Guidelines on Urological Trauma
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Ultrasonography and Elastography Imaging
Jemds.com Case Report Post Traumatic Hematocele - Ultrasonography and Elastography Imaging Shivesh Pandey1, Suresh Vasant Phatak2, Gopidi Sai Nidhi Reddy3, Apoorvi Bharat Shah4 1, 2, 3, 4 Department of Radio diagnosis, Jawaharlal Nehru Medical College, Sawangi (Meghe), Wardha, Maharashtra India. INTRODUCTION Hematocele with blunt scrotal trauma is an uncommon cause of the testicular pain. Corresponding Author: Elastography is the new recent advance in the field of ultrasound. USG and Dr. Suresh Vasant Phatak, elastography findings of the acute hematocele is described in this aricle. Department of Radiodiagnosis, Jawaharlal Testicular trauma is the third most common cause of acute scrotal pain,1 and Nehru Medical College, Sawangi (Meghe), high-frequency ultrasonography (USG) with a linear array transducer is the first Wardha, Maharashtra – 442001, India. E-mail: [email protected] preferred modality for testicular trauma evaluation. Extra testicular haematoceles or blood collections inside the tunica vaginalis are the most common findings in the DOI: 10.14260/jemds/2021/340 scrotum after blunt injury.2 On clinical assessment, haematocele appears as a hard mass like swelling and causes pain in the scrotum. In the majority of cases, How to Cite This Article: spontaneous resolution occurs with the support of conservative therapy,3 even if Pandey S, Phatak SV, Reddy GSN, et al. Post treated conservatively, may result in infection, discomfort, or atrophy in undiagnosed traumatic hematocele - usg and broad hematoceles and testicular hematomas over time.4 elastography imaging. J Evolution Med A testis with its coverings, epididymis, and spermatic cord are all contained in Dent Sci 2021;10(21):1636-1638, DOI: 10.14260/jemds/2021/340 each hemiscrotum. -
Penile Fracture Anurag Chahal,1 Sahil Gupta,2 Chandan Das1
Images in… BMJ Case Reports: first published as 10.1136/bcr-2016-215385 on 13 May 2016. Downloaded from Penile fracture Anurag Chahal,1 Sahil Gupta,2 Chandan Das1 1Department of DESCRIPTION Radiodiagnosis, All India A 32-year-old man presented to our emergency Institute of Medical Sciences, New Delhi, India department, with pain, swelling and a dorsal curva- 2Department of Surgical ture in his penis. He had severe pain and lost Disciplines, All India Institute tumescence with a snapping sound during vigorous of Medical Sciences, New sexual intercourse. On examination, he had a swel- Delhi, India ling with ecchymosis on the ventral aspect of his fi Correspondence to penis causing an acute dorsal angulation ( gure 1). Dr Sahil Gupta, There was no blood at the meatus/haematuria. [email protected] Taking the typical history and examination findings Figure 3 Ultrasound images showing ventral into account, the diagnosis of penile fracture was Accepted 1 May 2016 haematoma (H) displacing the corpus spongiosum (CS), made. Ultrasound showed a focal tear in the medial and central urethra (U) displaced towards the left with wall of the right corpora cavernosa with haema- the corpora cavernosa (CC) seen dorsally. toma tracking ventrally and displacing the corpora spongiosa to the other side (figures 2 and 3). The patient was taken for emergent haematoma diagnosis is usually clinical and requires prompt evacuation and corporal repair. surgical intervention.3 Sometimes, the presentation Penile fracture occurs when an erect penis under- may be occult and the patient may present with goes a blunt trauma during sexual intercourse or pain with or without swelling. -
Bilateral Fracture of Corpora Cavernosa with Complete
Rev. Fac. Med. 2018 Vol. 66 No. 4: 635-8 635 CASE REPORT DOI: http://dx.doi.org/10.15446/revfacmed.v66n4.65917 Bilateral fracture of corpora cavernosa with complete rupture of the anterior urethra: Case report and review of recent findings for surgical management Fractura bilateral de cuerpos cavernosos con sección completa de uretra anterior. Reporte de caso y revisión de conceptos actuales sobre el manejo quirúrgico Received: 25/06/2017. Accepted: 17/11/2017. David Andrés Castañeda-Millán1 • Otto Manrique-Mejía2 • César Capera-López1 • Wilfredo Donoso-Donoso1,2 1 Universidad Nacional de Colombia - Bogotá Campus- Faculty of Medicine - Department of Surgery - Urology Unit - Bogotá D.C. - Colombia. 2 Hospital Universitario Mayor Méderi - Urology Service - Bogotá D.C. - Colombia. Corresponding author: David Andrés Castañeda-Millán. Urology Unit, Departament of Surgery, Faculty of Medicine, Universidad Nacional de Colombia. Carrera 30 No. 45-03, building 471, office: 107.Telephone number: +57 1 3165000, ext.: 15106-15107. Bogotá D.C. Colombia. Email: [email protected]. | Abstract | | Resumen | Introduction: Penile fracture is a rare urological emergency associated Introducción. La fractura de cuerpos cavernosos es una urgencia urológica in up to 30% of cases with injury to the anterior urethra. Recent data que se asocia hasta en 30% de los casos a lesión de la uretra anterior. Datos suggest that early surgical intervention is the best treatment strategy. recientes postulan la intervención quirúrgica temprana como la mejor This investigation describes a case of bilateral corpora cavernosa estrategia de tratamiento. La presente investigación describe un caso de injury associated with complete rupture of the anterior urethra and lesión bilateral de cuerpos cavernosos asociada a sección completa de presents current concepts about its management. -
Penile Fracture
FEATURE Penile fracture BY PRASHANT K SINGH, CHRISTOPHER M MCLEAVY AND MARGARET LYTTLE Traumatic rupture of the tunica albuginea with either one or both corpora cavernosa of the penis is known as penile fracture. This may be associated with corpus spongiosum or urethral injury. Incidence ventrolaterally. During sexual intercourse, limbs are associated with higher incidence. Penile fracture was reported for the first the intracorporeal pressure can reach Other reported causes include vigorous time by Abul Kasem, an Arab physician, in 180mmHg, and the tunica albuginea intercourse, masturbation, falling off a bed, Cordoba, Spain more than 1000 years ago can withstand values up to 1500mmHg. placing an erect penis in underwear and [1]. It is not an uncommon condition but However, sudden flexion-based trauma spontaneously fracturing the penis while is often underreported [2]. It occurs more to an already thinned tunica albuginea urinating. In the Islamic world, instances frequently in Middle Eastern and North can result in rupture. Not unexpectedly, of penile fracture may be accidentally African countries (almost 55% of the total the most common site of rupture is self-inflicted by bending the erect penis number reported) than in the United States ventrolateral at the thinnest aspect, often in to achieve rapid detumescence, known as or Europe (almost 30% of those reported). the midshaft. taghaandan. Annual incidence in the USA is estimated The urethra passes through the corpus Injury can involve one or both of at 500–600 cases, responsible for one spongiosum. This is very elastic relative the corporal bodies and associated in every 175,000 emergency admissions to tunica albuginea, allowing expansion simultaneous urethral injuries may also [3]. -
Multimodality Imaging of the Male Urethra: Trauma, Infection, Neoplasm, and Common Surgical Repairs
Abdominal Radiology (2019) 44:3935–3949 https://doi.org/10.1007/s00261-019-02127-8 SPECIAL SECTION: UROTHELIAL DISEASE Multimodality imaging of the male urethra: trauma, infection, neoplasm, and common surgical repairs David D. Childs1 · Ray B. Dyer1 · Brenda Holbert1 · Ryan Terlecki2 · Jyoti Dee Chouhan2 · Jao Ou1 Published online: 22 August 2019 © Springer Science+Business Media, LLC, part of Springer Nature 2019 Abstract Objective The aim of this article is to describe the indications and proper technique for RUG and MRI, their respective image fndings in various disease states, and the common surgical techniques and imaging strategies employed for stricture correction. Results Because of its length and passage through numerous anatomic structures, the adult male urethra can undergo a wide array of acquired maladies, including traumatic injury, infection, and neoplasm. For the urologist, imaging plays a crucial role in the diagnosis of these conditions, as well as complications such as stricture and fstula formation. While retrograde urethrography (RUG) and voiding cystourethrography (VCUG) have traditionally been the cornerstone of urethral imag- ing, MRI has become a useful adjunct particularly for the staging of suspected urethral neoplasm, visualization of complex posterior urethral fstulas, and problem solving for indeterminate fndings at RUG. Conclusions Familiarity with common urethral pathology, as well as its appearance on conventional urethrography and MRI, is crucial for the radiologist in order to guide the treating urologist in patient management. Keywords Urethra · Retrograde urethrography · Magnetic resonance imaging · Stricture Introduction respectively. While the urethral mucosa is well depicted with these radiographic examinations, the periurethral soft tis- Medical imaging plays a crucial role in the diagnosis, treat- sues are not. -
Penile and Genital Injuries
Urol Clin N Am 33 (2006) 117–126 Penile and Genital Injuries Hunter Wessells, MD, FACS*, Layron Long, MD Department of Urology, University of Washington School of Medicine and Harborview Medical Center, 325 Ninth Avenue, Seattle, WA 98104, USA Genital injuries are significant because of their Mechanisms association with injuries to major pelvic and vas- The male genitalia have a tremendous capacity cular organs that result from both blunt and pen- to resist injury. The flaccidity of the pendulous etrating mechanisms, and the chronic disability portion of the penis limits the transfer of kinetic resulting from penile, scrotal, and vaginal trauma. energy during trauma. In contrast, the fixed Because trauma is predominantly a disease of portion of the genitalia (eg, the crura of the penis young persons, genital injuries may profoundly in relation to the pubic rami, and the female affect health-related quality of life and contribute external genitalia in their similar relationships to the burden of disease related to trauma. Inju- with these bony structures) are prone to blunt ries to the female genitalia have additional conse- trauma from pelvic fracture or straddle injury. quences because of the association with sexual Similarly, the erect penis becomes more prone to assault and interpersonal violence [1]. Although injury because increases in pressure within the the existing literature has many gaps, a recent penis during bending rise exponentially when the Consensus Group on Genitourinary Trauma pro- penis is rigid (up to 1500 mm Hg) as opposed to vided an overview and reference point on the sub- flaccid [6]. Injury caused by missed intromission ject [2]. -
Renal Trauma
GENITOURINARY TRACT TRAUMA Thomas M. Dykes, MD, FACR, FSAR Dr. Arvin and Beverly Robinson-Furman Family Endowed Chair in Radiology Professor Department of Radiology [email protected] I have no conflicts of interest RENAL TRAUMA • Epidemiology & general information in renal trauma • Imaging evaluation and grading (case based review using AAST guidelines) • Principles of management and follow-up in renal trauma Epidemiology of Renal Trauma • Renal injury occurs in 5% of trauma cases; up to 95% are blunt trauma • Associated multi-organ injury is present in 80-95% of blunt and penetrating renal trauma • 95% of blunt renal trauma is managed conservatively • Grade 1-3 traumas can be managed non-operatively (>95%) • Grades 4-5 injuries can be managed non-operatively in hemodynamically stable patients but there may be higher rates of infection • Patients with urinary extravasation can be managed without major intervention in over 90% of cases • Non-operative management for penetrating and high grade renal injuries is still debatable Indications for Imaging Evaluation & Grading Injury • Blunt trauma patients, hemodynamically stable – Gross hematuria – Microscopic hematuria with BP < 90mm Hg • Trauma patients with mechanism of injury (high speed deceleration, falls) or penetrating injury (GSW, knife wounds) – Up to 34% of multisystem trauma patients will have renal injury in the absence of hematuria or hemodynamic instability • The American Association of Surgery for Trauma (AAST) renal injury scale used to grade renal trauma. Validated as predictive of morbidity and the need for intervention to treat higher grade renal injuries. – Ambiguity in staging high grade injuries separating grade IV from V – No component accounting for contrast extravasation (bleeding) on CT nor size of perirenal hematoma AAST Renal Injury Scale Grade Type Description Management (guided imaging and patient signs/symptoms) I Contusion . -
Penile Fracture with Isolated Corpus Spongiosum Injury
International Journal of Impotence Research (2006) 18, 218–220 & 2006 Nature Publishing Group All rights reserved 0955-9930/06 $30.00 www.nature.com/ijir CASE REPORT Penile fracture with isolated corpus spongiosum injury JS Cerone, P Agarwal, S McAchran and A Seftel Department of Urology, Case Western Reserve University, Cleveland, OH, USA Penile fractures are classically described as presenting with rapid detumescence of an erection associated with blunt trauma. This clinical finding is due to a tear in the tunica albuginea surrounding the corpora cavernosum. We, however, present the case of a patient who presented with a ‘classical’ penile fracture but was found on surgical exploration to only have an isolated corpus spongiosum injury. International Journal of Impotence Research (2006) 18, 218–220. doi:10.1038/sj.ijir.3901389; published online 8 September 2005 Keywords: penile fracture; corpus spongiosum injury; tunica albuginea injury Introduction penis on his partner’s pelvic bone. Physical exam- ination revealed a flaccid edematous penis. No Penile fractures are generally due to rupture of the ecchymosis was noted on exam and there was no corpora cavernosum/tunica albuginea secondary blood at the meatus. The patient was noted to have to blunt or sexual trauma to the erect penis.1 There marked tenderness on palpation of the penoscrotal have been numerous cases reported in the literature. junction. No palpable abnormalities were noted. Penile fractures typically present with a ‘cracking’ The patient was able to void. A complete blood sound, rapid detumescence of the penis and often count, serum electrolytes and urine analysis pain, swelling and ecchymosis. -
Penile Fractures: the Successful Outcome of Immediate Surgical Intervention
International Journal of Impotence Research (2000) 12, 273±277 ß 2000 Macmillan Publishers Ltd All rights reserved 0955-9930/00 $15.00 www.nature.com/ijir Penile fractures: the successful outcome of immediate surgical intervention MS EI-Bahnasawy1* and MA Gomha1 1Mansoura Urology and Nephrology Center, Mansoura, Egypt The data of 60 patients admitted to Mansoura Urology and Nephrology Center with penile fractures and treated by immediate surgical repair were reviewed with respect to their presentation, investigations, operative and post-operative details. Forty-nine patients were followed up regarding penile curvatures, plaques and erectile function. Patients reporting decreased erectile function were further assessed by evaluating their response to intracavernous injection of PGE1 and by penile color duplex Doppler ultrasonography. All of our patients had the classic clinical presentation of penile swelling and ecchymosis. Only ®ve patients had accompanying urethral rupture. Penile ultrasonography was used to con®rm the diagnosis in 23 patients. Immediate exploration was done using subcoronal circumferential incision in about two-thirds of the cases. All tunica albuginea ruptures were unilateral except one case which was bilateral. Interrupted absorbable sutures were used for repair in most of the patients. Urethral repair was done in ®ve cases. Delayed complications were detected in only six cases (12.2%) in the form of mild penile curvature on erection, plaques and=or mild erectile dysfunction. Intracavernous injection (ICI) of PGE1 and penile duplex Doppler showed a normal pattern in three patients with erectile dysfunction while the fourth showed incompetent veno- occlusive mechanism. Psychosexual consultation was required for two of these patients while the third was successfully managed by self-ICI of PGE1 We conclude that the excellent outcome of our patients parallels other reports of early surgical repair regarding low morbidity, short hospital stay and rapid functional recovery. -
Mondor's Disease of the Penis Mistaken for Penile Fracture
ISSN 2465-8243(Print) / ISSN: 2465-8510(Online) http://dx.doi.org/10.14777/uti.2016.11.1.39 Case Report Urogenit Tract Infect 2016;11(1):39-41 Mondor’s Disease of the Penis Mistaken for Penile Fracture Young Hwan Jung, Dong Soo Ryu Department of Urology, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea Superficial thrombophlebitis of the dorsal vein of the penis, known as penile Received: 22 September, 2015 Mondor’s disease, is an uncommon genital disease. We report on a healthy Revised: 10 November, 2015 Accepted: 23 November, 2015 44-year-old man who presented with painful penile swelling, ecchymosis, and penile deviation after masturbation, which initially imitated a penile fracture. Thrombosis of the superficial dorsal vein of the penis without rupture of corpus cavernosum was found during surgical exploration. The patient recovered without erectile dysfunction. Keywords: Thrombophlebitis; Penis Correspondence to: Dong Soo Ryu http://orcid.org/0000-0002-7557-0820 Department of Urology, Samsung Changwon Hospital, Copyright 2016, Korean Association of Urogenital Tract Infection and Inflammation. All rights reserved. Sungkyunkwan University School of Medicine, 158 This is an open access article distributed under the terms of the Creative Commons Attribution Paryong-ro, Masanhoewon-gu, Changwon 51353, Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits Korea unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is Tel: +82-55-290-6551, Fax: +82-55-290-1224 properly cited. E-mail: [email protected] Mondor’s disease, a rare and self-limiting benign disease, not accompanied by rapid detumescence during mastur- which causes superficial venous thrombosis on the chest bation 1 day earlier. -
Michelle Lajiness Susanne Quallich Editors
The Nurse Practitioner in Urology Michelle Lajiness Susanne Quallich Editors 123 The Nurse Practitioner in Urology Michelle Lajiness • Susanne Quallich Editors The Nurse Practitioner in Urology Editors Michelle Lajiness Susanne Quallich Department of Urology and Department of Urology Department of Infectious Disease University of Michigan Beaumont Health System Rochester , MI Royal Oak , MI USA USA ISBN 978-3-319-28741-6 ISBN 978-3-319-28743-0 (eBook) DOI 10.1007/978-3-319-28743-0 Library of Congress Control Number: 2016936387 © Springer International Publishing Switzerland 2016 This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifi cally the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfi lms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specifi c statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. The publisher, the authors and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty, express or implied, with respect to the material contained herein or for any errors or omissions that may have been made. -
Evaluation and Treatment of Genital Injuries in Combat Warriors
ARTISS SYMPOSIUM 2012 Evaluation and Treatment of Genital Injuries in Combat Warriors SPONsoreD BY Department of Psychiatry, Walter Reed National Military Medical Center Center for the Study of Traumatic Stress Department of Psychiatry, Uniformed Services University Department of Urology, Walter Reed National Military Medical Center ARTISS SYMPOSIUM 2012 Evaluation and Treatment of Genital Injuries in Combat Warriors SPONSORED BY Department of Psychiatry, Walter Reed National Military Medical Center Center for the Study of Traumatic Stress Department of Psychiatry, Uniformed Services University Department of Urology, Walter Reed National Military Medical Center From the Conference Series: ARTISS SYMPOSIUM Evaluation and Treatment of Genital Injuries in Combat Warriors Editor’s Note: This transcript has been edited, however, as in most transcripts some errors may have been missed. The editors are responsible for any errors of content or editing that remain. IPD 2012 by Center for the Study of Traumatic Stress Department of Psychiatry Uniformed Services University of the Health Sciences 4301 Jones Bridge Road Bethesda, MD 20814-4799 First Edition Mary Lee Dichtel, RN Senior Medical Editor Educational Support Management Services, LLC [email protected] Contents List of Speakers ....................................................................................................i Preface .................................................................................................................1 Harold J. Wain, Ph.D. Welcome