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Urological Emergencies

Urological Emergencies. Ian Smith Urology Registrar. Spot Diagnosis?. Penis Fracture. Usually during intercourse. No official classification. History - exaggerated bend on erect penis, sometimes aware of snap, painful and instant detumescence (loss of erection) Relatively common.

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Urological Emergencies

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  1. Urological Emergencies Ian Smith Urology Registrar

  2. Spot Diagnosis?

  3. Penis Fracture • Usually during intercourse. • No official classification. • History - exaggerated bend on erect penis, sometimes aware of snap, painful and instant detumescence (loss of erection) • Relatively common.

  4. Anatomical Detail Outer superficial layer continuous with superficial subdermal layer of scrotum Bucks Fascia encloses penis. Attaches to perineal membrane

  5. Spot Diagnosis ?

  6. Fourniers Gangrene • Necrotizing fasciitis of scrotum, perineum, abdominal wall • RF’s - Age, diabetes, immunocompromised state • Polymicrobial • Sepsis - multi organ failure - death. • 25% idiopathic

  7. Management Similar tissue planes Gangrene to extend up to supra pubic space

  8. Spot Diagnosis?

  9. Renal Colic • Vast majority straight forward • Exceptions are • solitary kidney • bilateral obstruction • worsening renal function • Fever

  10. What is connection? Stone + Fever = urological emergency

  11. Mechanisms and cause: Blunt direct blow or acceleration/ deceleration (road traffic accidents, falls from a height, fall onto flank) Penetrating knives, gunshots, iatrogenic, e.g., percutaneous (PCNL) Renal Trauma

  12. Pseudo aneurysm G3 Grade 5

  13. Blunt scrotal trauma

  14. Normal Anatomy Corpora cavernosa Epididymis Fluid within tunica vaginalis

  15. Whats injured? Extra scrotal - soft tissue Intrascrotal but extratesticular - dartos Intra testicular - Need ultrasound to confirm

  16. Management

  17. Acute Retention • Acute urinary retention is painful • Think of this before you call. • 3 questions • Why is this person in retention • How long do I leave catheter in • Why am I unable to catheterise this person

  18. Men Women Bladder Factors - The majority - Often post surgical, post partum Outlet - Less common - Always think cervical cancer Bladder factors - Neurological central, peripheral - Drugs anticholinergics - Diseases ie Diabetes, MS - Chronic obsrtuction - Acute retention Outlet Factors - Prostate - Strictures (POST SURGICAL)

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