Genitourinary

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

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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

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

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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)

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

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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

*Deep Dive: Priapism (Core EM)

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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

*Deep Dive: Suprapubic Bladder Aspiration (NEJM)

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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)

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

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

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