undergraduate, Emergencies (non traumatic)

1. Urology Department
Under-graduate courses
Genito-urinary emergency
By Osama Heider, MBBcH Revised by M.A.Wadood , MD, MRCS

2. For our Lectures and Scientific resources
visit our web sites,
Uroainshams.blogspot.com
Uronotes2012.blogspot.com
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3. Urological emergencies
Traumatic Non-traumatic
• Renal injuries • Urine retention
• Bladder injuries • Renal colic
• Urethral injuries • Testicular torsion
• Testicular injuries • Priapism
• Penile fracture • Paraphimosis
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By Osama Heider, MBBcH Revised by M.A.Wadood , MD, MRCS

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

5. Renal colic
• 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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By Osama Heider, MBBcH Revised by M.A.Wadood , MD, MRCS

6. Renal colic- Management
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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By Osama Heider, MBBcH Revised by M.A.Wadood , MD, MRCS

7. Testicular torsion
• 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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By Osama Heider, MBBcH Revised by M.A.Wadood , MD, MRCS

8. Testicular torsion- Management
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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By Osama Heider, MBBcH Revised by M.A.Wadood , MD, MRCS

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

10. Priapism- Management
• 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.
©
By Osama Heider, MBBcH Revised by M.A.Wadood , MD, MRCS

11. Paraphimosis
• 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
©
By Osama Heider, MBBcH Revised by M.A.Wadood , MD, MRCS

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