Emergency medicine clinics of North America
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AUR is a commonly seen genitourinary emergency. It has many etiologies, including obstructive, neurogenic, pharmacologic, and extraurinary causes. Treatment is immediate bladder decompression by transurethral catheterization and treatment of the provoking etiology. ⋯ For the emergency physician, the key lies in recognizing its underlying cause. Neurologic and pharmacologic causes need to be considered in all patients. Urinary incontinence that is not caused by a neurologic emergency can be referred for further outpatient evaluation.
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Regardless of age, any presentation of an acute scrotum requires prompt triage and immediate evaluation. The potential for significant reduction in morbidity and mortality exists if timely diagnosis and treatment are provided. ⋯ Although the immediately lethal conditions presenting as acute scrotal pain should be considered, the combined incidence and morbidity associated with testicular torsion make its exclusion paramount in acute scrotal presentations. Similarly, a painless scrotal mass must be assumed to be a testicular neoplasm until proven otherwise, with appropriate work-up and rapid urologic follow-up assured.
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Diseases of the foreskin, penis, and urethra are uncommon conditions that constitute a small percentage of emergency department visits. However, it is important that the emergency physician recognize and treat these conditions and understand which conditions require urologic consultation. Rapid and proper treatment in the emergency department can alleviate patient discomfort, increase patient satisfaction, and prevent future morbidity.
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The emergency physician can expect to commonly evaluate patients with hematuria, and the differential diagnosis will include both benign and life-threatening causes. This differential is divided into the following categories: glomerular or nonglomerular, coagulopathy-related, traumatic, and factitious causes. Nonglomerular causes account for the majority of hematuria evaluated in the ED, with infection and stones being the most prevalent diagnoses. ⋯ Painless atraumatic gross hematuria in the elderly is caused by a malignancy until proven otherwise. A focused history, physical exam, and appropriate diagnostic testing in the ED usually yields a diagnosis. If the patient is discharged home, proper follow-up with the primary care physician, urologist, or nephrologist is indicated, depending upon the diagnosis.