Urological Emergencies in Clinical Practice стр.111

The abdominal contents should be covered with a sterile dressing, and the patient should be returned to the operating room to allow wound closure. Give intravenous analgesia, e.g., 5 mg morphine with 50 mg of intravenous cyclizine. Reassure patients and explain what has just happened and that you will need to take them back to the operating room for wound closure. At operation, wash the wound thoroughly with warm saline and debride any nonviable tissue. Resuture the wound with interrupted monofilament nonabsorbable sutures. Place the sutures 1 cm apart with a fair margin from the wound edge. The size of the suture depends on the site of the wound. The key thing is to include all the layers, including peritoneum. The sutures should remain in situ for 2 to 3 weeks. If there is evidence of sepsis, then antibiotics should be given.

POSTCIRCUMCISION BLEEDING

Bleeding following circumcision is most likely to be from the frenular artery on the ventral surface of the penis. If local pressure does not stop the bleeding (and if it is from the frenular artery it usually won't), take the patient to the operating room and either under ring block local anaesthesia or general anaesthetic, suture-ligature the bleeding vessel. Be careful not to place the suture through the urethra!

Not infrequently, a crust of coagulated blood develops around the circumference of the penis after circumcision. As blood oxidises it turns black, and this appearance can be mistaken for necrosis of the end of the penis. Reassurance of the patient (and the referring doctor!) is all that is needed.

BLOCKED CATHETER POST-TRANSURETHRAL RESECTION OF THE PROSTATE (TURP) AND CLOT RETENTION

In the U.K. National Prostatectomy Audit (Neal 1997) bleeding severe enough to require return to the operating room was reported in 0.6% of cases. However, not all patients need to return to the operating room. In many cases the bleeding can be controlled in the recovery room or on the ward.

Cross-match blood and other blood products [platelets and fresh frozen plasma (FFP) if a large transfusion is anticipated], and give plasma expanders, if the patient shows cardiovascular compromise, while awaiting the blood.


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