Urological Emergencies Flashcards
(47 cards)
What is acute urinary retention and what most commonly causes it?
Inability to urinate with increasing pain
A complication of BPH
What else can precipitate acute urinary retention?
Non-prostate related surgery
catheterization or urethral instrumentation
anaesthesia
medication with sympathomimetic or anti-cholinergic effects
What is the treatment for acute urinary retention?
Catherization
a Uroselective alphablocker (Alfuzosin) before treating with cathetar improves chance of voiding success
What is the most common cuase of lion pain?
Ureteric colic secondary to calculus
As the size of the calculus increases, what happens to the chance of it spontaneously passing?
Decreases
What is the definitive test for renal calculus?
Non-contrast CT scan “stone search”
What are the indications to treat a patient with renal calculus urgently?
Pain unrelieved
Pyrexia
Persistenct nause/vomiting
High grade obstruction
What are the treatment options for renal stones?
- Internal ureteric stent
- Stone fragemntation/ removal if no infection
- Percutaneous nephrostomy tube for infected hydronephrosis
Give some causes of frank haematuria?
Infection Stones Tumours Benign prostatic hyperplasia (BPH) Polycystic kidneys Trauma Coagulation/platelet deficiencies
If a patient comes in with frank haematuria then retention how should this be treated?
Large 3-way catheter
When is torsion of the spermatic cord most common?
At puberty
What clinical signs and symptoms are seen in torsion of the spermatic cord?
Sudden onset of pain - may refer to lower abdomen Nause/ vomiting testes high in scrotum Testes lie transversely Absence of cremasteric reflex
What is the blue dot sign?
Black necrotic appendix testes from torsion of the appedage/appendix testes
In terms of blood flow, how does it differ in torsion from epididymitis?
Absent blood flow in torsion
Increased blood flow in epididymitis
What is epididymitis?
Inflammation of the epididymis
What treatment is given for epididymitis?
Analgesia + scrotal support, bed rest
Ofloxacin 400mg/day for 14 days
How does idiopathc scrotal oedema present?
No scortal erythema No fever Tenderness minimal May be pruritis Self-limiting
What is paraphimosis?
Painful swelling of the foreskin distal to a phimotic ring
How does paraphimosis occur?
Often happens after foreskin retracted for catheterization or cystoscopy and staff member forgets to replace it in its natural position
What is a priapism?
Prolonged erection (> 4hrs), often painful and not associated with sexual arousal
What are the 2 classifications of priaprism? Are they treated the same?
Ischaemia
Non-ischaemic
No
What is Founier’s gangrene? Where does it most commonly occur?
A form of necrotizing fasciitis occurring about the male genitalia
Most commonly arises from skin, urethra or rectal region
What can predispose a patient to Fournier’s gangrene?
Diabetes
local trauma
periurethral extravasation
perianal infection
What symptoms are seen in Fournier’s gangrene?
Starts all cellulitis (swolle, erythematous, tender)
Marked pain, fever, systemic toxicity.
Swelling and crepitus of scrotum, dark purple areas
