Urological emergencies (renal) Flashcards
what is priapism and what are the different types
prolonged painful erection (>4 hours) not associated with sexual arousal
ischaemic (decreased venous flow) and non ischaemic (normal or increase arterial blood flow)
what are the investigations for priapism and the treatment
aspirate blood from corpus cavernosum - ischaemic (dark blood low oxygen high co2) in non ischaemic (normal arterial blood flow)
duplex US - ischaemic minimal/absent flow and in non ischaemic normal or high flow
in ischeamic - aspirate +/- irrigate with saline, alpha agonist injection, if over 48 hours too late - prosthetic prosthesis
non ischaemic - observe, may resolve spontaneously, selective arterial embolisation
who is epididimytis rare in what is it confused with what are the symptoms what is the sign what are the ix what is the treatment
rare in children
confused with torsion
dysuria/pyrexia, history of UTI, urethritis, catheter/instrument
cremesteric reflex present
doppler - swollen epididimytis and increased blood flow
send urine for culture and chalmydia PCR
analgesia, scrotal support, bed rest, oflaxacin 400mg for 14 days
what is paraphimoris and why does it happen
whats the treatment
painful swelling of the foreskin distal to the phimotic ring
not replacing foreskin after being retracted for catheter/cytoscopy
iced glove. granulated sugar 1-2 hours. compression of glans. dorsal slit
who does torsion of spermatic cord occur in how symptoms sign ix rx risk
puberty
trauma. athletic activity. majority spontaneous
sudden onset of pain usually in the night. may have history of self limiting pain. N/V. lower and referral of pain
absence of cremesteric reflex
doppler US
prompt exploration - if over 4 hours ischaemic - if necrotic remove
fix collateral side - bell clapper deformity
how does torsion of appendage occur
what can it be confused with
signs
treatment
insidious onset of similar to torsion of spermatic cord
torsion of spermatic cord
localised tenderness at upper pole and blue dot sign
testes mobile and cremesteric reflex present
resolves spontaneously
treatment of stones
which stone pass
when to intervene
NSAID +/- opiate. alpha blocker (tamsulosin) for small stones
6mm 21%
if stone hasn’t passed within 1 month
or severe initial presentation
what is emphysematous pylnephritis cause who does it more likely occur in assoc with what symptoms ix rx
severe infection of parenchymal and perirenal space E.Coli - gas forming pathogen diabetics ureteric obstruction fever. vom. flank pain ICUB - gas, CT nephrectomy
Fournieres gangrene - what is it causes symptoms ix rx mortality
necrotising fasciitis
DM, skin trauma etc
starts as cellulitis, swelling and crepitus of scrotum, dark purple areas
XR/US - shows gas in tissue
ABs and surgical debridement
mortality 20% higher in DM and alcoholics
how does a perinephtic abscess occur
symptoms
ix
rx
acute cortical abscess rupture
haemtogenous seeding from sites of infection
insidious set, 1/3 not pyrexial, half have flank mass, increase WCC, increased Cr
CT
AB and percutaneous/surgical drainage
when to image for renal trauma
frank haematuira, frank/occult in a child, occult and shock (SBP
investigation for renal trauma and the treatment
indications for surgery
CT with contrast
98% managed non op - angiography/embolize
surgery - persistent bleeding, expanding haematoma, pulsatile preirenal haematoma, urinary extravasation, non viable tissue, incomplete staging
what fracture is bladder injury assoc with
pelvic
symptoms of bladder injury
ix
treatment
suprapubic pain and inability to void, lower abd bruising, guarding/rigidity, decreased bowel sounds
CT cystoscopy
catheterise - if blood on external meatus or difficulty with catheter insertion then retrograde urethrogram
extra peritoneal bladder injury looks like what
flame shaped collection of contrast in pelvis
