Urological Emergencies: Causes, Symptoms & Treatment
UROLOGICAL
EMERGENC
IES
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UROLOGY DEAL WITH
•
GENITAL AND URINARY SYSTEM IN MEN
•
URINARY SYSTEM IN WOMEN
•
There are a lot of urologic
emergencies and most of them are
not life threatening
•
But u
rologic emergenc
ies
require
rapid diagnosis and immediate
treatment
Urological Emergencies
1)
Non traumatic
1.
Hematuria
2.
Renal Colic
3.
Urinary Retention
4.
Acute Scrotum
5.
Priapism
2)
Traumatic
1)
Renal Trauma
2)
Ureteral Injury
3)
Bladder Trauma
4)
Urethral Injury
5)
Testicular Trauma
6)
Penile Fracture
Urological Emergencies
1)
Non traumatic
1.
Hematuria
2.
Renal Colic
3.
Urinary Retention
4.
Acute Scrotum
5.
Priapism
2)
Traumatic
1)
Renal Trauma
2)
Ureteral Injury
3)
Bladder Trauma
4)
Urethral Injury
5)
Testicular Trauma
6)
Penile fracture
Hematuria
•
Blood in the urine
•
Types
:
–
Macroscopic
or
microscopic
–
Painless or painful
–
Initial / Terminal / Total
Hematuria…
•
Causes
–
Nephrological (medical) or
–
U
rological (surgical)
Non traumatic
emergency
Urological Emergencies
1)
Non traumatic
1.
Hematuria
2.
Renal Colic
3.
Urinary Retention
4.
Acute Scrotum
5.
Priapism
2)
Traumatic
1)
Renal Trauma
2)
Ureteral Injury
3)
Bladder Trauma
4)
Urethral Injury
5)
Testicular Trauma
6)
Penile fracture
R
E
N
A
L
C
O
L
I
C
(
A
C
U
T
E
F
L
A
N
K
P
A
I
N
)
•
The commonest urologic emergency
•
Sudden onset of severe pain in the flank
area
•
One of the commonest causes of the
“Acute Abdomen”.
•
Most often due to the passage of a stone
formed in the kidney, down through the
ureter.
Renal colic….
•
The pain is characteristically :
–
very sudden onset
–
colicky in nature
–
Radiates to the groin as the stone passes into
the lower ureter.
–
May change in location, from the flank to the
groin, (
according to the
the location of the
ureteral stone)
–
Associated with nausea / Vomiting
Non traumatic
emergency
Renal colic….
•
Work Up :
–
History
–
Examination: patient want to move around, in
an attempt to find a comfortable position.
Non traumatic
emergency
Renal colic….
–
Radiological investigation :
•
X ray graphy (DUSG)
•
Abdominal US
•
IVP (was)
•
Helical CT
•
MRI
Non traumatic
emergency
Renal colic….
•
T
r
e
a
t
m
e
n
t
o
f
t
h
e
S
t
o
n
e
:
–
T
e
m
p
o
r
a
r
y
r
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l
i
e
f
o
f
t
h
e
o
b
s
t
r
u
c
t
i
o
n
:
•
Insertion of a JJ stent or percutaneous
nephrostomy tube.
–
Definitive treatment of a ureteric stone:
•
ESWL.
•
PCNL
•
Ureteroscopy
•
Open Surgery: very limited.
Non traumatic
emergency
Urological Emergencies
1)
Non traumatic
1.
Hematuria
2.
Renal Colic
3.
Urinary Retention
4.
Acute Scrotum
5.
Priapism
2)
Traumatic
1)
Renal Trauma
2)
Ureteral Injury
3)
Bladder Trauma
4)
Urethral Injury
5)
Testicular Trauma
Urinary Retention
•
Acute Urinary retention
•
Chronic Urinary retention
Non traumatic
emergency
Acute Urinary retention
•
Painful inability to void, with relief of pain
following drainage of the bladder by
catheterization.
•
P
a
t
h
o
p
h
y
s
i
o
l
o
g
y
:
–
Increased urethral
resistance, i.e., bladder
outlet obstruction
(BOO)
–
Low bladder
pressure, i.e., impaired bladder
contractility
–
Interruption of sensory or motor innervations
of the bladder
Non traumatic
emergency
Acute urinary retention…
•
C
a
u
s
e
s
:
–
M
e
n
:
•
Benign prostatic enlargement (BPE) due to BPH
•
Carcinoma of the prostate
•
Urethral stricture
•
P
r
o
s
t
a
t
i
c
a
b
s
c
e
s
s
–
W
o
m
e
n
•
Pelvic prolapse (cystocoele, rectocoele,)
•
Urethral stricture;
•
Urethral diverticulum;
•
Post surgery for ‘stress’ incontinence
•
pelvic masses (e.g., ovarian masses)
Non traumatic
emergency
Acute urinary retention…
•
I
n
i
t
i
a
l
M
a
n
a
g
e
m
e
n
t
:
–
Urethral catheterisation
–
S
u
p
r
a
p
u
b
i
c
c
a
t
h
e
t
e
r
(
S
P
C
)
•
L
a
t
e
M
a
n
a
g
e
m
e
n
t
:
–
Treating the underlying cause
Non traumatic
emergency
Chronic urinary retention
•
Obstruction develops slowly, the bladder is
distended very gradually over
weeks/months, so
pain is not a feature
.
•
Presentation:
–
Urinary dribbling
–
Overflow incontinence
–
Palpable lower suprapubic mass
Non traumatic
emergency
Chronic urinary retention…
•
Usually associated with
–
Reduced renal function.
–
Upper tract dilatation
•
Bladder drainage under slow rate to avoid
sudden decompression> hematuria.
Non traumatic
emergency
Urological Emergencies
1)
Non traumatic
1.
Hematuria
2.
Renal Colic
3.
Urinary Retention
4.
Acute Scrotum
5.
Priapism
2)
Traumatic
1)
Renal Trauma
2)
Ureteral Injury
3)
Bladder Trauma
4)
Urethral Injury
5)
Testicular Trauma
Acute Scrotum
•
Emergency situation requiring prompt
evaluation, differential diagnosis, and
potentially immediate surgical exploration
Non traumatic
emergency
A
c
u
t
e
s
c
r
o
t
u
m
…
D
i
f
f
e
r
e
n
t
i
a
l
D
i
a
g
n
o
s
i
s
…
1.
Torsion of the Spermatic Cord
–
Most serious.
2.
Torsion of the Testicular and Epididymal
Appendages.
3.
Epididymitis.
–
Most common
Non traumatic
emergency
T
o
r
s
i
o
n
o
f
t
h
e
S
p
e
r
m
a
t
i
c
C
o
r
d
(A) extravaginal; (B) intravaginal
Non traumatic
emergency
T
o
r
s
i
o
n
o
f
t
h
e
S
p
e
r
m
a
t
i
c
C
o
r
d
(
I
n
t
r
a
v
a
g
i
n
a
l
)
•
S
urgical emergency
•
I
r
r
e
v
e
r
s
i
b
l
e
i
s
c
h
e
m
i
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i
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j
u
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o
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a
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p
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m
a
m
a
y
b
e
g
i
n
a
s
s
o
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n
a
s
4
h
o
u
r
s
Torsion of the Spermatic Cord…
Presentation:
•
A
c
u
t
e
o
n
s
e
t
o
f
s
c
r
o
t
a
l
p
a
i
n
.
Non traumatic
emergency
T
o
r
s
i
o
n
o
f
t
h
e
S
p
e
r
m
a
t
i
c
C
o
r
d
…
P
h
y
s
i
c
a
l
e
x
a
m
i
n
a
t
i
o
n
:
•
The affected testis is
high
– riding
t
ransverse
orientation.
•
Acute hydrocele or
massive scrotal edema
Non traumatic
emergency
Torsion of the Spermatic Cord…
•
C
o
l
o
r
D
o
p
p
l
e
r
u
l
t
r
a
s
o
u
n
d
:
–
Assessment of anatomy and
determining the presence or absence of
blood flow.
Epid.Orchitis
•
Presentation:
•
Scrotal swelling, erythema, and pain.
•
Dysuria and fever is more common
•
L
ocalized epididymal tenderness, a swollen and
tender epididymis,
Non traumatic
emergency
Epid.Orchitis…
•
Management:
–
parenteral antibiotic therapy should be
given
when UTI is documented or suspected.
–
Scrotal elevation,
–
the use of an athletic supporter
Non traumatic
emergency
Urological Emergencies
1)
Non traumatic
1.
Hematuria
2.
Renal Colic
3.
Urinary Retention
4.
Acute Scrotum
5.
Priapism
2)
Traumatic
1)
Renal Trauma
2)
Ureteral Injury
3)
Bladder Trauma
4)
Urethral Injury
5)
Testicular Trauma
Priapism
•
Persistent erection of the penis for more
than
4 hours
that is not related or
accompanied by sexual desire.
Non traumatic
emergency
Priapism…
•
2 Types:
–
ischaemic (veno-occlusive, low flow
(most
common)
•
Due to haematological disease, malignant
infiltration of the corpora cavernosa with malignant
disease, or drugs.
•
Painful.
–
nonischaemic
(arterial, high flow).
•
Due to perineal trauma, which creates an
arteriovenous fistula.
•
Painless
Priapism…
•
Causes:
–
Primary (Idiopathic) : 30%- 50%
–
Secondary:
•
Drugs
•
Trauma
•
Neurological
•
Hematological disease
•
Tumors
•
Miscellaneous
Non traumatic
emergency
Priapism…
•
The diagnosis
–
Usually obvious from the history
•
Duration of erection >4 hours?
•
Is it painful or not?.
•
Previous history and treatment of priapism ?
•
Identify any predisposing factors and underlying
cause
Non traumatic
emergency
Priapism…
–
Colour flow duplex ultrasonography in
cavernosal arteries:
•
Ischaemic
(inflow low
)
•
Nonischaemic
(inflow normal
)
–
Penile pudendal arteriography
Priapism…
•
Treatment:
–
Depends on the type of priapism.
–
Conservative treatment should first be tried
–
Medical treatment
–
Surgical treatment.
–
Treatment of underlying cause
•
→→ It is important to warn all patients with
priapism of the possibility of impotence.
Non traumatic
emergency
Urological Emergencies
1)
Non traumatic
1.
Hematuria
2.
Renal Colic
3.
Urinary Retention
4.
Acute Scrotum
5.
Priapism
2)
Traumatic
1)
Renal injuries
2)
Ureteral injuries
3)
Bladder injuries
4)
Urethral Injuries
5)
Testicular injuries
6)
Penile fracture
Traumatic Urological Emergencies
•
R
E
N
A
L
I
N
J
U
R
I
E
S
•
U
R
E
T
E
R
I
C
I
N
J
U
R
I
E
S
•
B
L
A
D
D
E
R
I
N
J
U
R
I
E
S
•
U
R
E
T
H
R
A
L
I
N
J
U
R
I
E
S
•
T
E
S
T
I
C
U
L
A
R
I
N
J
U
R
I
E
S
•
P
E
N
I
L
E
I
N
J
U
R
I
E
S
•
P
E
N
I
L
E
F
R
A
C
T
U
R
E
R
E
N
A
L
I
N
J
U
R
I
E
S
•
The kidneys relatively protected from
traumatic injuries.
•
Considerable degree of force is usually
required to injure a kidney.
Traumatic
emergency
•
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
nephrolithotomy (PCNL)
Renal injuries…
•
Indications for renal imaging:
–
Macroscopic hematuria
–
Penetrating chest, flank, and abdominal
wounds
–
A history of a rapid acceleration or
deceleration
Traumatic
emergency
Renal injuries…
•
W
h
a
t
I
m
a
g
i
n
g
S
t
u
d
y
?
–
Contrast-enhanced CT:
•
accurate, rapid, images other intra-abdominal
structures
–
Renal us
–
I
V
U
Traumatic
emergency
Renal injuries…
•
S
t
a
g
i
n
g
(
G
r
a
d
i
n
g
)
•
American Association for the Surgery of
Trauma Organ Injury Severity Scale
Traumatic
emergency
Renal injuries…
•
Management:
–
Conservative:
•
Over 95% of blunt injuries
Traumatic
emergency
Renal injuries…
•
Surgical exploration:
–
Persistent bleeding (persistent tachycardia
and/or hypotension
)
–
Expanding perirenal haematoma
–
Pulsatile perirenal haematoma
Traumatic
emergency
Urological Emergencies
1)
Non traumatic
1.
Hematuria
2.
Renal Colic
3.
Urinary Retention
4.
Acute Scrotum
5.
Priapism
2)
Traumatic
1)
Renal injuries
2)
Ureteral injuries
3)
Bladder injuries
4)
Urethral Injuries
5)
Testicular injuries
U
R
E
T
E
R
I
C
I
N
J
U
R
I
E
S
•
The ureters are protected from external
trauma by surrounding bony structures,
muscles and other organs
•
C
a
u
s
e
s
a
n
d
M
e
c
h
a
n
i
s
m
s
:
–
External Trauma
–
Internal Trauma
Traumatic
emergency
Ureteric injuries…
•
E
x
t
e
r
n
a
l
T
r
a
u
m
a
:
–
Rare
–
Severe force is required
–
Blunt or penetrating.
–
Blunt external trauma severe enough to injure
the ureters will usually be associated with
multiple other injuries
–
Knife or bullet wound to the abdomen or chest
may damage the ureter, as well as other
organs.
Traumatic
emergency
Ureteric injuries…
•
I
n
t
e
r
n
a
l
T
r
a
u
m
a
–
more common than external trauma
–
Surgery:
•
Hysterectomy, oophorectomy, and
sigmoidcolectomy
•
Ureteroscopy
•
Caesarean section
•
Aortoiliac vascular graft placement,
•
Laparoscopic procedures,
•
Orthopedic operations
Traumatic
emergency
Ureteric injuries…
•
Diagnosis:
–
Requires a high index of suspicion
–
Intraoperative:
–
Late:
•
1. An ileus: the presence of urine within the peritoneal
cavity
•
2. Prolonged postoperative fever or
urinary sepsis
•
3. Persistent drainage of fluid from abdominal or pelvic
drains, from the abdominal wound, or from the vagina.
•
4. Flank pain if the ureter has been ligated
•
5. An abdominal mass, representing a urinoma
Traumatic
emergency
Ureteric injuries…
•
Treatment options:
–
JJ stenting
–
Primary closure of partial transection of the ureter
–
Direct ureter to ureter anastomosis
–
Reimplantation of the ureter into the bladder
(ureteroneocystostomy
–
Transureteroureterostomy
–
Autotransplantation of the kidney into the pelvis
–
Replacement of the ureter with ileum
–
Permanent cutaneous ureterostomy
–
Nephrectomy
Traumatic
emergency
Ureteric injuries…
Traumatic
emergency
Urological Emergencies
1)
Non traumatic
1.
Hematuria
2.
Renal Colic
3.
Urinary Retention
4.
Acute Scrotum
5.
Priapism
2)
Traumatic
1)
Renal injuries
2)
Ureteral injuries
3)
Bladder injuries
4)
Urethral Injuries
5)
Testicular injuries
B
L
A
D
D
E
R
I
N
J
U
R
I
E
S
•
Causes:
–
Iatrogenic injury
–
Penetrating trauma to the lower abdomen or
back
–
Blunt pelvic trauma—in association with pelvic
fracture
–
Rapid deceleration injury—seat belt injury
with full bladder in the absence of a pelvic
fracture
Traumatic
emergency
T
y
p
e
s
o
f
P
e
r
f
o
r
a
t
i
o
n
A
-
i
n
t
r
a
p
e
r
i
t
o
n
e
a
l
p
e
r
f
o
r
a
t
i
o
n
Traumatic
emergency
B
-
e
x
t
r
a
p
e
r
i
t
o
n
e
a
l
p
e
r
f
o
r
a
t
i
o
n
the peritoneum is intact
and urine escapes into
the space around the
bladder, but not into
the peritoneal cavity.
Traumatic
emergency
Bladder injuries…
•
Presentation:
–
S
uprapubic pain and tenderness,
–
D
ifficulty or inability in passing urine,
–
H
aematuria
Traumatic
emergency
Bladder injuries…
•
Management:
–
Extraperitoneal
•
Bladder drainage +++++
•
Open repair +++
–
Intra peritoneal
:
•
open repair…why?
–
Unlikely to heal spontaneously.
–
Usually large defects.
–
Leakage causes peritonitis
–
Associated other organ injury.
Traumatic
emergency
Urological Emergencies
1)
Non traumatic
1.
Hematuria
2.
Renal Colic
3.
Urinary Retention
4.
Acute Scrotum
5.
Priapism
2)
Traumatic
1)
Renal injuries
2)
Ureteral injuries
3)
Bladder injuries
4)
Urethral Injuries
5)
Testicular injuries
U
R
E
T
H
R
A
L
I
N
J
U
R
I
E
S
•
A
N
T
E
R
I
O
R
U
R
E
T
H
R
A
L
I
N
J
U
R
I
E
S
•
P
O
S
T
E
R
I
O
R
U
R
E
T
H
R
A
L
I
N
J
U
R
I
E
S
Traumatic
emergency
A
N
T
E
R
I
O
R
U
R
E
T
H
R
A
L
I
N
J
U
R
I
E
S
•
Rare
•
Mechanism:
–
Direct injuries to the penis
–
Penile fractures
–
Inflating a catheter balloon in the anterior
urethra
–
Penetrating injuries by gunshot wounds.
Ant. Urethral injuries…
•
Symptoms and signs:
–
Blood at the end of the penis
–
Difficulty in passing urine
–
Frank hematuria
–
Hematoma may around the site of the rupture
–
Penile swelling
Traumatic
emergency
Ant. Urethral injuries…
•
Diagnosis:
–
Retrograde urethrography
•
Contusion: no extravasation of contrast:
•
Partial rupture : extravasation of contrast, with
contrast also present in the bladder:.
•
Complete disruption: no filling of the posterior
urethra or bladder
Traumatic
emergency
P
O
S
T
E
R
I
O
R
U
R
E
T
H
R
A
L
I
N
J
U
R
I
E
S
•
Great majority of posterior urethral injuries
occur in association with pelvic fractures
•
10% to 20% have an associated bladder
rupture
•
Signs
–
Blood at the meatus, gross hematuria, and
perineal or scrotal bruising.
–
High-riding prostate
Classification of posterior urethral injuries
Traumatic
emergency
Thank you…
Discover the different types of urological emergencies, both traumatic and non-traumatic, including hematuria, renal colic, urinary retention, acute scrotum, and more. Learn about the causes, symptoms, and immediate treatments required for these urgent urological conditions. Find out how to identify and manage renal colic, a common and painful emergency often caused by kidney stones. Explore the importance of rapid diagnosis and prompt intervention in addressing urological emergencies.
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Presentation Transcript
UROLOGICAL EMERGENCIES Mete Kilciler, MD Professor Bah esehir University Department of Urology
UROLOGY DEAL WITH GENITAL AND URINARY SYSTEM IN MEN URINARY SYSTEM IN WOMEN
There are a lot of urologic emergencies and most of them are not life threatening But urologic emergencies require rapid diagnosis and immediate treatment
Urological Emergencies 1) Non traumatic 1. Hematuria 2. Renal Colic 3. Urinary Retention 4. Acute Scrotum 5. Priapism 2) Traumatic 1) Renal Trauma 2) Ureteral Injury 3) Bladder Trauma 4) Urethral Injury 5) Testicular Trauma 6) Penile Fracture
Urological Emergencies 1) Non traumatic 1. Hematuria 2. Renal Colic 3. Urinary Retention 4. Acute Scrotum 5. Priapism 2) Traumatic 1) Renal Trauma 2) Ureteral Injury 3) Bladder Trauma 4) Urethral Injury 5) Testicular Trauma 6) Penile fracture
Hematuria Blood in the urine Types: Macroscopic or microscopic Painless or painful Initial / Terminal / Total
Non traumatic emergency Hematuria Causes Nephrological (medical) or Urological (surgical)
Urological Emergencies 1) Non traumatic 1. Hematuria 2. Renal Colic 3. Urinary Retention 4. Acute Scrotum 5. Priapism 2) Traumatic 1) Renal Trauma 2) Ureteral Injury 3) Bladder Trauma 4) Urethral Injury 5) Testicular Trauma 6) Penile fracture
RENAL COLIC (ACUTE FLANK PAIN) The commonest urologic emergency Sudden onset of severe pain in the flank area One of the commonest causes of the Acute Abdomen . Most often due to the passage of a stone formed in the kidney, down through the ureter.
Non traumatic emergency Renal colic . The pain is characteristically : very sudden onset colicky in nature Radiates to the groin as the stone passes into the lower ureter. May change in location, from the flank to the groin, (according to the the location of the ureteral stone) Associated with nausea / Vomiting
Non traumatic emergency Renal colic . Work Up : History Examination: patient want to move around, in an attempt to find a comfortable position.
Non traumatic emergency Renal colic . Radiological investigation : X ray graphy (DUSG) Abdominal US IVP (was) Helical CT MRI
Non traumatic emergency Renal colic . Treatment of the Stone: Temporary relief of the obstruction: Insertion of a JJ stent or percutaneous nephrostomy tube. Definitive treatment of a ureteric stone: ESWL. PCNL Ureteroscopy Open Surgery: very limited.
Urological Emergencies 1) Non traumatic 1. Hematuria 2. Renal Colic 3. Urinary Retention 4. Acute Scrotum 5. Priapism 2) Traumatic 1) Renal Trauma 2) Ureteral Injury 3) Bladder Trauma 4) Urethral Injury 5) Testicular Trauma
Non traumatic emergency Urinary Retention Acute Urinary retention Chronic Urinary retention
Non traumatic emergency Acute Urinary retention Painful inability to void, with relief of pain following drainage of the bladder by catheterization. Pathophysiology: Increased urethral resistance, i.e., bladder outlet obstruction (BOO) Low bladder pressure, i.e., impaired bladder contractility Interruption of sensory or motor innervations of the bladder
Non traumatic emergency Acute urinary retention Causes : Men: Benign prostatic enlargement (BPE) due to BPH Carcinoma of the prostate Urethral stricture Prostatic abscess Women Pelvic prolapse (cystocoele, rectocoele,) Urethral stricture; Urethral diverticulum; Post surgery for stress incontinence pelvic masses (e.g., ovarian masses)
Non traumatic emergency Acute urinary retention Initial Management : Urethral catheterisation Suprapubic catheter ( SPC) Late Management: Treating the underlying cause
Chronic urinary retention Non traumatic emergency Obstruction develops slowly, the bladder is distended very gradually over weeks/months, so pain is not a feature . Presentation: Urinary dribbling Overflow incontinence Palpable lower suprapubic mass
Non traumatic emergency Chronic urinary retention Usually associated with Reduced renal function. Upper tract dilatation Bladder drainage under slow rate to avoid sudden decompression> hematuria.
Urological Emergencies 1) Non traumatic 1. Hematuria 2. Renal Colic 3. Urinary Retention 4. Acute Scrotum 5. Priapism 2) Traumatic 1) Renal Trauma 2) Ureteral Injury 3) Bladder Trauma 4) Urethral Injury 5) Testicular Trauma
Non traumatic emergency Acute Scrotum Emergency situation requiring prompt evaluation, differential diagnosis, and potentially immediate surgical exploration
Acute scrotum Differential Diagnosis Non traumatic emergency 1. Torsion of the Spermatic Cord Most serious. 2. Torsion of the Testicular and Epididymal Appendages. 3. Epididymitis. Most common
Non traumatic emergency Torsion of the Spermatic Cord Click to see larger picture (A) extravaginal; (B) intravaginal
Torsion of the Spermatic Cord (Intravaginal) Surgical emergency Irreversible ischemic injury to the testicular parenchyma may begin as soon as 4 hours Testicular Torsion
Non traumatic emergency Torsion of the Spermatic Cord Presentation: Acute onset of scrotal pain.
Torsion of the Spermatic Cord Physical examination: Non traumatic emergency The affected testis is high riding transverse orientation. Acute hydrocele or massive scrotal edema Click to see larger picture
Torsion of the Spermatic Cord Color Doppler ultrasound: Assessment of anatomy and determining the presence or absence of blood flow.
Non traumatic emergency Epid.Orchitis Presentation: Scrotal swelling, erythema, and pain. Dysuria and fever is more common Localized epididymal tenderness, a swollen and tender epididymis,
Non traumatic emergency Epid.Orchitis Management: parenteral antibiotic therapy should be given when UTI is documented or suspected. Scrotal elevation, the use of an athletic supporter
Urological Emergencies 1) Non traumatic 1. Hematuria 2. Renal Colic 3. Urinary Retention 4. Acute Scrotum 5. Priapism 2) Traumatic 1) Renal Trauma 2) Ureteral Injury 3) Bladder Trauma 4) Urethral Injury 5) Testicular Trauma
Non traumatic emergency Priapism Persistent erection of the penis for more than 4 hours that is not related or accompanied by sexual desire.
Priapism 2 Types: ischaemic (veno-occlusive, low flow (most common) Due to haematological disease, malignant infiltration of the corpora cavernosa with malignant disease, or drugs. Painful. nonischaemic (arterial, high flow). Due to perineal trauma, which creates an arteriovenous fistula. Painless
Non traumatic emergency Priapism Causes: Primary (Idiopathic) : 30%- 50% Secondary: Drugs Trauma Neurological Hematological disease Tumors Miscellaneous
Non traumatic emergency Priapism The diagnosis Usually obvious from the history Duration of erection >4 hours? Is it painful or not?. Previous history and treatment of priapism ? Identify any predisposing factors and underlying cause
Priapism Colour flow duplex ultrasonography in cavernosal arteries: Ischaemic (inflow low ) Nonischaemic (inflow normal ) Penile pudendal arteriography
Non traumatic emergency Priapism Treatment: Depends on the type of priapism. Conservative treatment should first be tried Medical treatment Surgical treatment. Treatment of underlying cause It is important to warn all patients with priapism of the possibility of impotence.
Urological Emergencies 1) Non traumatic 1. Hematuria 2. Renal Colic 3. Urinary Retention 4. Acute Scrotum 5. Priapism 2) Traumatic 1) Renal injuries 2) Ureteral injuries 3) Bladder injuries 4) Urethral Injuries 5) Testicular injuries 6) Penile fracture
Traumatic emergency RENAL INJURIES The kidneys relatively protected from traumatic injuries. Considerable degree of force is usually required to injure a kidney.
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 nephrolithotomy (PCNL)
Traumatic emergency Renal injuries Indications for renal imaging: Macroscopic hematuria Penetrating chest, flank, and abdominal wounds A history of a rapid acceleration or deceleration
Traumatic emergency Renal injuries What Imaging Study? Contrast-enhanced CT: accurate, rapid, images other intra-abdominal structures Renal us IVU
Traumatic emergency Renal injuries Staging (Grading) American Association for the Surgery of Trauma Organ Injury Severity Scale
Traumatic emergency Renal injuries Management: Conservative: Over 95% of blunt injuries
Traumatic emergency Renal injuries Surgical exploration: Persistent bleeding (persistent tachycardia and/or hypotension) Expanding perirenal haematoma Pulsatile perirenal haematoma
Urological Emergencies 1) Non traumatic 1. Hematuria 2. Renal Colic 3. Urinary Retention 4. Acute Scrotum 5. Priapism 2) Traumatic 1) Renal injuries 2) Ureteral injuries 3) Bladder injuries 4) Urethral Injuries 5) Testicular injuries
Traumatic emergency URETERIC INJURIES The ureters are protected from external trauma by surrounding bony structures, muscles and other organs Causes and Mechanisms : External Trauma Internal Trauma
Traumatic emergency Ureteric injuries External Trauma: Rare Severe force is required Blunt or penetrating. Blunt external trauma severe enough to injure the ureters will usually be associated with multiple other injuries Knife or bullet wound to the abdomen or chest may damage the ureter, as well as other organs.
Traumatic emergency Ureteric injuries Internal Trauma more common than external trauma Surgery: Hysterectomy, oophorectomy, and sigmoidcolectomy Ureteroscopy Caesarean section Aortoiliac vascular graft placement, Laparoscopic procedures, Orthopedic operations
Traumatic emergency Ureteric injuries Diagnosis: Requires a high index of suspicion Intraoperative: Late: 1. An ileus: the presence of urine within the peritoneal cavity 2. Prolonged postoperative fever or urinary sepsis 3. Persistent drainage of fluid from abdominal or pelvic drains, from the abdominal wound, or from the vagina. 4. Flank pain if the ureter has been ligated 5. An abdominal mass, representing a urinoma
