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The Renal System > Urological Emergencies > Flashcards

Urological Emergencies Flashcards

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1
Q

What is acute urinary retention a complication of?

A

Benign prostatic hyperplasia

(very rare in women)

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2
Q

How does acute urinary retention present?

A

Inability to urinate

Pain

Distended bladder

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3
Q

How can acute urinary retention be caused?

A

Spontaneously

Precipitated (triggering event)

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4
Q

Which factors may precipitate acute urinary retention?

A

Non-prostate related surgery

Catheterisation or urethral instrumentation

Anaesthesia

Medications with sympathomimetic or anticholinergic effects

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5
Q

If a patient presents with <1 litres of retention what should be given if there is a trial without catheter?

A

Alpha blocker

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6
Q

What is the treatment for renal calculi?

A

NSAIDs (if no renal failure) +/- opiates

Alpha blockers may be given for stones which are expected to pass

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7
Q

Generally a patient with a renal calculus will require intervention if it has not passed within which time frame?

A

1 month

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8
Q

How are renal calculi best imaged?

A

Non-contrast CT

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9
Q

What are the indications to treat renal calculi urgenty?

A

Unrelieved pain

Pyrexia

Persistent nausea or vomiting

High grade obstruction

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10
Q

How are renal calculi removed?

A

Ureteric stent or stone fragmentation/removal if no infection

Percutaneous nephrostomy for infected hydronephrosis

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11
Q

What are the main causes for visible (frank) haematuria?

A
  1. Infection
  2. Stones
  3. Tumours
  4. Benign prostatic hyperplasia (BPH)
  5. Polycystic kidneys
  6. Trauma
  7. Coagulation/platelet deficiencies
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12
Q

What are the best investigations for visible haematuria?

A

CT urogram

Cytoscopy

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13
Q

Torsion of the spermatic cord generally occurs _____________

A

Torsion of the spermatic cord generally occurs spontaneously

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14
Q

Torsion of the spermatic cord is most common around with age?

A

Puberty

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15
Q

How does a torsion of the spermatic cord present?

A
  1. Testis high in scrotum
  2. Transverse position of testis
  3. Absence of cremasteric reflex
  4. Acute hydrocoele + oedema
  5. Red and inflamed
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16
Q

What is the best test for acute testicular torsion?

A

Doppler USS

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17
Q

In which instance must a testis be removed?

A

Necrotic damage

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18
Q

Why must the contralateral side be fixed in a testicular torsion?

A

Bell clapper deformity

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19
Q

What is a Bell clapper deformity?

A

A predisposing factor in testicular torsion in which the tunica vaginalis joins high on the spermatic cord, leaving the testis free to rotate

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20
Q

The blue dot sign is associated with which testicular pathology?

A

Torsion of testicular appendage

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21
Q

Which other condition is difficult to differentiate from testicular torsion?

22
Q

Epididymitis is _________ in children

Study These Flashcards
A

Epididymitis is rare in children

23
Q

Which clinical sign raises suspicion of epididymitis versus testicular torsion?

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A

Pyuria

(and dysuria)

24
Q

How can epididymitis be treated?

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A

Analgesia + scrotal support, bed rest

Ofloxacin 400mg/day for 14 days

25
How does idiopathic scrotal oedema present?
Children No fever Itching Minimal tenderness
26
What is paraphimosis?
Painful swelling of the foreskin distal to a phimotic ring
27
What is the treatment for paraphimosis?
1. Iced glove 2. Granulated sugar for 1-2hrs (draws out excess fluid to minimise swelling) 3. Multiple punctures in oedematous skin 4. Manual compression of glans with distal traction on oedematous foreskin 5. Dorsal slit (when non-surgical methods fail)
28
What is priapism?
Prolonged erection (\>4hrs) not associated with sexual arousal
29
What is a form of necrotizing fasciitis occurring about the male genitalia?
Fournier's gangrene
30
How does Fournier's gangrene normally begin initially?
As a cellulitis From skin, urethra or rectal region
31
Which predisposing factors exist for Fournier's gangrene?
Diabetes Local trauma Periurethral extravasation Perianal infection
32
What is the appropriate treatment for Fournier's gangrene?
**Surgical debridement** Antibiotics
33
What is emphysematous pyelonephritis?
Acute necrotizing parenchymal and perirenal infection caused by gas-forming uropathogens, usually E coli
34
Which comorbidiy predisposes to emphysematous pyelonephritis?
Diabetes
35
Which clinical symptoms and signs indicate a diagnosis of emphysematous pyelonephritis?
Fever Vomiting Flank pain Gas seen on KUB CT
36
Which treatment is often required for emphysematous pyelonephritis?
Nephrectomy
37
How does a perinephric abscess typically form?
Rupture of acute cortical abscess into perinephric space Haematogenous seeding from sites of infection
38
What are the clinical signs of a perinephric abscess?
Flank mass High WCC High serum creatinine Pyuria Insidious onset
39
What is the treatment for perinephric abscess?
Antibiotics and either percutaneous or surgical drainage
40
How many stages can renal trauma be classified?
5
41
How can renal trauma be imaged?
CT urogram
42
How are most renal bleeds due to trauma treated?
Embolisation and angiography
43
Which type of fracture is associated with bladder injury?
Pelvic
44
What are the two types of bladder trauma?
Intraperitoneal Extraperitoneal
45
How is a bladder injury imaged?
CT cystography
46
What is posterior urethral injury usually associated with?
Fracture of the pubic rami
47
Which clinical signs are present which indicate a urethral injury?
Blood at meatus Inability to urinate Palpably full bladder "High-riding" prostate Butterfly perineal haematoma
48
What is the treatment for a urethral injury?
Suprapubic catheter Delayed reconstruction (after 3 months)
49
When does a penile fracture typically occur?
Intercourse (Penis slips out of vagina and strike pubis)
50
Which investigation can be used to assess testicular injuries?
USS

The Renal System (37 decks)

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