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Flashcards in Urological Emergencies Deck (22)
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1
Q

what is the treatment of Acute Urinary retention?

A

if under 1 litre is retained prescribe a uroselective alphabocker (Alfuzosin, Tamsulosin)

If large volumes cathaterize but be wary of post-obstructive diuresis. Will need fluid and salt replacement if fluid loss is over 200ml/hout

2
Q

what diagnosis outwith the urinary tract should be considered for loin pain?

A

AAA

3
Q

what is the treatment of renal stones of under 4mm?

A

NSAID +/- opiate

alpha-blocker (Tamsulosin) for small stones that are expected to pass

4
Q

what are the indications for urgent treatment of renal stones?

How are they managed?

A

Pain unrelieved

Pyrexia

Persistent nausea/vomiting

High-grade obstruction

Rx – ureteric stent or stone fragmentation/removal if no infection

percutaneous nephrostomy for infected hydronephrosis

5
Q

List causes of Frank Haematuria

A

Infection

Stones

Tumours

Benign prostatic hyperplasia (BPH)

Polycystic kidneys

Trauma

Coagulation/platelet deficiencies

6
Q

what are the investigations for clot retention?

what is the treatment?

A

Ix – CT urogram + cystoscopy

use a 3-way irrigating haematuria catheter (toflush out blood clots)

7
Q

what is the presentation of testicular torsion?

A

Most common at puberty

Can occur with trauma or athletic activity but usually spontaneous. Adolescent often woken from sleep

Usually sudden onset of pain, sometimes previous episodes of self-limiting pain

May be nausea/vomiting

May be referral of pain to lower abdomen

8
Q

what would you find on an examination of testicular torsion?

A

testis high in scrotum

transverse lie

absence of cremasteric reflex

Acute hydrocoele + oedema may obliterate landmarks

9
Q

what are the investigations and treatment of testicular torsion?

A

Ix – Doppler USS sometimes helpful

Rx – Prompt exploration. Irreversible ischaemic injury may begin as soon as 4hrs

2 or 3-point fixation with fine non-absorbable sutures

If testis necrotic then remove

MUST fix contralateral side (bell clapper deformity)

10
Q

What is the diagnosis and treatment for torsion of the appendage?

A

Symptoms variable – may be insidious onset or identical to torsion of cord

If seen early, may have localised tenderness at upper pole and “blue dot” sign

Testis should be mobile and cremasteric reflex present

If diagnosis confirmed then will resolve spontaneously without surgery

11
Q

what is the presentation of epididymitis?

A

May be difficult to distinguish from torsion

Dysuria / pyrexia more common

Pyuria

Hx of UTI, urethritis, catheterization/instrumentation

12
Q

what are the investigations and treatment of epididymitis?

A

Doppler – swollen epididymis, increased bloodflow

Send urine for culture + Chlamydia PCR

Rx Analgesia + scrotal support, bed rest

Ofloxacin 400mg/day for 14 days

13
Q

what’s the treatment of paraphimosis

A

Iced glove, granulated sugar for 1-2hrs, multiple punctures in oedematous skin

Manual compression of glans with distal traction on oedematous foreskin

Dorsal slit

14
Q

what are the 2 classifications of priapism?

A

Ischaemic (veno-occlusive or low-flow).

Vascular stasis in penis and decreased venous outflow, a true compartment syndrome.

Corpora cavernosa are rigid and tender, penis often painful

Non-ischaemic (arterial or high-flow)

Traumatic disruption of penile vasculature results in unregulated blood entry and filling of corpora.

Fistula formation between cavernous artery and lacunar spaces allows blood to by-pass the normal helicine arteriolar bed

15
Q

how do you differentiate between the 2 types of priapism?

A

Aspirate blood from corpus cavernosum – dark blood, low O2 , high CO2 in low-flow

      - normal arterial blood in high-flow

Colour duplex USS - minimal or absent flow in cavernosal arteries in low-flow

normal to high flow in non-ischaemic priapism

16
Q

treatment of priapism

A

Ischaemic Aspiration +/- irrigation with saline

Injection of alpha-agonist, e.g. phenylephrine 100-200ug every 5-10 mins up to max 1000ug

Surgical shunt

Ischaemic priapism > 48-72hrs unlikely to respond to intracavernosal treatment

For very delayed presentation, may even consider immediate placement of a penile prosthesis

Non-ischaemic Observe, may resolve spontaneously

Selective arterial embolization with non-permanent materials

17
Q

what is the presentation and treatment of Fournier’s Gangrene?

A

Starts as cellulitis – swollen, erythematous, tender. Marked pain, fever, systemic toxicity

Swelling + crepitus of scrotum, dark purple areas

Often marked toxicity out of proportion to the local findings

Plain X-ray or USS may confirm gas in tissues

Rx – Antibiotics + surgical debridement

Mortality 20%, higher in diabetics and alcoholics

18
Q

What is the cause

Presentation

Main risk factor

Diagnosis

and Treatment of

Emphysematous pyelonephritis?

A

An acute necrotizing parenchymal and perirenal infection caused by gas-forming uropathogens, usually E coli

Usually occurs in diabetics

Often associated with ureteric obstruction

Fever, vomiting, flank pain

See gas on KUB (Kidney, ureter and bladder X-Ray)

CT defines extent of emphysematous process

Often requires nephrectomy

19
Q

what are the classifications of renal trauma?

A

I Haematoma, subcapsular, non-expanding, no parenchymal laceration

II Laceration <1cm parenchymal depth without urinary extravasation

III >1cm depth, no collecting system rupture or extravasation

IV Laceration through cortex, medulla and collecting system

Main arterial/venous injury with contained haemorrhage

V Shattered kidney

Avulsion of hilum, devascularizing kidney

20
Q

what are the indications for imaging (CT with contrast) for trauma?

A

Frank haematuria in adult

Frank or occult haematuria in child

Occult haematuria + shock (systolic <90mmHg at any point)

Penetrating injury with any degree of haematuria

21
Q

what is the main cause

presentation,

investigation,

treatment

of Urethral injury

A

Posterior urethral injury often associated with fracture of pubic rami

Post. urethra fixed at urogenital diaphragm and puboprostatic ligaments, so bulbomembranous junction most vulnerable

O/E Blood at meatus

Inability to urinate

Palpably full bladder

“High-riding” prostate

Butterfly perineal haematoma

Ix Retrograde urethrogram

Rx Suprapubic catheter

Delayed reconstruction after at least 3 months

22
Q

what is the classic presentation and treatment of a penile fracture?

A

Typically happens during intercourse – buckling injury when penis slips out of vagina and strikes pubis

Cracking or popping sound followed by pain, rapid detumescence, discolouration and swelling

20% incidence of urethral injury (frank haematuria/blood at meatus)

Rx Prompt exploration and repair

Circumcision incision with degloving of penis to expose all 3 compartments