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Flashcards in Urologic Emergencies Deck (58)
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1

Top 10 Urologic Emergencies

Renal trauma
Penile fracture
Testis rupture
Bladder rupture
Urethral disruption
Acute urinary retention
Priapism
Acute ureteral obstruction
Fournier's Gangrene
Testis torsion

2

When should you use a CT with contrast for renal trauma?

Blunt trauma with gross hematuria or micro-hematuria with chock
Penetrating trauma with hematuria
Pediatric trauma with micro-hematuria

3

Management of Renal Trauma

Most managed conservatively
+/- stent
+/- embolization
+/- percutaneous drain or nephrostomy tube

4

Indications for Surgical Intervention

Life threatening hemorrhage
Continued bleeding
Exploration for other injuries reveals expanding peritoneal hematoma
Repair or remove kidney

5

Causes of Penile Fracture

Aggressive intercourse
Off target penetration
Masturbation
Falling out of bed
Scored lover

6

Diagnosis of Penile Fracture

Audible snap
Sudden detumesce
Swelling
Bruising

7

Conservative Management of Penile Fracture

Erectile dysfunction
Curvature
Painful erections

8

Surgical Treatment of Penile Fracture

Deglove penis
Rule out urethral injury
Close corporal tear

9

Causes of Testis Rupture

Blunt or penetrating trauma
Straddle
Saddle horn
Bar fight
Kick
Drug deal gone bad

10

Exam for Testis Rupture

Scrotal swelling
Echymosis

11

Testis Rupture & Scrotal Ultrasound

Loss of tunic continuity
Internal echos
Heterogenecity

12

Management of Testis Rupture

Surgery to debride extruded tissue & close tunic
Early: salvage
late: orchiectomy

13

Bladder Rupture

Blunt >> Penetrating
60% extraperitoneal
30% intraperitoneal
10% combined
Hematuria always present
90% have pelvic fractures

14

Causes of Intraperitoneal Bladder Rupture

External blow, full bladder
MVA

15

Diagnosing Intraperitoneal Bladder Rupture

CT or Cystogram
Contrast around bowel & above superior acetabular line

16

Management of Intraperitoneal Bladder Rupture

Surgical repair

17

Causes of Extraperitoneal

Blunt trauma with pelvic fracture

18

Diagnosing Extraperitoneal Bladder Rupture

CT or cystogram
Contrast limited to pelvis, perineum, or genitalia
Starburst pattern of contrast below superior acetabular line

19

Management of Extraperitoneal Bladder Rupture

Catheter drainage
Surgical repair IF repairing something else

20

Cause Urethral Disruption

Blunt or penetrating trauma

21

Signs/Symptoms of Urethral Disruption

Blood at meatus
Distended bladder
Genital swelling & hematoma

22

Diagnosis of Urethral Disruption

Retrograde Urethrogram (RUG)

23

Incomplete Urethral Disruption Diagnosis

RUG shows contrast extravasation but with contrast into bladder

24

Management of incomplete Urethral Disruption

Catheter drainage

25

Complete Urethral Disruption Diagnosis

RUG shows contrast extravasation without contrast into bladder

26

Management of Complete Urethral Disruption

Suprapubic tube with early primary realignment or delayed reconstruction

27

Define Acute Urinary Retention

Sudden, unexpected, painful inability to void

28

Causes of Acute Urinary Retention

PBH
Urethral stricture
Blood clots in urethra
Stone in urethra
Drugs: antihistamines, narcotics, alpha adrenergics
Post op
Overdistension

29

Management of Acute Urinary Retention

Urethral catheter
Suprapubic tube
Suprapubic aspiration
Watch for hematuria
Post obstructive diuresis uncommon

30

Define Priapism

Painful, prolonged (>4 hours) erection