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Flashcards in Urological Emergencies Deck (41)
1

Complication of BPH
Inability to urinate with increasing pain

Acute urinary retention

2

What could cause acute urinary retention?

Surgery
Catheterisation
Urethral instrumentation
Anaesthesia
Medication

3

Treatment for acute urinary retention

Catheter

If painful retention with

4

Management of post-obstructive diuresis

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

5

Treatment for acute loin pain (e.g. caused by calculus)

NSAID +/- opiate
Alpha-blocker (Tamsulosin)

Indications to treat urgently:
-pain unrelieved
-pyrexia
-persistent nausea/vomitting
-high grade obstruction

If this is the case then ureteric stent or stone fragmentation/removal if no infection
-PERCUTANEOUS NEPHROSTOMY for infected hydronephrosis

6

Treatment for clot

3-way irrigating haematuria catheter

7

Investigations for frank haematuria

CT urogram and cystoscopy

8

Usually sudden onset of pain, sometimes previous episodes of self-limiting pain
May be nausea/vomiting
May be referral of pain to lower abdomen

Torsion of spermatic cord

9

-testis high in scrotum
transverse lie (lying -transversely instead of up and down)
-absence of cremasteric reflex

Torsion of spermatic cord

10

Absence of which reflex in torsion of spermatic cord?

Absence of cremasteric reflex

11

Blue dot sign

Torsion of appendage

12

Symtpoms of torsion of appendage

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

May have tenderness at upper pole and "blue dot sign"

Testis should be mobile and CREMASTERIC reflex present

13

Epididymitis

Rare in children
May be difficult to distinguish from torsion
Dysuria / pyrexia more common
Hx of UTI, urethritis, catheterization/instrumentation

14

What should you suspect if pyuria and presentation similar to torsion

Epididymitis

15

Cremasteric reflex present
Suspect if pyuria
Doppler – swollen epididymis, increased bloodflow

Send urine for culture + Chlamydia PCR

Epididymitis

16

What would doppler show in epididymitis?

Swollen spididymis and increased blood flow

17

What investigations should you ask for if epididymis suspected?

Urine for culture and CHLAMYDIA PCR

18

Treatment for epididymitis

Ofloxacin 400mg/day for 14 days

19

Idiopathic scrotal oedema

Self-limiting, unknown cause, not usually associated with scrotal erythema
No fever, tenderness minimal but may be pruritis

20

Often happens after foreskin retracted for catheterization or cystoscopy and staff member forgets to replace it in its natural position

Paraphimosis

21

Painful swelling of the foreskin distal to phimotic ring

Paraphimosis

22

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

23

Priapsim

Prolonged erection (>4 hrs) often painful and not associated with sexual arousal

24

Classification of priapism

Ischaemic (low flow)
Non-ischaemic (high flow)

Differentiate by aspirating 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

25

Treatment for ischeamic priapism

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

26

A form of necrotizing fasciitis occurring about the male genitalia
Most commonly arises from skin, urethra or rectal region

Fournier's gangrene

27

What is Fournier's gangrene?

A form of necrotising fasciits occuring outside male genitalia

28

Investigations for Fournier's gangrene

Plain x-ray or USS may confirm gas in tissues

29

Who doe emphysematous pyelonephritis usually affect?

Diabetics

30

Infection of the kidneys with gas in/around kidneys

Emphysematous pyelonephritis

31

Organism which usually causes emphysematous pyelonephritis

E. coli

32

High WCC
High serum creatinine
Pyuria

Perinephric abscess

33

Haematoma, subcapsular, non-expanding, no parenchymal laceration

Class I

34

Laceration

Class II

35

>1cm depth, no collecting system rupture or extravasation

Class III

36

Laceration through cortex, medulla and collecting system

Main arterial/venous injury with contained haemorrhage

Class IV

37

Shattered kidney
Avulsion of hilum, devascularizing kidney

Class V

38

Indications for imaging

Frank haematuria in adult
Frank or occult haematuria in child
Occult haematuria + shock (systolic

39

Suprapubic/abdominal pain and inability to void

Suprapubic tenderness, lower abdominal bruising, guarding/rigidity, diminished bowel sounds

suggests what?

Bladder injury

40

If there is blood at the external meatus or if the catheter doesn't pass easily through then what should you perform?

Retrograde urethrogram -- may well have urethral injury

41

Flame shaped collection of contrast in pelvis

Extraperitoneal injury