Genitourinary Genitourinary EmergenciesEmergenciesChemeketa Community CollegeChemeketa Community College

Paramedic ProgramParamedic Program

Penile Fracture Penile Fracture

Usually when erectUsually when erect

Hear a “crack” or “tear”Hear a “crack” or “tear”

Abrupt pain , swellingAbrupt pain , swelling

Ecchymosis, deviation, immediate Ecchymosis, deviation, immediate

flaccidityflaccidity

Urethral tear warrants immediate surgeryUrethral tear warrants immediate surgery

PriapismPriapism

Prolonged, painful erectionProlonged, painful erection Ischemia, fibrosisIschemia, fibrosis CausesCauses

Sickle cell diseaseSickle cell disease DrugsDrugs

EDED HypertensionHypertension DepressionDepression AnticoagulantsAnticoagulants

Urologist Urologist

Urinary CatheterizationUrinary Catheterization

Used to drain bladderUsed to drain bladder Prevent urinary incontinencePrevent urinary incontinence Short and long termShort and long term ComplicationsComplications

TraumaTrauma Put in and taken outPut in and taken out

Urethral injuryUrethral injury UTIUTI SepsisSepsis

UTIUTI

Women more often than menWomen more often than men Increase in bacteriaIncrease in bacteria

Fecal matterFecal matter Bubble bathsBubble baths TamponsTampons CatheterCatheter

Chlamydia most common cause for menChlamydia most common cause for men

PIDPID

Usually sexually transmitted infectionUsually sexually transmitted infection Vagina to fallopian tubesVagina to fallopian tubes Mild to severe crampy painMild to severe crampy pain Changes in menstrationChanges in menstration Sometimes hard to diagnose causeSometimes hard to diagnose cause Typically chlamydiaTypically chlamydia

ThrushThrush

Itching

Soreness and irritation

Vaginal discharge

Pain/discomfort during intercourse

Pain/discomfort during urination

Acute Scrotal PainAcute Scrotal Pain

TraumaTrauma Epididymitis Epididymitis TorsionTorsion OrchitisOrchitis Fournier’sFournier’s HerniaHernia Renal colicRenal colic AbscessAbscess VaricoceleVaricocele NeoplasmNeoplasm

Testicular TraumaTesticular Trauma

PainfulPainful Need I say moreNeed I say more

EpididymitisEpididymitis

Most common complaint of scrotal painMost common complaint of scrotal pain Differentiated from testicular torsion Differentiated from testicular torsion Inflammatory reaction to certain Inflammatory reaction to certain

pathogens pathogens Chlamydia trachomatisChlamydia trachomatis responsible for responsible for

2/3 of the cases2/3 of the cases

Testicular CancerTesticular Cancer

Misdiagnosed as EpididymitisMisdiagnosed as Epididymitis

Intractable painIntractable pain

N/VN/V

SepsisSepsis

ProstatitisProstatitis

Most misdiagnosed disorderMost misdiagnosed disorder DysuriaDysuria FrequencyFrequency UrgencyUrgency Back or perineal painBack or perineal pain FeverFever ChillsChills DehydrationDehydration

Testicular TorsionTesticular Torsion

True surgical emergencyTrue surgical emergency Most common in adolescent malesMost common in adolescent males Severe unilateral scrotal painSevere unilateral scrotal pain Possible swellingPossible swelling Arterial ischemia causing infarction of the Arterial ischemia causing infarction of the

testicletesticle Rapid recognition and treatmentRapid recognition and treatment

Ultrasound?Ultrasound?

Acute OrchitisAcute Orchitis

Approximately 20% of prepubertal Approximately 20% of prepubertal

patients with mumps develop orchitis patients with mumps develop orchitis

Testicular pain and swellingTesticular pain and swelling

Associated with epididymitis Associated with epididymitis

Testicular atrophy occurs in 60%Testicular atrophy occurs in 60%

Fournier Gangrene Fournier Gangrene (Necrotizing Fasciitis)(Necrotizing Fasciitis)

Immune compromisedImmune compromised Diabetes mellitusDiabetes mellitus Morbid obesity Morbid obesity Cirrhosis Cirrhosis Vascular disease of the pelvis Vascular disease of the pelvis Malignancies Malignancies

Pain and itching of the scrotal skin Pain and itching of the scrotal skin Progressive, rapidly spreading, inflammatory Progressive, rapidly spreading, inflammatory

infection located in the deep fascia, with infection located in the deep fascia, with secondary necrosis of the subcutaneous secondary necrosis of the subcutaneous tissues tissues

Mortality as high as 75% Mortality as high as 75%

'Aho T et al. (2006) Fournier's gangreneNat Clin Pract Urol 3: 54–57 doi:10.1038/ncpuro353

Appearance of patient's pubic region after initial debridement, with scrotum and suprapubic fat pad excised, testes preserved within tunica vaginalis, and penile skin and subcutaneous tissue

debrided

Necrotizing FasciitisNecrotizing Fasciitis

CausesCauses TraumaTrauma SurgerySurgery IdiopathicIdiopathic

Mean age 38-44 years Mean age 38-44 years Begins with erythema that quickly spreadsBegins with erythema that quickly spreads Dusky or purplish skin discoloration Dusky or purplish skin discoloration Morbidity and mortality is 70-80% Morbidity and mortality is 70-80%

Strangulated HerniaStrangulated Hernia

Painful enlargement Painful enlargement

of previous herniaof previous hernia

Even if reducedEven if reduced

N/V N/V

Bowel obstruction Bowel obstruction

symptomssymptoms

SepsisSepsis

Urethral Bleeding?Urethral Bleeding?

D/DxD/Dx

Urethral BleedingUrethral Bleeding TraumaTrauma

Saddle, Crotch, Perineal areaSaddle, Crotch, Perineal area CatheterCatheter ChancreChancre Meatitis Meatitis CancerCancer

Bladder Bladder UrethraUrethra

Foreign BodyForeign Body UrethraUrethra

CalculusCalculus KidneyKidney BladderBladder UrethraUrethra

Schistosomiasis Schistosomiasis