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Questions and Answers
What are the non-traumatic urological urgencies?
What are the non-traumatic urological urgencies?
Acute urinary retention, renal colic, spermatic cord torsion, priapism, hematuria, phimosis/paraphimosis.
What is the only emergency in urology?
What is the only emergency in urology?
Rupture/lesion of renal vessels.
What is nocturia?
What is nocturia?
The need for patients to wake up frequently during the night to urinate.
What are the main causes of acute urinary retention?
What are the main causes of acute urinary retention?
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What is a common treatment for acute urinary retention?
What is a common treatment for acute urinary retention?
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What symptoms are associated with renal colic?
What symptoms are associated with renal colic?
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How is acute urinary retention diagnosed?
How is acute urinary retention diagnosed?
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What can acute urinary retention complicate into?
What can acute urinary retention complicate into?
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What is priapism?
What is priapism?
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Which type of priapism is more dangerous?
Which type of priapism is more dangerous?
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Study Notes
Urological Urgencies and Emergencies
- Urgency is a non-life-threatening condition that may cause organ damage and ischemia.
- Divided into non-traumatic and traumatic urgencies.
Non-Traumatic Urological Urgencies
- Acute urinary retention
- Renal colic
- Spermatic cord torsion
- Priapism
- Hematuria
- Phimosis/Paraphimosis
Traumatic Urological Emergencies
- Renal trauma
- Ureteral injury
- Bladder trauma
- Urethral injury
Emergency in Urology
- The only medical emergency is the rupture or lesion of renal vessels leading to bleeding and kidney damage.
Nocturia
- Defined as the need to wake frequently during the night.
Acute Urinary Retention
- Occurs when urine cannot leave the bladder, distinct from anuria.
- Major causes include:
- Benign Prostatic Hypertrophy
- Urethral Stenosis
- Phimosis
- Spinal Cord Injury
- Urinary Tract Infection (UTI)
- Prostate cancer (T4 stage)
- Treatment options are bladder catheterization and addressing underlying causes; suprapubic cystostomy may be needed if catheterization fails.
Clinical Features and Diagnosis of Acute Urinary Retention
- Symptoms are sudden inability to empty the bladder, suprapubic pain, palpable bladder.
- Diagnosis through physical examination (bladder globe palpation) and ultrasound confirming fullness of the bladder.
- Serum creatinine levels are typically normal, indicating kidney function is not impaired.
- Complications may lead to post-renal Acute Kidney Injury (AKI).
Differentiation Between Acute Urinary Retention and Anuria
- Diagnosis can be supported using BUN, creatinine tests, and ultrasound; no pain or bladder globe present in anuria.
Urinary Retention and Cystotomy
- Cystotomy may be necessary when catheterization is unfeasible (e.g., in urethral stenosis).
Renal Colic
- Most common urgency in urology characterized by severe flank pain.
- Commonly caused by ureteral stones, blood clots, malformations, neoplasms, or trauma.
- Symptoms include:
- Severe unilateral and colicky flank pain, radiating to lower abdomen, groin, labia, or testicles.
- Microhematuria
- Nausea and vomiting
- Increased urinary frequency and urgency.
Diagnosis and Treatment of Renal Colic
- Diagnosis involves history, ultrasound (for stones in kidneys), spiral CT without contrast (for uretic stones), or MRI with contrast.
- Urinalysis may reveal hematuria, crystals, and leukocytes.
- Medical treatment options include NSAIDs for pain relief, and myorelaxants; antispasmodics are debatable.
- Aggressive treatments include:
- Extracorporeal lithotripsy to break stones.
- Urethral catheterization.
- Surgical options include endoscopic ureteral-lithotripsy, ureterolithotomy, percutaneous nephrolithotomy, and simple nephrectomy (if kidney fails).
Spermatic Cord Torsion
- It occurs due to twisting of the spermatic cord, leading to ischemia.
- Untwisting direction and urgent intervention are necessary.
- Orchiopexy may be performed to secure the testicle in place.
Priapism
- Characterized by a painful and prolonged erection lasting over three hours, not linked to sexual desire.
- Types:
- Low flow (venous) priapism: Blood occlusion in the deep dorsal vein, often linked to thrombosis.
- High flow (arterial) priapism: Abnormal blood inflow into the corpora cavernosa.
- Etiological factors for low flow include idiopathic causes, hematologic disorders, and certain pharmacological influences; high flow usually stems from trauma.
- Low flow priapism is more dangerous due to risk of ischemia, often observed in sickle cell disease and other blood disorders.
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Description
This quiz focuses on identifying the various urological urgencies and emergencies. It covers both non-traumatic and traumatic conditions that may pose risks of organ damage. Test your knowledge on conditions such as acute urinary retention, renal colic, and more.
