Urological Emergencies Flashcards
(65 cards)
Common cause of acute urinary retention?
Complication of BPH/BNH
Aetiology of acute urinary retention?
Unclear: • Prostate infection • Bladder over-distension • Excessive fluid intake • Alcohol • Prostatic infection
Classifications of acute urinary retention?
Spontaneous
Precipitated (i.e: there is a triggering event):
• Non-prostate related surgery
• Catheterisation or urethral instrumentation
• Anaesthesia
• Medication with sympathomimetic or anti-cholinergic effects
Presentation of acute urinary retention?
Inability to urinate, with increasing pain
Mx of acute urinary retention?
CATHETERISATION
If painful retention with <1L residue and normal serum electrolytes then:
• Trial without catheter (TWOC) during the same admission
• Prescribing a uroselective α-blocker (Tamsulosin) before TWOC improves chances of voiding
Occurrence of post-obstructive diuresis?
Often presents in patients with chronic bladder outflow obstruction in assoc. with uraemia, oedema, CCF and hypertension
Diuresis occurs due to solute diuresis (retention of urea, Na+ and water) AND due to a defect in the conc. ability of the kidney
Monitoring and Mx of post-obstructive diuresis?
Usually resolves in 24-48 hours
Monitor fluid balance and beware if urine ouput > 200 ml/hr
Severe cases may require IV fluid and Na+ replacement
Time period for haematuria?
Not uncommon but generally settles in 24 hours
Causes of acute loin pain?
Renal calculi
Causes outwith the urinary tract:
• AAA
Ix for renal stones?
X-ray (often seen near the transverse processes of vertebrae)
CT-KUB (kidneys, ureters, bladder)
Treatment of renal calculi?
NSAID (pain is mediated by PGs released by the ureter in response to obstruction) +/- opiate
α-blocker (Tamsulosin) for small stones that are expected to pass
If stone has not passed in 1 months, likely to require further intervention
Indications to treat renal calculi urgently?
Pain that is unrelieved with analgesia
Pyrexia (indicates infected urine above the stone)
Persistent N&V
High-grade obstruction
Urgent Mx options for renal calculi?
If no infection - ureteric stent or stone fragmentation/removal
For infected hydronephrosis - percutaneous nephrostomy
Causes of frank haematuria?
Infections and stones
Tumours and BPH
Coagulation/platelet deficiencies
Polycystic kidneys
Trauma
Ix with frank haematuria?
CT urogram + cystoscopy
How to treat clot retention with frank haematuria?
Use 3-way irrigating haematuria catheter
Ix for frank haematuria?
CT urogram + cystoscopy
Occurrence of torsion of the spermatic cord?
Most common at puberty; it may occur with trauma or athletic activity but it is usually spontaneous
Presentation of torsion of the spermatic cord?
Adolescent often woken from sleep by sudden onset pain; they may have had previous episodes of self-limiting pain
Pain may be referred to lower abdomen
May have N&V
Examination of torsion of the spermatic cord?
Testis high in the scrotum
Transverse lie
Absence of the cremasteric reflex (cremaster muscle does not pull the testis upwards)
Acute hydrocoele + oedema can obliterate landmarks
Ix for torsion of the spermatic cord?
Mainly a clinical diagnosis and exploration should not be delayed (irreversible ischaemic injury may begin as soon as 4 hours)
Doppler USS is sometime helpful
Mx for torsion of the spermatic cord?
2 or 3 point fixation with fine, non-absorbable sutures
If testis is necrotic, then remove
Most common underlying cause of torsion of the spermatic cord?
Congenital issue known as bell-clapper deformity; this is why, during treatment, the contralateral side must be fixed
Symptoms of torsion of an appendage?
Symptoms are variable; it may be insidious onset or identical to torsion of a cord
Early presentation may have localised tenderness at the upper pole and “blue dot” sign
Testis should be mobile and cremasteric reflex is present
