Which ONE of the following regarding percutaneous suprapubic catheterisation (SPC) is FALSE?
Answer: C: Although no minimal bladder volume has been determined, a poorly defined bladder is a contraindication for SPC insertion. A history of lower abdominal surgery, intraperitoneal surgery or irradiation places the patient at increased risk of complications such as bowel injury because they may result in adherence of the bowel to the bladder wall. Other contraindications to percutaneous insertion include coagulopathies and pelvic trauma; however, SPC via open surgical insertion is commonly used in pelvic trauma with urethral injury.
Complications of insertion include:
Indications for SPC insertion include:
SPC is associated with less bacteriuria as the periurethral area has a higher concentration of bacteria and the length of the tract is shorter in SPC.
References:
Regarding investigation of a patient with renal colic, which ONE of the following is TRUE?
Answer: A: Around 90% of stones are radio-opaque. Magnetic resonance imaging (MRI) can show anatomical changes of ureteric obstruction such as hydronephrosis, hydroureter and nephromegaly but is typically unable to identify ureteric stones.
Up to 20% of patients who have proven renal calculi do not have haematuria. There is no relationship between the degree of obstruction and the presence or absence of haematuria.
UTIs from urea-splitting organisms such as Proteus, Klebsiella, Pseudomonas and Staphylococcus can cause the formation of struvite stones. A urinary pH of >7.5 is suggestive of a urine infection from these urea-splitting organisms.
A pH <5 is associated with uric acid calculi.
Which ONE of the following patients with a urological presentation to the emergency department (ED) requires referral for admission?
Answer: B: Patient B has heavy gross haematuria and is at high risk of developing clot retention and bladder outlet obstruction. He requires a three-way catheter insertion and bladder irrigation with normal saline. If this is unsuccessful he requires further investigation such as a cystoscopy. The patient should not be discharged with a triple lumen catheter in situ.
Criteria for admission for patients with renal colic include:
The larger and more proximal the stone the less likely it is to pass.
A 4mm stone has 90% chance of passing, whereas an 8 mm stone has only 5% chance. Therefore, the patient A may be discharged with outpatient follow up.
Young otherwise healthy patients with uncomplicated acute pyelonephritis (patient C) can be managed as outpatients. Admission would need to be considered if the patient were immunocompromised, pregnant or had a chronic illness and a unilateral functioning kidney.
Torsion of the testicular appendage is a common cause of testicular pain in the 7–14-year age group. Onset is gradual, usually over 1–2 days, and the patient is still able to ambulate as normal. On examination the affected testicle itself is non-tender, of normal size and normal lie, and there is maximal tenderness at the upper pole of the testis. A small, hard, tender nodule may be palpated at the upper pole of the affected testicle. In 10% of patients the torted appendage may appear as a blue dot. Management of this is reassurance and supportive therapy such as scrotal support, ice and simple analgesia. It usually settles down in 7–10 days.
A young female patient presents to the ED with right flank pain, fever, rigors and vomiting. Her heart rate is 110 and systolic blood pressure (BP) is 95 mmHg. She has a penicillin allergy. Her body weight is 72 kg.
Which ONE of the following is the most appropriate empiric antibiotic regime?
Answer: D: In a patient with acute pyelonephritis, mild infections (with low-grade fever, no nausea or vomiting) can be treated with amoxicillin 875 mg + clavulanate 125 mg 12-hourly for 10 days or with cephalexin 500 mg 6-hourly for 10 days or trimethoprim 300 mg once daily for 10 days.
For severe infection, IV gentamicin 4–6 mg/kg (7 mg/kg if severe sepsis) plus 2 g IV ampicillin or amoxicillin 6-hourly is required. Gentamicin 4–6 mg/kg as the sole antibiotic agent is suitable if the patient has a penicillin allergy. Ceftriaxzone 1 g IV daily or cefotaxime 1 g IV 8-hourly can be used if gentamicin is contraindicated.
The total duration of antibiotic therapy is usually for 10–14 days.
Reference:
Causes of priapism include all of the following EXCEPT:
Answer: C: Priapism is a prolonged painful erection and can be divided into two types:
Low-flow is the far more frequent type and a true urological emergency, requiring rapid (within 4 hours) treatment to prevent long-term complications such as impotence. It is due to reduced venous outflow.
High-flow priapism is due to increased arterial blood flow. It is frequently painless and often doesn’t cause ischaemia and once resolved erectile function is usually retained. It is a very rare presentation caused typically by an arteriovenous fistula following trauma. The erection in high flow priapism is usually not fully rigid.
Some causes of low-flow priapism include:
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