UROLOGICAL EMERGENCY
Symptoms PAIN: Renal colic (ureteric colic) Testicular torsion Phimosis/Para-Phimosis/Balanoposthitis VOIDING DIFFICULTY: BPH (Bladder tamponde) HEMATURIA: Pain or Painless TRAUMA: Penile fracture Renal/Peri-Renal contussion
Renal Colic Symptom complex that is characteristic for the presence of obstructing urinary tract calculi Caused by distention of the renal capsule or stretching of the ureter Local mechanisms: inflammation, edema, hyperperistalsis, and mucosal irritation etc.
Renal Colic Mostly occurs during night or early morning Abrupt in onset Partially obstructing, continuously moving calculus appears to create the greatest amount of colic
Renal Colic Pain radiation of renal colic: flank, abdomen, groin, testis (UPJ stone), labia majora Midureteral stone: lateral flank and abdomen Stone near UVJ: scrotum or vulva urinary frequency and urgency
Associated symptoms and signs of renal colic Nausea Vomiting Ileus Intestinal stasis Diarrhea
Differential diagnosis of renal colic Gastroenteritis Acute appendicitis Colitis Salpingitis
Renal Colic PE U/A KUB IVP Renal echo CT scan (Helical CT) R-P
Treatment of renal colic at ER Narcotic analgesics NSAIDS Calcium channel blockers Hydration ESWL Consult urologist
Admission Indications Concurrent UTI ( not pyuria) Solitary kidney & complete obstruction Uncontrolled pain Intractable emesis Large stone ( diameter > 0.5 cm)
Acute Scrotal Pain Testicular Torsion Potentially infarction and infertility Epididymitis/Orchitis
Testicular Torsion Differential Dx: Epididymitis/Orchitis Sudden onset of severe pain Radiated to inguinal canal & LLQ/RLQ Boys to young man 4 hours of warm ischemia Color dupplex & emergent exploration Manual detorsion: The open book method Consult Urologist stat
Renal Function Evaluation ACUTE RENAL FAILURE Oliguria < 500 ml/ 24 hrs Prerenal Renal Postrenal Urine Na < 20 > 40 > 40 Urine osmo > 500 < 300 < 400 U/S cre ratio > 40:1 < 20:1 < 20:1 BUN/cre ratio > 20:1 10:1 <10: 1