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INTRODUCTION

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Urogenital complaints are common presentations to emergency departments and EMS providers. Although not the typical focus of prehospital education and planning, these clinical scenarios represent a potentially growing number of calls as more and more members of the public rely on EMS as their entry into the health care safety net. Despite the fact that these conditions are not the typical focus of EMS physicians and providers, appropriate care and attention can significantly impact the quality of care that these patients receive. In some cases, the prehospital patient encounter provides the needed clues to the diagnosis and proper management that would not otherwise be apparent. Even in cases where field care is not potentially definitive, attention to detail in the field and carefully relaying observations can speed diagnostic confirmation and intervention in the emergency department.

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OBJECTIVES

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  • List common causes of hematuria in prehospital patients.

  • Describe the initial prehospital evaluation and management of urogenital trauma.

  • Describe the initial prehospital evaluation and management of priapism.

  • Describe the initial prehospital evaluation and management of victims of sexual assault.

  • Describe common complications of urological procedures affecting prehospital patient care (Foley/suprapubic catheters, nephrostomy tubes, kidney transplant, failure of dialysis catheters (ie, venous air embolism).

  • Discuss flank pain.

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The kidneys are the filter systems of the blood. They receive nearly 25% of the cardiac output, filtering 180L per day though only approximately 1L/day is excreted as urine. The bladder stores urine in a low-pressure system with a normal capacity of 400 to 500cc. Injury or dysfunction of the mechanism of the filter or bladder can lead to significant illness.

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HEMATURIA

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Etiologies of hematuria are wide and varied. The most common causes are related to urogenital trauma, infection, nephritis, kidney stones, and tumors. It is important to note that medications may induce a red discoloration to the urine which may be mistaken for hematuria. These medications include but are not limited to sulfonamides, quinine, rifampin, and phenytoin. Posttraumatic hematuria may be secondary to renal or bladder injury. Infectious causes include hemorrhagic cystitis. Nephritis, kidney stones, and tumors are other causes. For the patient with flank pain that radiates into the groin (especially those with a history of renal colic) analgesia with narcotics and ketorolac may be appropriate in the prehospital setting. For older patients with no renal colic history the ketorolac should be omitted due to the potential for abdominal aortic aneurism to be masquerading as renal colic.

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URINARY RETENTION

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Patients with urinary retention typically present with acute lower abdominal pain and distention with an inability to urinate. In men older than 50 years of age, the most common cause is prostate hypertrophy. Other causes of urinary retention include obstructive, infectious and inflammatory, pharmacologic, neurologic, or other. Other common causes include prostatitis, cystitis, urethritis, and vulvovaginitis, and medication-induced urinary retention from anticholinergic and α-adrenergic agonist ...

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