The urethra's main job in males and females is to pass urine outside the body. This thin tube also has an important role in ejaculation for men. When a scar from swelling, injury or infection blocks or slows the flow of urine in this tube, it is called a urethral stricture. Some people feel pain with a urethral stricture.
Bladder injuries may result from blunt,Penetrating and Iatrogenic trauma.
Full bladder is more susceptible to injury than empty bladder.
Management varies from conservative to surgical aiming to directly repair the injury.
POSTERIOR URETHRAL VALVES- Pediatric Surgery
• Dear viewers,
• Greetings from “ Surgical Educator”
• Today I have uploaded one more video in Pediatric Surgery/Pediatric Urology- “ Posterior Urethral Valves”
• Posterior Urethral Valves is the congenital cause for Bladder Outlet Obstruction, resulting in abnormal development of the kidneys as well as the bladder.
• In this video, I talked about the learning outcomes, introduction, etiopathogenesis, clinical features, investigations, differential diagnosis, treatment, follow-up and prognosis of “ Posterior Urethral Valves”
• I hope you will enjoy the video for its educational value.
• You can watch all my teaching videos in the following links
• surgicaleducator.blogspot.com youtube.com/c/surgicaleducator
• Thank you for watching the video.
The urethra's main job in males and females is to pass urine outside the body. This thin tube also has an important role in ejaculation for men. When a scar from swelling, injury or infection blocks or slows the flow of urine in this tube, it is called a urethral stricture. Some people feel pain with a urethral stricture.
Bladder injuries may result from blunt,Penetrating and Iatrogenic trauma.
Full bladder is more susceptible to injury than empty bladder.
Management varies from conservative to surgical aiming to directly repair the injury.
POSTERIOR URETHRAL VALVES- Pediatric Surgery
• Dear viewers,
• Greetings from “ Surgical Educator”
• Today I have uploaded one more video in Pediatric Surgery/Pediatric Urology- “ Posterior Urethral Valves”
• Posterior Urethral Valves is the congenital cause for Bladder Outlet Obstruction, resulting in abnormal development of the kidneys as well as the bladder.
• In this video, I talked about the learning outcomes, introduction, etiopathogenesis, clinical features, investigations, differential diagnosis, treatment, follow-up and prognosis of “ Posterior Urethral Valves”
• I hope you will enjoy the video for its educational value.
• You can watch all my teaching videos in the following links
• surgicaleducator.blogspot.com youtube.com/c/surgicaleducator
• Thank you for watching the video.
Simple presentation to understand effects of diabetes on our excretory system so learn urology ,discuss urology at my channel https://www.youtube.com/my_videos?o=U next presentaiton will investigation in non invasive urinary bladder carcinoma .......soon
here give the knowledge that you should possess to manage acute and chronic urine retention. the lecture is more concerned about practical patient care and ward setting management. you should minimally be aware about following facts regarding urine retention. the multiple causes of retention will be discussed later in detailed manner. Direction of the lecture seems more toward BPH and acute retention management. beware there are many aspects of a patient present with an AUR. do no harm and always try to keep patient satisfaction. Let me know about your comments an Ideas. try to improve the quality. good luck.
Oncological Emergencies are the group of conditions that occur as a direct or indirect results of cancer or its treatment that are potentially life-threatening.
after definition it consist of classification and descriptive explanation of each disease and in the end NURSES ROLE
this power point presentation is made ideally according to criteria of ppt. with opener , energizes , bibliography ans much more criteria are followed.thank you..
The Art Pastor's Guide to Sabbath | Steve ThomasonSteve Thomason
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Welcome to TechSoup New Member Orientation and Q&A (May 2024).pdfTechSoup
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How to Split Bills in the Odoo 17 POS ModuleCeline George
Bills have a main role in point of sale procedure. It will help to track sales, handling payments and giving receipts to customers. Bill splitting also has an important role in POS. For example, If some friends come together for dinner and if they want to divide the bill then it is possible by POS bill splitting. This slide will show how to split bills in odoo 17 POS.
Unit 8 - Information and Communication Technology (Paper I).pdfThiyagu K
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This presentation provides a briefing on how to upload submissions and documents in Google Classroom. It was prepared as part of an orientation for new Sainik School in-service teacher trainees. As a training officer, my goal is to ensure that you are comfortable and proficient with this essential tool for managing assignments and fostering student engagement.
Students, digital devices and success - Andreas Schleicher - 27 May 2024..pptxEduSkills OECD
Andreas Schleicher presents at the OECD webinar ‘Digital devices in schools: detrimental distraction or secret to success?’ on 27 May 2024. The presentation was based on findings from PISA 2022 results and the webinar helped launch the PISA in Focus ‘Managing screen time: How to protect and equip students against distraction’ https://www.oecd-ilibrary.org/education/managing-screen-time_7c225af4-en and the OECD Education Policy Perspective ‘Students, digital devices and success’ can be found here - https://oe.cd/il/5yV
How to Create Map Views in the Odoo 17 ERPCeline George
The map views are useful for providing a geographical representation of data. They allow users to visualize and analyze the data in a more intuitive manner.
1. Urological Emergencies
Symptoms and LUT Non-
Traumatic Emergencies
Presenter : Dr MANIRABONA E, MD, PG-Y2 General Surgery
Supervisor : Dr NGENDAHAYO Edouard, Urologist
2. SCOPE
• Introduction
• Urological Emergency Symptoms
• Non Traumatic Lower urological emergencies
1. Priapism
2. Paraphimosis
3. Testicular torsion
4. Fournier’s gangrene
• Take Home Message
• References
3. INTRODUCTION
• Significant proportion of the urological complaints in hospitals
are acute urological emergencies
• These complaints require immediate, often life-saving treatment
either surgical or medical management
• In many cases there is an underlying disease that can trigger a
urological complaint
4. Flank Pain
• regarded as Classic symptom of renal or ureteric pathology
• Only 50% of patients who present with flank pain have a ureteric stone confirmed
on imaging studies
• Other 50% have non-stone-related disease and more often non-urological
disease
• Differential diagnosis dependent on age, side of the pain and sex of the patient
• Roots serving pain sensation from the kidney also serve pain sensation from
other organs
5. Etiologies of Flank Pain
• Urological causes: Ureteric stones, renal stones, infection
(pyelonephritis, perinephric abscess, pyonephrosis), PUJO
• Medical causes : MI, Pneumonia, rib fracture, malaria, PE
• Gynecological and obstetric disease: Twisted ovarian cysts,
ectopic pregnancy, salpingitis
• Other non-urological causes: Diverticulitis, IBD, PUD,
gastritis
6. HEMATURIA
• Relatively rarely an emergency- presents as
clot retention, clot colic or anemia
• It is such an alarming symptom
• Macroscopic, frank, or gross hematuria-
visible to naked eyes
• Dipstick hematuria- detected by urine dipstick
• Microscopic hematuria- presence of > 3
RBCs/hpf
7. ANURIA, OLIGURIA AND INABILITY TO
PASS URINE
Anuria- complete absence of urine production
• BOO reveals percussable and palpably distended bladder
• U/O will resume once a catheter has bypassed obstruction and BPH is most
common etiology
• Obstruction at level of ureters or ureteric orifices, bladder will not be palpable or
percussable usually as result of locally advanced prostatic, rectal, cervical
cancers
• Catheterization reveals no or very little urine and diuresis will not be improved
8. Oliguria- scanty urine production and more precisely less than
400 mL/day in adults and less than 1mL/kg/h in children
• Prerenal causes : Hypovolemia, Hypotension
• Renal causes : Acute vasculitis, AGN, AIN and ATN from drugs,
toxins or sepsis
• Postrenal causes- BPH, Ureteric obstruction
9. SUPRAPUBIC PAIN
• Bladder overdistention may result from BOO like BPH and urethral
stricture
• UTI is associated with urethral burning on voiding, frequent and
incomplete bladder emptying
• Inflammatory conditions like interstitial cystitis and carcinoma
• Gynecological causes include endometriosis, fibroids, and ovarian
pathology
• GIT causes include IBD and irritable bowel syndrome.
10. SCROTAL PAIN AND SWELLING
Scrotal pain may arise
• Scrotum- testicular torsion or appendages, epididymo-orchitis
• Referred- Pain of ureteric colic may be referred to the testis
• Classic presentation of testicular torsion is sudden onset of acute
pain in the hemi-scrotum
• Localized tenderness in the epididymis and the absence of testicular
tenderness helps to distinguish epididymo-orchitis from testicular
torsion
11. Acute Urinary Retention
• Painful inability to void relieved by bladder drainage
• Reduced or absent urine output with lower abdominal pain are not in
itself enough to make a diagnosis of AUR
• Diagnosis is the presence of a large volume of urine when drained
leads to resolution of pain
• volumes of 500–800 mL are typical but <500 mL should be
questionable, Volumes >800 mL are defined as acute-on-chronic
retention
12. AUR-Pathophysiology
There are three broad mechanisms
• Increased urethral resistance : i.e. BOO
• Low bladder pressure: i.e. impaired bladder contractility
• Interruption of sensory or motor innervation of the bladder
13. Etiologies of AUR in Men
• Commonest cause is benign prostatic enlargement (BPE)
due to benign prostatic hyperplasia (BPH) leading to BOO
• Less common causes include malignant prostatic
enlargement, urethral stricture and rarely prostatic abscess
• It is either spontaneous (preceded by the presence of LUTS)
or precipitated by event ( previously asymptomatic patient)
14. Etiologies of AUR in Women
• AUR is less common than it is in men
• Causes include pelvic prolapse (cystocele, rectocele, uterine)
• Pelvic masses (e.g. ovarian masses)
• Prolapsing organ directly compressing the urethra; urethral
stricture and urethral diverticulum
15. Causes in Either Sex
• Hematuria leading to clot retention and postoperative retention
• Pain- Adrenergic stimulation of the bladder neck
• Sacral (S2–S4) nerve compression
• Damage-so-called cauda equina compression
1. Prolapsed L2–L3 disk or L3–L4 intervertebral disk
2. Trauma to the vertebrae
3. Benign or metastatic tumors
16. Neurological Causes of Urinary Retention
• History of constipation and associated back pain
• Nighttime back pain and sciatica
• Spinal tumor or cauda equina compression from a prolapsed
intervertebral disk
• Inability to feel bladder is full and urethral voiding
• Difficulty in knowing passage of feces or flatus
• Males loose erection ability and orgasm
17. Is It Acute or Chronic Retention ?
• Elderly men whose urinary retention not aware- bladder filling or emptying
• Chronic urinary retention with maintained voiding and bladder volume >
800 mL and intravesical pressure >30 cm H2O associated hydronephrosis
• Bladder is insensitive to gross distention, voiding continues without
sensation of incomplete emptying
• Sudden inability to pass urine is termed acute on chronic urinary retention
• Foley catheter and urine volume <800mL or more
18. Urinary Retention-Initial Management
• Urethral catheterization is the mainstay of initial management of
urinary retention
• Pain from overdistended bladder become improved
• SPC is requires once urethral catheter failed and in every
procedure urine volume must be recorded
• Urine volume helps diagnosis confirmation and determines
subsequent management
19. NON-TRAUMATIC UROLOGIC EMERGENCIES IN
MEN
PRIAPISM
• Persistent and painful
erection >4hrs not related to
sexual arousal nor relieved by
sexual intercourse
• Classified into low-flow and
high-flow priapism
20. PRIAPISM
• Low-flow or ischemic priapism results from decreased venous
and lymphatic drainage of the corpus cavernosum
• High-flow priapism is less likely to be ischemic and most often
caused by traumatic arterial laceration
• Main complication of priapism is erectile dysfunction due to
inflammation and fibrosis of the corpus cavernosum
21. Etiologies of Priapism
Most cases of low-flow priapism in adults are secondary to
pharmacotherapy or drug abuse
• Drug of abuse such as alcohol, cocaine for heavy users
• Anti HTN drugs like CCBs, prazosin and hydralazine
• Psychiatric medications, trazodone, chlorpromazine, thioridazine
• Erectile dysfunction medications like sildenafil, vardenafil, and tadalafil
22. Other causes of low-flow priapism include
• Blood dyscrasias
• Hypercoagulable states such as sickle cell disease, thalassemia
polycythemia and vasculitis
• Most common cause of high-flow priapism regardless of age is
arteriovenous fistula formation secondary to perineal trauma
23. Pathophysiology
Low-flow priapism
• Sludging of red blood cells clogs the spaces of the corpus cavernosum
leading to impaired drainage of blood
• Impaired venous outflow can also lead to thrombosis and further ischemia
from remaining stagnant blood
High-flow priapism
Arteriovenous shunt following perineal trauma causes abnormally high flow
of blood through the corpus cavernosum
24. Diagnosis
• Erect, tender penis and soft glans unrelated to sexual arousal
• High-flow state is usually less painful and carries smaller risk of ischemia
with recent history of perineal trauma
• Definitive distinction between high- flow and low-flow is made by penile
blood gas analysis from corpus cavernosum
• Color duplex ultrasonography to differentiate flow patterns
• CBC, Coagulation studies and Hb Electrophoresis
25. Management
• First step is hydration and analgesia
• Ischemic priapism : terbutaline sulfate SC (0.25 to 0.5 mg) every
30min PRN
• Aspiration of cavernosal blood and direct caversonal injection of
phenylephrine (100- 200 mg every 5-10 min with max of 1000 mg)
• High-flow priapism arterial blood flow is intact, selective arterial
embolization using an autologous clot is highly effective
26. Paraphimosis
• Foreskin becomes fixed in the
retracted position and cannot be
reduced
• Impaired venous return from the
glans, edema, induration,
ischemia and necrosis of gland
27. Etiologies
• Most common cause of paraphimosis is previous phimosis
• Iatrogenic
• Poor urogenital hygiene
• Chronic balanoposthitis
• Genital piercing
28. Diagnosis
• Patients present with edema and pain of the glans and the inability to pull
back the retracted foreskin
• Diagnosis is straightforward as non-retractable foreskin and the resulting
edema are easily visualized
• It is important to distinguish various infections and strictures of the penis
• Balanitis is an infection of the glans only
• Balanoposthitis is an infection of the glans and the foreskin
29. Management
• Goals to treatment of paraphimosis
are to relieve pain and prevent
further ischemia to the glans
• Manual reduction of the foreskin
should be attempted
• Dorsal slit procedure entails incising
the fibrotic ring of the prepuce
• Circumcision is the definitive
treatment of paraphimosis
30. Testicular Torsion
• It results from a twisting of the
spermatic cord
• Impaired blood flow to the testis
and venous drainage resulting in
edema, ischemia and necrosis
• First peak at age 1-2 years old and
the second higher peak in
adolescence
• Time is testicle
31. Pathophysiology
• Malformation that allows testicle to rotate more freely around the
spermatic cord
• Malformed tunica vaginalis extends over the whole testicle
• Testicle is horizontally fixed “bell-clapper deformity” present in 12%
• Strong cremasteric reflex during nocturnal erections
32. Diagnosis
• Acute scrotal pain and swelling and associated nausea and vomiting
• High-riding testicle and an absent cremasteric reflex
• Negative Prehn’s sign
• Urinalysis and Ultrasonography
33. Management
Testicular torsion salvage rates
over time
• Emergent surgery to detorse the
affected testicle
• Attachment to the scrotal wall
• Procedure is also done on the
unaffected testicle
34. Fournier’s gangrene
• Necrotizing fasciitis of external
genitalia, perineal or perianal
region
• Polymicrobial from GIT or GU
• Affects all ages and both genders
• Life threatening with a mortality
rate of 13-22%
35. ETIOLOGIES
• 50-60% of infections stem from lower GIT or GU source
• Risk Factors : HIV, DM, alcohol, perineal trauma, etc.
• Organisms include E. coli, bacteroides and staphylococci
• Most likely culprit for an infection of colorectal origin is clostridium
36. Pathophysiology
• It begins locally with skin infection and spreads down the fascial plane
• It results into inflammation and ischemia then necrosis later
• Low oxygen content and necrosis potentiate the effects of the
anaerobic bacteria and cause rapid dissemination of the infection
37. Diagnosis
• Patients present with genital induration, pain, erythema and crepitus
• Diagnosis is straightforward when the lesions are found
• Plain radiograph or CT may demonstrate air in the perineal tissues
• Retrograde urethrogram reveals suspected periurethral infection
• Perirectal infection source suspected proctoscopy may be revealing
38. Management
• It relies on an aggressive medical and surgical approach
• Rapid fluid resuscitation and broad spectrum ATB
• Surgical debridement, aggressive wound care and redebridement
• SPC and Fecal diversion may be needed
• Genital skin is highly elastic and grafts are not required unless over 60% of
the skin is removed
39. Take Home Message
• UE delays in treatment may lead to permanent damage
• Priapism focus is on diagnosis and distinguishing high-flow from low-flow forms as latter
requires emergent treatment
• Paraphimosis is straightforward diagnosis ,various methods of reduction and circumcision
• Testicular torsion diagnosis is heavily clinical and salvage of testicle is decreasing with
time to treatment
• Fournier’s gangrene is potentially fatal, aggressive medical and surgical therapy improve
chances of survival and outcome
40. References
1. Non-Traumatic Urologic Emergencies in Men: A Clinical Review Jesse Brown VA Medical
Center, Department of Emergency Medicine, Chicago, IL, University of Illinois at Chicago,
Chicago, IL
2. Urological Emergencies In Clinical Practice-Springer-Verlag London (2013) Hashim Hashim
M.D., FEBU, FRCS (Urol) (auth.), John Reynard, Nigel C. Cowan, Dan Wood, Noel Armenakas
(eds.)-
3. Lue-Smith and Tanagho's General Urology-McGraw-Hill Medical (2012) Jack W. McAninch,
Tom F