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Urology > Urologic Emergencies > Flashcards

Urologic Emergencies Flashcards

(58 cards)

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1
Q

Top 10 Urologic Emergencies

A 
Renal trauma
Penile fracture
Testis rupture
Bladder rupture
Urethral disruption
Acute urinary retention
Priapism
Acute ureteral obstruction
Fournier's Gangrene
Testis torsion
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2
Q

When should you use a CT with contrast for renal trauma?

A

Blunt trauma with gross hematuria or micro-hematuria with chock
Penetrating trauma with hematuria
Pediatric trauma with micro-hematuria

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3
Q

Management of Renal Trauma

A

Most managed conservatively
+/- stent
+/- embolization
+/- percutaneous drain or nephrostomy tube

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4
Q

Indications for Surgical Intervention

A

Life threatening hemorrhage
Continued bleeding
Exploration for other injuries reveals expanding peritoneal hematoma
Repair or remove kidney

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5
Q

Causes of Penile Fracture

A 
Aggressive intercourse
Off target penetration
Masturbation
Falling out of bed
Scored lover
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6
Q

Diagnosis of Penile Fracture

A

Audible snap
Sudden detumesce
Swelling
Bruising

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7
Q

Conservative Management of Penile Fracture

A

Erectile dysfunction
Curvature
Painful erections

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8
Q

Surgical Treatment of Penile Fracture

A

Deglove penis
Rule out urethral injury
Close corporal tear

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9
Q

Causes of Testis Rupture

A 
Blunt or penetrating trauma
Straddle
Saddle horn
Bar fight
Kick
Drug deal gone bad
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10
Q

Exam for Testis Rupture

A

Scrotal swelling

Echymosis

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11
Q

Testis Rupture & Scrotal Ultrasound

A

Loss of tunic continuity
Internal echos
Heterogenecity

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12
Q

Management of Testis Rupture

A

Surgery to debride extruded tissue & close tunic
Early: salvage
late: orchiectomy

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13
Q

Bladder Rupture

A 
Blunt >> Penetrating
60% extraperitoneal
30% intraperitoneal
10% combined
Hematuria always present
90% have pelvic fractures
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14
Q

Causes of Intraperitoneal Bladder Rupture

A

External blow, full bladder

MVA

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15
Q

Diagnosing Intraperitoneal Bladder Rupture

A

CT or Cystogram

Contrast around bowel & above superior acetabular line

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16
Q

Management of Intraperitoneal Bladder Rupture

A

Surgical repair

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17
Q

Causes of Extraperitoneal

A

Blunt trauma with pelvic fracture

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18
Q

Diagnosing Extraperitoneal Bladder Rupture

A

CT or cystogram
Contrast limited to pelvis, perineum, or genitalia
Starburst pattern of contrast below superior acetabular line

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19
Q

Management of Extraperitoneal Bladder Rupture

A

Catheter drainage

Surgical repair IF repairing something else

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20
Q

Cause Urethral Disruption

A

Blunt or penetrating trauma

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21
Q

Signs/Symptoms of Urethral Disruption

A

Blood at meatus
Distended bladder
Genital swelling & hematoma

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22
Q

Diagnosis of Urethral Disruption

A

Retrograde Urethrogram (RUG)

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23
Q

Incomplete Urethral Disruption Diagnosis

A

RUG shows contrast extravasation but with contrast into bladder

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24
Q

Management of incomplete Urethral Disruption

Study These Flashcards
A

Catheter drainage

25
Complete Urethral Disruption Diagnosis
RUG shows contrast extravasation without contrast into bladder
26
Management of Complete Urethral Disruption
Suprapubic tube with early primary realignment or delayed reconstruction
27
Define Acute Urinary Retention
Sudden, unexpected, painful inability to void
28
Causes of Acute Urinary Retention
``` PBH Urethral stricture Blood clots in urethra Stone in urethra Drugs: antihistamines, narcotics, alpha adrenergics Post op Overdistension ```
29
Management of Acute Urinary Retention
``` Urethral catheter Suprapubic tube Suprapubic aspiration Watch for hematuria Post obstructive diuresis uncommon ```
30
Define Priapism
Painful, prolonged (>4 hours) erection
31
Ischemic Priapism
Low flow, most common Compartment syndrome Multiple causes
32
Causes of Ischemic Priapism
Drugs: intracavernosal injections, trazadone, cocaine, PDE5 inhibitors Sickle cell disease Blood dycrasias (leukemia) Idiopathic
33
Non Ischemic Priapism
High flow due to AV fistula | Usually due to trauma
34
Treatment of Priapism
Phenylephrine + 1:100,000 epinephrine solution | Surgical: Winter & Al Ghorab shunt
35
Diagnosis of Acute Ureteral Obstruction
``` Flank and/or abdominal pain: colicky, cramping Pain radiating to groin N/V UA Noncontrast abdominal/pelvic CT ```
36
UA in Acute Ureteral Obstruction
Hematuria Pyre with epithelial Without nitrites Bacteria suggests contamination
37
Etiologies of Acute Ureteral Obstruction
``` Stones Clot Retroperineal fibrosis Surgical mishap Bladder outlet obstruction Malignancy: ureter, RP nodes, adjacent organs ```
38
Emergent Acute Ureteral Obstruction
Solitary kidney Bilateral obstruction Association infection: fever, chills, high WBC, pyuria, bacteria, hypotension, tachycardia
39
Non-Emergent Acute Ureteral Obstruction
``` Pyuria without other evidence of infection Hydronephrosis Perinephric fluid (urine) Hematuria Mildly increased creatinine ```
40
Emergent Management of Acute Ureteral Obstruction
Ureteral stent Nephostomy tube Stone removal with ureteroscopy (no infection present)
41
Ureteral stent
Requires surgery, anesthesia Convenient but painful Flomax reduces symptoms
42
Nephrostomy Tube
Provides reliable, unequivocal drainage More comfortable Invasive & inconvenient
43
Non-emergent Management of Acute Ureteral Obstruction
Toradol: IM P.O analgesia Tamsulosin: dilates ureter to help pass the stones
44
Define Fournier's Gangrene
Necrotizing infection of skin, fat & fascia of genitalia & perineum
45
Mortality with Fournier's Gangrene
20-30%
46
Risk Factors for Fournier's Gangrene
``` Obesity DM Immunosuppression Alcoholism Malnutrition ```
47
Diagnosis of Fournier's Gangrene
``` Pain Swelling Fever Musculoskeletal changes Tachycardia Tachypnea Erythema Edema Crepitus Fluctuance Discoloration Purulent drainage Foul odor X-ray, CT or US ```
48
Treatment of Fournier's Gangrene
Wide, aggressive debridement Broad spectrum antibiotics to cover anaerobes Post-op wound care
49
Post-op Wound Care with Fournier's Gangrene
``` Repeat debridement Dressing changes Wound vac Skin grafts, flaps HBO ```
50
Extravaginal Testis Torsion
``` Neonate with swollen, discolored scrotum Nontender, firm testis with hydrocele Cord twists above tunica vaginalis Presumed to occur in utero Salvage is rare ```
51
Intravaginal Testis Torsion
Adolescents More common Within tunica vaginalis Acute scrotal and/or ipsilateral abdominal pain Firm, tender, high riding testis with hydrocele & edema Absent cremasteric reflex
52
Differential Diagnosis of Testis Torsion
Torsion of testis appendage Epididymitis Incarcerated hernia
53
Distinguishing Torsion of Testis Appendage
Blue dog sign Tender, firm nodule Normal US
54
Distinguishing Epididymitis
Doppler US: normal testis flow, increased epididymal flow
55
Distinguishing Incarcerated Hernia
Bowel sounds in scrotum | Gas in scrotum on US or x-ray
56
Intravaginal Testicular Torsion Doppler Scrotal Ultrasound
Absence of flow is 90% sensitive, 99% specific
57
Treatment of Intravaginal Testicular Torsion
Manual detorsion Immediate exploration with detorsion & bilateral fixation Orchiectomy for non-viable testis
58
Extravaginal Testicular Torsions Treatment
Orchiectomy with contralateral fixation

Urology (12 decks)

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