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urological emergencies Flashcards

(56 cards)

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1
Q

what is acute urinary retention a complication of

A

BPH

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2
Q

what is acute urinary retention

A

inability to urinate with increasing pain

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3
Q

what can cause precipitated acute urinary retention

A
  • non prostate related surgery
  • catheterization or urethral instrumentation
  • anaesthesia
  • meds with sympathomimetic or anticholinergic effects
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4
Q

treatment for acute urinary retention

A

if painful with <1litre residue and normal serum electrolytes then trial without catheter
-alphablockers before TWOC improves chances of success

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5
Q

who usually gets post-obstructive diuresis

A

patients with chronic bladder outflow obstruction in association with uraemia, oedema, CCF, hypertension

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6
Q

what could acute loin pain be

A

urinary tract or AAA for example

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7
Q

what causes the loin pain in ureteric colic

A

prostaglandins released by ureter in response to obstruction

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8
Q

treatment for acute loin pain

A

NSAID +/- opiate

-alpha blocker for small stones that are expected to pass

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9
Q

indications to treat a ureteric colic urgently

A
  • pain unrelieved
  • pyrexia
  • persistent nausea/vomiting
  • renal impairment
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10
Q

urgent treatment of ureteric colic involves what?

A
  • ureteric stent or stone fragmentation/removal if no infection
  • percutaneous nephrostomy for infected hydronephrosis
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11
Q

treatment of clot retention causing frank haematuria

A

3 way irrigating haematuria catheter

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12
Q

investigation for frank haematuria

A
  • CT urogram/USS

- cytoscopy

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13
Q

what things could cause acute scrotum

A
  • torsion of spermatic cord
  • torsion of appendix testis
  • epididymitis
  • inguinal hernia
  • hydrocele
  • trauma
  • derm lesions
  • inflammatory vasculitis
  • tumour
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14
Q

symptoms of spermatic cord torsion

A
  • sudden onset pain
  • nausea/vomiting
  • lower abdo pain
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15
Q

what is found on examination in spermatic cord torsion

A
  • testis high in scrotum
  • transverse lie
  • absence of cremasteric reflex
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16
Q

if the testis are necrotic what do you do

A

remove them

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17
Q

presentation of torsion of appendage (penis)

A
  • localised tenderness at upper pole

- blue dot sign

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18
Q

what can cause epididymitis

A
  • UTI
  • urethritis
  • catheterisation
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19
Q

what is found on examination in epididymitis

A
  • cremasteric reflex present
  • pyuria
  • swelling and increased blood flow on doppler
  • send for urine culture and and chlamydia PCR
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20
Q

treatment for epididymitis

A

analgesia and scrotal support and bed rest

-ofloxacin 400mg/day for 14 days

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21
Q

what is paraphimosis

A

painful swelling of the foreskin distal to a phimotic ring

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22
Q

when does paraphimosis usually happen

A

after foreskin retracted for catheterization or cytoscopy and staff forget to put foreskin back in natural position

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23
Q

treatment for paraphimosis

Study These Flashcards
A

iced glove
granulated sugar for 1-2 hours
multiple punctures in oedematous skin

24
Q

what is priapism

Study These Flashcards
A

prolonged unwanted erection (>4hrs)

not associated with s3xual arousal

25
causes of priapism
- intracorporeal injection for ED - trauma - haematologic dyscriasis - neurological condition - idiopathic
26
what are the two types of priapism
ischaemic and non-ischaemic
27
what is ischaemic priapism
Vascular stasis in penis and decreased venous outflow, a true compartment syndrome. Corpora cavernosa are rigid and tender, penis often painful
28
what is non-ischaemic priapism
traumatic disruption of penile vasculature results in unregulated blood entry and filling of corpora
29
diagnosis of priapism
aspirate blood from corpus cavernosum - dark blood means low flow ischaemic - normal blood means non-ischaemic colour duplex USS - minimal flow in ischaemic - normal to high flow in non-ischaemic
30
treatment of ischaemic priapism
aspiration +/- irrigation with saline injection of alpha agonist surgical shunt
31
treatment for non-ischaemic priapism
observe | selective arterial embolisation
32
fournier's gangrene
form of necrotizing fasciitis occurring around the male genitalia
33
pre disposing factors for fournier's gangrene
- diabetes - local trauma - periurethral extravastion - perianal infection
34
presentation of fournier's gangrene
- starts as cellulitis - swelling and crepitus of scrotum, dark purple areas - marked toxicity
35
investigation for fournier's gangrene
plain x-ray or USS may confirm gas in tissues
36
treatment for fournier's gangrene
antibiotics and surgical debridement
37
what is emphysematous pyelonephritis
An acute necrotizing parenchymal and perirenal infection caused by gas-forming uropathogens, usually E coli
38
what is emphysematous pyelonephritis usually associated with
diabetes and ureteric obstruction
39
symptoms of emphysematous pyelonephritis
fever vomiting flank pain
40
what usually causes a perinephric abscess
rupture of an acute cortical abscess into the perinephric space or from haematogenous seeding from sites of infection
41
diagnosis of perinephric abscess
- high WCC - high serum creatinine - pyuria - CT
42
treatment fo perinephric abscess
antibiotics and percutaneous or surgical drainage
43
class 1 renal trauma
44
class II renal trauma
45
class III renal trauma
46
class IV renal trauma
47
class V renal trauma
48
different classes of renal trauma
49
indications for imaging in terms of haematuria
- Frank haematuria in adult - Frank or occult haematuria in child - Occult haematuria + (systolic <90mmHg at any point) - Penetrating injury with any degree of haematuria
50
presentation of a bladder injury
- suprapubic tenderness - lower abdo bruising - guarding/rigidity - diminished bowel sounds
51
diagnosis of extraperitoneal injury
flame-shaped collection of contrast in pelvis
52
what would urethral injury be like on examination
- blood at meatus - inability to urinate - palpably full bladder - high riding prostate - butterfly perineal haematoma
53
investigations for urethral injury
retrograde urethrogram
54
treatment for urethral injury
suprapubic catheter
55
presentation of a penile fracture
- cracking or popping sound - pain - rapid detumescence - discolouration - swelling
56
treatment for penile fracture
circumcision incision with degloving of penis to expose all 3 compartments

renal (28 decks)

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