Urology Emergencies Flashcards
What is urine retention
Patient is unable to void even though bladder is distended with urine
Type of urine retention
Acute
Chronic
Acute on chronic
What is acute retention of urine
Sudden over distention of bladder associated with severe lower abdominal pain and less than 1L urine
Chronic retention of urine definition
Gradual bladder distension over months with little or no pain
Associated with dribbling or overflow incontinence
More than 1L liquid drained
Presentation of acute on chronic urine retention
More than 1L liquid drained
Pain
Due to infections , calculus
Signs of acute retention
Tenderness
Hypogastric mass
Signs of chronic retention
Dribbling
Non tender bladder
Can be felt up to the umbilicus or not at all
Urgent relief with urine Foley catheter
Suprapubic cystostomy with needle puncture/aspiration to relieve pain
Type of suprapubic cystostomy
Open
Blind with trocar and cannula (5cm above pubic symphysis )
When is blind suprapubic cystostomy considered
After failed urethral catheterization
When is formal suprapubic cystostomy considered
In patients with precious surgical scars to reduce risk of bowel injury
What is clot retention
Accumulation of blood clots in urinary bladder associated with hematuria and clotting
Treatment of clot retention
Urethral catheterization
Does hematuria requires catheterization
No , rather serial urine collection
Investigation of chronic retention
Urgent BUE , Cr
Ultrasound scan of bladder and kidneys
Management of chronic retention
Relief ( should expect post obstructive diuresis /hematuria)
Fluid and electrolyte replacement therapy
Definitive management is surgical
What is testicular torsion
Twist of spermatic cord with strangulation of blood supply to the testis and epididymis
Testicular torsion peak age
10-30 years
Symptoms of testicular torsion
Severe pain in hemiscrotum
Radiation to groin ,flank , epigastrium
Nausea
Vomiting
Signs of testicular torsion
Testis moderately swollen , tender, high riding
Lie horizontally in Bell clapper anomaly
Cremasteric reflex absent
No relief by elevating testis
Differential diagnosis of testicular torsion
Epididymo-orchitis
Strangulated hernia
Referred pain form ureteric colic
Investigation in testicular torsion
Urgent exploration
Ultrasound
Lands done
Complications in testicular torsion in case of delay
Orchidopathy
Permanent ischemic damage to testis
testicular atrophy
Loss of hormone and sperm production
Subsequent infertility
Management of testicular torsion
Detorsion
Orchidopexy
What is paraphimosis
Uncircumcised foreskin retracted under glans penis and foreskin becomes Edematous and cannot be pulled back over glans
Symptoms of paraphimosis
Pain
Treatment of paraphimosis
Initial - forceful squeezing of Edematous prepuce for several minutes
Surgery if persistent with dorsal longitudinal slit
Circumcision last resort
What is phimosis
the inability to retract the skin (foreskin or prepuce) covering the head (glans) of the penis.
Common causes of bilateral ureteric obstruction
Calculi
Ureteric ligation
Tumour obstruction
Treatment of bilateral ureteric obstruction
Hemodialysis to treat life threatening hyperkalemia , pulmonary edema
Bilateral percutaneous nephrostomy
Antegrade ureteric stenting for calculi
Underlying cause treatment
Main dx associated with spinal cord compression
Prostate ca
Complications of Spinal cord compression
Paraplegia
Autonomic dysfunction
Symptoms of spinal cord compression
Back pain
Lower limb weakness
Investigations in spinal cord compression
Radioactive bone scan
Spinal MRI
Treatment of spinal cord compression
High dose steroids
Prostate ca - emergency androgens deprivation therapy
Spinal radiotherapy
Neurosurgical decompression
What is priaprism
Prolonged and painful erection in absence of sexual stimulus more than 4-6h which affects corpus carvenosa
Classifications of Priaprism.
Low flow - more common
High flow
Cause of low flow Priaprism
Ischemic in veno occlusion with painful rigid erection
Investigation of priaprism
Blood gas analysis - hypoxia and acidosis in low flow
Blood gas similar to arterial blood in high flow
Main cause of high flow priaprism and presentation
Post traumatic
Semi rigid painless erection
Common cause of low flow priaprism
SCD
Hemoglobinopathies
Drugs
Herbal medications
Treatment of low flow priaprism
Corporeal aspiration and intracarvenosal injection
Underlying cause treatment
Glanular- carvenosal shunt in intractable cases
Treatment of high flow priaprism
Selective arteriography and Embolization
Pyonephrosis
Closed renal Infection of collecting system with distal obstruction
Symptoms of pyonephrosis
Flank pain, renal angle tenderness
Common causes of pyonephrosis
Calculus
Ureteric ligation
Tumour
Treatment of pyonephrosis
Percutaneous nephrostomy
Treat underlying cause
