Urological Emergencies - Bladder and Renal

Question 1

Under what conditions does the majority of bladder trauma occur?

Answer 1

Pelvic fractures

Question 2

How does bladder trauma present?

Answer 2

Suprapubic/abdo pain + tenderness
Inability to void (empty)
Bruising

Question 3

When a catheter is fitted in bladder trauma what can you expect to see?

Answer 3

Visible haematuria

Question 4

How are the majority of bladder trauma managed?

Answer 4

Self-healing

If penetrating injury/bone in bladder/fractures involved in the area etc. -> laparotomy

Question 5

What is emphysematous pyelonephritis?

What causes it?

Who most likely gets it?

Answer 5

Acute necrotising parenchymal and perirenal infection

Most commonly E.Coli

Diabetics

Question 6

A patient presents with fever, vomiting and flank pain and pockets of gas can be seen surrounding the kidneys on CT.

How is this condition managed?

Answer 6

Emphysematous pyelonephritis

HDU w/ ABs
~ nephrectomy

Question 7

Patient presents with fever and palpable flank mass.

Urinalysis shows pyuria and bloods show raised creatine and WCC.

How is this managed?

Answer 7

Perinephric abscess

Pyuria = WBCs in urine

Small - ABs
Large - drainage
V. rarely - nephrectomy

Question 8

Related to haematuria name the 4 situations in which you would order a contrast CT:

Answer 8

• Visible haematuria in adult
• Visible/non-visible haematuria in kids
• Non-visible + (systolic <90mmHg at any point)
• Penetrating injury w/visible or non-visible

Question 9

How can the vast majority of renal trauma is managed?

Answer 9

Non-operatively

Unstable/persistent bleeding = nephrectomy

Question 10

Most common referral to urology is acute urinary retention. What is done to manage it?

Answer 10

1. CATHETER

Alpha-blockers can also be used to relax the smooth muscle of the bladder