Urology Emergencies

Question 1

What is urine retention

Answer 1

Patient is unable to void even though bladder is distended with urine

Question 2

Type of urine retention

Answer 2

Acute
Chronic
Acute on chronic

Question 3

What is acute retention of urine

Answer 3

Sudden over distention of bladder associated with severe lower abdominal pain and less than 1L urine

Question 4

Chronic retention of urine definition

Answer 4

Gradual bladder distension over months with little or no pain
Associated with dribbling or overflow incontinence
More than 1L liquid drained

Question 5

Presentation of acute on chronic urine retention

Answer 5

More than 1L liquid drained
Pain
Due to infections , calculus

Question 6

Signs of acute retention

Answer 6

Tenderness
Hypogastric mass

Question 7

Signs of chronic retention

Answer 7

Dribbling
Non tender bladder
Can be felt up to the umbilicus or not at all

Answer 8

Urgent relief with urine Foley catheter
Suprapubic cystostomy with needle puncture/aspiration to relieve pain

Question 9

Type of suprapubic cystostomy

Answer 9

Open
Blind with trocar and cannula (5cm above pubic symphysis )

Question 10

When is blind suprapubic cystostomy considered

Answer 10

After failed urethral catheterization

Question 11

When is formal suprapubic cystostomy considered

Answer 11

In patients with precious surgical scars to reduce risk of bowel injury

Question 12

What is clot retention

Answer 12

Accumulation of blood clots in urinary bladder associated with hematuria and clotting

Question 13

Treatment of clot retention

Answer 13

Urethral catheterization

Question 14

Does hematuria requires catheterization

Answer 14

No , rather serial urine collection

Question 15

Investigation of chronic retention

Answer 15

Urgent BUE , Cr
Ultrasound scan of bladder and kidneys

Question 16

Management of chronic retention

Answer 16

Relief ( should expect post obstructive diuresis /hematuria)
Fluid and electrolyte replacement therapy
Definitive management is surgical

Question 17

What is testicular torsion

Answer 17

Twist of spermatic cord with strangulation of blood supply to the testis and epididymis

Question 18

Testicular torsion peak age

Answer 18

10-30 years

Question 19

Symptoms of testicular torsion

Answer 19

Severe pain in hemiscrotum
Radiation to groin ,flank , epigastrium
Nausea
Vomiting

Question 20

Signs of testicular torsion

Answer 20

Testis moderately swollen , tender, high riding
Lie horizontally in Bell clapper anomaly
Cremasteric reflex absent
No relief by elevating testis

Question 21

Differential diagnosis of testicular torsion

Answer 21

Epididymo-orchitis
Strangulated hernia
Referred pain form ureteric colic

Question 22

Investigation in testicular torsion

Answer 22

Urgent exploration
Ultrasound
Lands done

Question 23

Complications in testicular torsion in case of delay

Answer 23

Orchidopathy
Permanent ischemic damage to testis
testicular atrophy
Loss of hormone and sperm production
Subsequent infertility

Question 24

Management of testicular torsion

Answer 24

Detorsion
Orchidopexy

Question 25

What is paraphimosis

Answer 25

Uncircumcised foreskin retracted under glans penis and foreskin becomes Edematous and cannot be pulled back over glans

Question 26

Symptoms of paraphimosis

Answer 26

Pain

Question 27

Treatment of paraphimosis

Answer 27

Initial - forceful squeezing of Edematous prepuce for several minutes

Surgery if persistent with dorsal longitudinal slit

Circumcision last resort

Question 28

What is phimosis

Answer 28

the inability to retract the skin (foreskin or prepuce) covering the head (glans) of the penis.

Question 29

Common causes of bilateral ureteric obstruction

Answer 29

Calculi
Ureteric ligation

Tumour obstruction

Question 30

Treatment of bilateral ureteric obstruction

Answer 30

Hemodialysis to treat life threatening hyperkalemia , pulmonary edema

Bilateral percutaneous nephrostomy
Antegrade ureteric stenting for calculi
Underlying cause treatment

Question 31

Main dx associated with spinal cord compression

Answer 31

Prostate ca

Question 32

Complications of Spinal cord compression

Answer 32

Paraplegia
Autonomic dysfunction

Question 33

Symptoms of spinal cord compression

Answer 33

Back pain
Lower limb weakness

Question 34

Investigations in spinal cord compression

Answer 34

Radioactive bone scan
Spinal MRI

Question 35

Treatment of spinal cord compression

Answer 35

High dose steroids
Prostate ca - emergency androgens deprivation therapy
Spinal radiotherapy
Neurosurgical decompression

Question 36

What is priaprism

Answer 36

Prolonged and painful erection in absence of sexual stimulus more than 4-6h which affects corpus carvenosa

Question 37

Classifications of Priaprism.

Answer 37

Low flow - more common
High flow

Question 38

Cause of low flow Priaprism

Answer 38

Ischemic in veno occlusion with painful rigid erection

Question 39

Investigation of priaprism

Answer 39

Blood gas analysis - hypoxia and acidosis in low flow
Blood gas similar to arterial blood in high flow

Question 40

Main cause of high flow priaprism and presentation

Answer 40

Post traumatic
Semi rigid painless erection

Question 41

Common cause of low flow priaprism

Answer 41

SCD
Hemoglobinopathies
Drugs
Herbal medications

Question 42

Treatment of low flow priaprism

Answer 42

Corporeal aspiration and intracarvenosal injection
Underlying cause treatment
Glanular- carvenosal shunt in intractable cases

Question 43

Treatment of high flow priaprism

Answer 43

Selective arteriography and Embolization

Question 44

Pyonephrosis

Answer 44

Closed renal Infection of collecting system with distal obstruction

Question 45

Symptoms of pyonephrosis

Answer 45

Flank pain, renal angle tenderness

Question 46

Common causes of pyonephrosis

Answer 46

Calculus
Ureteric ligation
Tumour

Question 47

Treatment of pyonephrosis

Answer 47

Percutaneous nephrostomy
Treat underlying cause