Urology problems Flashcards
What is acute urinary retention?
complication of BPH
unable to urinate with increasing pain
What is the cause fo acute urinary retention?
largely unknown - prostate infection, bladder overdistention, excessive fluid intake, alcohol, prostatic infection
What are the two types of acute urinary retention?
precipitated or spontaneous
What is precipitated acute urinary retention?
due to a trigger - non prostate surgery, catheterisation, urethral instrumentation, medication (with sympathomimetic or anti cholengeric effects), anaesthesia
What is the treatment for acute urinary retention?
catheter
alpha blockers
What is post obstructive diuresis?
chronic bladder outflow obstruction in association with uraemia, oedema, CCF and hypertension
retained urea, sodium and water and a defect in the concentrating ability of the kidneys
How is post obstructive diuresis treated?
monitor - should self resolve in 24-48 hours
if not - IV fluid and Na replacement
How are small stones that are expected to pass treated?
alpha blocker (tramsulosin)
What are the spontaneous passage rates depending on size?
<4mm = 80% 4-6mm = 59% >6mm = 1%
When should you treat calculi urgently?
pain unrelieved
pyrexial
persistant nausea/vomiting
How are calculi removed?
ureteric stent
stone fragmentation
if infection - percutaneous nephrostomy
How does torsion of the spermatic cord present?
pubertal age can occur due to trauma or athletic activity nausea/vomiting sudden pain previous episodes of slight pain referral of pain to lower abdomen
What would be seen on examination of a torsion of the spermatic cord?
testis high in the scrotum
transverse lie
absence of cremasteric reflex
How is torsion of the spermatic cord investigated?
doppler ultrasound - shows blood flow
How is torsion of the spermatic cord treated?
2-3 point fixation with fine non absorbable sutures
if necrotic - remove
How does torsion of the appendage present?
blue dot sign
testes mobile and cremasteric reflec present
resolves spontaneously
What is epididymitis?
normally presents in younger men
dysuria/pyrexia
history of UTI, urethritis, catheterisation/instrumentation
What are the examination findings for epididymitis?
cremasteric reflex present
pyuria
on doppler - swollen epididymis, increased blood flow
send uring for culture and chlamidiyal PCR
What is the treatment for epididymitis?
analgesia and scrotal support
ofloxacin 400mg/day for 14 days
What is paraphimosis?
painful swelling of the foreskin distal to the phimotic ring - retracted and cannot come back forward
What is the treatment for paraphimosis?
iced glove, granulated sugar
multiple punctures in oedematous skin
dorsal slit
compression of glans
What is a priapism?
prolonged erection > 4hrs not associated with arousal
What can cause priapism?
intracorpeal injectiosn for ED trauma haematologic dycrasias neurological conditions idiopathic
What are the two classifications of priapism?
ischaemic
non ischaemic
Describe ischaemic priapism?
vascular stasis in the penis meaning blood can flow in but not out - compartment syndrome
corpora cevernosa are rigid and tender and the penis is often painful
Describe non ishcaemic priapism?
high flow - traumatic distruption of penile vasculature results in unregulated blood entry and filling of. the corpora
fistulas can form between the cavernous artery and lacunar spaces which allows blood to bypass the normal helicene arteriolar bed
How is priapisms investigated?
aspirate blood from the corpus cavernous (dark blood, low O2 and high CO2 in low flow), normal in high flow
colour duplex - minimal flow in low flow, normal/high flow in high flow
What is the treatment of ischaemic priapisms?
aspiration and irrigation with saline
inject with alpha agonist
surgical shunt
What is the treatment for non ischaemic priapisms?
may resolve spontaneously
What is fourniers gangrene?
form of necrotising facitis affecting the male genitalia
What are the risk factors for fourniers gangrene?
diabetes
local trauma
periurethral invasion
perianal invasion
How does fourniers gangrene present?
starts as cellulitis - swollen, erythematous, tender
marked pain, fever and systemic toxicity
swelling and crepitus of the scrotum
How is fourniers gangrene investigated?
Xray or USS
What is the treatment of fourniers gangrene?
antibiotics and surgical debridement
What is emphysematous pyelonephritis?
an emergency!
acute necrotising parenchymal and perirenal infection caused by gas forming uropathogens
What can predispose to emphysematous pyelonephritis?
diabetes and ureteric obstruction
What is the presentation of emphysematous pyelonephritis?
fever
vomiting
flank pain
What can diagnose emphysematous pyelonephritis?
abdo xray to see gas
CT shows the extent of the erythematous process
What is the treatment of emphysematous pyelonephritis?
nephrectomy
What is a perinephric abscess?
usually due to a rupture of an acute cortical abscess into the perinephric space or from heamatogneous seeding from site of infection
What is the presentation of a perinephric abscess?
flank mass insidious onset increased WCC increased serum creatinine pyuria
How are peirnephric abscesses investigated?
CT
What is the treatment for perinephric abscesses?
antibiotics
percutaneous or surgical drainage
What are bladder injuries most commonly associated with?
pelvic fracture
What is the presentation of bladder injuries?
suprapubic/abdo pain inability to void tenderness abdo bruising guarding/rigidity deminished bowel sounds
How are bladder injuries investigated?
CT cystography
What is the sign of an extraperitoneal injury?
flame shaped contrast in pelvis
What is the treatment of bladder injury?
large bore cannula
antibiotics
What is an urethral injury associated with?
fracture of pubic rami - bulbomembranous junction is the most vulnerable part
What are the examination findings of a urethral injury?
blood at meatus inability to urinate palpably full bladder high riding prostate butterfly perineal haematoma
What are the investigations done for urethral injuries?
retrograde urethrogram
How are urethral injuries treated?
suprapubic catheter
