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 Outer superficial layer continuous with superficial subdermal layer of scrotum Bucks Fascia encloses penis. Attaches to perineal membrane

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

Gangrene to extend up to supra pubic space Management Similar 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

Stone + Fever = urological emergency What is connection? Stone + Fever = urological emergency

Renal Trauma Mechanisms and cause: Blunt Penetrating 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

Blunt scrotal trauma

Fluid within tunica vaginalis Normal Anatomy Corpora cavernosa Epididymis Fluid within tunica vaginalis

Extra scrotal - soft tissue Intrascrotal but extratesticular - dartos Whats injured? Extra scrotal - soft tissue Intrascrotal but extratesticular - dartos Intra testicular - Need ultrasound to confirm

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 Women Bladder Factors - The majority - Often post surgical, post partum Outlet - Less common - Always think cervical cancer Bladder factors - Neurological central, peripheral - Drugs anticholinergics - Diseases ie Diabetes, MS - Chronic obsrtuction - Acute retention Outlet Factors - Prostate - Strictures (POST SURGICAL)