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Urological emergency
- 1. Urological Emergencies Dr. Mudassir Hussain
- 2. • Pain • Urinary retention • Hematuria • Fever • Upper tract obstruction • Acute Scrotum
- 3. • Upper tract obstruction – Unilateral Vs Bilateral
- 4. • Presentation – Pain in flanks – Fever – Asymptomatic – Decrease urine output – Hematuria – Palpable flank swelling – Renal failure (acute, chronic)
- 5. • Important questions – Obstruction is unilateral or bilateral – Any complicating factor – What is the cause of obstruction
- 6. • Diagnosis of obstruction – Ultrasound KUB • Duplex ultrasound • Ureteric Jets • Diagnosis of cause – Ultrasound KUB – X ray KUB – IVP – CT Urogram – MAG Scan – Antegrade pyelogram – Retrograde pyelogram
- 7. • Goal of treatment – Preserve renal functions – Prevent sepsis – Avoid renal replacement therapy – Treatment of cause
- 8. • Treatment of obstruction only – Percutaneous nephrostomy – Double J stenting – Infection – Renal failure – Severe pain – Extensive workup required – Longer waiting list for definitive treatment
- 9. • Percutaneous nephrostomy – Less invasive – Easier to perform in sick patients – Can not be performed without knowing the definitive obstructing cause • Double J stenting – Need anesthesia / sedation – Need to know the obstructing cause – Can fail – Can worsen sepsis – Can obstruct – Better for coagulopathy states
- 10. • No PCN, NO DJ – Non obstructed hydronephrosis – Poor functioning renal unit – Unilateral obstruction with no complicating factors – Definitive treatment can be given – Renal parenchymal disease – Bladder outlet obstruction
- 11. • 35 year old male presents in ER with complains of Pain in his right scrotum since 2 days – What are the important points in history – How will u examine
- 12. • Causes of Acute scrotal Pain – Epidydimo-orchitis – Torsion of testis – Trauma – Torsion of appendix testis – Obstructed inguinal hernia – Hemorrhage in testicular mass – Infected hydrocele
- 13. • History – Onset – Duration – Previous scrotal swelling – Trauma – LUTS – Fever – Urethral catheterization
- 14. • Examination – Examine normal side first – Erythema – Shape of swelling – Get above swelling – Tenderness – Frehen’s test – Discharge at meatus – Abdominal exam
- 15. • Investigation – Clinical examination – Ultrasound
- 16. Flank Pain Flank Pain H & E, Ultrasound, x-ray, urine Dr, Serum creatinine Urological Analgesia Treat complicating factors Refer to out patient department Non urological Analgesia Refer to relevant specialty
- 17. Acute Urinary retention Acute urinary retention H & E, Ultrasound, X ray, Precipitated Temporary drainage Treat the precipitating factor Spontaneous Retain catheter Investigate and definitive treatment
- 18. Chronic Urinary retention Chronic urinary retention H & E, Ultrasound, X ray, Serum creatinine Normal renal functions Do no place catheter Investigate and definitive treatment Hydronephrosis or RF Retain catheter Observe renal functions Investigate and definitive treatment
- 19. Urinary tract infections Urinary tract infection H & E, Urine Dr, CS, CBC, Ultrasound, X Ray Uncomplicated Course of oral antibiotics Manage as outpatient Complicated IV antibiotics, Relief of obstruction, Eliminate source of infection
- 20. Hematuria Hematuria H & E, Ultrasound, X Ray, Urine Dr, coagulation profile Trauma Staging Conservative Angioembolization Exploration Infection Empirical antibiotics, Urine cultures Stone Investigate and treat as Out patient Post PCNL Conservative Angioembolization Renal tumour Conservative Angioembolization Bladder tumour Conservative Cystofulgration Glomerulonephritis Nephrology
- 21. Upper tract obstruction Ureteric obstruction H & E, Ultrasound, X-ray, serum creatinine Unilateral No complicating factors Investigate and definitive treatment Complicating factors Temporary drainage Investigate and definitive treatment Bilateral Temporary drainage Investigate and Definitive drainage
- 23. Triage is the fundamental skill of emergency physician
- 24. Ultrasound is not mandatory for all Flank Pain
- 25. Every elderly with LUTS is not suffering from BPH Do DRE
- 26. Every unilateral ureteric obstruction is not ureteric stone Every ureteric stone will not respond to alpha- blockers
- 27. Every patient with complains of inability to void is not in retention
- 28. Bladder irrigation is not the treatment of hematuria
- 29. Antibiotics are not the treatment for renal failure
- 30. Only PCN will not improve renal functions fluids infection
- 31. Know your resources Use your resources Ask for Help