Urological emergencies

Question 1

What can cause acute urinary retention?

Answer 1

Prostate infection

Bladder overdilation

Question 2

In who is acute urinary retention common?

Answer 2

Men with BPH

Question 3

What are the two types of acute urinary retention?

Answer 3

Spontaneous

Precipitated

Question 4

What can precipitate acute urinary retention?

Answer 4

Catheterisation
Instrumentation
Anaesthesia

Question 5

What clinical signs can be seen in acute urinary retention?

Answer 5

Full, palpable bladder

Question 6

How is acute urinary retention solved?

Answer 6

If less than 1 litre then try alpha blocker.

If not, then catheterise.

Question 7

What drugs can be given for calculi?

Answer 7

NSAIDs and opiate for pain

Alpha blocker to pass small stones

Question 8

At what point will stones that have not been passed require investigation?

Answer 8

After 1 month

Question 9

What imaging modality is used to view calculi?

Answer 9

CT

No contrast!

Question 10

What presentation of calculi needs urgent treatment?

Answer 10

Pyrexia
Persistent n&v
High grade obstruction

Question 11

What are some options of treating kidney stones?

Answer 11

Extracorporeal shock wave lithotripsy

Ureteric stent

Question 12

If haematuria presents, what imaging would you use?

Answer 12

CT urogram with contrast

Cystoscopy

Question 13

What can haematuria be a sign of?

Answer 13

Trauma
Infection
Stones
Tumour
BPH

Question 14

What investigation is done for the acute scrotum?

Answer 14

Doppler USS

Question 15

What is the blue dot sign?

Answer 15

Torsion of testicular appendage

Question 16

What may be seen on examination of spermatic cord torsion?

Answer 16

Testis high in scrotum
Transverse lie
Absence of cremasteric reflex

Question 17

What is the cremasteric reflex?

Answer 17

When inner thigh is lightly stroked the the testis should ascend due to contraction of cremaster muscles

Question 18

How can testicular appendage torsion and spermatic cord torsion be differentiated?

Answer 18

Cremaster reflex present in appendage torsion

Testis are mobile

Question 19

How is testicular appendage torsion fixed?

Answer 19

Will resolve spontaneously

Question 20

What are the symptoms of epididymitis?

Answer 20

Pyrexia

Hydrocoele

Question 21

What causes epidiymitis?

Answer 21

Chlamydia

UTI

Question 22

On examination what is seen with epididymitis?

Answer 22

Cremaster reflex present

Doppler shows swollen epididymis

Question 23

What investigations should be done for epididymitis?

Answer 23

Urine culture

Chlamydia PCR

Question 24

What is the treatment for epididymitis?

Answer 24

Analgesia
Rest
Ofloxacin

Question 25

What is paraphimosis?

Answer 25

Swelling of foreskin distal to the phimotic ring

Question 26

When does paraphimosis occur?

Answer 26

When foreskin retracted and not replaced

Question 27

What is the treatment for paraphimosis?

Answer 27

Iced glove Granulated sugar Manual replacement of foreskin

Question 28

What is priapism?

Answer 28

Prolonged erection (>4hrs), not associated with sexual arousal

Question 29

What might cause a priapism?

Answer 29

trauma intracorporeal injection sickle cell

Question 30

How can priapism be classified?

Answer 30

Ischaemic | Non-ischaemic

Question 31

What is ischaemic priapism?

Answer 31

Vascular stasis in penis and decreased venous outflow

Question 32

What is non-ischaemic priapism?

Answer 32

Due to trauma to penile vascularisation

Question 33

What is the treatment for non-ischaemic priapism?

Answer 33

May resolve spontaneously

Question 34

What is the treatment for ischaemic priapism?

Answer 34

Aspiration | Injection of alpha-agonist

Question 35

What is Fournier's gangrene?

Answer 35

Necrotising fasciitis around male genitalia

Question 36

What pre-disposes to Fournier's gangrene?

Answer 36

Diabetes Trauma Perianal infection

Question 37

What does Fournier's gangrene look like?

Answer 37

Swollen, erythematous, tender, painful, systemic toxicity.

Question 38

What investigations are needed for Fournier's gangrene?

Answer 38

Plain X ray to confirm gas in tissues

Question 39

What is the treatment for Fournier's?

Answer 39

Abx | Surgical debridement

Question 40

What is emphysematous pyelonephritis?

Answer 40

Necrotising infection of renal parenchyma by E Coli

Question 41

In who does emphysematous pyelonephritis occur?

Answer 41

Diabetics

Question 42

What symptoms may be present with emphysematous pyelonephritis?

Answer 42

Fever Vomiting Flank pain Ureteric obstruction

Question 43

What investigations are done for emphysematous pyelonephritis?

Answer 43

KUB shows gas | CT shows extent

Question 44

What is the treatment for emphysematous pyelonephritis?

Answer 44

Nephrectomy

Question 45

How many classifications of renal trauma are there?

Answer 45

5

Question 46

If there is a laceration through the collecting system what classification of trauma is present?

Answer 46

4

Question 47

If there is a laceration of less than 1cm what classification of renal trauma is present?

Answer 47

2

Question 48

What symptoms point towards a bladder trauma?

Answer 48

Suprapubic pain Inability to void Guarding Diminished bowel sounds

Question 49

What investigation must be done if blood at external meatus?

Answer 49

Retrograde urethrogram

Question 50

What is likely to happen with a pelvic fracture?

Answer 50

Bladder trauma | Urethral damage

Question 51

What is a butterfly haematoma?

Answer 51

Blood spread to anus in a symmetrical pattern | Sign of urethral injury

Question 52

What are the possible consequences of penile fracture?

Answer 52

ED Permanent curvature Pain during intercourse