History and Physical Examination

Direct history is obtained from conscious patients. Witnesses and emergency personnel can provide valuable information regarding unconscious or seriously injured patients. Possible indicators of major renal injury include a rapid deceleration event (fall, high-speed motor vehicle accidents) and a direct blow to the flank. In assessing trauma patients after motor vehicle accidents, the history should include the vehicle's speed and whether the patient was a passenger or pedestrian. In...

Intensive Care Procedures 351

Behavioral Pain Scale Payen

The use of analgetics and sedatives for the treatment of pain, anxiety, and agitation is a daily challenge in the intensive care environment. It is usually needed for the mechanically ventilated patient. To achieve a sufficient level of patient shielding while minimizing side effects and a short and cost-effective weaning period, the algorithm for analgosedation (AS) is an important task for the clinician. Emphasis should be placed on the consequent and correct implementation of a concept while...

Hemorrhagic Cystitis

Hemorrhagic cystitis is defined as gross hematuria secondary to diffuse inflammation of the bladder. Viral infection, radiation-induced inflammation, and chemotherapy-induced inflammation account for the majority of cases among cancer patients. While relatively un- common in patients with genitourinary malignancies, viral-mediated hemorrhagic cystitis occurs in as many as 50 of patients undergoing bone marrow transplantation (Bedi et al. 1995). The principle etiologic factor involved is the BK...

Pyelonephritis and Pyonephrosis

Urinary tract infection (UTI) occurs in approximately 8 of girls and 6 of boys during their first 6 years of life (Marild and Jodal 1998). Although older patients Fig. 8.16a-c. DMSA scan showing multiple photopenic areas consistent with renal scars (Courtesy H.G. Rushton) may complain of irritative voiding symptoms and thus direct clinical suspicion to the urinary tract, infants and neonates may present with only nonspecific symptoms such as poor feeding, irritability, and failure to thrive....

Urological Aspects of Terrorist Related Injuries

A review of the literature reveals that there is a paucity of data on terrorist-related urological injuries. Important data is available from the Israeli Trauma Registry (ITR), which records all hospitalizations for physical trauma at most of the Israeli trauma centers. Unfortunately, the accumulated experience of the Israeli medical system with terrorist-related injuries during the last two decades is exceptional in duration and intensity, out-ranging any comparable practice gained elsewhere,...

Paraphimosis and Phimosis

Phimosis Boy

Paraphimosis is a frequently encountered condition in the pediatric emergency department. Because of their age and lack of understanding, children have a tendency to neglect to reduce their foreskin following retraction at the time of micturition. Occasionally medical personnel will cause an iatrogenic paraphimosis by inadvertently leaving the foreskin retracted following insertion of an indwelling urethral catheter. Subsequent edema and venous congestion proximally could lead to decreased...

References

Springer, BerlinNewYork Heidelberg Abrams P, Cardozo L, Fall M et al (2002) The standardisation of terminology of lower urinary tract function report from the Standardisation Sub-committee of the International Continence Society. Neurourol Urodyn 21 167 American College of Surgeons. Committee on T (1997) Advanced trauma life support program for doctors ATLS. American College of Surgeons, Chicago Anderson JB, Grant JB (1991) Postoperative retention of urine a...

Radiation Cystitis

Radiation cystitis is a late complication of radiotherapy which, by definition, occurs at least 90 days after the initiation of radiation treatment but maybe delayed up to 10 years or more (Cox et al. 1995). Most patients develop severe irritative voiding symptoms however, gross hematuria dominates the clinical picture (Pas-quier et al. 2004). While any patient receiving pelvic radiotherapy is at risk, radiation cystitis is most common among those treated for prostate or cervical cancer. Three...

Treatment of Intractable Bladder Hemorrhage

The approach to the patient with intractable bladder hemorrhage is fairly standard and begins with a thorough evaluation to determine its cause. Information obtained on history e.g., prior malignancy, prior radiotherapy, prior cyclophosphamide, etc. may suggest the etiology however, multiple factors maybe involved and assumptions should not be made. Outside of the acute setting, all cases in which the etiology has not been identified require a formal hematuria workup, including cystoscopy,...

Unilateral Upper Urinary Tract Obstruction

One of the most common forms of failed drainage in the upper urinary tract is acute unilateral ureteral ob- Table 10.1. Etiology of upper urinary tract obstruction Intrinsic Urothelial carcinoma Fibroepithelial polyp UPJ obstruction Renal cell carcinoma Wilms tumor Cystic renal diseases Parapelvic cysts Renal artery aneurysm Retroperitoneal malignancy primary or metastatic Inflammatory bowel disease Trauma ureteral ligation Radiation therapy Lymphocele Urinoma Retroperitoneal fibrosis Pelvic...

Introduction

Virilization

Pediatric urologic emergencies fortunately remain rare occurrences within the emergency department of a hospital or ambulatory care center. More commonly, congenital anomalies noted at birth, or benign lesions that prompt significant parental anxiety such as benign scrotal conditions , often result in a visit to the emergency department for evaluation. These urgencies nonetheless require both the appropriate investigations and management in order to allay patient and parental concern. The...