1. Genitourinary Emergencies
Chemeketa Community College
Paramedic Program

2. Penile Fracture Usually when erect Hear a “crack” or “tear”
Abrupt pain , swelling
Ecchymosis, deviation, immediate flaccidity
Urethral tear warrants immediate surgery

3. Priapism Prolonged, painful erection Ischemia, fibrosis Causes
Sickle cell disease
Drugs ED
Hypertension
Depression
Anticoagulants
Urologist

4. Urinary Catheterization
Used to drain bladder
Prevent urinary incontinence
Short and long term
Complications
Trauma
Put in and taken out
Urethral injury
UTI
Sepsis

7. UTI Women more often than men Increase in bacteria
Fecal matter
Bubble baths
Tampons
Catheter
Chlamydia most common cause for men

8. PID Usually sexually transmitted infection Vagina to fallopian tubes
Mild to severe crampy pain
Changes in menstration
Sometimes hard to diagnose cause
Typically chlamydia

9. Thrush Itching Soreness and irritation Vaginal discharge
Pain/discomfort during intercourse
Pain/discomfort during urination

11. Acute Scrotal Pain Trauma Epididymitis Torsion Orchitis Fournier’s
Hernia
Renal colic
Abscess
Varicocele
Neoplasm

12. Testicular Trauma
Painful
Need I say more

13. Epididymitis Most common complaint of scrotal pain
Differentiated from testicular torsion
Inflammatory reaction to certain pathogens
Chlamydia trachomatis responsible for 2/3 of the cases

14. Testicular Cancer Misdiagnosed as Epididymitis Intractable pain N/V
Sepsis

15. Prostatitis Most misdiagnosed disorder Dysuria Frequency Urgency
Back or perineal pain
Fever
Chills
Dehydration

16. Testicular Torsion True surgical emergency
Most common in adolescent males
Severe unilateral scrotal pain
Possible swelling
Arterial ischemia causing infarction of the testicle
Rapid recognition and treatment
Ultrasound?

17. Acute Orchitis
Approximately 20% of prepubertal patients with mumps develop orchitis
Testicular pain and swelling
Associated with epididymitis
Testicular atrophy occurs in 60%

18. Fournier Gangrene (Necrotizing Fasciitis)
Immune compromised
Diabetes mellitus
Morbid obesity
Cirrhosis
Vascular disease of the pelvis
Malignancies
Pain and itching of the scrotal skin
Progressive, rapidly spreading, inflammatory infection located in the deep fascia, with secondary necrosis of the subcutaneous tissues
Mortality as high as 75%

20. Appearance of patient's pubic region after initial debridement, with scrotum and suprapubic fat pad excised, testes preserved within tunica vaginalis, and penile skin and subcutaneous tissue debrided
'Aho T et al. (2006) Fournier's gangrene
Nat Clin Pract Urol 3: 54–57 doi: /ncpuro353

22. Necrotizing Fasciitis
Causes
Trauma
Surgery
Idiopathic
Mean age years
Begins with erythema that quickly spreads
Dusky or purplish skin discoloration
Morbidity and mortality is 70-80%

23. Strangulated Hernia Painful enlargement of previous hernia N/V
Even if reduced
N/V
Bowel obstruction symptoms
Sepsis

25. Urethral Bleeding?
D/Dx

26. Urethral Bleeding Trauma Catheter Chancre Meatitis Cancer Foreign Body
Saddle, Crotch, Perineal area
Catheter
Chancre
Meatitis
Cancer
Bladder
Urethra
Foreign Body
Calculus
Kidney
Schistosomiasis