Urological Emergencies Flashcards
(58 cards)
what is acute urinary retention most commonly a complication of
benign prostatic hyperplasia
other causes of urinary retention
infection bladder over distension excessive fluid intake alcohol prostatic infection non-protate related surgery cathertisation or recent instrumentation anaesthesia medication
2 types of urinary retention
spontaneous
precipitated
treatment of urinary retention
catheter
give uroselective alpha blocker - improves chances of success without catheter
treatment for post-obstructive diuresis
monitor fluid balance and urine output
usually resolves in 48 hours but may need IV fluid and sodium replacement
what is post-obstructive diuresis
when you put a catheter in someone who has had chronic urinary retention and they pee out loads of salt and fluid
differential for loin pain
Ureteric colic - secondary to calculus
renal problems
other causes - AAA
treatment for renal calculus
NSAIDs +/- opiates
Alpha blocker - for small stones expected to pass
what percentage of <4mm stones have spontaneous passage
80%
4-6mm 59%
>6mm 21%
what are some indications to treat stones urgently
pain unrelieved
pyrexia
persistent nausea/vomiting
high-grade obstruction
urgent treatment for stones
uteric stent or stone fragmentation/removal if no infection
percutaneous nephrostomy for infected hydronephrosis
what causes haematuria
infection stones tumour benign prostatic hyperplasia (if big) trauma polycystic kidneys coagulation/platelet deficiencies
what is the treatment for clot retention
3 way irrigating haematuria catheter
investigation for haematuria
CT urogram
Cystoscopy
what are the differentials fro acute scrotum
Torsion of spermatic cord Torsion of appendix testes Epididymitis/epididymo-orchitis Inguinal hernia Hydrocoele Trauma/insect bite Dermatological lesions Inflammatory vasculitis Tumour
most common presentation of torsion of spermatic cord
teenager find severe pain in testes - often woken from sleep
Sudden onset pain - sometimes have previous episodes of self limiting pain
usually spontaneous but can occur with trauma or athletic activity
signs of torsion of the spermatic cord
testis high in scrotum
transverse lie
absence of cremasteric reflex
acute hydrocele +oedema (may obliterate land marks)
investigations for torsion
Doppler USS
Management for torsion
prompt exploration - irreversible ischaemic injury can occur as soon as 4 hours
2 or 3 point fixation with nine non-absorbable sutures
if testes necrotic then remove
MUST fix other side - to stop the same thing happening again
symptoms or torsion of appendage
can be insidious onset or present the same as cord torsion
if seen early may have localised tenderness at upper pole and ‘blue dot’ sign
testis should be mobile and cremasteric reflex present
treatment for torsion of appendage
if diagnosis confirmed then will resolve spontaneously without surgery
what is epididymitis
inflammation of the epidymitis usually caused by infection
how do differentiate epididymitis from torsion
dysuria
pyrexia
past history of UTI, urethritis, cathertisation/instrumentation
can be due to STI
signs of epididymitis
cremasteric reflex present
suspect if pyuria
doppler shows swollen epididymis, increased blood flow
send urine for culture + chlamydia PCR
