urological emergencies Flashcards
what is acute urinary retention
sudden, painful experience of having a full bladder but being unable to urinate
what can cause acute urinary retention
BPH, BPE, prostate infection, excessive fluid intake, alcohol, BOO
what are some precipitated causes of acute urinary retention
surgery, catheterisation, anaesthesia, urethral instrumentation, medications
how do you manage acute urinary retention
catheterise urgently, alpha blockers eg tamsulosin
what is the most common cause of acute loin pain
uteric colic secondary to stones
what are symptoms of bladder stones
lower abdo pain, pain on urination, increased frequency, haematuria, difficulty urinating
how do you manage bladder stones
NSAIDs +/- opiate, alpha blocker eg tamsulosin, give 1 month for stone to pass then surgery
what is frank haematuria
visible blood in urine
what can cause frank haematuria
infection, stones, BPH, polycystic kidneys, trauma
what investigations are done for frank haematuria
urinaltsis, CT urogram, cystoscopy
how do you treat frank haematuria
treat underlying, clot retention
what can cause an acute scrotum
torsion of spermatic cord, torsion of testes, epididmytis, trauma, vasculitis, hydrocele, tumour
what can cause torsion of spermatic cord
trauma, athletic activity, spontaneous
at what age group is torsion of the spermatic cord most common
puberty
what are some symptoms of torsion of the spermatic cord
sudden onset of pain, N+V, referred pain to lower abdo
what is seen on exam of torsion of spermatic cord
testes in high scrotum, transverse lie, no cremasteric reflex
what is the cremasteric reflex
when inner thigh is stroked in a downwards direction, ipsilateral testicle is pulled upwards
how do you diagnose torsion of spermatic cord
USS doppler
who is commonly affected by epididymitis
14-35
what are symptoms of epididymitis
hard to distinguish from torsion, dysuria and pyrexia more common
what investigations are done for epididymitis
cremasteric reflex present, USS, urine culture (for chlamydia)
how do you treat epididymitis
analgesia and bed rest
what is paraphimosis
when foreskin is pulled behind the tip of penis and becomes stuck, penis then becomes swollen
what is the most common cause of paraphimosis
foreskin is retracted for catheter and staff forget to put it back
what is priapism
prolonged erection >4 hours (painful and not sexual)
what can cause priapism (5)
injection for ED eg papaverine, trauma, haematological eg sickle cell, neurological, idiopathic
what is ischaemic priapism
blood stasis where blood cannot leave the penis (most common)
how do you treat ischaemic priapism
aspirate and give alpha agonist
what is non-ischaemic priapism
trauma to penile vasculature leads to unregulated blood entry (less painful)
how do you manage non-ischaemic priapism
embolize and do USS
what is fournier’s gangrene
necrotising fasciitis around male genitalia
what are risk factors for fournier’s gangrene
diabetes, local trauma, perinanal infection, alcoholic
what are symptoms of fournierns gangrene
starts as cellulitis, swollen, red, tender, pain, fever, dark purple areas develop (necrosis)
how do you manage fournier’s gangrene
broad antibiotics and surgical debridement
what is emphysematous pyelonephritis
acute necrotising infection of renal parenchyma
what organisms cause emphysematous pyelonephritis
gas forming ones eg e.coli and klebsiella
what is emphysematous pyelonephritis associated with
uretic obstruction (often in diabetics)
what are symptoms of emphysematous pyelonephritis
flank pain and mass, vomiting, fever
what investigations and management is done for emphysematous pyelonephritis
CT –> nephrectomy
what can cause a perinephric abscess
mainly UTIs, surgery, haematogenous spread of infection
what are symptoms of perinephric abscess
insidious onset, fever, flank mass
what are investigations of perinephric abscess
bloods, CT
how do you manage perinephric abscess
broad ABs and surgical drainage
what are symptoms of a bladder injury from trauma
suprapubic/ abdo pain, inability to void, tenderness, bruising, diminished bowel sounds, haematuria
how do you manage bladder injury from trauma
large bore catheter, antibiotics, imaging
what can cause a urethral trauma injury
fracture of pubic rami
what is seen on exam of a traumatic urethral injury
blood at meatus, can’t pee, palpable full bladder, high riding prostate, butterfly perineal haematoma
how do you manage a traumatic urethral injury
suprapubic catheter
what can cause a penile fracture
sexual intercourse
what are symptoms of a penile fracture
cracking/ popping, pain, discolouration and swelling
