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Penis Fracture
•Usually during intercourse.
•No official classification.
•History - exaggerated bend on erect penis, sometimes aware of snap, painful and instant detumescence (loss of erection)
•Relatively common.
Anatomical Detail
Bucks Fascia encloses penis.
Attaches to perineal membrane
Outer superficial layer continuous with superficial subdermal layer of
scrotum
Management
•Exploration is the rule. Very few treated conservatively
•Why?
•Urethral injury
•Scar and plaque formation
•Curved penis (cordee)
•Erectile dysfunction
Fourniers Gangrene
•Necrotizing fasciitis of scrotum, perineum, abdominal wall
•RF’s - Age, diabetes, immunocompromised state
•Polymicrobial
•Sepsis - multi organ failure - death.
•25% idiopathic
Renal Colic
•Vast majority straight forward
•Exceptions are
•solitary kidney
•bilateral obstruction
•worsening renal function
•Fever
Renal Trauma
• 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
(PCNL)
Is classification important?
Stable vs Unstable only relevant classification
Does patient have 2 kidneys
Management•Stable conservative. Unstable explore
(which usually means nephrectomy)
•Many go careers without doing this
•Most conservatively managed since CT
•Impressive the way kidneys heal.
•Collecting system injury - stent
•Why - try to prevent urinoma, aid closure of defect.
•Can get HT - page kidney
Whats injured?Extra scrotal - soft tissue
Intrascrotal but extratesticular - dartosIntra testicular - Need ultrasound to
confirm
Acute Retention
•Acute urinary retention is painful
•Think of this before you call.
•3 questions
•Why is this person in retention
•How long do I leave catheter in
•Why am I unable to catheterise this person
Men
Bladder factors- Neurological central, peripheral
- Drugs anticholinergics- Diseases ie Diabetes, MS
- Chronic obsrtuction - Acute retention
Outlet Factors- Prostate
- Strictures (POST SURGICAL)
Women
Bladder Factors- The majority
- Often post surgical, post partumOutlet
- Less common - Always think cervical cancer
Duration Catheter
•At least 3 days. Men should be started on alpha blocker.
•Keep on permanent drainage for 24 hours then to flip flow valve
•Trial of void should be supervised with accurate post void residuals. Dont do this on a weekend.
Failed TOV?
•Should be taught intermittent clean self catheterisation till we can determine cause.
•Has this patient had previous urological intervention (TURP, Radiotherapy, Prostatectomy)
•Urodynamics - functional assessment of bladder.
Cant catheterise?
•Patient not relaxed - tensing sphincter
•Urethral stricture
•Bladder neck stricture (post surgical)
•Prostate (least common)
•Call us if you can’t get a catheter in