| 🫘 Acute Kidney Injury |
- Oliguria/anuria, fatigue, confusion or nausea.
- Fluid overload: oedema, hypertension, pulmonary oedema.
- May follow sepsis, dehydration, obstruction, nephrotoxins or major illness.
- Can be pre-renal, intrinsic renal or post-renal.
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- U&E, creatinine/eGFR and compare with baseline.
- Urine output monitoring.
- Urinalysis: blood/protein/casts may suggest intrinsic renal disease.
- Renal ultrasound if obstruction suspected or cause unclear.
- ECG if hyperkalaemia possible.
- Consider VBG/ABG for acidosis and lactate if unwell.
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- Identify and treat cause: sepsis, hypovolaemia, obstruction, nephrotoxins.
- Stop or hold nephrotoxic/renal-risk medicines where appropriate.
- Optimise fluid balance: cautious IV fluids if hypovolaemic; diuretics/renal input if overloaded.
- Treat hyperkalaemia, acidosis or pulmonary oedema urgently.
- Nephrology referral for severe AKI, uncertain cause, intrinsic renal signs or dialysis indications.
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| ⚡ Hyperkalaemia |
- Often asymptomatic until severe.
- Muscle weakness, palpitations or syncope.
- ECG: peaked T waves, PR prolongation, QRS widening, sine-wave pattern, VT/VF/asystole.
- Causes: AKI/CKD, acidosis, tissue breakdown, potassium-sparing drugs, ACEi/ARB, trimethoprim.
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- Repeat potassium if unexpected and patient stable, but do not delay treatment if severe/ECG changes.
- ECG immediately.
- U&E, bicarbonate, glucose, calcium, magnesium.
- Check for haemolysed sample/pseudohyperkalaemia if clinically inconsistent.
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- Protect heart: IV calcium gluconate/chloride if ECG changes or severe hyperkalaemia, according to local policy.
- Shift potassium: insulin-glucose infusion and nebulised salbutamol where appropriate.
- Remove potassium: potassium binders, diuretics if passing urine, or dialysis if refractory/severe renal failure.
- Stop potassium-raising drugs and treat cause.
- Continuous ECG monitoring and repeat potassium checks.
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| 🚽 Acute Urinary Retention |
- Severe suprapubic pain and inability to pass urine.
- Palpable distended bladder.
- Causes: BPH, constipation, urethral stricture, medications, neurological disease, infection.
- May cause AKI if prolonged or bilateral obstruction.
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- Bladder scan for retained volume.
- U&E/creatinine if prolonged retention, frail, high residual, bilateral hydronephrosis concern or post-obstructive diuresis risk.
- Urinalysis and urine culture if infection suspected.
- Consider renal ultrasound if AKI or chronic retention suspected.
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- Immediate urethral catheterisation if safe.
- If urethral catheter fails or urethral injury suspected, call urology for suprapubic catheter consideration.
- Start alpha-blocker if likely BPH and no contraindication.
- Monitor urine output after decompression.
- Watch for post-obstructive diuresis and haematuria.
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| 🔴 Testicular Torsion |
- Sudden severe unilateral testicular/scrotal pain.
- Nausea and vomiting common.
- High-riding or transverse testis.
- Absent cremasteric reflex may occur.
- Most common in adolescents but can occur at any age.
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- Clinical diagnosis: do not delay surgery for imaging if high suspicion.
- Doppler ultrasound may help if diagnosis uncertain and does not delay exploration.
- Urinalysis if epididymo-orchitis differential, but torsion must be excluded first.
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- Immediate urology referral for scrotal exploration.
- Surgical detorsion and bilateral orchidopexy.
- Manual detorsion may be attempted only if surgery delayed, but does not replace surgery.
- Analgesia and nil by mouth.
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| 🪨 Renal / Ureteric Colic |
- Severe colicky flank pain radiating to groin.
- Restlessness, nausea and vomiting.
- Haematuria common but absence does not exclude stone.
- Fever suggests infected obstruction.
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- Urinalysis for blood and infection.
- U&E/creatinine, FBC/CRP if infection or significant symptoms.
- Pregnancy test where relevant.
- Non-contrast CT KUB is highly sensitive in adults.
- Ultrasound first-line in pregnancy and often in children.
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- NSAID first-line analgesia if not contraindicated; opioid rescue if needed.
- Antiemetic and hydration to normal intake; avoid forced fluids.
- Urgent urology if fever/sepsis, AKI, single kidney, bilateral obstruction, uncontrolled pain/vomiting, pregnancy or large/obstructing stone.
- Medical expulsive therapy may be considered for selected distal ureteric stones.
- Definitive treatment: ESWL, ureteroscopy or percutaneous nephrolithotomy depending on stone.
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| 🍆 Priapism |
- Erection lasting ≥4 hours unrelated to sexual stimulation.
- Ischaemic priapism: painful, rigid corpora, soft glans.
- Associated with sickle cell disease, drugs, intracavernosal injections, antipsychotics, PDE5 inhibitors or malignancy.
- Non-ischaemic priapism is usually less painful and follows trauma.
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- Cavernosal blood gas differentiates ischaemic from non-ischaemic.
- FBC, reticulocytes and sickle testing if relevant.
- Doppler ultrasound may assess flow.
- Medication and recreational drug history.
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- Ischaemic priapism is a urological emergency.
- Analgesia, penile block/sedation where needed.
- Aspiration of corpora cavernosa ± irrigation.
- Intracavernosal phenylephrine under monitoring/local protocol.
- Treat sickle crisis if present: oxygen if hypoxic, analgesia, hydration, haematology input.
- Surgical shunt if refractory.
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| 🔥 Acute Pyelonephritis / Urosepsis |
- Fever, rigors, flank pain and loin tenderness.
- Dysuria, frequency, urgency may occur.
- Nausea, vomiting or systemic illness.
- Sepsis, pregnancy, male sex, immunosuppression or obstruction increases risk.
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- Urinalysis and urine culture before antibiotics if possible.
- FBC, U&E, CRP; blood cultures if febrile/septic.
- Pregnancy test where relevant.
- Imaging if obstruction, stone, sepsis, AKI, recurrent infection or failure to improve.
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- Antibiotics according to local/NICE guidance and culture results.
- IV antibiotics/admission if septic, vomiting, pregnant, immunocompromised, male with severe infection, AKI or unable to tolerate oral treatment.
- Fluids, analgesia and antiemetics.
- Urgent drainage if infected obstructed kidney: nephrostomy or ureteric stent.
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| 💥 Bladder Rupture / Lower Urinary Tract Trauma |
- Suprapubic pain, inability to void and visible haematuria after trauma.
- Often associated with pelvic fracture.
- Intraperitoneal rupture may cause peritonitis.
- Blood at urethral meatus suggests urethral injury.
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- CT cystography or retrograde cystography.
- CT trauma imaging for associated injuries.
- Urinalysis, FBC, U&E, group and save if bleeding/trauma.
- Retrograde urethrogram if urethral injury suspected before catheterisation.
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- ABCDE trauma approach.
- Do not blindly catheterise if urethral injury suspected.
- Intraperitoneal bladder rupture usually needs surgical repair.
- Extraperitoneal rupture may be managed with catheter drainage if uncomplicated.
- Urology and trauma team involvement.
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| 💧 Post-Obstructive Diuresis |
- Polyuria after relief of urinary obstruction.
- Risk after high-volume retention, bilateral obstruction or chronic obstruction.
- May cause dehydration, hypotension, hypokalaemia, hyponatraemia or AKI.
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- Hourly urine output initially if high risk.
- U&E, creatinine, sodium, potassium, magnesium.
- Fluid balance and daily weight if prolonged.
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- Monitor urine output closely after catheterisation.
- Replace fluids carefully, often a proportion of urine output, guided by local protocol and clinical status.
- Correct electrolytes.
- Admit/observe if very high urine output, frailty, AKI, hypotension or electrolyte derangement.
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| 🦠 Fournier’s Gangrene |
- Severe perineal, genital or scrotal pain.
- Swelling, erythema, crepitus, skin necrosis or foul discharge.
- Pain out of proportion may precede skin changes.
- Risk factors: diabetes, immunosuppression, obesity, alcoholism, perianal/urogenital infection.
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- Clinical diagnosis - do not delay surgery for imaging.
- FBC, U&E, CRP, lactate, blood cultures, clotting, group and save.
- CT may define extent if stable but should not delay debridement.
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- Immediate surgical/urology referral.
- Sepsis management, IV fluids and broad-spectrum IV antibiotics.
- Urgent debridement, often repeated.
- ICU input if shock or organ dysfunction.
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| 🧬 Obstructed Infected Kidney / Pyonephrosis |
- Fever/sepsis with flank pain and hydronephrosis/stone.
- May have rigors, vomiting, AKI or hypotension.
- Can progress rapidly to septic shock.
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- Urine and blood cultures.
- FBC, U&E, CRP, lactate.
- CT KUB or ultrasound showing obstruction/hydronephrosis.
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- Urological emergency: antibiotics alone are not enough.
- Sepsis pathway and IV antibiotics.
- Urgent decompression with ureteric stent or nephrostomy.
- Definitive stone treatment after infection controlled.
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