Urology Flashcards
What is the most likely organism in a post prostat biopsy infection?
What antibiotic will you use
E.Coli for urosepsis
IV gent and Amoxicillin
How may US help in urosepsis?
IVC filling?
cannula
cardiac function
hydronephrosis
Risk factors for fourniers
DM
alcoholism
obestiy
cirrhosis
malignancy
Immunosuppresion
left sided abdo pain
diagnosis and thy
left small VUJ stone with hydronephrosis
fat stranding around kidney
enlarged ureter
stone evident
with renal stones what are the two main investigtations and why (excluding CT for diagnosing)
bloods - to see for infection or impaired renal function
urine dip - ?infection
what are the criteria for discharge of renal stone
eating and drinking
pain under control
no infection
FU planned
swollen left tender testicle
investigations and why
Most likely diagnosis
- urine disptick - ?infection
- urine PCR - STD
- renal function - ?impaired also for abx (gent)
- US - ?abscess
Epidydymoorchitis
what are the indications for admission in epidydymoorchitis
- Septic
- pain not controlled
- complications eg abscess
- social eg homeless
- unable to arrange adequate FU
abx treatment for epididymoorchitis
trimethoprin 300mg nocte 7/7
ceftrixone 500mg IM
2 week apart azithro doses - 500mg oral
What are the complications of priapism
erectile dysfunction
disfigurement of the penis
what is the role of cavernosal gas in priapism?
ischamic v non ischamic because ischaemic needs urgent drainage.
Cut of is PH 7.25
what ix may you do in priapism other than cavernosum gas
- FBC/blood film for causes eg malaria thallasemia
- biochem - causes eg gout diabetes
- doppler for ischaemic v non ischaemic
what is the emergency management of priapism?
- Ice blocks and local pressure
- analgesia
- aspirate 50ml blood from each corpus cavernosum
- +/ inject adrenaline and apply pressure
- consult urology
what are the common causes of priapism
- Drugs - sildenafil, prazocin
- Haem - malaria, sickle cell, CML
- Neurogenic- spinal cord injury, redback spider bite
what are the two key factors in determining outcome of priapism
ischaemic v non ischaemic
duration - risk of impotence starts at 4 hours, 100% by 72 hours
left loin pain and haematuria
what are the immediate management priorities for testicular torsion
analgesia
uro consult or urgent transfer for exploration
NBM
2 year old
list two abnormalities and diagnosis
paraphymosis
oedematous foreskin
engorged glans with high risk of ischaemia
what are the methods for foreskin reduction in paraphymosis
- manual traction - circumfrential pressure and distal pulling ?sugar to act as osmotic agent
- aspiration via block
- surgical - dorsal slit
how do you do a penile block in paraphymosis
- Consent
- Sterile technique
- Local anaesthetic: Bupivicaine 0.25% 0.1ml/kg
- Injection site:
o Dorsal nerves of penis
o Pull penis downwards
o Inject perpendicular to the skin at 10 & 1 - 0.5-1cm lateral to and
caudal to the pubic symphysis.
diagnosis
urinary retention
causes of urinary retention from different catagories
- infective - UTI
- medication - anticholinergic
- neurological - cauda equina
- structural - BPH
- iatrogenic - blocked cathter
how is urinary retention diagnosed
difficulty voiding and over 300ml in bladder
what are the steps in inserting SPC
Confirm and bladder position with bedside US
* Position supine / Prep and drape / sterile gloves
* Infiltrate local anaesthesia 2cm above pubic symphysis
o insert needle until aspirate urine
o direction ~perpendicular (more cephalad in children, more caudal in adults
* Core steps
o Needle to bladder / introduce wire / scalpel to skin / dilator / catheter / split away
sheath
o Scalpel incision / firm pressure into bladder with trocar, remove trochar / insert
catheter / split away sheath
* Post-procedure: Attach collection bag / dress skin / cares and follow up organised
