- More of a symptom than an actual diagnosis
- Describe timing of gross hematuria (initial, terminal or total)
Hematuria
- Irritative voiding symptoms; frequency, urgency, dysuria
- Suprapubic discomfort or TTP
- Women may experience hematuria and symptoms often appear following sexual intercourse
Acute Cystitis
•Fever, flank pain, irritative voiding symptoms, shaking chills, associated N/V/D, tachycardia and costovertebral angle tenderness is usually pronounced
**MEDEVAC**
Pylenophritis
•Perineal, sacral or suprapubic pain with high fever
•Irritative voiding symptoms
•Obstructive symptoms leading to urinary retention
•Warm and often exquisitely tender prostate is detected on examination
**MEDEVAC**
Acute Prostatitis
•Variable degree or irritative voiding symptoms
•Low back pain and perineal pain
•Suprapubic discomfort
•History of UTI’s
•Prostate may be normal, boggy, or indurated
•Diagnosed with a good history
**MEDEVAC**
Chronic Bacterial Prostatitis
- May follow acute physical strain; heavy lifting, trauma, or sexual activity
- Associated symptoms of urethritis and cystitis
- Pain develops in the scrotum and may radiate along the spermatic cord or to the flank
- Fever, scrotal swelling, and the epididymis may be distinguishable from the testes (testes may appear as one enlarged mass)
- Prostate may be tender on rectal examination
- Prehn Sign (elevation of the scrotum above the pubic symphysis improves pain from epididymitis)
Epididymitis
•Sudden onset of pain that is typically localized to the flank
•May be associated with nausea and vomiting
•Patients are constantly moving trying to find a comfortable position
•Pain may occur episodically and may radiate anteriorly over the abdomen and as stone progresses down the ureter pain may be referred to the ipsilateral groin
•Obstructing stones usually present with acute, unremitting, and severe colic
**“If obstructing stone with associated infection - MEDEVAC!**
Urinary Stone
•The consistent inability to attain or maintain a sufficiently rigid penile erection for sexual performance
•PT history is critical to the proper classification and treatment
•Androgen deficiency, arterial, venous, neurogenic, hormonal, or psychogenic causes, concurrent medical problems
•Most common cause is a decrease in arterial flow resultant from progressive vascular disease
•Medications such as antihypertensives, antidepressants, and opioid agents
***IF Priapism MEDEVAC**
Erectile DYsfunction
- Symptoms can be obstructive component of the prostate of to the secondary response of the bladder to the outlet resistance (irritative)
- Obstructive - hesitancy, decreased force and caliber of stream, sensation of incomplete bladder emptying, double voiding, straining to urinate, post-void dribbling
- Irritative - urgency, frequency, nocturia
- American Urological Association (AUA) symptom index is the most important tool used in the evaluation of patients with BPH (scale of 0-5)
- DRE will show smooth, firm, elastic enlargement of the prostate (induration should alert you of the possibility of cancer)
Benign Prostatic Hypertrophy (BPH)
- MOST prostate cancers are detected because of elevations in serum PSA (not DRE)
- May manifest as focal nodules or areas of induration within the prostate upon DRE examination
- Rarely present with signs of urinary retention or neurological symptoms secondary to epidural metastases
- Axial skeleton is most common site of metastases (PT may present with back pain)
Prostate Cancer
•TTP, ecchymosis, swelling, laceration, bleeding
**MEDEVAC**
Scrotal Trauma
•Starts as a benign infection or simple abscess that quickly leads to widespread necrosis of otherwise previously healthy tissue
•Scrotal, rectal, or genitalia pain out of proportion to their physical exam findings
•Tense edema of scrotum and other involved skin, blisters/bullae, crepitus, fever, pain, tachycardia and hypotension
**MEDEVAC**
Fournier’s Gangrene
- Feels like a “bag of worms”, especially in upright position
- Usually asymptomatic, some patients have mild pain
- Mass is separate from testes
- Size increases with Valsalva maneuver
Varicocele
- Gradually enlarging painless cystic mass that transilluminates
- May indicate tumor
Hydrocele
- Fuild filled cyst at the head of the epididymis that may contain nonviable sperm
- Painless, palpated a distinct from the testes, typically transilluminates as cystic in nature
Spermatocele
Painless enlargement of the testes; patient is usually first to recognize but delay in seeking medical attention for 3-6 months
•Sensation of heaviness
•Acute testicular pain because of intra-testicular hemorrhage occurs in about 10% of patients
•10% are asymptomatic in presentation
•10% manifest with symptoms of metastatic disease - back pain, cough, lower extremity edema
•5% of PTs present with Gynecomastia
Testicular Mass
•Acute scrotal pain often occurring several hours after vigorous physical activity or minor trauma to the testicles
•Profound tenderness and swelling, nausea and vomiting
•Negative cremasteric reflex due to impingement of cremasteric muscle and nerve
•Bell Clapper deformity - high riding tetes oriented transversely
**MEDEVAC**
Testicular Torsion
- Rupture of the corpus cavernosum
- Immediate pain, deforming hematoma (eggplant deformity), ““cracking sound””, immediate loss of erection (detumescence), may cause urethral injury
•Self inflicted injuries, amputation, vacuum injuries, zipper injuries, constricting/strangulation injuries, degloving injuries, penetrating injuries (animal bites, GSW, stabbing injuries), contusions
**MEDEVAC**
Penile Rupture/Fracture
- Fibrous constriction of the foreskin preventing retraction that can be the result of Balanitis or Balanoposthitis
- May cause urinary retention
Phimosis
•Retracted foreskin develops a fixed constriction proximal to the glans
•Penis distal to the constricting foreskin may become swollen and painful, or even gangrenous, and urinary retention may result
**MEDEVAC**
Paraphimosis
•Sudden decrease in kidney function and is characterized as an increase in serum creatinine
•Oliguria may be present (<400-500ml of urine/day)
•Three categories - Pre-renal (kidney hypoperfusion leading to decreased GFR), Intrinsic kidney disease, and Post-renal (obstructive uropathy)
•UREMIA - nausea, vomiting, altered sensorium, pericarditis, malaise
•Pericardial effusion leading to tamponade and friction rub, arrythmias, rales in hypervolemia, nonspecific abdominal pain and ileus
•May experience symptoms and signs of the underlying disease process causing their AKI, may be hyper/hypovolemic
**MEDEVAC**
Renal Failure (Acute Kidney Injury AKI)
- Serum sodium concentration less than 135 mEq/L (135 mmol/L) often caused by hypotonic fluids
- Usually reflected by excess water retention relative to sodium rather than sodium deficiency
MILD - nausea, malaise
MODERATE - headache, lethargy, disorientation
SEVERE - respiratory arrest, seizure, coma, permanent brain damage, brainstem herniation, death
**MEDEVAC if showing severe signs**
Hyponatremia
- Sodium concentration greater than 145 mEq/L
- Typically hypovolemic due to free water losses
- Dehydration patients, orthostatic hypotension, oliguria
EARLY SIGNS
•Lethargy, irritability and weakness
SEVERE SIGNS (usually Sodium \>158mEq/L) •Hyperthermia, delirium, seizures, coma \*\*MEDEVAC if showing severe signs\*\*
Hypernatremia
- Serum potassium levels less than 3.5 mEq/L (3.5 mmol/L)
- Most common cause is GI loss from infectious diarrhea
MILD - MODERATE
•Muscular weakness, fatigue, muscle cramps
SEVERE (less than 2.5 mEq/L)
•Flaccid paralysis, hyporeflexia, hypercapnia, tetany, rhabdomyolysis
**MEDEVAC if showing severe signs**
Hypokalemia
