Genitourinary Emergencies Chemeketa Community College Paramedic Program

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

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

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

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

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

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

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

Testicular Trauma Painful Need I say more

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

Testicular Cancer Misdiagnosed as Epididymitis Intractable pain N/V Sepsis

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

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?

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

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%

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:10.1038/ncpuro353

Necrotizing Fasciitis Causes Trauma Surgery Idiopathic Mean age 38-44 years Begins with erythema that quickly spreads Dusky or purplish skin discoloration Morbidity and mortality is 70-80%

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

Urethral Bleeding? D/Dx

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