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Urological emergencies Flashcards

(68 cards)

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1
Q

What is acute urinary retention a complication of?

A

BPH

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2
Q

What are the symptoms of acute urinary retention?

A

Inability to urinate with increasing pain

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3
Q

What are the different types of acute urinary retention?

A

Spontaneous

Precipitated

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4
Q

What can cause precipitated acute urinary retention?

A

Non-prostate related surgery
Catheterization or urethral instrumentation
Anaesthesia
Medication with sympathomimetic or anticholinergic effects

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5
Q

What is the treatment of acute urinary retention?

A

Catheter

If painful retention <1L residue and normal serum electrolytes then trial without catheter (TWOC) during same admission

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6
Q

What is post-obstructive acute urinary retention?

A

Often present in patients with chronic bladder outflow obstruction in association with uraemia, oedema, CCF, hypertension

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7
Q

How do you monitor post-obstructive diuresis?

A

Monitor fluid balance and beware if urine output >200 ml/hr

Usually resolves in 24 -48 hrs but in severe cases may require IV fluids and sodium replacement

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8
Q

What are the differentials of acute loin pain?

A

Ureteric colic secondary to calculus

Possibility of diagnosis outwith urinary tract, especially AAA

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9
Q

What is the pain mediated by in renal colic?

A

Prostaglandin release by ureter in response to obstruction

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10
Q

What is the treatment for ureteric colic?

A

PR diclofenac +/- opiate

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11
Q

How likely is a spontaneous passage of a ureteric stone?

A

<4mm 80%
4-6mm 59%
>6mm 21%

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12
Q

What are indications to treat a ureteric obstruction urgently?

A

Pain unrelieved
Pyrexia
Persistent nausea/ vomiting
High-grade obstruction

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13
Q

What is the emergency treatment for a ureteric stone?

A

Ureteric stent
Stone fragmentation if not infection
Percutaneous nephrostomy for infected hydronephrosis

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14
Q

What can cause frank haematuria?

A 
Infection 
Stones
Tumours 
BPH
Polycystic kidneys
Trauma 
Coagulation/ platelet deficiencies 
Clot retention
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15
Q

What investigation is required for frank haematuria?

A

CT urogram

Cystoscopy

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16
Q

What are the differentials of an acute scrotum?

A 
Torsion of spermatic cord
Torsion of appendix testis
Epididymitis/ epididymo-orchitis
Inguinal hernia
Hydrocele
Trauma/ insect bite
Dermatological lesions
Inflammatory vasculitis
Tumour
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17
Q

What is the cause of torsion of a spermatic cord?

A

Most common at puberty
Occurs with trauma or athletic activity but usually spontaneous
Adolescent often woken from sleep

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18
Q

What are the symptoms of an acute torsion?

A 
N+V 
Referral of pain to lower abdomen
Testis high in scrotum
Transverse lie
Absence of cremasteric reflex 
Acute hydrocele and oedema may obliterate landmarks
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19
Q

How can an acute torsion be investigated?

A

Doppler USS but do NOT delay exploration with fixation of both testes

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20
Q

What can be seen of a torsion of the appendage?

A

Localised tenderness at upper pole with a blue dot sign

Testis should be moblie and cremasteric reflex present

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21
Q

How will epididymitis present?

A

Dysuria
Pyrexia
UTI
Urethritis

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22
Q

What are the signs of epididymitis?

A

Cremasteric reflex present
Suspect if pyuria
Doppler - swollen epididymis, increased blood dow
Send urine for culture + chlamydia PCR

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23
Q

What is the treatment for epididymitis?

A

Analgesia + scrotal support, bed rest

Ofloxacin 400g/day for 14 days if chlamydia

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24
Q

What is paraphimosis?

A

Painful swelling of the foreskin distal to the phimotic ring
Happens after the foreskin is retracted for catheterization or cystoscopy and staff member forgets to replace in its natural position

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25
How is paraphimosis treated?
Iced glove Multiple punctures in oedematous skin Manual compression of gland with distal retraction on oedematous foreskin Dosal slit
26
What is priapism?
Prolonged erection (>4hrs), often painful and not associated with sexual arousal
27
What is the aetiology of priapism?
``` Intracorporeal injection for ED Trauma Hematological dyscrasias Neurological conditions Idiopathic ```
28
What is the classification of priapism?
Ischaemia (veno-occlusive or low flow) Vascular stasis in penis and decreased venous outflow Non-ischaemia
29
What causes non-ischaemic priapism?
Traumatic disruption of penile vasculature results in unregulated blood entry and filling of corpora Fistula formation between cavernous artery and lacular spaces allows blood to by pass the normal helicine arteriolar bed
30
How is non-ischaemic priapism diagnosed?
Aspirate blood from corpus cavernosum - dark blood, low O2, high CO2 Duplex - minimal or absent flow in cavernosal arteries in low-flow normal to high flow in non-ischaemic priapism
31
How is ischaemic priapism treated?
Aspiration +/- irrigation with saline Injection of alpha-agonist (phenylephrine) Surgical shunt
32
How is non-ischaemic priapism treated?
Observe, may resolve spontaneously | Selective arterial embolization with non-permanent materials
33
What is fournier's gangrene?
Necrotizing fasciitis occuring about the male genitalia | Arises from skin, urethra or recatal region
34
What are predisposing factors to fournier's gangrene?
Diabetes Local trauma Periurethral extravasation Perianal infection
35
What will fournier's gangrene start as?
Cellulitis - swollen, erythematous, tender Marked pain, fever, systemic toxicity Swelling and crepitus of scrotum, dark purple areas
36
How is fournier's gangrene investigated?
Plain x-ray or USS to look for gas in tissues
37
How is fournier's gangrene treated?
Antibiotics | Surgical debridement
38
What is emphysematous pyelonephritis?
Necrotizing parenchymal and perineal infection caused by gas-forming uropathogens, usually e.coli
39
What is emphysematous pyelonephritis associated with?
Diabetes | Ureteric obstruction
40
What will emphysematous pyelonephritis present with?
Fever, vomiting, flank pain Gas on KUB CT to define extent of emphysematous process
41
What is a perinephric abscess?
Usually results from rupture of an acute cortical abscess into the perinephric space or from haematogenous seeding from sites of infection Flank mass in 50%
42
What will a perinephric abscess show clinically?
High WCC High serum creatinine Pyuria
43
What is the investigation of choice for a perinephric abscess?
CT
44
What is the treatment of choice for a perinephric abscess?
Antibiotics + percutaneous or surgical drainage
45
What is stage 1 renal trauma?
Haematoma, subcapsular, non-expanding, no parenchymal laceration
46
What is stage 2 renal trauma?
Laceration <1cm parenchymal depth without urinary extravasation
47
What is stage 3 renal trauma?
>1cm depth, no collecting system rupture or extravasation
48
What is stage 4 renal trauma?
Laceration through cortex, medulla and collecting system | Main arterial/ venous injury with contained haemorrhage
49
What is a stage 5 renal trauma?
Shattered kidney | Avulsion of hilum, devascularization kidney
50
What are indications for imaging in renal trauma?
Frank haematuria in adult Frank or occult haematuria in child Occult haematuria + shock (systolic <90 mmHg at any point) Penetrating injury with any degree of haematuria
51
What is the investigation of choice in renal trauma?
CT with contrast
52
What is the treatment of choice in renal trauma?
98% non op | Angiography or embolization
53
When is surgery indicated in renal trauma?
Persistent renal bleeding Expanding perirenal haematoma Pulsatile perirenal haematoma
54
What injury is a bladder injury associated with?
Pelvic injury
55
What are the symptoms of a bladder injury?
Suprapubic/ abdo pain + inability to void Suprapubic tenderness, lower abdo bruising Guarding/ rigidity Diminished bowel sounds
56
When should you NOT pass a catheter in suspected bladder injuries?
Blood at external meatus suggests urethral injury - pass suprapubic catheter
57
What is the imaging of choice in bladder injuries?
CT cystography
58
What is the treatment for a bladder injury?
Large bore catheter Antibiotics Repeat cystogram in 14 days
59
What is a posterior urethral injury associated with?
Fracture of pubic rami
60
What part of the urethra is most vulnerable to injury?
Posterior urethra is fixed at the urogenital diaphragm and puboprostatic ligaments so bulbomembranous junction most vulnerable
61
What are the signs of a urethral injury?
``` Blood at meatus Inability to urinate Palpably full bladder High riding prostate Butterfly perineal haematoma ```
62
What is the investigation of choice in a urethral injury?
Retrograde urethrogram
63
What is the treatment of choice in a urethral injury?
Suprapubic catheter | Delayed reconstruction after at least 3 months
64
How does a penile fracture occur?
During intercourse, buckling injury when penis slips out of vagina and strikes pubis Cracking or popping followed by pain, discoloration and swelling
65
What is the treatment of choice in a penile fracture?
Prompt exploration and repair | Circumcision incision with degloving of penis to expose all 3 compartment
66
What will testicular injury present with?
Exquisite pain and nausea | Swelling and brusing
67
What is the imaging modality of choice in a testicular injury?
USS to determine integrity and vascularity
68
What is the treatment of choice in a testicular injury?
Early exploration/ repair improves testis salvage, reduced convalescence, better preserves fertility and hormonal function

Renal (22 decks)

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