Presentation on theme: "Urological Emergencies Ian Smith Urology Registrar."— Presentation transcript:
Urological Emergencies Ian Smith Urology Registrar
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 Bucks Fascia encloses penis. Attaches to perineal membrane Outer superficial layer continuous with superficial subdermal layer of scrotum
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
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)
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
Normal Anatomy Corpora cavernosa Epididymis 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
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