urological emergencies

Question 1

what is acute urinary retention

Answer 1

sudden, painful experience of having a full bladder but being unable to urinate

Question 2

what can cause acute urinary retention

Answer 2

BPH, BPE, prostate infection, excessive fluid intake, alcohol, BOO

Question 3

what are some precipitated causes of acute urinary retention

Answer 3

surgery, catheterisation, anaesthesia, urethral instrumentation, medications

Question 4

how do you manage acute urinary retention

Answer 4

catheterise urgently, alpha blockers eg tamsulosin

Question 5

what is the most common cause of acute loin pain

Answer 5

uteric colic secondary to stones

Question 6

what are symptoms of bladder stones

Answer 6

lower abdo pain, pain on urination, increased frequency, haematuria, difficulty urinating

Question 7

how do you manage bladder stones

Answer 7

NSAIDs +/- opiate, alpha blocker eg tamsulosin, give 1 month for stone to pass then surgery

Question 8

what is frank haematuria

Answer 8

visible blood in urine

Question 9

what can cause frank haematuria

Answer 9

infection, stones, BPH, polycystic kidneys, trauma

Question 10

what investigations are done for frank haematuria

Answer 10

urinaltsis, CT urogram, cystoscopy

Question 11

how do you treat frank haematuria

Answer 11

treat underlying, clot retention

Question 12

what can cause an acute scrotum

Answer 12

torsion of spermatic cord, torsion of testes, epididmytis, trauma, vasculitis, hydrocele, tumour

Question 13

what can cause torsion of spermatic cord

Answer 13

trauma, athletic activity, spontaneous

Question 14

at what age group is torsion of the spermatic cord most common

Answer 14

puberty

Question 15

what are some symptoms of torsion of the spermatic cord

Answer 15

sudden onset of pain, N+V, referred pain to lower abdo

Question 16

what is seen on exam of torsion of spermatic cord

Answer 16

testes in high scrotum, transverse lie, no cremasteric reflex

Question 17

what is the cremasteric reflex

Answer 17

when inner thigh is stroked in a downwards direction, ipsilateral testicle is pulled upwards

Question 18

how do you diagnose torsion of spermatic cord

Answer 18

USS doppler

Question 19

who is commonly affected by epididymitis

Answer 19

14-35

Question 20

what are symptoms of epididymitis

Answer 20

hard to distinguish from torsion, dysuria and pyrexia more common

Question 21

what investigations are done for epididymitis

Answer 21

cremasteric reflex present, USS, urine culture (for chlamydia)

Question 22

how do you treat epididymitis

Answer 22

analgesia and bed rest

Question 23

what is paraphimosis

Answer 23

when foreskin is pulled behind the tip of penis and becomes stuck, penis then becomes swollen

Question 24

what is the most common cause of paraphimosis

Answer 24

foreskin is retracted for catheter and staff forget to put it back

Question 25

what is priapism

Answer 25

prolonged erection >4 hours (painful and not sexual)

Question 26

what can cause priapism (5)

Answer 26

injection for ED eg papaverine, trauma, haematological eg sickle cell, neurological, idiopathic

Question 27

what is ischaemic priapism

Answer 27

blood stasis where blood cannot leave the penis (most common)

Question 28

how do you treat ischaemic priapism

Answer 28

aspirate and give alpha agonist

Question 29

what is non-ischaemic priapism

Answer 29

trauma to penile vasculature leads to unregulated blood entry (less painful)

Question 30

how do you manage non-ischaemic priapism

Answer 30

embolize and do USS

Question 31

what is fournier's gangrene

Answer 31

necrotising fasciitis around male genitalia

Question 32

what are risk factors for fournier's gangrene

Answer 32

diabetes, local trauma, perinanal infection, alcoholic

Question 33

what are symptoms of fournierns gangrene

Answer 33

starts as cellulitis, swollen, red, tender, pain, fever, dark purple areas develop (necrosis)

Question 34

how do you manage fournier's gangrene

Answer 34

broad antibiotics and surgical debridement

Question 35

what is emphysematous pyelonephritis

Answer 35

acute necrotising infection of renal parenchyma

Question 36

what organisms cause emphysematous pyelonephritis

Answer 36

gas forming ones eg e.coli and klebsiella

Question 37

what is emphysematous pyelonephritis associated with

Answer 37

uretic obstruction (often in diabetics)

Question 38

what are symptoms of emphysematous pyelonephritis

Answer 38

flank pain and mass, vomiting, fever

Question 39

what investigations and management is done for emphysematous pyelonephritis

Answer 39

CT --> nephrectomy

Question 40

what can cause a perinephric abscess

Answer 40

mainly UTIs, surgery, haematogenous spread of infection

Question 41

what are symptoms of perinephric abscess

Answer 41

insidious onset, fever, flank mass

Question 42

what are investigations of perinephric abscess

Answer 42

bloods, CT

Question 43

how do you manage perinephric abscess

Answer 43

broad ABs and surgical drainage

Question 44

what are symptoms of a bladder injury from trauma

Answer 44

suprapubic/ abdo pain, inability to void, tenderness, bruising, diminished bowel sounds, haematuria

Question 45

how do you manage bladder injury from trauma

Answer 45

large bore catheter, antibiotics, imaging

Question 46

what can cause a urethral trauma injury

Answer 46

fracture of pubic rami

Question 47

what is seen on exam of a traumatic urethral injury

Answer 47

blood at meatus, can't pee, palpable full bladder, high riding prostate, butterfly perineal haematoma

Question 48

how do you manage a traumatic urethral injury

Answer 48

suprapubic catheter

Question 49

what can cause a penile fracture

Answer 49

sexual intercourse

Question 50

what are symptoms of a penile fracture

Answer 50

cracking/ popping, pain, discolouration and swelling