- Dorsal Slit
- Manual Testicular Detorsion
- Paraphimosis Reduction
- Penile Injection/Aspiration
- Suprapubic Bladder Aspiration
- Suprapubic Catheterization
- Urethral Catheterization
- Zipper Injury Management

Dorsal Slit
Rapid Review
- Background
- Incision along the upper aspect of the foreskin to visualize the urethral meatus or relive strangulation of the glans from paraphimosis.
- Indications
- Paraphimosis (after non-invasive reduction techniques have failed)
- Phimosis causing urinary retention (if catheter insertion not feasible)
- Contraindications
- No absolute contraindications. Use caution in patients with bleeding disorders or suspected infection of the foreskin. Consult urology if available.
- Complications
- Infection, bleeding, injury to glans/urethra
Pearls
Deep Dive

Manual Testicular Detorsion
Rapid Review
- Background
- Manual rotation of the affected testis to restore perfusion. Should be performed within 6-8 hours. Successful in 30-70% of patients.
- Indications
- Testicular torsion (confirmed or clinically suspected)
- Contraindications
- Duration of torsion > 6 hours
- Complications
- Pain may prevent adequate detorsion
Pearls

Paraphimosis Reduction
Rapid Review
- Background
- Paraphimosis is the inability to reduce a swollen, proximally positioned foreskin over the glans penis, causing vascular congestion and edema. Requires emergent reduction, which can be accomplished manually or with the use of non-invasive strategies (osmotic agents, ice water compression)
- Indications
- All patients with paraphimosis
- Contraindications
- Necrotic or ulcerated foreskin/penis
- Complications
- Penile/foreskin lacerations, swelling, pain, failure to achieve reduction (will then require dorsal slit)
Pearls

Penile Injection/Aspiration
Rapid Review
- Background
- Procedure used in the management of ischemic priapism to preserve erectile tissue
- Indications
- Low-flow priapism not responding to conservative therapy
- Contraindications
- High-flow priapism, bleeding disorder, overlying skin infection
- Complications
- Recurrent priapism, fibrosis, urethral injury, infection
Pearls
Deep Dive

Suprapubic Bladder Aspiration
Rapid Review
- Background
- Insertion of a needle into the anterior abdominal wall (suprapubic region) to obtain an uncontaminated urine sample from the bladder. Performed when traditional urethral catheterization cannot be performed.
- Indications
- Urinary retention, urinalysis/culture in children less than 2 years of age or those with urethral stricture/trauma.
- Contraindications
- Unidentifiable bladder, known bladder tumor, overlying skin infection.
- Complications
- Infection, peritoneal/bowel perforation, hematuria
Pearls
Deep Dive

Suprapubic Catheterization
Rapid Review
- Background
- Placement of a drainage catheter into the urinary bladder above the pubic symphysis. Utilized when other methods (ex. Foley catheter) are not clinically feasible.
- Indications
- Urethral obstruction (BPH, trauma, morbid obesity, urethral strictures, genital malignancy)
- Contraindications
- Inability to palpate or identify bladder on ultrasound
- Complications
- Bowel perforation, infection, hematuria
Pearls

Urethral Catheterization
Rapid Review
- Background
- Urinary catheterization is used to help facilitate drainage from the urinary bladder; may be used for diagnostic or therapeutic purposes.
- Indications
- Hygienic care of bedridden patients, acute urinary retention, monitoring of urine output, collection of uncontaminated urine specimen.
- Contraindications
- Traumatic injury to lower urinary tract
- Complications
- Bleeding, urethral strictures, infections, urethral perforation, paraphimosis (males)
Pearls

Zipper Injury Management
Rapid Review
- Background
- Penile zipper injuries occur most frequently in young children and adolescents. Management involves analgesia, mineral oil, and cutting the median bar of the zipper, if needed.
- Indications
- Penile zipper injury (may be caught in the teeth or in the sliding mechanism)
- Contraindications
- None
- Complications
- Additional trauma during extrication
Pearls
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