Acute Conditions in Urology & Scrotal Swellings. Done by: Khadija S. El-Hammasi Supervised by: Dr. Yhaya Elshebiny. Acute Conditions in Urology. Acute Urological conditions: Urolithiasis (Calculus Disease) Trauma of Genitourinary system Infection of Genitourinary system Testicular torsion
Acute Conditions in Urology& Scrotal Swellings
Done by: Khadija S. El-Hammasi
Supervised by: Dr. Yhaya Elshebiny
-Incidence: 1% of the population.
Causes of calculi formation:
2.Secondary due to stasis Infection
Metabolic disorders (cystinuria)
-Types of the calculi:
1.Calcium oxalate (75%)
2. Phosphate (15%)
3. Urate (5%)
5. Xanthine & pyruvate (rare)
- Factors predispose to the development of renal stones?
1.Recent reduction in fluid intake
2.Increased exercise with dehydration
3.Medications that cause hyperuricemia (high uric acid)
4.History of gout
To evaluate kidney function
Treatment: For acute symptoms (renal colic)
Antispasmodics e.g. desmopressin to inhibit uretric peristalsis relief the renal colic
Further management depends on
-Kidney stones 0.5 – 2.5 cm +/- DJ stint.
-Ureter stones 0.5 – 2.5 cm +/- DJ stint for stones located in the upper & middle part of the ureter (possible lower).
Who to investigate?
Arteriogram following blunt abdominal trauma shows acute renal artery thrombosis of left kidney.
Small perirenal hematoma
1. Large pelvic mass that displace the ureter laterally.
2.Surgical procedure: e.g. Gynecological procedure in
female (hysterectomy)& Endoscopic manipulation of
▪Signs of acute peritonitis may be present due to urinary extravasations into the peritoneal cavity.
▪Catheterization: microscopic heamaturia
▪Excretory urography (IVU): delayed excretion of contrast due to hydronephrosis.
▪U/S: detect hydroureter or urinary extravasation.
▪Immediate re-exploration & repair.
Stab wound of right ureter shows
extravasation on intravenous urogram.
Rupture of bladder with
extravasation of urine intothe peritoneal cavity
Cystogram demonstrating extravastion
-Scrotal swelling +/- ruptured testis
-Tender enlarged testis.
- CT scan
-Surgical exploration may be require to evacuate hematocele & repair a split in the tunica albuginea.
-Bacterial infection of one or both kidneys.
-Most common organism is E-coli.
2.Dysuria & Frequency
3.Fever & rigors
2.pyuria, bacteruria & microscopic
3.>100,000 colonies/ml in urine culture
Right kidney is markedly enlarged andhas a wedge-shaped area of low attenuation
-IVU renal enlargement
-U/S dilated collecting system from obstruction, presence of urinary stones or renal abscess
- CT scan
-I.V Abx +/- nephrostomy
-Common organism is E-coli.
1.Irritative Sx (Dysuria, frequency & urgency)
3. Suprapubic pain & tenderness
1.Pyuria, bacteruria + hematuria
-Radiological investigation is limited to cases where renal infection is suspected
-Commonly in young males
-Common organism is E-coli, Pseudomonas
-Sigh & Symptoms:
2.Low back pain, perenial pain
3.Bladder irritation & outflow obstruction
4.Tender, warm, large & firm prostate on PR examination
1.Pyuria, bacteruria + microscopic hematuria
*Tx I.V Abx
-Persistent, painful erection.
2. Leukemia, sickle cell dx
4.Pt on hemodialysis
1.Aspiration of blood from the corpora cavernosa
2.Anastomosis of the great saphenous vein to the engorged corpora cavernosa thus establishing venous drainage of the corpora
**The swelling may take as long as 2 months to resolve
the actual torsion is usually of the spermatic cord
Congenital: occurs in infants due to patent processus vaginalis peritoneal fluid can enter the scrotum
Can “get above it”
Testes cannot be felt separately
Dull to percussion
Not campressible or pulsatial
Can’t be reduced
Normal skin color & temp
Not tender if primary (may be tender if secondary)
Size can be reach up to 10-20cm in diameter
Fluid-filled swellings connected with the epididymis.
Must be done to confirm your diagnosis & R/O testicular tumore
DXT=deep x-ray therapy, RPLND=retroperitoneal lymph node dissection
The pt must be examined standing, not to miss the diagnosis
Microsurgery is used in most cases. Has less recurrence rate and better success.
Embolization is preferred in case of recurrence
A peritoneal sac protrudes through the deep inguinal ring, passes down the inguinal canal, &may extend as far as the upper pole of the testis.
The defect is congenital & is due to persistent processus vaginalis