Dr.Ahmed Azzo.
Urology sessionUrologic emergencies
1)Traumatic :-2)Non traumatic most common :-
1-renal colic .
2-urine retention.
3-priapism.
4-paraphemosis.
-Define urine retention :- is inability to pass urine inspite of full bladder.
Chronic retention –painless ,most common cause :-BPH,CAP.(>50yrs),constipation (in pediatric age group),Multiple sclerosis,CVA,SPINAL TRAUMA (in old age).Severe pain (especially post op) means retention.
O/E:-bladder reaches above umbilicus >1000cc or 2000cc//500ml & less =acute retention.Thin bladder wall , distended bladder on US.
MX:-catheter is used to drain the retained urine.
Nelaton catheter was used to drain putting it=non self retaining catheter ,now we use foly catheter.
Start to treat the cause for example BPH
Alpha blocker(tamsulosin)& finasteride(5-alpha reductase inhibitor) = 7days after usage of foly catheter.
Alpha blocker used for 6mo-1yr,maximum 2yrsit reduces the size of prostate .(the adenomatous part will be reduced).
Anti –DHT = it causes :-impotency , loss of libido.
Herbal therapy:reduce inflammation ,reduce prostate size.
Anticholinergic :-not used in urinary retention( only used if urgency ,frequency is present ).
Note :-hematuria will occur while evacuation of distended bladder due to rupture of distended mucosal BVs,to avoid this evacuate the bladder intermittently.
2-renal colic =flank pain::: ((the flank is the area between lower costal edge & iliac crest)):acute pain in this area is of two types
1.colicky:-has obstructive cause mostly.
2.dull:deep seated pain:-inflammatory cause mostly.
Colicky pain :-Radiated to groin ,external gentilia,Upper abdomen .
Associated symptoms :-nausea-vomiting-ileus-fever(if superadded infection).No peritoneal signs(very important).
Investigation :-
1-GUE:hematuria
2-plain CT scan "without contrast):of choice :-85% of stones appear clear .
3-IVU(after36hrs of colic relief) to avoid spasm that prevent excretion of contrast.
Management :-
1-pain free pt before any investigation :-NSAIDs (injectable , trans rectal route:suppositories):voltarin .
If not available :tramal,morphine (opiods).
Most renal colic is due to stone.
ABs not indicated only if infection signs are present fever ,rigor, GUE:show +ve for infection,leucocytosis .
Treat the cause –stone if the size <4mm it will pass spontaneously, anatomy of pelvic calyces,shape ,size of ureter,(sitewithin the ureter: in upper urter ,stone less likely to pass.
Medical dissolution therapy.
DDx Painful scrotal swelling :-Epididymo-orchitis
Torsion:-long mesochorium,poorly developed gubernaculums:initiating factor is cold exposure,vigorous cremasteric reflex.(DDx:epididymo-orchitis).
Trauma
Obstructed hernia
10%of tumours.
How to differentiate epididymo-orchitis from torsion??
من الملزمة العملي
Prehn's sign :-+ve in epididymo-orchitis (hanging pain)(UTI is present)hematogenous spread in T.b and Brucella.
Loss of cremasteric reflex in torsion (important).
Torsion types :-
1-intravaginal:-most common type in adult (adolescent).
2-extravaginal :in neonate
--priapism :-erection >4hrsemergency.
Fistula between artery & vein is the cause in high flow rateMore risky
Obstruction of arteries is the cause in low flow rate :SCA :less risky.