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
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
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