Urological Emergencies Ian Smith Urology Registrar Spot Diagnosis

Penis Fracture • Usually during intercourse. • No official classification. • History - exaggerated

Anatomical Detail Outer superficial layer continuous with superficial subdermal layer of scrotum Bucks Fascia

Fourniers Gangrene • Necrotizing fasciitis of scrotum, perineum, abdominal wall • RF’s - Age,

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

Renal Colic • Vast majority straight forward • Exceptions are • solitary kidney •

What is connection? Stone + Fever = urological emergency

Renal Trauma • Mechanisms and cause: –Blunt • direct blow or acceleration/ deceleration (road

Normal Anatomy Epididymis Corpora cavernosa Fluid within tunica vaginalis

Whats injured? Extra scrotal - soft tissue Intrascrotal but extratesticular - dartos Intra testicular

Acute Retention • Acute urinary retention is painful • Think of this before you

Men Bladder factors - Neurological central, peripheral - Drugs anticholinergics - Diseases ie Diabetes,

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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

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

What is connection? Stone + Fever = urological emergency

Renal Trauma • Mechanisms and cause: –Blunt • 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 G 3 Grade 5

Blunt scrotal trauma

Normal Anatomy Epididymis Corpora cavernosa Fluid within tunica vaginalis

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