Urological Emergencies Flashcards Preview

Renal and Urology > Urological Emergencies > Flashcards

Flashcards in Urological Emergencies Deck (55):
1

What is the difference between spontaneous and precipitated acute urinary retention

Precipitated means there was a triggering event such as surgery, catheterisation, anaesthesia, medication

2

What is acute urinary retention usually a complication of

BPH

3

How do you treat acute urinary retention

catheter

4

When is a trial without catheter indicated

if painful retention with less than 1 litre residue and normal serum electrolytes

5

What should be given before TWOC

uroselective alphablocker eg alfyzosin or tamsulosin

6

What is acute urinary retention?

Painful inability to void, with rrelief of pain following catheterization

7

What mechanisms can lead to acute urinary retention

bladder ourflow obstruction due to increased urethral resistance
low bladder pressure
interuption of nerves to bladder
failure to contract bladder and relax external sphincter

8

What are the features of chornic bladder outflow obsturction

uraemia, oedema, CCF, hypertention

9

What is the treatment of ureteric colic secondary to calculuc

NSAID +/- opiate
alpha blocker (tamsulosin) for small stones that are expected to pass
if stone doesnt pass within a month likely to need an intervention to remove

10

What are the indications to treat calculi urgently

pain is unrelieved
pyrexia
nausea and vominting
high grade obsturction

11

How are calculi treated surgically

ureteric stent or stone fragmentation/removal if no infection
percutaneous nephrostomy for infected hydronephrosis

12

What are potential causes of frank haematurea

infection
stones
tumours
BPH
polycystic kidneys
trauma
coagulation/platelet deficiency

13

How do you treat a clot retention

use a three way irrigating haematuria catheter

14

What imaging is required in haematurea

CT urogram and cystoscopy

15

What are the causes of an acute scrotum

torsion of spermatic cord
torsion of appendix testis
epididymitis
inguinal hernia
hydrocoele
trauma
insect bite
dermatological lesions
inflammatory vasculitis
tumour

16

when is torsion of the spermatic cord most common

puberty

17

What is the clinical presentation of torsion of the spermatic cord

sudden onset pain
nausea
vomiting
referal of pain to lower abdomen
testis high in scrotum, transverse lie, absence of cremasteric reflex on examination
may be aute hydrocoele/oedema

18

What investigation may be done in torsion

doppler USS

19

What is the treatment of torsion

prompt exploration- ischaemic damge may occur after 4 hours
2 or 3 points fixation with fine non absobable sutures
if testis necrotic then remove
must fix contralateral side (bell clapper deformity)

20

What is the clinical presentation of torsion of appendage

more indisdius but can be identical to torsion
localised tenderness at upper pole - 'blue dot sign'
mobile testes with cremasteric reflex
resolves spontaneously

21

What is the clinical presentation of epidydimitis

rare in children!
similar to torsion
dysuria and pyrexia
history of UTI, urethritis, catheterisation
cremaster reflex present
pyuria

22

What is seen on a doppler of epidydimytis

swollen epidydymis
increased blood flow

23

What other investigations should be done in epididymitis

urine culture
PCR for chlamydia

24

What is the treatment of epidydymitis

analgeasi and scrotal support
bed rest
14 days ofloxacin

25

What is paraphimosis

painful swelling of the foreskin distal to phimotic ring

26

What is the treatment of paraphimosis

iced glove, granulated sugar for 1-2 hrs
mulitiple punctures in oedematous skin
manual compression of gland with distal retraction
dorsal slit

27

What is a priapism

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

28

What causes a priapism

intracorporeal injection for ED eg papaverine
trauma
sickle cell
neurological conditions
idiopathic

29

How is priapism classified

ischaemic
non ischaemic

30

What is ischaemic priapism

vascular stasis in penis and decreased outflow (compartment syndrome)

31

What is non ischaemic

traumatic distruction of penile vasculatur results on unreguated blood entry and filling or corpora

32

How do you diagnose priapism

aspirate blood from corpus cavernosum (dark blood, low O2, in low flow, normal arteriolar 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

33

How do you treat ischaemic priapism

apsiration and irrigation with saline
alpha agonist eg phenylephrine
surgical shunt

34

how do you treat non ischamic

observe - can resolve spontaneous
selective arterial embolization with non permanent materials

35

What is fourniers gangrene

necrotizing fasciitis in the male genitalia

36

What predisposes to fourniers gangrene

diabetes, local trauma, periurethral extravasion, perianal infection

37

What is emphysematous pyelonephritis

an acute necrotising parenchymal and perirenal infection caused by gas forming uropathogens usually E.coli
often requires nephropathy

38

Who usually gets emphysematous pyelonephritis

diabetes
often assiciated with ureteric obstruction

39

What invesigations can confirm emphysematous pyelonephritis

KUB - see gas
CT can define extent of emphysematous process

40

What results in a perinephric absess

usually results from rupture of an acute cortical absess into the perinephric space or haematogenous seeding from sites of infection

41

What is the presentation of a perinephric absess

flank mass in half
pyrexia
high WCC, high serum creatinine, pyuria

42

how do you investigate a perinephric absess

CT

43

What are the classification of renal trauma

1 - haematoma
2- laceration less than 1 cm
3- laceration more than 1cm, no collecting system rupture
4- laceration through cortex, medulla, collectig system
5- shattered kidney

44

When should you image the kidney

frank haematuria in adult
frank or occult haematuria
occult haematura and showck
penetrating injury with any haematuria

45

how is the best way to image a kidney with trauma

CT with contrast

46

How are most blunt renal injuries treated

angiography/embolization

47

What type of fracture is commonly associated with a bladder injury

pelvic

48

What are the features of bladder injury

suprapubic pain
unable to void
tneder
brusing
gurading
diminished bowel sounds

49

When should a urethrogram be done

if glood at external meatus or if catheter does not pass easily

50

How is the bladder imaged

CT cystography

51

What fracture is associated with urethral imjusry

pubic rami

52

What are the features of a urethral injusry

blood at meatus
inability to urinate
full bladder
high riding prostate
butterfly perineal haematoma

53

How do you treat a urethral injury

suprapubiv catherters
delayed reconstruction after 3 months

54

What may also be injured in a penile fracture

urethra - frank haematuria

55

How do testicular injuries usually present

pain and nausea
swellin
bruising
ultrasound to asses interity and vascularity