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GU tract (Urinary retention (Urinary obstruction e.g. stones, Flank pain,…
GU tract
Urinary retention
Urinary obstruction e.g. stones
Flank pain
Fever and LUTS
Distended abdomen and palpable bladder
Inability to urinate
Urine dipstick, USS, U+Es, FBC
Ureteric stent or nephrostomy if no stones
Catheterisation sometimes to void urine and/R alpha-blocker therapy to dilate vessels and urethra if cause is BPH
Testicular torsion
Risk factors
<25 years, neonates and bell clapper deformity
Signs and symptoms
Testicular pain, acute on and off pain, no pain relief on elevation of scrotum (cough, scrotal swelling and oedema, scrotal erythema, reactive hydrocele, high riding testicle, horizontal lie and negative cremasteric reflex.
Aetiology
For adolescent boys and young adult intra-vaginal torsion, bell clapper deformity is most common anatomical defect. This occurs when both the tunica vaginalis occur superior to the testicle which means the testicle is freely mobile within the tunica. Another cause is trauma. There is no real cause for neonatal torsion.
Investigations and diagnosis
USS to image fluid and whirlpool sign
Doppler to visualise decreased blood flow to affected testicle
Epidemiology
Not a disease of the elderly - can occur in neonates (extra vaginal torsion of tunica vaginalis) and adolescent boys (intra vaginal torsion of tunic vaginalis)
Management
Non-neonates = urgent urological referral for emergency scrotal exploration and supportive care (Within 6 hours of pain onset.
After 6 hours = remove affected testis and supportive care
Definition
Twisting of the testicle on the spermatic cord leading to constriction of vascular supply and time sensitive ischemic and/or necrosis of testicular tissue.
Cryptorchidism
Incomplete migration of test is during embryogenesis
Common when have family history
Risk factors include a low birth weight as well as FHx
Clinical diagnosis
If prepubertal
Orchiopexy if unilateral - if bilateral consider genetic evaluation and surgical exploration
If postpubertal
Orchiopexy and biopsy or orchiectomy.
Nephro/urolithiasis
Risk factors
High dietary calcium
Signs and symptoms
Rental calculi = loin/flank to groin pain, uteric calculi = renal colic
Gross haematuria
Asymptomatic
UTI/UT obstruction
Urinary frequency/urgency
Nausea and vomiting
Aetiology
Most stones are comprised of calcium oxalate/calcium phosphate and form when the normally soluble material supersaturates the urine and begins to crystalise
Investigations and diagnosis
Mid stream urine (MCNS)
Serum U+Es, creatinine and calcium
Non-contrast CT (1st) or renal USS for renal calculi but low sensitivity for Ureteric stones.
FBC - infection
Epidemiology
10% lifetime risk and more prevalent in males in hotter climates due to dehydration risk
Management
Strong IV analgesics e.g. diclofenac
Small stones can pass spontaneously
If persistent symptoms - ESWL (Extracorporeal shock wave lithotripsy), fragmenting stones so can be passed spontaneously
Endoscopy laser if larger stones
Incontinence
Stress
Related to increased parity and vaginal deliveries due to weakening and stretching of muscles and connective tissues as well as damage to pudendal and pelvic nerves.
Leakage of urine when intra-abdominal pressure increases e.g. coughing, sneezing, laughing
Mixed
Urge
A strong desire to void urine, and patient may be unable to hold, this is due to hypersensitivity (UTI, stones, tumours) of the bladder and detrusor instability
Bladder retraining - to maximise time between urinary voids
Can be treated with anticholinergic agents e.g. oxybutynin
Ureteric trauma
Rare
Surgical causes e.g. hysterectomy
Penetrating injury
Hydrocoele/varicocoele
Hydrocele
Non-tender soft swelling of the testes
Testes transilluminates
Can be associated with an indirect inguinal hernia
Enlargement of mass following activity
Aetiology - secretion of fluid from tunica vaginalis resulting in a collection of this fluid
Variation in mass throughout the day
Only clinical diagnosis
Can observe if no discomfort or perform surgery to remove the hernia sac (processes vaginalis) if patient in discomfort
Varicocele
Dilation of veins in testicle
Usually left sided
"Feels like a bag of worms)
Paraphimosis/phimosis
Paraphimosis
Aetiology
Retraction of foreskin of uncircumcised man with the neglection to replace the foreskin
Retraction behind the glans pens leads to phimotic ring causing constriction of distal glans, leading to vascular engorgement, resulting in secondary oedema
Can cause ischemic of pens distal to phimotic ring and necrosis can occur if left unnoticed/untreated.
Management
No necrosis
Manipulation
Necrosis
May need surgical debridement
Phimosis
Inability to react foreskin when once was able
Foreskin to tight to be retracted