Relief of urinary retention

CONTRAINDICATIONS

 No true emergency exists

 Successful, blind insertion of Foley catheter

    Physiologic (i.e., normal) phimosis especially in younger boys (<3 years old)

    Preferred treatment may be medical (local skin care, topical steroids) or surgical but non–emergent (dilation or circumcision by a urologist)

    It is uncommon that phimosis needs to be treated emergently in the emergency department (ED); inability to reduce the prepuce is not in itself an indication for emergent surgical intervention

 Coagulopathy (relative contraindication)

RISKS/CONSENT ISSUES

 Pain (local anesthesia will be given)

 Local bleeding

 Infection (sterile technique will be used)

 Scarring at the site of incision/dilation (though definitive treatment will likely include circumcision, removing the scarred tissue)

 Damage to glans penis and urethral meatus

SUPPLIES

 Povidone–iodine or chlorhexidine

 1% Lidocaine without epinephrine

 5-mL syringe

 27-gauge needle

 Sterile field supplies

 Sterile gloves

 Straight hemostat

 Straight scissors

 Topical antibiotic ointment

 Gauze

 Paper tape

TECHNIQUE

 Patient Preparation

    Position: Supine with legs slightly abducted

    Clean penis and surrounding region with antiseptic solution

    Sterile drape revealing only the genital region

    Consider light procedural sedation as well

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Delayed Sequence Intubation Reduction of Nursemaid’s Elbow (Radial Head Subluxation) No Desat: Maximally Aggressive Preoxygenation Elbow Arthrocentesis Episiotomy Subclavian Vein—Central Venous Access

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