1 / 68

UROLOGIC EMERGENCIES

UROLOGIC EMERGENCIES. Hakan KOYUNCU;MD Asistant Profesor Yeditepe University Medical Faculty Department of Urology. 34-yo male Severe right sided flank pain. 34 M, R flank pain. Hx PE urinalysis imaging. RENAL COLIC. Stones of the urinary tract Hematoma or tissue in the ureter

martha-potter
Télécharger la présentation

UROLOGIC EMERGENCIES

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. UROLOGIC EMERGENCIES Hakan KOYUNCU;MDAsistant Profesor Yeditepe University Medical Faculty Department of Urology

  2. 34-yo male • Severe right sided flank pain

  3. 34 M, R flank pain • Hx • PE • urinalysis • imaging

  4. RENAL COLIC • Stones of the urinary tract • Hematoma or tissue in the ureter • Upper ureter: lumbar-inguinal • Lower ureter: genital • Intermittant • Not affected by body positioning • Lumbar tenderness • Nausea & vomiting

  5. R: Appendicitis - Cholelithiasis • urinalysis: hematuria • KUB • IVP • Computerized Tomography • Pain management,hydration, hot bath • Treatment of the underlying cause

  6. Solitary kidney • Ureteral stone • Hydronephrosis anuria, uremia

  7. 62 yo male • Severe abdominal and inguinal pain, 30 hrs in duration, “have not slept for 5 min.” • Feels like voiding every 10-15 minutes, passes a few drops each time • He presented to the ER of a hospital, was diagnosed as cystitis, was given a parasymphatholytic, but did not get any better.

  8. Acute Urinary Retention • Bladder neck – prostate – urethra • Usually in elderly with BPH • Massive hematuria, acute prostatitis, prostate abcess, stones lodged at the bladder neck/urethra, phimosis, uretral trauma • History • Suprapubic mass • Urethral catheterization • Suprapubic catheterization (cystostomy)

  9. 47 yo diabetic • Alcohol (+) • Fever, malaise, redness and discomfort in scrotum

  10. Fournier’s Gangrene • Synergistic effect of multiple microorganisms in the urogenital/anal region • Effects soft tissue and fascia, necrosis • Generally starts from genital/perineal region • Uretral trauma, urinary ekstravasation, urethral instrumantation, perianal abcess and fissur are predisposing factors • Immunocompromised patients (diabetes, alcoholism) • Begins like cellulitis, rapidly spreads along the fascial planes • Necrosis and gangrene • Hypoxia  anaerobic bacteria  gas formation, crepitation

  11. Malaise, discomfort • Scrotal-perineal pain • Redness • Fever, chills, sweating, scrotal edema • Gangrene • Rapid deterioration in general health • Rapidly involves the abdomen and causes death

  12. Management • Bacteroides, Klebsiella, Proteus, Streptococus, Clostridium Perfringens • An avarage of 4 microorganisms per patient

  13. Phimosis • Inability to retract the preputium • Bad hygiene-recurrent infections • Uncircumsized boys/adults • Prepitual edema, redness, purulent discharge • Physiologic until 3 years of age • Dorsal slit or circumsition

  14. Paraphimosis: • The foreskin, once retracted over the glans penis, cannot be replaced in its normal position • Usually chr. inflammation of preputium, stricture • Lymphatic, venous, and arterial flow are compromised, leading to necrosis • Firmly squeezing glans for 5 mins. • Skin can then be drawn over the glans (lubricant) • dorsal slit, circumsition

  15. 42 yo male • High fever, chills, malaise, frequency, perineal pain • DRE: enlarged, pain, warm prostate • Lab: leucoytosis, shift to the left • culture-sensitivity

  16. AdmittedAntibiotics, NSAID Urinary retention in the evening ???? • Suprapubic catheterisation

  17. The patients general health deteriorates on day 3, fever does not resolve

  18. Prostate Abcess • Coliform bacteria • Generally urethral (ascending) • Staphilococcus via hematogenous route • Diabetes, immune compromised, urethral trauma, prostate biopsy • Pollakiuria, disuria, acute urinary retention; fever, malaise • Usually excacerbation of symptoms after acute prostatitis • DRE: fluctuation • Lab: pyuria, leucocytosis

  19. TRUS: definitive diagnosis • Drainage • Antibiotics • Suprapubik catheterization

  20. Telephone: • 15 yo male • Enlargement and pain in L testis

  21. Testicular Torsion • Newborn – adolesents • %50 uykuda olur • Usually anomaly of tuniga vaginalis or the spermatic cord • Pain-sudden onset, skrotal edema, enlargement and redness, nausea, vomiting • PE: usually retracted, Loss of cremasteric reflex Increased pain with testicular elevation (Prehn)

  22. Epidydimis may be palpated in an abnormal location – early sign • Leucocytosis within a few hours • Doppler US or nuclear scan • Manuel de-torsion (inside out) (local anest) • Eksploration !!! • 5-6 hrs

  23. 35 yo male Errection for 4 hrs in duration, pain • Perineal trauma? • Blood gas: high 02 & low CO2

More Related