Emergency Urology

209 Pages·2016·28.51 MB·English

by  David Thurtle

Emergency

UROLOGY
David Thurtle BMedSci BMBS MRCS
Academic Clinical Fellow in Urology,
Cambridge University Hospitals
NHS Foundation Trust, UK
Suzanne Biers BSc MBBS MD FRCS (Urol)
Consultant Urologist,
Cambridge University Hospitals
NHS Foundation Trust, UK
Michal Sut Lek Med MMedSci FRCS (Urol)
Senior Registrar, Urology,
Cambridge University Hospitals
NHS Foundation Trust, UK
James Armitage BSc MBBS MD FRCS (Urol)
Consultant Urologist,
Cambridge University Hospitals
NHS Foundation Trust, UK
Prelims.indd 1 20/12/2016 15:28
tfm Publishing Limited, Castle Hill Barns, Harley, Nr Shrewsbury, SY5 6LX, UK.
Tel: [phone]; Fax: [phone]
E-mail: [email protected]; Web site: www.tfmpublishing.com
First Edition: © 2017
Cover images: iStock.com (from left to right):
X-ray image of KUB, showing left kidney stone, © Sutthaburawonk
Retained Foley catheter, © ChaNaWiT
Pelvis — male false color cutaway view, © Medical Art Inc.
Kidney stones, ©John Lerskau
Background image — human kidneys anatomy, © Nerthuz
Paperback ISBN: 978-1-910079-42-3
E-book editions: 2017
ePub ISBN: 978-1-910079-43-0
Mobi ISBN: 978-1-910079-44-7
Web pdf ISBN: 978-1-910079-45-4
The entire contents of ‘Emergency Urology’ is copyright tfm Publishing Ltd.

Apart from any fair dealing for the purposes of research or private study, or criticism or review, as permitted under
the Copyright, Designs and Patents Act 1988, this publication may not be reproduced, stored in a retrieval system or
transmitted in any form or by any means, electronic, digital, mechanical, photocopying, recording or otherwise, without
the prior written permission of the publisher.
Neither the authors, the editors nor the publisher can accept responsibility for any injury or damage to persons or
property occasioned through the implementation of any ideas or use of any product described herein. Neither can they
accept any responsibility for errors, omissions or misrepresentations, howsoever caused.
Whilst every care is taken by the authors, editors and the publisher to ensure that all information and data in this book
are as accurate as possible at the time of going to press, it is recommended that readers seek independent verification of
advice on drug or other product usage, surgical techniques and clinical processes prior to their use.
The authors, editors and publisher gratefully acknowledge the permission granted to reproduce the copyright material
where applicable in this book. Every effort has been made to trace copyright holders and to obtain their permission for
the use of copyright material. The publisher apologizes for any errors or omissions and would be grateful if notified of
any corrections that should be incorporated in future reprints or editions of this book.
Printed by Gutenberg Press Ltd., Gudja Road, Tarxien, PLA 19, Malta.
Tel: [phone]; Fax: +356
Prelims.indd 2 20/12/2016 15:28
Contents
Contributing Authors v Chapter 4 Genitoscrotal Emergencies 69
Acknowledgements vii Acute scrotum 69
Abbreviations viii Penile emergencies 79
Preface xi Priapism 84
Fournier’s gangrene 88
Chapter 1 Assessing the Unwell
Urological Patient 1 Chapter 5 Trauma in Urology 93
ABCDE 1 Upper urinary tract trauma 93
History 1 Lower urinary tract trauma 99
Examination 5 Genitoscrotal trauma 104
Routine investigations 9
Imaging investigations 11
Sepsis 12 Chapter 6 Special Circumstances 109
Paediatric urological emergencies 109
Urological emergencies in
Chapter 2 Upper Urinary Tract pregnancy 114
Emergencies 17 Neurogenic bladder 119
Acute kidney injury 17 Oncological emergencies 125
Renal colic 27 Post-operative emergencies 128
Kidney infections 36 Tubes, prostheses and altered
urinary tract anatomy 136
Chapter 3 Lower Urinary Tract
Emergencies 43 Chapter 7 Procedures in Urology 147
Urinary retention 43 Urethral catheterisation 147
Haematuria 52 Suprapubic catheterisation 153
Urinary tract infection and cystitis 59 Catheter complications 158
Prostatitis 65 Local anaesthetic penile blocks 166
Urethritis 67
Prelims.indd 3 20/12/2016 15:28
iv Contents
Chapter 8 Interventional Uroradiology Appendix 1: Example emergency
Procedures 171 department protocol for suspected
Nephrostomy 171 sepsis 183
Antegrade ureteric stent insertion 173 Appendix 2: The ABCDE approach 185
Ileal conduit access and ureteric
stenting 174 Index 191
Mitrofanoff imaging/access 176
Renal embolisation 177
Drainage of collections 180
Prelims.indd 4 20/12/2016 15:28
Contributing Authors
Samih Al-Hayek MD FRCS (Urol) Andrew Fry MA MB BChir PhD FRCP
Consultant Urologist, Cambridge Consultant in Nephrology and Acute
University Hospitals NHS Foundation Medicine, Cambridge University
Trust, UK Hospitals NHS Foundation Trust, UK
Tariq Ali MBBS MRCP MSc MRGP Tom Mitchell DPhil BMBCh FRCS (Urol)
AFHEA FRCR Academic Clinical Lecturer and
Fellow in Interventional Radiology, Honorary Urology Registrar,
Cambridge University Hospitals NHS Cambridge, UK
Foundation Trust, UK
Adam Nelson MBChB MRes MRCS AFHEA
James Armitage BSc MBBS MD Academic Clinical Fellow and
FRCS (Urol) Honorary Urology Registrar,
Consultant Urologist, Cambridge Cambridge, UK
University Hospitals NHS Foundation
Trust, UK Ben Pullar MBBS FRCS (Urol)
Specialist Registrar in Urology,
Suzanne Biers MD FRCS (Urol) Cambridge University Hospitals NHS
Consultant Urologist, Cambridge Foundation Trust, UK
University Hospitals NHS Foundation
Trust, UK Andrew Robb MCh FRCSEd(Paed Surg)
DipIMC(RCSEd)
Alexandra Colquhoun MD FRCS (Urol) Consultant Paediatric Urologist,
Consultant Urologist, Cambridge Birmingham Children’s Hospital,
University Hospitals NHS Foundation Birmingham, UK
Trust, UK
CJ Shukla PhD FRCS (Urol)
Ragada El-Damanawi MBBS MRCP Consultant Urologist, NHS Lothian,
Specialist Registrar in Nephrology, Edinburgh, UK
Cambridge University Hospitals NHS
Foundation Trust, UK
Prelims.indd 5 20/12/2016 15:28
vi Contributing Authors
Michal Sut Lek Med MMedSci FRCS (Urol) Holly Weaver MA MB BCh
Specialist Registrar, Cambridge Foundation Doctor, Cambridge
University Hospitals NHS Foundation University Hospitals NHS Foundation
Trust, UK Trust, UK
Nikesh Thiruchelvam MD MBBS BSc Andrew Winterbottom MBBCh
FRCS (Urol) MRCS FRCR
Consultant Urologist, Cambridge Consultant Interventional Radiologist,
University Hospitals NHS Foundation Cambridge University Hospitals NHS
Trust, UK Foundation Trust, UK
David Thurtle BMBS BMedSci MRCS
Academic Clinical Fellow in Urology,
Cambridge University Hospitals NHS
Foundation Trust, UK
Prelims.indd 6 20/12/2016 15:28
Acknowledgements
Mr Tev Aho, Consultant Urologist, Foundation Trust, UK: illustrations in
Cambridge University Hospitals NHS Chapters 4 and 7.
Foundation Trust, UK: HoLEP images, Dr Jacek Libiszewski, Consultant
Chapter 3. Radiologist, Peterborough and
Boston Scientific, Marlborough, MA, USA: Stamford Hospitals NHS Foundation
AUS figures, Chapter 6. Trust: MSCC MRI image, Chapter 6.
Dr Ciaran Conway, GP Registrar, Severn Mediplus Ltd, UK: images in Chapter 6
Deanery, UK: hydrocoele images, – insertion of Mediplus Ltd. S-Cath™
Chapter 1. system and components.
Drvgaikwad. Paraphimosis image, Chapter Mr Joseph Norris, Academic Clinical
4. Used under Creative Commons Fellow, University College London
licence 3.0. (http://creativecommons. Hospitals NHS Foundation Trust.
org/licenses/by/3.0), via Wikimedia Mr Andrew Robb, Consultant Paediatric
Commons.) Urologist, Birmingham Children’s
Elsevier Publishing Ltd, UK: Fournier’s Hospital: paediatric clinical images in
gangrene image, Chapter 4 and Chapter 6.
perineal bruising image, Chapter 5. The Resuscitation Council (UK): the ABCDE
Bullock N, Doble A, Turner W, Cuckow approach – Appendix 2.
P. Urology: An Illustrated Colour Text. The UK Sepsis Trust: Sepsis definitions
Elsevier, Churchill Livingstone, 2007; p and information used in Chapter 1
49, Fig. 3 and p138, Fig. 1. and Emergency Department Sepsis
Klemen Jagodič et al. Intra-operative Screening and Action Tool – Appendix 1.
penile fracture images, Chapter 4. Used Kay Trabucchi, Urology Nurse Specialist,
under Creative Commons Attribution West Suffolk Hospital NHS Trust:
licence 2.0. Klemen Jagodič, et al. bladder scan image, Chapter 3.
Journal of Medical Case Reports 2007; 1: Dr Anne Warren, Consultant
14. DOI: 10.1186/1752-1947-1-14. Histopathologist, Cambridge University
Dr Abeyna Jones, Occupational Hospitals NHS Foundation Trust, UK:
Medicine Registrar and NHS Clinical microscopy images, Chapters 2 and 3.
Entrepreneur Fellow, King’s College Dr Andrew Winterbottom, Consultant
Hospital, UK: difficult catheterisation Interventional Radiologist, Cambridge
algorithm, Chapter 7. University Hospitals NHS Foundation
Dr Olivia Kenyon, Foundation Doctor, Trust: radiological figures and legends
Cambridge University Hospitals NHS throughout the book.
Prelims.indd 7 20/12/2016 15:28
Abbreviations
5-ARI 5-alpha-reductase inhibitor β-HCG beta-human chorionic
AAA abdominal aortic aneurysm gonadotrophin
ABG arterial blood gas CAUTI catheter-associated urinary tract
Abx antibiotics infection
ACEI angiotensin converting enzyme CCF congestive cardiac failure
inhibitor CFU colony-forming units
ACS acute coronary syndrome Ch Charrière. Unit of measurement,
ADH antidiuretic hormone see ‘Fr’
AKI acute kidney injury CI contrast-induced
AML angiomyolipoma CIS carcinoma in situ
ANA antinucleic acid CISC clean intermittent self-
ANCA antineutrophil cytoplasmic catheterisation
antibody CKD chronic kidney disease
APTT activated partial thromboplastin COPD chronic obstructive pulmonary
time disease
ARB angiotensin II receptor blocker CPR cardiopulmonary resuscitation
ATLS® Advanced Trauma Life Support CRP C-reactive protein
ATN acute tubular necrosis CRT capillary refill time
AUR acute urinary retention CT computed tomography
AUS artificial urinary sphincter CUR chronic urinary retention
BAUS British Association of Urological CXR chest X-ray
Surgeons DH drug history
BCG bacillus Calmette–Guérin DHT dihydrotestosterone
BD bis in die (twice daily) DIC disseminated intravascular
BNF British National Formulary coagulopathy
BOO bladder outlet obstruction DMSA dimercaptosuccinic acid scan
BP blood pressure DRE digital rectal examination
BPE benign prostatic enlargement DSD detrusor sphincter dyssynergia
BPH benign prostatic hyperplasia ECG electrocardiography
bpm beats/min, breaths/min ED erectile dysfunction
BXO balanitis xerotica obliterans eGFR estimated glomerular filtration rate
Prelims.indd 8 20/12/2016 15:28
Abbreviations ix
ENT ear, nose and throat LA local anaesthetic
EPN emphysematous pyelonephritis LFT liver function test
ESR erythrocyte sedimentation rate LUTS lower urinary tract symptoms
ESWL extracorporeal shock wave MAGI male accessory gland infection
lithotripsy MC&S microscopy, culture and
FAST focused assessment with sensitivities
sonography for trauma MRI magnetic resonance imaging
FBC full blood count MSCC metastatic spinal cord
FiO fraction of inspired oxygen compression
2
Fr French – a measurement system MSU mid-stream urine
for catheter diameter. 1 Fr = NB nota bene
1/3mm. Synonymous with NICE National Institute for Health and
Charrière, the system’s French Care Excellence
inventor NSAIDs non-steroidal anti-inflammatory
GA general anaesthesia drugs
GBM glomerular basement membrane NSF nephrogenic systemic fibrosis
GFR glomerular filtration rate MRI magnetic resonance imaging
GI gastrointestinal MRSA methicillin-resistant
GN glomerulonephritis Staphylococcus aureus
GP general practitioner MRU magnetic resonance urography
GUM genitourinary medicine MS multiple sclerosis
Hb haemoglobin MSCC metastatic spinal cord
HELLP haemolysis, elevated liver compression
enzymes, low platelets NIV non-invasive ventilation
HIV human immunodeficiency virus OD omni die (once daily)
HoLEP holmium laser enucleation of the ON omni nocte (once nightly)
prostate PaO partial pressure of oxygen in
2
HPCUR high-pressure chronic urinary arterial blood
retention PCNL percutaneous nephrolithotomy
HR heart rate PDE phosphodiesterase
HSP Henoch–Schönlein purpura PID pelvic inflammatory disease
IBD inflammatory bowel disease PMH past medical history
ICU intensive care unit PO per os (by mouth)
INR International Normalised Ratio PR per rectum
ISC intermittent self-catheterisation PSA prostate-specific antigen
ISD intermittent self-dilatation PTH parathyroid hormone
ITU intensive therapy unit PUJ pelviureteric junction
IV intravenous PV per vagina
JVP jugular venous pulse/pressure PVR post-void residual (urinary
KDIGO Kidney Disease Improving Global volume)
Outcomes RCC renal cell carcinoma
KUB kidneys, ureters, bladder RR respiratory rate
Prelims.indd 9 20/12/2016 15:28