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. Management Exploration is the rule. Very few treated conservatively
Why?
Urethral injury
Scar and plaque formation
Curved penis (cordee)
Erectile dysfunction

7. Spot Diagnosis ?

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

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

10. Spot Diagnosis?

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

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

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

14. Nephrostomy inserted under LA1

15. 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)

16. Classification

19. Pseudo aneurysm G3
Grade 5

20. Is classification important?
Stable vs Unstable only relevant classification
Does patient have 2 kidneys

21. 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

22. Blunt scrotal trauma

23. Straddle injuries
Sporting injuries - hockey, cricket
Assult

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

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

26. Testicular rupture with haematocele
Normal
Scrotal wall injury
Testicular rupture with haematocele

27. Management

28. 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

29. 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)

30. 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.

31. 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.

32. 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

33. Questions