Urological Emergencies

Question 1

Acute urinary retention

(Gradual or Sudden?) ____________

Answer 1

Sudden inability to micturate

Question 2

Acute urinary retention is always painful

T/F

Answer 2

F

Invariably but not always painful

Question 3

Painless Acute urinary retention are associated with ?

Answer 3

CNS pathology

Question 4

Epidemiology of AUR

___% of all men in their 7th decade

___% of all men in their 8th decade

Answer 4

10

33

Question 5

Chronic urinary retention is invariably (painful or painless?)

Answer 5

Painless

Question 6

Acute on chronic retention can occur in ____,_____,______, etc

Answer 6

BPH
CA-P
strictures

Question 7

Clinical evaluation of CUR patient

DRE is unreliable in ________

Answer 7

Full bladder

Question 8

Problems of urethral catheterization

•risk of urethral _______, which can lead to _____ and _____
•increased risk of _______
•increased patient discomfort

Answer 8

Trauma; bleeding; strictures

UTIs

Question 9

Management of urinary retention

_______ catheterization
__________ catheterization

Answer 9

Urethral

Suprapubic

Question 10

Suprapubic catheterization

Can be :
-) _________ cystostomy
-) __________ cystostomy

Answer 10

Cystofix

Open

Question 11

Suprapubic catheterization is the only reasonable option in ______ structures and acute _________

Answer 11

Tight; prostatitis

Question 12

Problems of Suprapubic catheterization

• requires ____________
  -potential risk of ———— in untrained hands

Answer 12

Higher level of training

Bowel injury

Question 13

Advantages of Suprapubic catheterization

-)reduced risk of _____
-)improved ____________
-)no risk of __________ or _______
-)_____________ can be tried

Answer 13

UTI

patient comfort

urethral damage or stricture

trial of micturition

Question 14

Complications After Relieve of Acute on Chronic Retention

Post obstructive diuresis
-output is >_____mls/hr for ____hours
-______ damage and impaired nephron’s ability to __________
-hypovolaemia, reduced electrolytes

Answer 14

200; 2

tubular; concentrate urine

Question 15

Post obstructive diuresis

Risk factors

Increased _______, _________ , ______ kidney, post void volume > ______ .

Admit and offer IVF to correct fluid and electroyte imbalance.

Answer 15

Blood pressure

renal failure; solitary

IL

Question 16

After relieve of acute on chronic retention, Most pts will exhibit diuress

T/F

Answer 16

F

Most pts will not exhibit diuress

Question 17

Age Specific Haematuria

_______- 25 yrs
________- 30
_______-35
_______-45
_________- 50

Answer 17

Schistosomia

Trauma

UTI

Calculi

Tumors

Question 18

CLINICAL FEATURES of hematuria

Pain - Painless haematuria highly suggestive of ____________.
Pain - _________,_______

Answer 18

malignant disease

Inflammation, stones

Question 19

Hematuria :Duration

• Short hx - _______ ,________

-Long (months / years) - _______,________,___________ etc.

Answer 19

Tumor , acute infections

TB, Calculi, hydronephrosis

Question 20

Most cases of gross haematuria are self limiting.

T/F

Answer 20

T

Question 21

Treatment of hematuria

• Can patient empty bladder? - If not - _________ with __________
  and flush to ________

If there’s Continued clot formation or significant haematuria, use a _________ catheter and start continuous ________.

Answer 21

catheterize

haematuric catheter

evacuate clot.

3 way Foley ; irrigation

Question 22

Massive Haematuria - Haematuria
severe enough to threaten the patients with the risk of severe __________

Answer 22

hypovolaemia

Question 23

Intractable Haematuria -______,_______ haematuria, which fails to respond to ___________ treatment.

Invariably from ________,_______, or _____

_________- main culprit

Answer 23

Severe, persistent

conservative

kidney or bladder or prostatic urethra

Bladder

Question 24

Haematuria most times self limiting.

T/F

Answer 24

T

Question 25

First episode of haematuria gives best chance of early diagnosis and cure of malignant disease. T/F

Answer 25

T

Question 26

Degree of haematuria correlates with severity of underlying problem in early cases.

Answer 26

F It does not

Question 27

_________ + ________ + ___________ = RCC.

Answer 27

Haematuria Loin mass loin pain

Question 28

Painless haematuria - _________ disease until proved otherwise.

Answer 28

Malignant

Question 29

All patients (with few exceptions) having hematuria should have an ______ or _____ + ____________.

Answer 29

IVU USS cystoscopy

Question 30

In Bladder injuries - _________ is mandatory.

Answer 30

catheterisation

Question 31

If urethral injury suspected - Avoid urethral catheterization because it can convert _________ into a —————

Answer 31

partial rupture complete one.

Question 32

In a normal Capacity bladder, Sensation of Pain occurs when the volume exceeds a. 150mls d. 400mls b. 200mls C. 300mls e. 500mls

Answer 32

E

Question 33

The drugs known to precipitate Acute Urinary Retention (AUR) include: b. ___________ c. _________ d. _____________ e. ________

Answer 33

Diuretics Prazosin Alfuzosin Probanthilin

Question 34

Causes of Acute Urinary Retention (AUR) in women include: a. ________ c. ______________ uterus e. Psychogenic

Answer 34

Cystitis Retroverted gravid

Question 35

Likely causes of AUR include a. Benign Prostatic hyperplasia (BPH) b. Urethral stricture disease c. Prostatic carcinoma d. Bilateral ureteric stones e. Tumors involving the bladder fundus.

Answer 35

A B C

Question 36

Acute Urinary Retention can be defined as: (a)Inability to pass urine despite the urge to void b)Inability to pass urine despite the presence of a full bladder. c) Anuria (d)Oliguria (e)All of the above

Answer 36

B

Question 37

The following drugs are known to precipitate AUR a. Morphin b. Probanthilin c. Diuretics d. Prazosin e. Alfuzosin

Answer 37

B C D E

Question 38

Causes of AUR in women include a. Cystitis b. Urethral Stricture c. Retroverted gravid uterus d. Carbuncle e. Psychogenic

Answer 38

A B C

Question 39

AUR IS (a)Commonly associated with CUR (b) Always painful (c) Usually of short duration of onset (d)Almost invariably associated with a palpable bladder (e)The commonest urologic disorder presenting to the emergency room.

Answer 39

C

Question 40

Urethral stricture • _______ age group • Previous history of ______,______, or _______ – few weeks or ____ yrs before presentation • Previous LUTS may be absent. • Poor stream (improved or not improved?) by straining • Post STI- ________ urethra and (short or long?) • Post catheterisation strictures rising •______/______ tests are mandatory • Treatment is __________

Answer 40

Any trauma,STI,instrumentation; 20 Improved anterior; long RUCG\MCUG urethroplasty

Question 41

TRAUMA • Now a major cause of AUR • Usually occurs in ____________ • AUR usually associated with ______ at external meatus • AUR more common with _________ urethral trauma • Pelvic fracture- ________ urethra •saddle- ________ urethra

Answer 41

young male adults blood ; posterior posterior; anterior

Question 42

•_________ attempt(s) at passage of a well lubricated urethral catheter permitted

Answer 42

A single

Question 43

______________________ (SPC) is the safest

Answer 43

Suprapubic cystosomy

Question 44

IMPORTANT MESSAGES Avoid ______________ Always use an ____________________ gel.

Answer 44

suprapubic tap anaesthetic lubricating

Question 45

______________ is scientifically a better option than urethral catherization for an indwelling catheter

Answer 45

Suprapubic cystostomy

Question 46

Always observe patient for at least ____________ after relieve of obstruction

Answer 46

few hours

Question 47

IMPORTANT MESSAGES ____________ Antibiotics – Controversial Replacement of Indwelling Catheter- ________-__________ Clean intermittent Catheterization.

Answer 47

Prophylactic 2-4 weeks-3months.

Question 48

Commonest causes Of hematuria in Lagos – ______,______,______,_______,________ ________ - rare Tumors can arise at any age

Answer 48

Trauma, Tumors, BPH,Stones, SCD Infection

Question 49

Painless haematuria highly suggestive of ______________ Painful hematuria– ________,_________

Answer 49

malignant disease. Inflammation, stones

Question 50

Short history of hematuria- ______,_______ Long (months / years) history of hematuria – _______,________, hydronephrosis etc.

Answer 50

Tumor, acute infections TB, Calculi

Question 51

Haematuria in Renal trauma • Can be absent in ______ of vascular pedicle • When persistent and life threatening is an indication for _______ and _____ • .conservativeTx involves absolute _______ until urine is completely clear • _________ injury is an indication for surgery • .most injuries are _______ and _______

Answer 51

avulsion CT and surgery bed rest; Penetrating blunt and minor

Question 52

Prostatic origin of hematuria • ______ commonest • May be severe • Will respond to __________ • Do __________ in non responsive cases • Cystoscopic clot evacuation with Elliks evacuator • Place for emergency _________ and _______________

Answer 52

Bph bladder irrigation Diathermy fulguration prostatectomy 5 alpha reductase inhibitor