Urol 401 GU Emergencies
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Transcript of Urol 401 GU Emergencies
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8/16/2019 Urol 401 GU Emergencies
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History
• 19-year-old male with acute rightscrotal pain for the last 5 hours
• No fever, dysuria, nausea andvomiting
• No previous pain episodes
•No history of trauma
• Past history: Unremara!le
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Physical e"am
• # $ %&'(, P $ &(, )P $ 1*5+&
• hest, a!domen, and e"tremities are
all normal• Penis: Uncircumcised, no discharge
or lesions
• .eft testis: Normal• /ight scrotum: 0wollen,
erythematous and e"tremely tender
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"am
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.a!oratory
• U+2: 5 3), * /), 4od' )acteria
• ): 3) 9', Hct %9
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6ifferential 6iagnosis
• 0permatic cord torsion
• #orsion of testicular appendage
• pididymitis + orchitis
• #rauma
•
4alignancy• 7diopathic
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4anagement
• pididymitis - 2nti!iotics
• #orsion of appendage - 8!servation
• #orsion of cord - "ploration
• #rauma - "ploration
• 4alignancy - "ploration
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7maging-6oppler Ultrasound
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4anagement "ploration
• )ell-clapper
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4anagement 8rchiope"y
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pididymitis+8rchitis
• tiology
– 0e"ually active
• N' onorrhea• hylamidia
• Ureaplasma urealyticum
– Prepu!ertal
• ' oli
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7nfection: 4anagement
• 0#6
– 2;ithromycin
– 4etronida;ole
• Prepu!ertal
– #rim+sulfa
– ephalosporine
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#orsion of 2ppendage
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#orsion of 2ppendage
• 8!servation <if you can !e certain of
the diagnosis=
• "ploration if you can>t rule out
spermatic cord torsion
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2cute 0crotum 0ummary
• 0permatic cord torsion most
common cause
• 6oppler ultrasound most accuratenoninvasive imaging study
– 5? false negative
• 0uspect spermatic cord torsion
– 7mmediate e"ploration
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History
• (-year-old white male w+ painful
erection @ hours
• Past History: depression
• 4edications: tra;adone
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"am
• # $ %&, P $ &A, )P $ 1(+A(
• Penis: erect with tumescence of
corpora cavernosa, soft glans and
ventrum
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4anagement
• 2spiration + 7rrigation
– )lood gas on aspirate
– pH $ &', p8( $ %A
• Phenylephrine 7rrigation
– 4onitor patient <)P, pulse=
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"am
• # $ %&, P $ &A, )P $ 1(+A(
• Penis: erect
•
2spirate - )right red !lood – pH $ &'*, p8( $ A
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High-flow Priapism
• History of trauma
• 6iagnosis:
– 6uple" 6oppler ultrasound
– 2rteriography
• 4anagement: m!oli;ation