RENAL AND GENITOURINARYEMERGENCIESTREATMENT
■ Supportive care only with analgesia, bed rest, scrotal elevation
■ Surgical exploration in severe cases
Inguinal Hernia
Inguinal hernias peak in a bimodal distribution, before 1 year of age and then
after age 40. They can be direct or indirect. A hernia is clinically significant
when it becomes incarcerated (nonreducible) or strangulated.
INDIRECTINGUINALHERNIA
■ Protrudes through the internal ring, lateralto the inferior epigastric vessels
due to a congenitally patent processus vaginalis
DIRECTINGUINALHERNIA
■ Protrudes directly through the transversalis fascia and the external inguinal
ringmedialto the inferior epigastric vessels
■ Are acquired hernias
SYMPTOMS/EXAM
■ Often asymptomatic
■ Pain and tenderness if incarceration occurs
■ Nausea and vomiting if resultant bowel obstruction
■ More toxic appearance with peritonitis or shock if strangulation develops
DIFFERENTIAL
■ Includes femoral hernia, testicular torsion, testicular tumor, hydrocele
DIAGNOSIS
■ Typically a clinical diagnosis
■ Abdominal radiographs if obstruction or perforation is suspected
TREATMENT
■ Incarcerated hernia should be reduced via Trendelenberg position, sedation,
and gentle pressure.
■ A nonreducible hernia or suspicion of strangulation warrants immediate
surgical consultation.
■ Inguinal hernias in infants and children have a higher risk of incarceration
and should be repaired shortly after diagnosis is made.
ACUTE URINARY RETENTIONAcute urinary retention is defined as the sudden inability to pass urine. May be
caused by obstruction, neurogenic causes, or medications (see Table 18.11).
SYMPTOMS
■ Abdominal discomfort and distention (unless neurogenic)
■ Hesitancy, decreased force of stream, straining with voiding, sensation of
incomplete emptying in patients with obstructive etiology
■ Dysuria, urgency, frequency, or discharge with infection
Direct inguinal hernias
protrude DIRECTLY through
the transversalis fascia and
external ring.