We all listened to a great case this morning about a very sick patient who ultimately was found to have sepsis and DKA secondary to Fournier's gangrene. Broadly, we discussed:
* early, aggressive and critical fluid resuscitation in DKA and sepsis
* early recognition of a patient's severity of illness and potential to decompensate (also early consideration of what interventions ie. central line may be necessary to keep the patient safe as inpatient)
* early and appropriate consultation (especially of Surgery) by all possibly involved parties
* along those lines, urological emergencies are often also surgical ones
So, to discuss further:
Urological emergencies: a sampling
To pick some big ones:
Penile trauma:
* corpus cavernosum tears
* "pop", pain and swelling --> eggplant deformity (look it up)
* 10-20% occur with urethral trauma
* ultrasound! Or MRI
* surgical repair significantly decreases chances of erectile dysfunction and chronic pain
Urethral trauma: in pictures!
* 10-20% of pelvic fractures have urethral injury!
Bladder injury:
* intraperitoneal rupture is a surgical emergency; retroperitoneal will drain on its own; you can have both at once
* direct blunt trauma to inflated bladder, penetrating, pelvic fracture
* 10-30% of posterior urethral injuries also occur with bladder injury!
* high rates in children
Paraphimosis:
* foreskin caught behind glans --> swelling --> blister-like distension of penis tip --> necrosis and ulceration into urethra
* suspect in ALL ages
* infection risk in DM, immunoxompromise
* pain control
* reduceable at bedside but POSSIBLE need for OR (http://emedicine.medscape.com/article/143885-overview)
***Also consider testicular torsion, testicular rupture, renal injuries, and urinary retention.***