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

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

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

Only a small percentage of renal colic presentations RF’s - Diabetes, intercurrent UTI.

Nephrostomy inserted under LA 1

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)

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

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

Testicular rupture with haematocele 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 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)

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