Urological Emergencies Ian Smith Urology Registrar.

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Urological Emergencies Ian Smith Urology Registrar

Transcript of Urological Emergencies Ian Smith Urology Registrar.

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

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

ManagementSimilar 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

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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 AnatomyCorpora

cavernosaEpididymis

Fluid within tunica

vaginalis

Whats injured?Extra scrotal - soft tissue

Intrascrotal but extratesticular - dartosIntra 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 partumOutlet

- 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