Acute Presentations
Sudden severe unilateral testicular pain, absent cremasteric reflex, and negative Prehn sign.
Testicular torsion
- Immediate surgical detorsion + orchiopexy (bilateral)
Gold standard imaging test for suspected urethral injury.
Retrograde urethrogram
First step in management of acute urinary retention due to BPH.
Foley catheter placement
Most common organism causing uncomplicated cystitis.
E. coli
Type of priapism caused by failure of venous outflow leading to hypoxia.
Painless prolonged erection lasting >4 hours, often due to trauma or spinal cord injury.
Non-ischemic (high-flow) priapism
- Usually self-resolves, observation ± ice, rarely embolization
Most appropriate initial imaging for suspected testicular torsion.
Scrotal US w/ Doppler
Immediate management for ischemic priapism after analgesia.
Aspiration of corpus cavernosum
- Then phenylephrine
Flank pain, fever, CVA tenderness, and WBC casts on UA suggest this diagnosis.
Pyelonephritis
- Outpt: Fluoroquinolone/TMP-SMX
- Inpt: Ceftriaxone/Pip-Tazo
Most common cause of obstructive uropathy overall.
Kidney stone (urolithiasis)
Painful erection with rigid corpora and soft glans, commonly associated with sickle cell disease or trazodone use.
Ischemic (low-flow) Priapism
- Pain control (penile block)
- Aspirate corpus cavernosum
- Intracavernosal phenylephrine (MC)
Lab finding in ischemic priapism: pH < 7.25, pO₂ < 30 mmHg, and this elevated gas.
Elevated pCO2
Definitive management for paraphimosis if manual reduction fails.
Dorsal slit procedure
- Circumcision following
Treatment for gonorrhea infection in the ED.
Ceftriaxone 500 mg IM ± Doxycycline
Condition where prostate enlargement compresses the urethra causing LUTS
Benign prostatic hyperplasia
- Acute: foley catheter
- Chronic: tamsulosin, finasteride
- Severe: TURP
Foreskin stuck behind the glans causing constriction and impaired blood flow.
Paraphimosis
- Manual reduction + compression (ice)
- Failed? → Dorsal slit → Circumcision
Post-void residual volume >200–300 mL suggests this condition.
Urinary retention
- Foley catheter
- ± alpha blockers
Emergent treatment for Fournier’s gangrene.
Surgical debridement + broad-spectrum IV abx (zosyn + vancomycin + clindamycin)
High fever, tender prostate, and urinary symptoms—avoid this exam maneuver.
Digital rectal exam
- Fluoroquinolone/TMP-SMX
Ascending infection spreading to epididymis in men <35 is most commonly caused by these two organisms.
Gonorrhea & Chlamydia
- Ceftriaxone + Doxycycline
Blunt perineal trauma with blood at the urethral meatus and inability to void.
Straddle injury (urethral injury)
- NO FOLEY
- Suprapubic catheter
- Surgical consult
Best initial labs in suspected obstructive uropathy causing AKI.
BUN, creatinine, electrolytes, urinalysis
Definitive management for testicular torsion.
Surgical detorsion w/ orchiopexy
Necrotizing infection of the perineum seen in diabetics requiring emergent surgery.
Fournier's gangrene
- Surgery + broad-spectrum abx
Obstructive uropathy that occurs distal to the bladder is most commonly due to this category of causes.
Prostatic/urethral causes (postvesical obstruction)