Genito-urinary emergency

Urology Department

Under-graduate courses

By Osama Heider, MBBcH Revised by M.A.Wadood , MD, MRCS

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Urological emergencies

Traumatic • Renal injuries

• Bladder injuries

• Urethral injuries

• Testicular injuries

• Penile fracture

Non-traumatic • Urine retention

• Renal colic

• Testicular torsion

• Priapism

• Paraphimosis

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By Osama Heider, MBBcH Revised by M.A.Wadood , MD, MRCS

Causes of urinary retention

– Benign prostatic hyperplasia (BPH)

– Prostatic carcinoma

– Urethral stricture

– Pelvic mass (especially in women)

– Urinary tract infection

– Constipation

– Neurological

– Postoperative pain or immobility

Types of Retention

can be acute or chronic.

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Urinary retention

By Osama Heider, MBBcH Revised by M.A.Wadood , MD, MRCS

• Starts in the flank and radiates around the

abdomen, and it can radiate into the testes in

men and the labia in women.

Diagnosis

• Urinalysis mostly shows microscopic hematuria.

• Radiology includes IVP or CT-scan

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Renal colic

By Osama Heider, MBBcH Revised by M.A.Wadood , MD, MRCS

Initial management includes analgesics (NSAIDs,

antispasmodics & opioids in non responsive cases)

Definitive management

1.Conservation

2.Surgical intervention (uretroscopic or open)

•decided upon chances of a renal calculus to pass

spontaneously

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Renal colic- Management

By Osama Heider, MBBcH Revised by M.A.Wadood , MD, MRCS

• The classic presentation for testicular

torsion is a sudden onset of pain

that typically wakes the patient at

night and is associated with

abdominal discomfort and possibly

vomiting.

• The peak age is in adolescence.

• On examination, the testis is usually

very tender and often is riding high or

lying abnormally as a result of

shortening of the cord via the torsion.

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Testicular torsion

By Osama Heider, MBBcH Revised by M.A.Wadood , MD, MRCS

Diagnosis (primarly clinical diagnosis) plus

• Scrotal dupplex shows affection or cut off of

arterial blood supply to affected testicle

Treatment

• Mechanical detorsion is now obsolete.

• Scrotal exploration as early as 6 hours to save

the testicle or orchidectomy of devitalized testis.

• Orchiopexy of other testis is done.

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Testicular torsion- Management

By Osama Heider, MBBcH Revised by M.A.Wadood , MD, MRCS

• Persistent painful erection unrelated to sexual

desire.

• Divided into low flow and high flow.

• High flow priapism has a preceding history of

perineal trauma.

• The aspirated blood also can be sent for

corporal blood gas analysis to see if the blood

is arterial or venous in origin.

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Priapism

By Osama Heider, MBBcH Revised by M.A.Wadood , MD, MRCS

• conservative measures such as applying ice packs.

• If failed corpora should be aspirated with a butterfly

needle and syringe & slow infusion of alpha agonist.

• If failed a shunt is done to communicate the corpora

cavernosa and corpus spongiosum of the glans

penis.

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Priapism- Management

By Osama Heider, MBBcH Revised by M.A.Wadood , MD, MRCS

• Swelling of the glans penis and a failure of the foreskin to

protract over the glans having been previously retracted.

• The tight retracted foreskin causes the glans to swell, with

subsequent swelling of the foreskin itself.

Management

• Reduce by squeezing edema of the glans penis by gentle

persistent pressure for several minutes.

• Circumcision should be considered

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Paraphimosis

By Osama Heider, MBBcH Revised by M.A.Wadood , MD, MRCS

Thank You

By Osama Heider, MBBcH Revised by M.A.Wadood , MD, MRCS