Questions and Answers
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?
Rupture/lesion of renal vessels.
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?
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What is a common treatment for acute urinary retention?
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What symptoms are associated with renal colic?
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How is acute urinary retention diagnosed?
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What can acute urinary retention complicate into?
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What is priapism?
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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.
