1. Urological Emergencies
Ian Smith Urology Registrar

2. Spot Diagnosis?

3. 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.

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

6. Spot Diagnosis ?

7. Fourniers Gangrene
Necrotizing fasciitis of scrotum, perineum, abdominal wall
RF’s - Age, diabetes, immunocompromised state
Polymicrobial
Sepsis - multi organ failure - death.
25% idiopathic

8. Gangrene to extend up to supra pubic space
Management
Similar tissue planes
Gangrene to extend up to supra pubic space

9. Spot Diagnosis?

10. Renal Colic Vast majority straight forward Exceptions are
solitary kidney
bilateral obstruction
worsening renal function
Fever

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

12. 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)

15. Pseudo aneurysm G3
Grade 5

16. Blunt scrotal trauma

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

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

19. Management

20. 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

21. 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)