achilles
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a 3 yr old male comes to the ER with severe pain in the penis. he was having sex with his wife on top, when he had severe onset of sudden pain in penis. swelling of penis and deviation followed the pain. on exam he is in severe distress and the penis is uncircumscribed,grossly swollen and deviated to the right. there is no blood at the meatus. what is the most appropriate management in this patient?
a)do a surgical exploration of penis
b)do a retrograde urethrogram and surgical exploration of penis
c)do a foley's catheterization
d)prescribe analgesic,antibiotic and anti-inflammatory and follow up in 24hrs
e)do a circumcision
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| sobia naeem
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b...it cant be a 3 year old though.
Edited by sobia naeem on 03/14/06 - 12:51 AM
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| DrS
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b)do a retrograde urethrogram and surgical exploration of penis
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| achilles
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 right sobia...he cant be 3 yrs old...he is actually 34 yrs old...and you both got the answer right too...
kaplan notes did not mention about getting a urethrogram done everytime with a penile injury and so i got this one wrong and choose A even when i was getting tempted to go for B !!
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| achilles
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DrS , sobia , another point i got confused with was that the question said-"there is no blood at the meatus", which does say that there is no urethral injury....so irrespective of that kind of history we should still always get a retrograde urethrogram in the management of penile injury ??
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| DrS
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Well I remember reading somewhere that u have to do a urethrogram as well, let me just see if I can find some sources.......
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| cyra
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"The diagnosis of penile rupture can usually be made solely on the basis of history and physical examination findings; however, in equivocal cases, diagnostic cavernosography or MRI should be obtained. Concomitant urethral injury must be considered; therefore, preoperative retrograde urethrographic studies should generally be performed."
Heres the link: http://www.emedicine.com/med/topic3415.htm
But it also says(towards the end)...
Successful voiding does not exclude urethral injury; therefore, a retrograde urethrogram is required any time a urethral injury is suspected. Signs and symptoms of urethral injury are as follows:
- Blood at the meatus
Gross hematuria
Microscopic hematuria (>5 RBCs per high-power field)
Dysuria
Urinary retention
The question however doesnot give any clues to suspect urethral injury...rather it says there was no blood at the meatus.So,why can't it be a?
Edited by cyra on 03/17/06 - 02:47 PM
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| achilles
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thanks so much cyra !! i really appreciate it.
and this was a question straight from uw....and the answer given was B.
i totally agree with what you are saying(actually i choose A as the answer)and so the confusion...was this answer wrong in uw or are we missing something here.
if i find the answer then i'll post it here.
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| cyra
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You're welcome achilles.I hope we can figure the "why" out, here and in the osteomyelitis question.
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| aimhigh
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Hi Achilles, I noticed that UW is targeted more on detailed info than kaplan notes, which you may also agree with.
For this case, I will check the urtheral as what the website cyra cited emphasized. In this case, no blood in the meatus does not ganrantee no ininjury to the urtheral....as that website mentions, microscopic bleed may occur. so, I will just stick to what UW says...don't you agree?
P.s. Glad that the discussion forum is active again...I felt quite bored in the last several days. <8P>
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| achilles
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i'll agree with you on that UW is targeted more on detailed info than kaplan. this info was not given in kaplan and they have not mentioned anything about the need for a urethroogram in every case and the only Rx they have talked about is surgery. they have not elaborated much on urethrogram, if it will be needed or wont be needed. so i'll go with UW on this one too.
thanks aimhigh.
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