UROLOGIC EMERGENCIES

Question 1

testicular torsion
- cause
- sx
- urgency
- tx

Answer 1

• cause: twisting of spermatic cord–> ischemia
• sx: sudden, severe unilat scrotal pain, high riding testis, absent cremasteric reflex
• urgency: surgical emergency (6 hrs to save)
• tx: detorison + orchiopexy

orchiopexy- reposition testicle into scrotum

Question 2

fournier’s gangrene
- cause
- RFs
- Sx
- urgency
- tx

Answer 2

• cause: polymicrobial nec fasciitis of perineum
• RFs: DM, immunosuppressed, obesity
• sx: rapid pain/swell, crepitus, foul smell drainage, systemic tox
• urgency: life threatening
• tx: broad spec IV abx, surgical debridement, ICU care

Question 3

obstructed pyelonephritis
- cause
- sx
- urgency
- tx

Answer 3

• cause: UTI + obstruction
• sx: fever, flank pain, pyuria, septic signs
• urgency: risk of urosepsis
• tx: IV abx + urgent decompression (ureteral stent or nephrostomy)

Question 4

2 types of priaprism

Answer 4

ischemic = low flow
non ischemic = high flow

Question 5

priapism–>ischemic (low flow)
- cause
- sx
- tx

Answer 5

• cause: sickle cell, meds (trazodone, PDE5i)
• sx: painful, rigid erection >4 hrs
• tx: aspiration + phenylephrine injx

Question 6

priaprism–> non ischemic (high flow)
- causes
- sx
- urgency
- tx

Answer 6

• cause: trauma related
• sx: often painless
• less urgent
• tx: imaging guided tx

Question 7

acute urinary retention
- cause
- sx
- tx

Answer 7

• cause: BPH, spinal cord injury, meds (anticholinergics, opioids)
• sx: lower abd pain/suprapubic , inability to void
• tx: foley cath, workup underlying cause

Question 8

paraphimosis
- cause
- sx
- tx

Answer 8

• cause: retracted foreskin cant return –> causes venous congestion
• sx: swollen glans, tight retracted foreskin
• tx: manual reduction or dorsal slit/circumcision