trauma
Extravasation
Infection

45
Q

What is the progression of fournier’s gangrene?

A

Cellulitis –> swelling, dark purple areas –> toxicity

46
Q

Describe the features of x-ray/USS of fourniers gangrene

A

Gas in tissues

47
Q

How is fournier’s gangrene treated?

A

Antibiotics and debridement

48
Q

What is emphysematous pyelonephritis?

A

Acute necrotising infection caused by gas forming uropathogens e.g. e.coli

49
Q

Who is most affected by emphysematous pyelonephritis?

A

Diabetics associated with ureteric obstruction

50
Q

How does emphysematous pyelonephritis present?

A

Fever, vomiting, flank pain

51
Q

What investigations are done on emphysematous pyelonephritis?

A

CT

X-ray - gas

52
Q

What treatment is often required in emphysematous pyelonephritis?

A

Nephrectomy if antibiotics and drainage fails

53
Q

How does a perinephric abscess often arise?

A
  • Rupture of an acute cortical abscess into the perinephric space
  • Haematogenous spread of infection
54
Q

How does a perinephric abscess present?

A

Insidious onset, pyrexia, 50% flank mass,

55
Q

What will biochemistry of a patient with a perinephric abscess show?

A

High WCC, serum creatinine and pyuria

56
Q

How is a perinephric abscess diagnosed and treated?

A

CT scan

Antibiotics or drainage

57
Q

What are the 5 classes of kidney trauma?

A

I - haematuria
II - laceration <1cm
III - >1cm laceration but no rupture or extravasation
IV - laceration through cortex, medulla and collecting system, main arterial/venous injury with contained haemorrhage
V - shattered kidney

58
Q

What are the indications for imaging in kidney trauma?

A

Frank haematuria/occult in children
Occult haematuria and shock
Penetrating injury

59
Q

How is renal trauma investigated?

A

CT with contrast

60
Q

How is renal trauma treated?

A

Most can be managed by angiography and embolisation

Surgery - persistent bleeding, expanding haematuria, pulsatile haematoma, urinary extravasation, non-viable tissue

61
Q

What is bladder trauma associated with?

A

Pelvic fracture

62
Q

How does bladder trauma present?

A

Suprapubic/abdominal pain, inability to void, suprapubic tenderness, lower abdominal bruising, guarding/rigidity, diminished bowel sounds

63
Q

What indicated urethral injury?

A

Blood at external meatus

Catheter does not pass easily

64
Q

How is badder trauma investigated?

A

CT cystography

65
Q

How will extraperitoneal injury appear on imaging?

A

Flame shaped collection of contrast in pelvis

66
Q

State the treatment for bladder trauma

A

Large bore catheter and antibiotics - repeat cystogram in 14 days

67
Q

What merits immediate repair in bladder trauma?

A 
Intraperitoneal injury 
Penetrating injury 
Inadequate drainage/clots in urine 
Bladder neck/rectal/vaginal injury 
Open pelvic fracture 
Bone fragments into the bladder
68
Q

What is posterior urethral injury often associated with?

A

Fracture of the pubic rami

69
Q

Why is the bubomembranous junction the most vulnerable?

A

Fixed at urogenital diaphragm and puboprostatic ligaments

70
Q

In urethral trauma what clinical features will be present?

A

Blood at meatus, inability to urinate, full palpable bladder, high-riding prostate, perineal haematoma (butterfly appearance)

71
Q

How is urethral injury investigated?

A

Retrograde urethrogram

72
Q

How is urethral injury treated?

A

Suprapubic catheter and delayed reconstruction

73
Q

How does penile trauma most commonly occur?

A

Usually during intercourse, bucking injury when penis slips out of vagina and strikes pubis

74
Q

Describe the process of penile trauma

A

Crack/pop followed by detumescence and discolouration

75
Q

How is penile trauma managed?

A

Prompt exploration and repair but circumcision incision with degloving to expose all 3 compartments

76
Q

How does testicular trauma present?

A

Exquisite pain and nausea sometimes with associated swelling and bruising

77
Q

Describe the management of testicular trauma

A

USS to assess integrity and vascularity followed by surgical repair

Renal (20 decks)

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