Urology Flashcards
Most common cause of urinary retention in ED
Prostatomegaly
Causes of urinary retention
Mechanical: clot retention, structures, BPH, prostate cancer
Neurological: spinal cord/ cauda equina
Drugs: anticholinergics
Post operative
Local pain: herpes
What is post obstructive duiresis
When bladder drained if draining >200mls / hr for > 2 hours
Discuss with urology
Criteria for patients to go home with catheter
No signficant comorbidities
Can cope with leg bag
Discharge education with leg bag
Fu planning
Safety Ned to return
What is epididymorchitis
Caused by
Inflammation of the epididymis or testes
Often cause by UTI or STI
Investigations for epididymoorchitis
Ultrasound
msu
Urinary pcr
Urethral swabs
Organisms that course epidimoorchitis
Gram negative E.coli
STI: chlamydia, gonorrehea
Infectious: viral: mumps, enterovirus, adenovirus, mycoplasma pneumonia, brucellosis
Risk uti vs epididmyorchitis
UTI: older age, obstructive urinary disease, recent instrumentation
STD: younger age <35, higher risk group
Complications of epididymorchitis
Abscess formation
Reduced fertility : mumps
Chronic inflammation
Chronic inflammation
Gangrene/ septicaemia
Clinical features of epididymorchitis
Pain: symptoms are unilateral
Gradual onset over 24 hours
Localised to scrotum
tenderness over the epididymus
Fever
Frequency
Dysuria
Urethral discharge mass
Phrens sign
What is phrens sign
When lift scrotum it is relief of pain
Epididymorchitis instead of torsion
Epididymorchitis vs torsion
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
Ddx epididymorohcitis
Fornier gangrene
Torsion
Trauma
Tumour
Treatment of epididymorchitis
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
Epididymorchitis follow up
Std Avoid unprotected sexual intercourse until completed treatment
What is priapism
Defined as involuntary, painful, sustained erection of the penis that is not associated with sexual desire
>4 hr
2 types of priapism
Ischaemia - low flow, venooclusive
Non ischaemic priapism - high flow or arterial priapism
Age of priapism
5-10 years
20-40 years
What is the cause of priapism
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
What is the major neurotransmitter leading to erection in priapism
Nitric oxide
Causes of priapism
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
Complications
Erectile dysfunction due to fibrosis
Impotence
Rarely ischaemia gangrene
Occasionally urinary retention
