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Renal and urology > Urological emergencies > Flashcards

Urological emergencies Flashcards

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1
Q

How does acute urinary retention present?

A

Inability to urinate

Increasing pain

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2
Q

What condition is acute urinary retention a complication of?

A

Benign prostatic hyperplasia

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3
Q

What is the treatment for acute urinary retention?

A

Catheter

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4
Q

What are the indications for trial without catheter following catheterisation to treat acute urinary retention?

A

>1 litre residue

Normal serum electrolytes

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5
Q

What drug may be prescribed to try and improve success of trial without catheter following catherisation for acute urinary retention?

A

Alpha blocker - relaxes smooth muscle in the bladder wall

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6
Q

Why might haematuria occur following acute urinary retention?

A

Decompression of bladder may cause some bleeding

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7
Q

When is post-obstructive diuresis usually present?

A

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

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8
Q

What causes post-obstructive diuresis?

A

Solute diuresis (retained urea, sodium and water) and defect in concentrating ability of kidney

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9
Q

How should post-obstructive diuresis be managed?

A

Monitor fluid balance and beware if urine output > 200ml/hr

Usually resolves in 24-48hr but in severe cases may require IV fluid and sodium replacement

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10
Q

What differential for acute loin pain outwith the urinary tract should always be remembered?

A

AAA

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11
Q

What is the gold-standard investigation for looking at kidney stones?

A

Non-contrast CT

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12
Q

What causes the pain in ureteric obstruction by a renal stone?

A

Prostaglandin release in response to obstruction

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13
Q

What is the treatment for small kidney stones?

A

NSAIDs

Opiate

Alpha blocker (if expected to pass spontaneously)

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14
Q

What signs would indicate urgent treatment for renal calculi required?

A

Pain unrelieved

Pyrexia

Persistent nausea/vomiting

High-grade obstruction

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15
Q

What is the treatment for significant renal calculi?

A

Ureteric stent or stone fragmentation/removal if no infection

   Percutaneous nephrostomy for infected hydronephrosis: drain infected urine first, deal with stone later
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16
Q

What are the causes of frank haematuria?

A

Infection

Stones

Tumours

Benign prostatic hyperplasia (BPH)

Polycystic kidneys

Trauma

Coagulation/platelet deficiencies

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17
Q

What is the most common cause of haematuria?

A

Infection

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18
Q

What treatment should be used if a patient is passing clots followed by an inability to urinate?

A

3-way irrigating haematuria catheter to perform bladder washout and remove clots

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19
Q

When is torsion of spermatic cord most common?

A

Puberty

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20
Q

How does testicular torsion present?

A

Sudden onset pain

May be predisposed by previous episodes of self-limiting pain

May be nauseous

Referred pain to abdomen

Usually spontaneous, but can be brought on by trauma or sports

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21
Q

What is the treatment for testicular torsion?

A

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

If testis necrotic then remove

MUST fix contralateral side (bell clapper deformity)

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22
Q

What imaging is used to investigate testicular torsion?

A

Doppler ultrasound

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23
Q

What signs on examination indicate testicular torsion?

A

Testis high in scrotum

Transverse lie

Absence of cremasteric reflex

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24
Q

Which testicular pathology is indicated by a ‘blue dot’ sign?

A

Testicular appendage torsion

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25
What is epididymitis?
Inflammation of the epididymis at the back of the testicle
26
What symptoms are more likely to be present in epididymitis that would distinguish it from testicular torsion?
Dysuria Fever
27
What may be in the history of a patient presenting with epididymitis?
UTI Urethritis Catheterization/instrumentation
28
What would be seen on examination and imaging with epididymitis?
Cremasteric reflex present Pyuria Doppler – swollen epididymis, increased bloodflow
29
What investigations should be sent off with epididymitis?
Urine for culture PCR for chlamydia
30
What is the treatment for epididymitis?
Analgesia and scrotal support Bed rest Ofloxacin 400mg/day for 14 days
31
What is paraphimosis?
Painful swelling of the foreskin distal to a phimotic ring
32
How does paraphimosis often occur?
Often happens after foreskin retracted for catheterization or cystoscopy and staff member forgets to replace it in its natural position
33
What is the treatment for paraphimosis?
Iced glove, granulated sugar for 1-2hrs, multiple punctures in oedematous skin Manual compression of glans with distal traction on oedematous foreskin Dorsal slit
34
What is the diagnosis here?
Paraphimosis
35
What is priapism?
Prolonged erection (\> 4hrs), often painful and not associated with sexual arousal
36
How can priapism be classed?
Ischaemic Non-ischaemic
37
What is the cause of ischaemic priapism?
Vascular stasis in penis and decreased venous outflow, a true compartment syndrome
38
What signs on examination would indicate an ischaemic priapism?
Corpora cavernosa are rigid and tender, penis often painful
39
What is the pathology in non-ischaemic priapism?
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
40
How can priapism be diagnosed?
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
41
How is non-ischaemic priapism treated?
Observe, may resolve spontaneously Selective arterial embolization with non-permanent materials
42
What is Fournier's gangrene?
A form of necrotizing fasciitis occurring about the male genitalia Most commonly arises from skin, urethra or rectal region
43
What are some predisposing factors to Fournier's gangrene?
Diabetes Local trauma Periurethral extravasation Perianal infection
44
How does Fournier's gangrene present?
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
45
What increases mortality in Fournier's?
Mortality 20% increased in alcoholics and diabetics
46
What is the treatment for Fournier's?
Antibiotics and surgical debridement
47
What is emphysematous pyelonephritis?
An acute necrotizing parenchymal and perirenal infection caused by gas-forming uropathogens
48
What is the most common causative organism in emphysematous pyelonephritis?
E. Coli
49
In which patients does emphysematous pyelonephritis usually occur?
Diabetic patients Associated with ureteric obstruction
50
How does emphysematous pyelonephritis present?
Fever Vomiting Flank pain
51
What signs on imaging would indicate emphysematous pyelonephritis?
Gas on Xray CT to see extent of emphysematous process
52
How is emphysematous pyelonephritis usually treated?
Nephrectomy
53
How does a perinephric abscess occur?
From rupture of an acute cortical abscess into the perinephric space From haematogenous seeding from sites of infection
54
How does perinephric abscess present?
Insidious onset, approx 33% not pyrexial Flank mass in 50% Pyruria
55
What blood tests are raised in perinephric abscess?
White cell count Serum createnine
56
What imaging is used in perinephric abscess?
CT
57
What is the treatment for perinephric abscess?
Antibiotics and percutaneous or surgical drainage
58
What is class 1 renal trauma?
Haematoma: Subcapsular Non-expanding No parenchymal laceration
59
What is class 2 renal trauma?
Laceration \<1cm parenchymal depth without urinary extravasation
60
What is class 3 renal trauma?
\>1cm depth, no collecting system rupture or extravasation
61
What is class 4 renal trauma?
Laceration through cortex, medulla and collecting system Main arterial/venous injury with contained haemorrhage
62
What is class 5 renal trauma?
Shattered kidney Avulsion of hilum, devascularizing kidney
63
What are the indications for renal imaging following trauma?
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
64
What imaging is used to view the kidneys following trauma?
Contrast CT
65
What fracture is bladder injury commonly associated with?
Pelvic fracture
66
How does bladder injury present?
Suprapubic/abdominal pain Inability to void Suprapubic tenderness Lower abdominal bruising Guarding/rigidity Diminished bowel sounds
67
What sign on imaging indicates extraperitoneal injury?
Flame-shaped collection of contrast in pelvis
68
What would indicate urethral injury?
Blood at external urethral meatus Catheter doesn't pass easily
69
What is the treatment for extraperitoneal injury?
Large-bore catheter Antibiotics Repeat cystogram in 14 days
70
What fracture is a posterior urethral injury associated with?
Fracture of pubic rami
71
What would indicate a posterior urethral injury on examination?
Blood at meatus Inability to urinate Palpably full bladder “High-riding” prostate Butterfly perineal haematoma
72
What imaging is used to investigate posterior urethral injury?
Retrograde urethrogram
73
What is the treatment for posterior urethral injury?
Suprapubic catheter Delayed reconstruction after at least 3 months
74
How does testicular injury present?
Exquisite pain Nausea Swelling / bruising variable
75
What imaging is used to investigate testicular injury?
Ultrasound to assess integrity/vascularity
76
What is the treatment for testicular injury?
Early exploration/repair improves testis salvage, reduces convalescence, better preserves fertility and hormonal function

Renal and urology (11 decks)

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