ArcherM2

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I start a specialty night float tomorrow night which means I cover Vascular, Plastics, Transplant and Urology at our institution. I've had experience with the first three, but we do not rotate at all on Urology, we are only expected to cover their patients overnight and on weekends. I was wondering if anyone had any pearls on handling urology specific situations. I'm almost done with internship, so I can handle the majority of the general post-surgical complications/admission work/etc, I'm looking for common urologic issues that are frequently encountered that I would look like a goof if I missed or intervened inappropriately. Thanks in advance for any advice!
 

felipe5

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Kudos for your anticipation. For basic information I thought urology secrets was always a good book, but now as a resident Weider's Pocket Urology can be classified as my new bible.

I take it that your institution has attendings that take back up call? If so then the key is to gather the appropriate information and run it by the right people. A non-exhaustive list of things you may encounter:

-difficult catheter placement--I'd definitely familarize myself with the method of inserting a coude tipped catheter. I start out with an 18 or 20Fr. Try it a couple of times, and contrary to most people's initial thoughts, bigger is better when it comes to most challenging situations (upsizing=more momentum behind it). Remember to get a basic history as well--past h/o voiding issues? Past prostate/urethral surgery, past GU instrumentation? Do a DRE as well before you call then attending if you can't get one in--options after that point include punching in a suprapubic catheter or 'scoping one in +/- dilation.

Clot retention--this one can be time consuming but is not really challenging. First find out why they are having this issue. Be prepared to insert larger catheters, irrigate out clots and possibly start continuous bladder irrigation if need be.

-stones--information I'd want to know about: Size? Location?--most non obstructing renal calculi shouldn't be causing significant amts of pain. Associated hydronephrosis/hydroureter? Renal insufficiency, signs of infection? Pain controlled on narcs? These factors can contribute to the decision of attempting trials of medical expulsive therapy (ie discharging home) vs admitting vs stenting/perc'ing

-testicular torsion--to OR

-fourniers gangrene--to OR

-priapism--UGGGGH. Hopefully others on this forum can chime in but these can suck and really should probably be managed only by experienced individuals as corporal irrigation , intracorporal phenylephrine injections and shunts can be on your list of things to do (in that order). Info I want to know about---how long has he been up, any inciting factors (drugs, trauma, neuro status).

-trauma-- comes in many flavors. call your attending.

I'll throw more in if I think of them...good luck :horns:
 
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