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44 Cards in this Set
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- Back
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finding blood at the urinary meatus
could indicate |
pelvic fractures
in which a displaced fracture fragment may cause a urethral disruption. |
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A superiorly displaced prostate indicates
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disruption of the posterior urethra
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When meatal blood is noted
a urinary catheter should not be placed because |
in order to prevent the conversion of a partial urethral laceration into a complete transection.
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A retrograde urethrogram is virtually mandatory in this setting in order to make the diagnosis and to minimize the chances of long-term complications of a urethral transection
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blood at the meatus
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Definition of microscopic hematuria
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More than 5 RBCs/ hpf on a single sample
(1-3 RBCs is normal) |
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All patients in whom microscopic hematuria is found with concurrent non renal injuries and those with hemodynamic instability should have
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a diagnostic imaging study like a urethrogram
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a noninvasive modality with superior imaging detail that allows detection of even minor injuries and minimal extravasation
estimation of extent of hematoma and simultaneous evaluation of other organs. |
CT
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How high should the bag be placed on a cystogram and why?
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At 2 ft
pressure generated approximates the physiologic voiding pressure Unless adequate pressure is generated the cystogram may be falsely negative Ideally the procedure is performed under fluoroscopy to avoid extravasation. |
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% of renal injuries
which have: renal contusions which include renal parenchymal ecchymosis minor lacerations subcapsular hematomas with an Intact renal capsule. |
92%
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Grades III through V renal injuries that feature extravasation or
collecting system rupture are managed how? |
surgically
others are managed with observation |
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An acute tear or
rupture of the corpus cavernosa tunica albuginea Signs: acutely swollen but flaccid discolored & tender history of trauma during sexy time Snapping sound 30-40 yo men How is this managed? |
penile Fx
hematoma evacuation and suture repair of tunica albuginea. |
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Explain how to manage a zipper injury to the penis.
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Gentle manipulation after 1% lidocaine to release entrapment
Cutting the median bar of the movable part of the zipper with a bone cutting plier may help Next option is general anesthesia or circumcision. |
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a phlegmon that is located on scrotal wall
i.e simple hair follicle abcess Sometimes very difficult to distinguish from other infections what is this and how is it tx? |
Simple scrotal abscess of a hair follicle
I & D sometimes circumferential excision of entire roof of abcess - allows for optimal wound care and healing Abx not usually required in immuno intact men. |
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polymicrobial
synergistic necrotizing inf of the male genitalia that originates from the skin urethra or rectum leads to end-artery thrombosis in the subcutaneous tissue that promotes widespread necrosis of previously healthy tissue |
Fournier’s gangrene
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How to tx Fournier’s gangrene?
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aggressive fluid resuscitation
wide antibiotic coverage sometimes wide surgical debridement with pre and post op hyperbaric O2 treatment Often urology is consulted. |
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What is the mortality rate from Fournier’s gangrene?
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Mortality is 20%.
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Definitive tx is circumcision
Topical steroids for 4 - 6 weeks has shown to be 70-90% effective also. |
phimosis
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Tx: Compression of the glans for several minutes to reduce edema
Occasionally several small puncture holes can allow edema fluid to be expressed Last - give lidocaine /s Epi into constricting band and then superficial dorsal incision of the band. |
paraphimosis
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inflammation of the testicle usually in conjunction with other systemic infections such as mumps or
viral illness Pts present with testicular tenderness and swelling over a few days duration Tx: symptomatic and Dz specific |
orchitis
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Persistent
usually painful pathologic erection in which both corpora cavernosa are engorged with stagnant blood Glans penis and corpus spongiosum are characteristically soft and uninvolved results in 35% Impotence |
priapism
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pharmacological agents related to intra cavernosal injection of vasoactive substances for impotence
use of oral agents for HTN or mental disorders can cause |
priapism
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what is a male GU complication of sickle cell Dz?
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priapism
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history of an athletic event
strenuous physical activity or trauma just before the onset of scrotal pain a fair number occur during sleep when unilateral cremaster muscle contraction results in |
testicular torsion
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regarding testicular torsion
the pain may be constant or intermittent and ? it IS or IS NOT Positional in Nature |
IS
NOT |
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peak incidence is at puberty
but can occur at any age |
testicular torsion.
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If one were to stand at the patient's feet
the patient's right testis would be rotated which way? |
counterclockwise
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True or False:
In an obvious cases of testicular torsion a urologic evaluation surgical exploration is not necessary.. |
false
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usually more gradual onset than that of testicular torsion because of its inflammatory etiology
under age 40 primarily caused by STD over age 40 common urinary pathogens such as Escherichia coli and Klebsiella. |
epididymitis
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may note
transient relief of their pain in the recumbent position w scrotal elevation (Positive Prehns Sign) Also opiates for pain control |
epididymitis
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passage of a urethral catheter using lubricant with Lidocaine (Lidocaine Jelly)
alleviates their pain and urinary retention. |
relief of urinary retention
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meatal stenosis
urethral stricture bladder neck stricture and benign prostatic hypertrophy can all cause |
urinary retention
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The catheter should be passed to its fullest extent to obtain a free flow of urine
and only then can |
the catheter balloon be inflated
also the catheter should be left indwelling and connected to a portable leg drainage bag consultation and follow-up with a urologist for a genitourinary evaluation are necessary. |
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occur three times more often in males
usually in the third to fifth decades of life increased risk for those with prior experience Patients in mountainous desert or tropical regions and those in sedentary jobs have a higher frequency |
urinary stones
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has the smallest diameter of the urinary tract and is a common location for impacted stones.
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ureterovesical junction (UVJ)
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what factors may predict urinary stone passage without surgery?
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small
regular partial blockage distal location at first diagnosis. |
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acute onset of
remarkably severe episodic visceral pain little if any tenderness on examination unable to find a comfortable position anxious pacing reluctant to lie still on the examining table. |
renal stone
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Fever and other symptoms of UTI along with CVA tenderness (CVA tenderness alone may be present with stones - so look for fever/UTI sx).
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pyelonephritis
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used to identify hematuria or
infection in renal colic |
UA
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What is the disadvantage of using CT to diagnose renal stones?
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no renal function evaluation
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What is the advantage of using IVP to diagnose renal stones?
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eval renal function.
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When should one use US in diagnosing renal stones?
What should one remember if one uses this method? |
pregnancy
no radiation insensitive in middle third of ureter may miss smaller stones. |
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What should one use plain films for in regards to kidney stones?
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use to follow after initial diagnosis
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What is the most important treatment for kidney stones?
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pain control
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When should you admit for kidney stones?
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infection with concurrent obstruction
uncontrolled pain intractable emesis |
