Urology problems

Question 1

What is acute urinary retention?

Answer 1

complication of BPH

unable to urinate with increasing pain

Question 2

What is the cause fo acute urinary retention?

Answer 2

largely unknown - prostate infection, bladder overdistention, excessive fluid intake, alcohol, prostatic infection

Question 3

What are the two types of acute urinary retention?

Answer 3

precipitated or spontaneous

Question 4

What is precipitated acute urinary retention?

Answer 4

due to a trigger - non prostate surgery, catheterisation, urethral instrumentation, medication (with sympathomimetic or anti cholengeric effects), anaesthesia

Question 5

What is the treatment for acute urinary retention?

Answer 5

catheter

alpha blockers

Question 6

What is post obstructive diuresis?

Answer 6

chronic bladder outflow obstruction in association with uraemia, oedema, CCF and hypertension
retained urea, sodium and water and a defect in the concentrating ability of the kidneys

Question 7

How is post obstructive diuresis treated?

Answer 7

monitor - should self resolve in 24-48 hours

if not - IV fluid and Na replacement

Question 8

How are small stones that are expected to pass treated?

Answer 8

alpha blocker (tramsulosin)

Question 9

What are the spontaneous passage rates depending on size?

Answer 9

<4mm = 80%
4-6mm = 59%
>6mm = 1%

Question 10

When should you treat calculi urgently?

Answer 10

pain unrelieved
pyrexial
persistant nausea/vomiting

Question 11

How are calculi removed?

Answer 11

ureteric stent
stone fragmentation
if infection - percutaneous nephrostomy

Question 12

How does torsion of the spermatic cord present?

Answer 12

pubertal age 
can occur due to trauma or athletic activity
nausea/vomiting
sudden pain 
previous episodes of slight pain
referral of pain to lower abdomen

Question 13

What would be seen on examination of a torsion of the spermatic cord?

Answer 13

testis high in the scrotum
transverse lie
absence of cremasteric reflex

Question 14

How is torsion of the spermatic cord investigated?

Answer 14

doppler ultrasound - shows blood flow

Question 15

How is torsion of the spermatic cord treated?

Answer 15

2-3 point fixation with fine non absorbable sutures

if necrotic - remove

Question 16

How does torsion of the appendage present?

Answer 16

blue dot sign
testes mobile and cremasteric reflec present
resolves spontaneously

Question 17

What is epididymitis?

Answer 17

normally presents in younger men
dysuria/pyrexia
history of UTI, urethritis, catheterisation/instrumentation

Question 18

What are the examination findings for epididymitis?

Answer 18

cremasteric reflex present
pyuria
on doppler - swollen epididymis, increased blood flow
send uring for culture and chlamidiyal PCR

Question 19

What is the treatment for epididymitis?

Answer 19

analgesia and scrotal support

ofloxacin 400mg/day for 14 days

Question 20

What is paraphimosis?

Answer 20

painful swelling of the foreskin distal to the phimotic ring - retracted and cannot come back forward

Question 21

What is the treatment for paraphimosis?

Answer 21

iced glove, granulated sugar
multiple punctures in oedematous skin
dorsal slit
compression of glans

Question 22

What is a priapism?

Answer 22

prolonged erection > 4hrs not associated with arousal

Question 23

What can cause priapism?

Answer 23

intracorpeal injectiosn for ED
trauma
haematologic dycrasias
neurological conditions
idiopathic

Question 24

What are the two classifications of priapism?

Answer 24

ischaemic

non ischaemic

Question 25

Describe ischaemic priapism?

Answer 25

vascular stasis in the penis meaning blood can flow in but not out - compartment syndrome corpora cevernosa are rigid and tender and the penis is often painful

Question 26

Describe non ishcaemic priapism?

Answer 26

high flow - traumatic distruption of penile vasculature results in unregulated blood entry and filling of. the corpora fistulas can form between the cavernous artery and lacunar spaces which allows blood to bypass the normal helicene arteriolar bed

Question 27

How is priapisms investigated?

Answer 27

aspirate blood from the corpus cavernous (dark blood, low O2 and high CO2 in low flow), normal in high flow colour duplex - minimal flow in low flow, normal/high flow in high flow

Question 28

What is the treatment of ischaemic priapisms?

Answer 28

aspiration and irrigation with saline inject with alpha agonist surgical shunt

Question 29

What is the treatment for non ischaemic priapisms?

Answer 29

may resolve spontaneously

Question 30

What is fourniers gangrene?

Answer 30

form of necrotising facitis affecting the male genitalia

Question 31

What are the risk factors for fourniers gangrene?

Answer 31

diabetes local trauma periurethral invasion perianal invasion

Question 32

How does fourniers gangrene present?

Answer 32

starts as cellulitis - swollen, erythematous, tender marked pain, fever and systemic toxicity swelling and crepitus of the scrotum

Question 33

How is fourniers gangrene investigated?

Answer 33

Xray or USS

Question 34

What is the treatment of fourniers gangrene?

Answer 34

antibiotics and surgical debridement

Question 35

What is emphysematous pyelonephritis?

Answer 35

an emergency! | acute necrotising parenchymal and perirenal infection caused by gas forming uropathogens

Question 36

What can predispose to emphysematous pyelonephritis?

Answer 36

diabetes and ureteric obstruction

Question 37

What is the presentation of emphysematous pyelonephritis?

Answer 37

fever vomiting flank pain

Question 38

What can diagnose emphysematous pyelonephritis?

Answer 38

abdo xray to see gas | CT shows the extent of the erythematous process

Question 39

What is the treatment of emphysematous pyelonephritis?

Answer 39

nephrectomy

Question 40

What is a perinephric abscess?

Answer 40

usually due to a rupture of an acute cortical abscess into the perinephric space or from heamatogneous seeding from site of infection

Question 41

What is the presentation of a perinephric abscess?

Answer 41

``` flank mass insidious onset increased WCC increased serum creatinine pyuria ```

Question 42

How are peirnephric abscesses investigated?

Answer 42

CT

Question 43

What is the treatment for perinephric abscesses?

Answer 43

antibiotics | percutaneous or surgical drainage

Question 44

What are bladder injuries most commonly associated with?

Answer 44

pelvic fracture

Question 45

What is the presentation of bladder injuries?

Answer 45

``` suprapubic/abdo pain inability to void tenderness abdo bruising guarding/rigidity deminished bowel sounds ```

Question 46

How are bladder injuries investigated?

Answer 46

CT cystography

Question 47

What is the sign of an extraperitoneal injury?

Answer 47

flame shaped contrast in pelvis

Question 48

What is the treatment of bladder injury?

Answer 48

large bore cannula | antibiotics

Question 49

What is an urethral injury associated with?

Answer 49

fracture of pubic rami - bulbomembranous junction is the most vulnerable part

Question 50

What are the examination findings of a urethral injury?

Answer 50

``` blood at meatus inability to urinate palpably full bladder high riding prostate butterfly perineal haematoma ```

Question 51

What are the investigations done for urethral injuries?

Answer 51

retrograde urethrogram

Question 52

How are urethral injuries treated?

Answer 52

suprapubic catheter