Transcript Urological Emergencies Ian Smith Urology Registrar Spot Diagnosis

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.
Anatomical Detail
Outer superficial layer continuous with
superficial subdermal layer of scrotum
Bucks Fascia encloses penis.
Attaches to perineal
membrane
Management
• Exploration is the rule. Very few treated
conservatively
• Why?
• Urethral injury
• Scar and plaque formation
• Curved penis (cordee)
• Erectile dysfunction
Spot Diagnosis ?
Fourniers Gangrene
• Necrotizing fasciitis of scrotum,
perineum, abdominal wall
• RF’s - Age, diabetes,
immunocompromised state
• Polymicrobial
• Sepsis - multi organ failure - death.
• 25% idiopathic
Management
Similar tissue
planes
Gangrene to extend
up to supra pubic
space
Spot Diagnosis?
Renal Colic
• Vast majority straight forward
• Exceptions are
• solitary kidney
• bilateral obstruction
• worsening renal function
• Fever
What is connection?
Stone + Fever = urological emergency
• Only a small percentage of renal colic
presentations
• RF’s - Diabetes, intercurrent UTI.
Nephrostomy inserted under LA
1
Renal Trauma
• 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)
Classification
Pseudo aneurysm G3
Grade 5
Is classification
important?
Stable vs Unstable only relevant
classification
Does patient have 2 kidneys
Management
• Stable conservative. Unstable explore
(which usually means nephrectomy)
• Many go careers without doing this
• Most conservatively managed since CT
• Impressive the way kidneys heal.
• Collecting system injury - stent
• Why - try to prevent urinoma, aid
closure of defect.
• Can get HT - page kidney
Blunt scrotal trauma
• Straddle injuries
• Sporting injuries - hockey, cricket
• Assult
Normal Anatomy
Epididymis
Corpora
cavernosa
Fluid within
tunica
vaginalis
Whats injured?
Extra scrotal - soft tissue
Intrascrotal but extratesticular - dartos
Intra testicular - Need ultrasound to confirm
Normal
Scrotal wall injury
Testicular rupture with
haematocele
Management
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
Men
Bladder factors
- Neurological central, peripheral
- Drugs anticholinergics
- Diseases ie Diabetes, MS
- Chronic obsrtuction - Acute retention
Outlet Factors
- Prostate
- Strictures (POST SURGICAL)
Women
Bladder Factors
- The majority
- Often post surgical, post partum
Outlet
- Less common - Always think cervical cancer
Duration Catheter
• At least 3 days. Men should be started
on alpha blocker.
• Keep on permanent drainage for 24
hours then to flip flow valve
• Trial of void should be supervised with
accurate post void residuals. Dont do
this on a weekend.
Failed TOV?
• Should be taught intermittent clean self
catheterisation till we can determine
cause.
• Has this patient had previous urological
intervention (TURP, Radiotherapy,
Prostatectomy)
• Urodynamics - functional assessment of
bladder.
Cant catheterise?
• Patient not relaxed - tensing sphincter
• Urethral stricture
• Bladder neck stricture (post surgical)
• Prostate (least common)
• Call us if you can’t get a catheter in
Questions