304 Urology Flashcards
What is the most common urological emergency?
Acute urinary retention
What are some examples of bladder outflow obstructions (BOO’s)?
BPH
Prostate cancer
Stricture
Urethral stone
Clot retention
Pelvic organ prolapse
UTI / abscess
What are some common contractility problems that cause acute urinary retention?
Drugs
Pain
Cord compression
MS
Diabetes
Post-op
UTI
What is the treatment for acute bladder retention?
Insert catheter
- urethral
- suprapubic
Record residual volume
(MSU / blood cultures +/- antibiotics)
Admit if pain +++ / renal impairment
What is chronic urinary retention?
Patients can’t completely empty their bladder
May present with ‘acute on chronic retention’
Painless inability to void
May present with nocturnal incontinence alone
> 1L urine in bladder
What are the differences between high and low pressure urinary retention?
High Low
Painless Painless
Incontinent Dry
Raised creatinine Normal creatinine
Hydroureters / Normal ureters/
hydronephrosis kidneys
What is high pressure urinary retention?
Refers to the urinary retention causing such high intra-vesicular pressures that the anti-reflux mechanism of the bladder and ureters is overcome and ‘backs up’ into the upper renal tract leading to hydroureter and hydronephrosis, impairing the kidneys’ clearance levels
What is low pressure urinary retention?
Occurs in patients with retention with the upper renal tract unaffected due competent urethral valves or reduced detrusor muscle contractility / complete detrusor failure
Not as emergent as high pressure retention
What are some causes of haematuria?
Tumour (24% in macro, <5% in microscopic)
Infection
Trauma
Stones
What is a cystoscopy?
A procedure to look inside the bladder
What are some signs of trauma to the kidney?
Loin or abdominal bruising
Loin tenderness
Loss of loin contour
Loin mass
Macroscopic haematuria / clots
What is the management for renal trauma?
Largely conservative – bed rest, 5/7 antibiotics
More severe grades require intervention
- Surgical – nephrectomy
- Radiological – arterial embolisation
What is testicular torsion?
When a testicle rotates and twists the spermatic cord, which carries blood to the testicle
What are some differentials for scrotal pain?
-Torsion of testicle (twisting)
-Torsion of Hydatid of Morgagni / testicular appendix
-Epididymitis (where a tube (the epididymis) at the back of the testicles becomes swollen and painful)
-Orchitis (an inflammation of one or both testicles)
What are the symptoms of testicular torsion?
Twisting of spermatic cord and thus testicular artery; ischaemic pain
Causes:
Acute onset of painful testicle
Nausea / vomiting
Lower abdo pain
Horizontal lie
High lying in scrotum
