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