Genitourinary

  • Manual Testicular Detorsion
  • Paraphimosis Reduction
  • Penile Injection/Aspiration
  • Suprapubic Bladder Aspiration
  • Urethral Catheterization

Manual Testicular Detorsion

  • 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
Video Credit: Medgeeks

*Deep Dive: Ultrasound-Guided Manual Testicular Detorsion in the Emergency Department (Science Direct)



Paraphimosis Reduction

  • 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)
Video Credit: Dr. Dhanraj Chavan

*Deep Dive: How To Do Paraphimosis Reduction Without Dorsal Slit (Merck Manuals)



Penile Injection/Aspiration

  • 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
Video Credit: Larry Mellick

*Deep Dive: Priapism (Core EM)



Suprapubic Bladder Aspiration

  • 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
Video Credit: umemergencymed

*Deep Dive: Suprapubic Bladder Aspiration (NEJM)



Urethral Catheterization

  • 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)
Video Credit: College of DuPage

*Deep Dive: How To Do Urethral Catherization in a Female (Merck Manuals)

*Deep Dive: How To Do Urethral Catheterization in a Male (Merck Manuals)


Brandon Simpson, PA-C
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