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Hakan KOYUNCU;MD
Associate Professor
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
Intermittant
Not affected by body positioning
Lumbar tenderness
Nausea & vomiting
R: Appendicitis - Cholelithiasis
urinalysis: hematuria
KUB
IVP
Computerized Tomography
History
Suprapubic mass
Urethral catheterization
Suprapubic catheterization (cystostomy)
47 yo diabetic
Alcohol (+)
Fever, malaise,
redness and
discomfort in
scrotum
Fournier’s Gangrene
culture-sensitivity
Admitted
Antibiotics, NSAID
Urinary retention in the evening ????
•Suprapubic catheterisation
The patients general health
deteriorates on day 3, fever does not
resolve
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
TRUS: definitive diagnosis
Drainage
Antibiotics
Suprapubik catheterization
Telephone:
15 yo male
Enlargement and pain in L testis
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)
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
35 yo male
Errection for 4 hrs in duration,
pain
Perineal trauma?
Blood gas: high 02 & low CO2
Priapism
Etiology:
– Most frequent: intracavernosal injection
– Idiopathic
– Disease (leucemia, sickle cell disease,..)
Obstruction of venous drainage, c.c.’da pooling
of viscous low oxygenated blood in corpus
cavernosum edema, fibrosis, erectile
dysfunction
Increase venous outflow
Find out underlying reason-if possible
Non-surgical management first:
– Aspiration
– Alfa adrenergikc agonist injection
• (phenephrine, 10mg/ml, diluted in 19 ml saline)
If non-surgical tx fails:
– Distal or proximal shunt
TRAUMA
History
PE (lumbar echimosis, pain with palpation)
Hematuria
– (Renal vascular injury - 36 % not associated with
hematuria)
Variable clinical presentation
(asymptomatic-shock)
Radiologic Imaging
KUB (loss of psoas or renal contour)
IVU (delayed renal function,
nonhomogenous collecting system)
USG (lumbar hematoma and urinoma
lokalizasyonu)
Computerized Tomography
Renal angiography
American Association for the Surgery of Trauma
Absolute Indication
– Persistant renal bleeding
– Expanding perirenal hematoma
– Perirenal hematoma with pulsation
Relative indication
– Urinary extravasation
– Inability in proper staging
– Delayed arterial injury
Bladder & Urethra