Urological Emergencies in Clinical Practice стр.115

Presentation and Treatment

The classic presentation is with pain in the leg and paraesthesia. Passive stretching of the affected muscles causes worsening of

150 H. HASHIM AND J.REYNARD

the pain. The pain may be out of all proportion to the physical signs. The skin may be pink and the pulse may still be present. It is possible to measure compartment pressures, but the equipment for doing this and expertise in recording and interpreting the pressures so measured are unlikely to be available in many cases. A high index of suspicion, therefore, is required to make a clinical diagnosis.

The mainstay of treatment is decompression of the affected compartment by a fasciotomy. Ideally such a procedure should be carried out by an expert (orthopaedic, vascular, or plastic surgeon), but if this is unlikely to be available at very short notice, the urologist will have to proceed with fasciotomy, relying on his anatomical knowledge to avoid damage to structures such as the common peroneal nerve.

References

Dickenson AJ, Leaper DJ. Wound dehiscence and incisional hernia.

Surgery 1999;17:229-232. Halliwell JR, Hewitt BS, Joyner MH, Warner MA. Effect of various

lithotomy positions on lower extremity pressure. Anesthesiology

1998;89:1373-1376. Kendrick J, Gonzales B, Huber D, et al. Complications of vasectomies in

the United States. J Fam Pract 1987;25:245-248. Neal DE. The National Prostatectomy Audit. Br J Urol 1997;79(suppl 2):

69-75.

Further Reading

American College of Surgeons Committee on Trauma. Advanced Trauma Life Support for Doctors—Student Course Manual, 6th ed. Chicago: American College of Surgeons, 1999.

Webb A, Shapiro M, Singer M, et al. Oxford Textbook of Critical Care. Oxford: Oxford Medical Publications, 1999.

Chapter 8

Ureteric Colic in Pregnancy

John Reynard

While hypercalciuria and uric acid excretion increase in pregnancy (predisposing to stone formation), so too do urinary citrate and magnesium levels (protecting against stone formation). The net effect is that the incidence of ureteric colic is the same as in nonpregnant women (Coe et al. 1978). Depending on what series you read, somewhere between 1 in 1500 to 1 in 2500 pregnancies are complicated by ureteric stones. The great majority of ureteric stones in pregnant women occur during the second and third trimesters (Stothers and Lee 1992). The development of a ureteric stone during pregnancy is an important event, not only because it results in pain, the cause of which can be difficult to establish and to distinguish from other causes, but also because it can be difficult to treat and because it is associated with a significant risk of preterm labour (Hendricks et al. 1991).


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