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Renal and Urology > Urological Emergencies > Flashcards

Urological Emergencies Flashcards

1
Q

What is the difference between spontaneous and precipitated acute urinary retention

A

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

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2
Q

What is acute urinary retention usually a complication of

A

BPH

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3
Q

How do you treat acute urinary retention

A

catheter

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4
Q

When is a trial without catheter indicated

A

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

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5
Q

What should be given before TWOC

A

uroselective alphablocker eg alfyzosin or tamsulosin

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6
Q

What is acute urinary retention?

A

Painful inability to void, with rrelief of pain following catheterization

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7
Q

What mechanisms can lead to acute urinary retention

A

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

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8
Q

What are the features of chornic bladder outflow obsturction

A

uraemia, oedema, CCF, hypertention

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9
Q

What is the treatment of ureteric colic secondary to calculuc

A 
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
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10
Q

What are the indications to treat calculi urgently

A

pain is unrelieved
pyrexia
nausea and vominting
high grade obsturction

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11
Q

How are calculi treated surgically

A

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

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12
Q

What are potential causes of frank haematurea

A 
infection
stones
tumours
BPH
polycystic kidneys
trauma
coagulation/platelet deficiency
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13
Q

How do you treat a clot retention

A

use a three way irrigating haematuria catheter

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14
Q

What imaging is required in haematurea

A

CT urogram and cystoscopy

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15
Q

What are the causes of an acute scrotum

A 
torsion of spermatic cord
torsion of appendix testis
epididymitis
inguinal hernia
hydrocoele
trauma
insect bite
dermatological lesions
inflammatory vasculitis
tumour
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16
Q

when is torsion of the spermatic cord most common

A

puberty

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17
Q

What is the clinical presentation of torsion of the spermatic cord

A 
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
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18
Q

What investigation may be done in torsion

A

doppler USS

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19
Q

What is the treatment of torsion

A

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)

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20
Q

What is the clinical presentation of torsion of appendage

A

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

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21
Q

What is the clinical presentation of epidydimitis

A 
rare in children!
similar to torsion
dysuria and pyrexia
history of UTI, urethritis, catheterisation
cremaster reflex present
pyuria
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22
Q

What is seen on a doppler of epidydimytis

A

swollen epidydymis

increased blood flow

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23
Q

What other investigations should be done in epididymitis

A

urine culture

PCR for chlamydia

24
Q

What is the treatment of epidydymitis

A

analgeasi and scrotal support
bed rest
14 days ofloxacin

25
Q

What is paraphimosis

A

painful swelling of the foreskin distal to phimotic ring

26
Q

What is the treatment of paraphimosis

A

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

27
Q

What is a priapism

A

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

28
Q

What causes a priapism

A 
intracorporeal injection for ED eg papaverine
trauma
sickle cell 
neurological conditions
idiopathic
29
Q

How is priapism classified

A

ischaemic

non ischaemic

30
Q

What is ischaemic priapism

A

vascular stasis in penis and decreased outflow (compartment syndrome)

31
Q

What is non ischaemic

A

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

32
Q

How do you diagnose priapism

A

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
Q

How do you treat ischaemic priapism

A

apsiration and irrigation with saline
alpha agonist eg phenylephrine
surgical shunt

34
Q

how do you treat non ischamic

A

observe - can resolve spontaneous

selective arterial embolization with non permanent materials

35
Q

What is fourniers gangrene

A

necrotizing fasciitis in the male genitalia

36
Q

What predisposes to fourniers gangrene

A

diabetes, local trauma, periurethral extravasion, perianal infection

37
Q

What is emphysematous pyelonephritis

A

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

38
Q

Who usually gets emphysematous pyelonephritis

A

diabetes

often assiciated with ureteric obstruction

39
Q

What invesigations can confirm emphysematous pyelonephritis

A

KUB - see gas

CT can define extent of emphysematous process

40
Q

What results in a perinephric absess

A

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

41
Q

What is the presentation of a perinephric absess

A

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

42
Q

how do you investigate a perinephric absess

A

CT

43
Q

What are the classification of renal trauma

A

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
Q

When should you image the kidney

A

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

45
Q

how is the best way to image a kidney with trauma

A

CT with contrast

46
Q

How are most blunt renal injuries treated

A

angiography/embolization

47
Q

What type of fracture is commonly associated with a bladder injury

A

pelvic

48
Q

What are the features of bladder injury

A 
suprapubic pain 
unable to void
tneder
brusing
gurading
diminished bowel sounds
49
Q

When should a urethrogram be done

A

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

50
Q

How is the bladder imaged

A

CT cystography

51
Q

What fracture is associated with urethral imjusry

A

pubic rami

52
Q

What are the features of a urethral injusry

A 
blood at meatus
inability to urinate
full bladder
high riding prostate
butterfly perineal haematoma
53
Q

How do you treat a urethral injury

A

suprapubiv catherters

delayed reconstruction after 3 months

54
Q

What may also be injured in a penile fracture

A

urethra - frank haematuria

55
Q

How do testicular injuries usually present

A

pain and nausea
swellin
bruising
ultrasound to asses interity and vascularity

Renal and Urology (20 decks)

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