Urological emergencies Flashcards Preview

Renal and urology > Urological emergencies > Flashcards

Flashcards in Urological emergencies Deck (76):
1

How does acute urinary retention present?

Inability to urinate

Increasing pain

2

What condition is acute urinary retention a complication of?

Benign prostatic hyperplasia

3

What is the treatment for acute urinary retention?

Catheter

4

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

>1 litre residue

Normal serum electrolytes

5

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

Alpha blocker - relaxes smooth muscle in the bladder wall

6

Why might haematuria occur following acute urinary retention?

Decompression of bladder may cause some bleeding

7

When is post-obstructive diuresis usually present?

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

8

What causes post-obstructive diuresis?

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

9

How should post-obstructive diuresis be managed?

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

10

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

AAA

11

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

Non-contrast CT

12

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

Prostaglandin release in response to obstruction

13

What is the treatment for small kidney stones?

NSAIDs 

Opiate

Alpha blocker (if expected to pass spontaneously)

14

What signs would indicate urgent treatment for renal calculi required?

Pain unrelieved

Pyrexia

Persistent nausea/vomiting

High-grade obstruction

15

What is the treatment for significant renal calculi?

Ureteric stent or stone fragmentation/removal if no infection

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

16

What are the causes of frank haematuria?

Infection

Stones

Tumours

Benign prostatic hyperplasia (BPH)

Polycystic kidneys

Trauma

Coagulation/platelet deficiencies

17

What is the most common cause of haematuria?

Infection

18

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

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

19

When is torsion of spermatic cord most common?

Puberty

20

How does testicular torsion present?

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

21

What is the treatment for testicular torsion?

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

  If testis necrotic then remove

  MUST fix contralateral side (bell clapper deformity)

22

What imaging is used to investigate testicular torsion?

Doppler ultrasound

23

What signs on examination indicate testicular torsion?

Testis high in scrotum

  Transverse lie

  Absence of cremasteric reflex

24

Which testicular pathology is indicated by a 'blue dot' sign?

Testicular appendage torsion

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?

Q image thumb

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

A image thumb
59

What is class 2 renal trauma?

Laceration <1cm parenchymal depth without urinary extravasation

A image thumb
60

What is class 3 renal trauma?

>1cm depth, no collecting system rupture or extravasation

A image thumb
61

What is class 4 renal trauma?

Laceration through cortex, medulla and collecting system

  Main arterial/venous injury with contained haemorrhage

A image thumb
62

What is class 5 renal trauma?

Shattered kidney

  Avulsion of hilum, devascularizing kidney

A image thumb
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

A image thumb
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