Urological Emergency Flashcards
What can cause acute urinary retention
BPH
Tumours
Anything that obstructs outflow
How do you treat acute urinary retention
Catheterisation
Give a uroselective alpha-blocker like alfuzosin
If less than 1L residue and normal electrolytes then trial off the catheter to see if normal function returns
What can cause acute loin pain
Ureteric colic secondary to calculus
Must consider non-urinary causes like AAA
How do you treat ureteric calculi
NSAID’s +/- opiate
Give alpha-blocker (Tamsulosin) for small stones that expected to pass
If stone is too large to pass then will need surgical intervention - pass scope up and laser the stone to fragment or PC nephrostomy if infected
What is the definitive test for calculi
Non contrast CT
What symptoms suggest that a calculi needs urgent treatment
Unrelieved pain
Pyrexia - infection
Persistent nausea/vomiting
High grade obstruction
List causes of frank haematuria
Infection Stones Tumours Benign prostatic hyperplasia (BPH) Polycystic kidneys Trauma Coagulation/platelet deficiencies
What investigations should you do for a patient with frank haematuria
CT urogram + cystoscopy
How do you manage haematuria
Use a 3 way irrigating catheter
Washout of bladder - prevents clots forming
Monitor output and haemoglobin
Remove once settled
What can cause an acute scrotum
Torsion of spermatic cord Torsion of appendix testis Epididymitis / epididymo-orchitis Inguinal hernia Hydrocoele Trauma / insect bite Dermatological lesions Inflammatory vasculitis Tumour
Testicular torsion is most common in which group
Teenagers – due to growth of testes
How does torsion of the spermatic cord present
Sudden onset of pain - severe and unilateral
May be woken from sleep
Nausea and vomiting
Lower abdominal pain
How do you diagnose torsion of the spermatic cord
Doppler can be used to rule it out – will show if there is blood flow to the testes
Mostly a clinical diagnosis - don’t delay treatment
How do you treat torsion of the spermatic cord
Urgent investigation - take them to theatre
Fix the teste and cord with non-absorbable suture
Remove any dead tissue
Fix both sides to prevent recurrence
What is the bell clapper deformity
When the teste sits transversely and is very mobile
High risk of torsion so should be fixed
What pathology gives the blue dot sign
Torsion of hydatid of Morgagni
Presents similarly to torsion
Seen in pre-pubescent children
Supportive treatment
What can cause epididymitis
STI
UTI
Urethritis
Catheterisation
How does epididymitis present
Similar to torsion - pain etc
Dysuria
Pyrexia
Generally unwell
What tests should you do if epididymitis is suspected
Doppler - will show swollen epididymis and increased blood flow
Urine culture
STI test
How do you treat epididymitis
Analgesia + scrotal support, bed rest
Ofloxacin 400mg/day for 14 days
What is paraphimosis
Painful swelling of the foreskin distal to a phimotic ring
Foreskin is retracted but cannot come forward again
Gradually it pinches off blood supply – become more and more oedematous
How do you treat paraphimosis
Ice to reduce swelling
Puncture oedmatous skin
Manual compression of glands and try and move the foreskin back to place
May need a dorsal slit in tissue
What is priapism
Prolonged erection (>4hrs)
Painful
Not due to sexual arousal
Caused by lack of venous outflow from the penis or unregulated arterial flow that makes it rigid and painful
What can cause priapism
Intracorporeal injection for ED, e.g. papaverine Trauma (penile / perineal) Haematologic dyscrasias e.g. sickle cell Neurological conditions Idiopathic
How do you treat ischaemic priapism
Aspiration and irrigation with saline
Inject an alpha agonist - phenylephrine - every 5-10 mins
Surgical shunt
How do you treat non-ischaemic priapism
Observe - may resolve itself
May need selective arterial embolization
What is Fournier’s gangrene
A form of necrotizing fasciitis occurring about the male genitalia
Can be caused by diabetes, immunocompromise, trauma, infection
How does Fournier’s gangrene present
Starts as cellulitis - swelling, erythema, tenderness
Pain, fever
Crepitus in scrotum - some bacteria produce gas
Marked toxicity
How do you treat Fournier’s gangrene
Antibiotics
Surgical debridement
What is emphysematous pyelonephritis
An acute necrotizing parenchymal and perirenal infection caused by gas-forming uropathogens, usually E coli
Associated with ureteric obstruction and diabetes
How does emphysematous pyelonephritis present
Fever, vomiting, flank pain
Gas pockets seen on US
List indications for kidney imaging
Frank haematuria in adult
Frank or occult haematuria in child
Occult haematuria + shock Penetrating injury with any degree of haematuria
how do you treat kidney trauma
Most can be managed non-operatively by angiography/embolization
If persistent bleeding then do surgery
What can cause a bladder injury
Pelvic fractures
How does bladder injury present
Suprapubic pain
Inability to void
Bruising
Haematuria
How would you diagnose a extraperitoneal bladder injury
Contrast CT
Would show a flame-shaped collection of contrast in pelvis
Urethral injury is associated with what
Fracture of the pubic rami
How does a urethral injury present
Blood at meatus Inability to urinate Palpably full bladder “High-riding” prostate Butterfly perineal haematoma
How do you treat urethral injury
Suprapubic catheter
Delayed reconstruction after at least 3 months - need to wait for haematoma to resolve
How does a penile fracture occur and present
Usually due to intercourse - buckling injury when penis strikes the pubis
Cracking/popping sound with pain, discolouration and swelling
How do you treat a penile fracture
Prompt exploration and repair
Circumcision incision with degloving of penis to expose all 3 compartments
What is hydrocele
Excess fluid around the testes
