A/8. Urological emergency Flashcards
Total urinary retention def
acute onset suprapubic discomfort with the desire, but inability, to urinate
Total urinary retention etiology
More common in men due to
* BPH
* prostate cancer
* urethral stricture
* Other causes include:
*neurological disorders
*blood clot obstructing lower urinary
tract
*and infection
Total urinary retention treatment
- Perform suprapubic catheterization when trans-urethral catheterization is contraindicated.
- 3-7 days course with alpha-blockers can rapidly relief the obstruction in patients with BPH
trans-urethral catheterization is
contraindicated in?
what to do instead?
Perform suprapubic catheterization when transurethral CI
- urethral trauma
- urethral stricture
- lower urinary tract infection
how ro relief the obstruction in patients with BPH
3-7 days course with alpha-blockers can rapidly relief obstruction
terazosin (Hytrin),
doxazosin (Cardura),
tamsulosin (Flomax),
alfuzosin (Uroxatral),
and silodosin
Total urinary retention must be differenciated from
acute anuria
( Urine output < 0.5 ml/kg/h) seen with AKI
Renal colic def
acute onset abdominal pain due to kidney stone
Renal colic Symptoms
typically, pain starts in the flank and radiates around the abdomen,
and it can radiate into
the testes in men and
the labia in women
Renal colic diagnostics
- Definitive diagnosis by stone visualization with low-dose CT (1st line), US, or X-ray.
- Abdominal examination is frequently unremarkable, which may help to exclude
other differential diagnoses (acute appendicitis, peritonitis, diverticulitis,
salpingitis, ruptured AAA). - If urinalysis doesn’t show microscopic hematuria, an alternative diagnosis should
be considered.
Treatment Renal colic
Initial treatment for all patients should include
* IV fluids, analgesics, antiemetics.
* Definitive treatment is stone removal; approach guided by stone characteristics (location, size, type).
* Acute intervention is indicated in cases of ‘obstructive pyelonephritis’ -
*patient presenting with acute-onset flank pain, fever, N/V, increased inflammatory markers and
stone visible on CT.
*Treat acutely with..
-urine deviation (Double-J stent, percutaneous nephrostomy)
-antibiotics
-relieving the obstruction
-supportive
when is acute intervention indicated in which case of renal colic?
how is it treated?
in cases of ‘obstructive pyelonephritis
patient presenting with
* acute-onset flank pain
* fever
* N/V
* increased inflammatory markers
* and stone visible on CT.
*Treat acutely with..
-urine deviation (Double-J stent, percutaneous nephrostomy)
-antibiotics
-relieving the obstruction
-supportive
Testicular torsion def
results from inadequate fixation of the lower pole of the testis to the tunica vaginalis
If fixation is absent or insufficient, the testis may twist on the
spermatic cord, potentially producing ischemia from reduced arterial inflow and venous outflow obstruction.
Testicular torsion Etiology
commonly presents in males 12-18 years old;
after an inciting event (trauma,
vigorous physical activity) or spontaneously
Testicular torsion symptoms
acute, severe pain,
high-riding testis,
and absent cremasteric reflex. (Stroking of the skin causes the cremaster muscle to contract and pull up the ipsilateral testicle toward the inguinal canal.)
Testicular torsion diagnostic
- mainly clinical
- may be supported by color Doppler US in equivocal cases.
