0071643192.pdf

RENAL AND GENITOURINARY

EMERGENCIES

SYMPTOMS/EXAM

■ Predisposing factor: Recent history of straddle or groin injury, spinal cord

lesions

■ The penis is semierect and painless.

■ Perineal compression with the thumb (blocking arterial inflow) may cause

detumescence (Piesis sign).

DIAGNOSIS

■ Rule out low-flow state, as above.

TREATMENT

■ Urology consult

■ Observation alone may be effective as there are few long-term consequences.

■ Selective angiography to control arterial inflow

■ Surgical ligation of fistula

PENILE FRACTURE

Rupture of the tunica albuginea surrounding the corpus cavernosum as a

result of blunt trauma to the erect penis (see Figure 18.7)

SYMPTOMS/EXAM

■ Patient reports a “snapping sound” followed by rapid detumescence.

■ The penis appears swollen, deformed, tender, and discolored.

DIAGNOSIS

■ Primarily clinical

■ Retrograde urethrogram can be used to evaluate for associated urethral injury.

FIGURE 18.7. Penile fracture. Swollen, deformed, and discolored penis. (See also

color insert.)

(Reproduced, with permission, from Knoop KJ, Stack LB, Storrow AB. Atlas of Emergency

Medicine, 2nd ed. New York: McGraw-Hill, 2002:228.)

With high-flow (nonischemic)

priapism the penis is

semierect and painless.

Observation alone is often

effective.