Urology

Question 1

Most common cause of urinary retention in ED

Answer 1

Prostatomegaly

Question 2

Causes of urinary retention

Answer 2

Mechanical: clot retention, structures, BPH, prostate cancer

Neurological: spinal cord/ cauda equina

Drugs: anticholinergics

Post operative

Local pain: herpes

Question 3

What is post obstructive duiresis

Answer 3

When bladder drained if draining >200mls / hr for > 2 hours
Discuss with urology

Question 4

Criteria for patients to go home with catheter

Answer 4

No signficant comorbidities
Can cope with leg bag
Discharge education with leg bag
Fu planning
Safety Ned to return

Question 5

What is epididymorchitis
Caused by

Answer 5

Inflammation of the epididymis or testes
Often cause by UTI or STI

Question 6

Investigations for epididymoorchitis

Answer 6

Ultrasound
msu
Urinary pcr
Urethral swabs

Question 7

Organisms that course epidimoorchitis

Answer 7

Gram negative E.coli
STI: chlamydia, gonorrehea
Infectious: viral: mumps, enterovirus, adenovirus, mycoplasma pneumonia, brucellosis

Question 8

Risk uti vs epididmyorchitis

Answer 8

UTI: older age, obstructive urinary disease, recent instrumentation

STD: younger age <35, higher risk group

Question 9

Complications of epididymorchitis

Answer 9

Abscess formation
Reduced fertility : mumps
Chronic inflammation
Chronic inflammation
Gangrene/ septicaemia

Question 10

Clinical features of epididymorchitis

Answer 10

Pain: symptoms are unilateral
Gradual onset over 24 hours
Localised to scrotum
tenderness over the epididymus
Fever
Frequency
Dysuria
Urethral discharge mass
Phrens sign

Question 11

What is phrens sign

Answer 11

When lift scrotum it is relief of pain
Epididymorchitis instead of torsion

Question 12

Epididymorchitis vs torsion

Answer 12

Epididymorchitis: gradual onset, fever, and elevated crp, older aged urinary symptoms, mild- mid pain

Torsion of testes: acute onset, no fever, normal CRP, younger age, lack of urinary symptoms, severe pain

Question 13

Ddx epididymorohcitis

Answer 13

Fornier gangrene
Torsion
Trauma
Tumour

Question 14

Treatment of epididymorchitis

Answer 14

Analgesia
Scrotal support
Antibiotics
UTI source
Trimethoprim 300mg po if
Cephalexin 500mg po bd for
Treat 14 days

STI related
Ceftriaxone 500mg I’m
Azithromycin 1g po one
Doxycycline 100mg po bd 14 days STI

Question 15

Epididymorchitis follow up

Answer 15

Std Avoid unprotected sexual intercourse until completed treatment

Question 16

What is priapism

Answer 16

Defined as involuntary, painful, sustained erection of the penis that is not associated with sexual desire
>4 hr

Question 17

2 types of priapism

Answer 17

Ischaemia - low flow, venooclusive

Non ischaemic priapism - high flow or arterial priapism

Question 18

Age of priapism

Answer 18

5-10 years
20-40 years

Question 19

What is the cause of priapism

Answer 19

During erection of smooth muscle relaxation and increased arterial flow into the corpora cavernosa causing engorgement and rigidity

Engorgement of corpora cavernosa caused compression of the venous outflow tracts. Resulting in blood trapping within the corpora cavernosa
Often only effects corpora’s cavernosa

Question 20

What is the major neurotransmitter leading to erection in priapism

Answer 20

Nitric oxide

Question 21

Causes of priapism

Answer 21

Idiopathic - nitric oxide
Medications: implicated medicine: cocaine, antihypertensive, psychoactive drugs, phosphodiesterase inhibitors, alpha 1 blocks: tamaulosin
Haematological disease: sickle cell, leukaemia, thalassaemia, multipolar myeloma, thrombotic thrombocytopenia purples
Neurologic: spinal trauma
Trauma: perineal
Venoms: red back spider

Question 22

Complications

Answer 22

Erectile dysfunction due to fibrosis
Impotence
Rarely ischaemia gangrene
Occasionally urinary retention