In this post, I link to and excerpt from Emergency Medicine Cases’ Ep 143 Priapism and Urinary Retention: Nuances in Management.*
*Helman, A. Episode 143 Priapism and Urinary Retention: Diagnosis and Management. Emergency Medicine Cases. July, 2020. https://emergencymedicinecases.com/priapism-urinary-retention. Accessed 9-14-2020.
Here are three additional resources to be reviewed along with Ep 143:
- Cauda Equina And Conus Medullaris Syndromes. Last update: August 11, 2021. From StatPearls.
- Cauda Equina Syndrome from the American Association Of Neurological Surgeons
- Spinal Cord Compression. Last Update: February 24, 2021. From StatPearls.
All that follows is from the show notes of this outstanding resource.
In this month’s main episode podcast on Urologic Emergencies – Priapism and Urinary Retention with Dr. Natalie Wolpert and Dr. Yonah Krakowsky we answer questions such as: for priapism, how much time to do we have to fix it before there’s irreversible tissue damage? How is priapism managed differently depending on the cause? What is the value of a corporal blood gas for managing priapism? What are the indications for cavernosal phenylephrine injections? What are the common medications that cause urinary retention that we often miss leading to needless recurrent urinary retention? Why is a suprapubic catheter in many respects safer than a urethral catheter for managing urinary retention? Which patients are at high risk for complications of post-obstructive diuresis? and many more…
Take Home Points for priapism and urinary retention
- Priapism: time is tissue; treatment should be started by the emergency physician, not the urologist
- Assume ischemic priapism until proven otherwise
- In urinary retention, important to consider and rule out the dangerous neurologic causes including cauda equina syndrome* [and spinal cord compression**]
- Use lots of lubricant with lidocaine for urethral catheter insertion and inject slowly
- In the setting of enlarged prostate, if a 16-F Coude catheter insertion is unsuccessful, then increase the size of the catheter
- Patients with high risk of post-obstructive diuresis and it’s complications should be observed in the ED for at least 4 hours
- The urethral catheter should remain in-situ for at least 1 week and an alpha-blocker should be considered to decrease the likelihood of re-catheterization after a trial of void
Please review the complete show notes which are outstandingly detailed.