3Penis 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.
4Anatomical DetailOuter superficial layer continuous with superficial subdermal layer of scrotumBucks Fascia encloses penis.Attaches to perineal membrane
15Renal Trauma Mechanisms and cause: Blunt Penetrating direct blow or acceleration/ deceleration (road traffic accidents, falls from a height, fall onto flank)Penetratingknives, gunshots, iatrogenic, e.g., percutaneous (PCNL)
20Is classification important? Stable vs Unstable only relevant classificationDoes patient have 2 kidneys
21ManagementStable conservative. Unstable explore (which usually means nephrectomy)Many go careers without doing thisMost conservatively managed since CTImpressive the way kidneys heal.Collecting system injury - stentWhy - try to prevent urinoma, aid closure of defect.Can get HT - page kidney
28Acute Retention Acute urinary retention is painful Think of this before you call.3 questionsWhy is this person in retentionHow long do I leave catheter inWhy am I unable to catheterise this person
29Men Women Bladder Factors - The majority - Often post surgical, post partumOutlet- Less common - Always think cervical cancerBladder factors- Neurological central, peripheral- Drugs anticholinergics- Diseases ie Diabetes, MS- Chronic obsrtuction - Acute retentionOutlet Factors- Prostate- Strictures (POST SURGICAL)
30Duration CatheterAt least 3 days. Men should be started on alpha blocker.Keep on permanent drainage for 24 hours then to flip flow valveTrial of void should be supervised with accurate post void residuals. Dont do this on a weekend.
31Failed 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.
32Cant catheterise? Patient not relaxed - tensing sphincter Urethral strictureBladder neck stricture (post surgical)Prostate (least common)Call us if you can’t get a catheter in