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1. Renal > Urology problems > Flashcards

Urology problems Flashcards

1
Q

What is acute urinary retention?

A

complication of BPH

unable to urinate with increasing pain

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2
Q

What is the cause fo acute urinary retention?

A

largely unknown - prostate infection, bladder overdistention, excessive fluid intake, alcohol, prostatic infection

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3
Q

What are the two types of acute urinary retention?

A

precipitated or spontaneous

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4
Q

What is precipitated acute urinary retention?

A

due to a trigger - non prostate surgery, catheterisation, urethral instrumentation, medication (with sympathomimetic or anti cholengeric effects), anaesthesia

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5
Q

What is the treatment for acute urinary retention?

A

catheter

alpha blockers

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6
Q

What is post obstructive diuresis?

A

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

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7
Q

How is post obstructive diuresis treated?

A

monitor - should self resolve in 24-48 hours

if not - IV fluid and Na replacement

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8
Q

How are small stones that are expected to pass treated?

A

alpha blocker (tramsulosin)

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9
Q

What are the spontaneous passage rates depending on size?

A 
<4mm = 80%
4-6mm = 59%
>6mm = 1%
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10
Q

When should you treat calculi urgently?

A

pain unrelieved
pyrexial
persistant nausea/vomiting

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11
Q

How are calculi removed?

A

ureteric stent
stone fragmentation
if infection - percutaneous nephrostomy

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12
Q

How does torsion of the spermatic cord present?

A 
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
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13
Q

What would be seen on examination of a torsion of the spermatic cord?

A

testis high in the scrotum
transverse lie
absence of cremasteric reflex

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14
Q

How is torsion of the spermatic cord investigated?

A

doppler ultrasound - shows blood flow

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15
Q

How is torsion of the spermatic cord treated?

A

2-3 point fixation with fine non absorbable sutures

if necrotic - remove

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16
Q

How does torsion of the appendage present?

A

blue dot sign
testes mobile and cremasteric reflec present
resolves spontaneously

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17
Q

What is epididymitis?

A

normally presents in younger men
dysuria/pyrexia
history of UTI, urethritis, catheterisation/instrumentation

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18
Q

What are the examination findings for epididymitis?

A

cremasteric reflex present
pyuria
on doppler - swollen epididymis, increased blood flow
send uring for culture and chlamidiyal PCR

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19
Q

What is the treatment for epididymitis?

A

analgesia and scrotal support

ofloxacin 400mg/day for 14 days

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20
Q

What is paraphimosis?

A

painful swelling of the foreskin distal to the phimotic ring - retracted and cannot come back forward

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21
Q

What is the treatment for paraphimosis?

A

iced glove, granulated sugar
multiple punctures in oedematous skin
dorsal slit
compression of glans

22
Q

What is a priapism?

A

prolonged erection > 4hrs not associated with arousal

23
Q

What can cause priapism?

A 
intracorpeal injectiosn for ED
trauma
haematologic dycrasias
neurological conditions
idiopathic
24
Q

What are the two classifications of priapism?

A

ischaemic

non ischaemic

25
Q

Describe ischaemic priapism?

A

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

26
Q

Describe non ishcaemic priapism?

A

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

27
Q

How is priapisms investigated?

A

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

28
Q

What is the treatment of ischaemic priapisms?

A

aspiration and irrigation with saline
inject with alpha agonist
surgical shunt

29
Q

What is the treatment for non ischaemic priapisms?

A

may resolve spontaneously

30
Q

What is fourniers gangrene?

A

form of necrotising facitis affecting the male genitalia

31
Q

What are the risk factors for fourniers gangrene?

A

diabetes
local trauma
periurethral invasion
perianal invasion

32
Q

How does fourniers gangrene present?

A

starts as cellulitis - swollen, erythematous, tender
marked pain, fever and systemic toxicity
swelling and crepitus of the scrotum

33
Q

How is fourniers gangrene investigated?

A

Xray or USS

34
Q

What is the treatment of fourniers gangrene?

A

antibiotics and surgical debridement

35
Q

What is emphysematous pyelonephritis?

A

an emergency!

acute necrotising parenchymal and perirenal infection caused by gas forming uropathogens

36
Q

What can predispose to emphysematous pyelonephritis?

A

diabetes and ureteric obstruction

37
Q

What is the presentation of emphysematous pyelonephritis?

A

fever
vomiting
flank pain

38
Q

What can diagnose emphysematous pyelonephritis?

A

abdo xray to see gas

CT shows the extent of the erythematous process

39
Q

What is the treatment of emphysematous pyelonephritis?

A

nephrectomy

40
Q

What is a perinephric abscess?

A

usually due to a rupture of an acute cortical abscess into the perinephric space or from heamatogneous seeding from site of infection

41
Q

What is the presentation of a perinephric abscess?

A 
flank mass
insidious onset
increased WCC 
increased serum creatinine 
pyuria
42
Q

How are peirnephric abscesses investigated?

A

CT

43
Q

What is the treatment for perinephric abscesses?

A

antibiotics

percutaneous or surgical drainage

44
Q

What are bladder injuries most commonly associated with?

A

pelvic fracture

45
Q

What is the presentation of bladder injuries?

A 
suprapubic/abdo pain 
inability to void
tenderness
abdo bruising 
guarding/rigidity
deminished bowel sounds
46
Q

How are bladder injuries investigated?

A

CT cystography

47
Q

What is the sign of an extraperitoneal injury?

A

flame shaped contrast in pelvis

48
Q

What is the treatment of bladder injury?

A

large bore cannula

antibiotics

49
Q

What is an urethral injury associated with?

A

fracture of pubic rami - bulbomembranous junction is the most vulnerable part

50
Q

What are the examination findings of a urethral injury?

A 
blood at meatus
inability to urinate
palpably full bladder
high riding prostate
butterfly perineal haematoma
51
Q

What are the investigations done for urethral injuries?

A

retrograde urethrogram

52
Q

How are urethral injuries treated?

A

suprapubic catheter

1. Renal (28 decks)

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