Educational content from recorded physician discussions — not medical advice. Always talk to your child's care team about your child's situation.
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Essential urology for general surgeons with Drs. Ponsky and Cherullo
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#115: Must Know Urology for The General Surgeon w/ Dr. Ponsky and Dr. Cherullo | Behind The Knife Dominate the ABSITE. Day. Operating Room. Wards. Boards. ABSITE. Your privacy choices We use cookies and similar technologies for product anal
podcast46:04 · Jul 2026
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Essential urology for general surgeons with Drs. Ponsky and Cherullo
Testicular torsion should be treated like appendicitis—it is never wrong to explore a scrotum in fear of torsion to fix it.
clinicalEdward Cherullo4:59 ↗
Testicular torsion classically appears at ages 10-11, 12-14, 15-16 when testicles grow during puberty; very rare when older or younger.
epidemiologicalEdward Cherullo5:40 ↗
In very early torsion, ultrasound can still show arterial flow because the pathology is venous outflow obstruction first, then arterial inflow obstruction.
clinicalEdward Cherullo6:28 ↗
In very young children (1-2 years old), ultrasound may show false positive for torsion because the testicular artery is so small that no flow is identifiable.
clinicalEdward Cherullo6:51 ↗
Untwisting a torsed testicle is like opening a book—twist toward the ipsilateral thigh.
clinicalEdward Cherullo7:08 ↗
Fix the torsed testicle with non-absorbable fine suture, usually 5-0 Prolene, to dartos fascia to prevent re-torsion.
clinicalEdward Cherullo7:28 ↗
Pex the contralateral testicle because it may have the same anatomic abnormality that caused torsion on the first side.
clinicalEdward Cherullo7:37 ↗
Manual detorsion by twisting the testicle to the ipsilateral thigh can provide immediate relief and the surgeon will feel the testicle de-twist, but operative fixation is still required.
clinicalEdward Cherullo8:08 ↗
It is almost never wrong to order a scrotal ultrasound for testicular pain because it is the best test to ensure anatomically nothing is wrong and helps reassure the patient.
clinicalLee Ponsky9:37 ↗
For chronic testicular pain with normal anatomy, treatment is scrotal support, sitz baths, and a 6-week anti-inflammatory taper starting at high dose, with 80% success rate.
clinicalLee Ponsky10:32 ↗
Pneumaturia is a clear sign of colovesical fistula, though patients may not understand what is happening and need to be asked about it.
clinicalLee Ponsky11:39 ↗
On cystoscopy for colovesical fistula, it is a minority of the time that you see an obvious large defect—often it is a pinhole and very difficult to identify.
clinicalLee Ponsky12:13 ↗
The pathophysiology for colovesical fistula creation is almost always colorectal (chronic diverticulitis, colon cancer, inflammatory bowel disease)—very rarely is the primary pathology urologic.
epidemiologicalEdward Cherullo13:17 ↗
Pinhole bladder defects from colovesical fistula do not require closure—patients do well without transmural abscesses or fistulization to staple lines.
clinicalEdward Cherullo16:03 ↗
Any permanent material in the urothelial tract (staples, Ethibond, Prolene) will collect urinary salts and start to form stones.
clinicalEdward Cherullo17:09 ↗
Bladder closure uses absorbable suture (2-0 or 3-0 Vicryl), closed in two layers in a watertight fashion, can be run or interrupted—bladder is very forgiving tissue.
clinicalEdward Cherullo17:22 ↗
After bladder repair, upsize Foley to 20 Fr for excellent drainage, leave a drain, and study the patient with cystogram on day 4-5 before discharge; with no leak, drain and catheter come out.
clinicalEdward Cherullo17:58 ↗
For postoperative urinary retention after straightforward abdominal surgery, recommend starting all patients on an alpha-blocker (tamsulosin or Rapaflo for quicker onset).
clinicalLee Ponsky20:20 ↗
Trial-of-void involves filling the bladder through the catheter with 200-300 cc, removing the catheter, and measuring void—acceptable if less than 100 cc residual urine.
clinicalLee Ponsky21:27 ↗
Postoperative urinary retention often unmasks underlying BPH or other lower urinary tract problems that patients were not aware of before surgery.
clinicalEdward Cherullo23:20 ↗
With blood at the meatus or pelvic fracture, do not instrument the urethra—get a retrograde urethrogram first to assess urethral integrity.
clinicalEdward Cherullo25:28 ↗
Urethral injury from pelvic trauma typically occurs at the point where the urethra enters the external sphincter (GU diaphragm) at the apex of the prostate.
clinicalEdward Cherullo25:44 ↗
Blind catheter placement with blood at meatus can convert a partial urethral tear (which might heal spontaneously) into a complete tear, with long-term sequelae including incontinence and impotence.
clinicalEdward Cherullo26:28 ↗
If a urology resident got blood at the meatus and did not get a retrograde urethrogram, 'we would kill them' because trying to advance a catheter without visualization could cause complete disruption.
opinionLee Ponsky27:22 ↗
Retrograde urethrogram requires fluoroscopy (C-arm), contrast material, Foley catheter placed just within the urethral meatus, patient obliqued if possible, inject contrast under fluoroscopic guidance to visualize entire urethra and contrast entering bladder.
clinicalLee Ponsky28:04 ↗
If orthopedics will use hardware to plate the symphysis or fractured pelvis, try not to place suprapubic tubes because of infection risk to their hardware per literature.
clinicalEdward Cherullo29:08 ↗
For renal trauma, try to avoid surgical exploration unless forced—angioembolization is preferred for partial injury to save some kidney.
clinicalLee Ponsky30:41 ↗
If patient is unstable and bleeding from renal trauma, control the hilum of the kidney (through root of mesentery if needed) and often this results in nephrectomy.
clinicalLee Ponsky31:07 ↗
Urologic trauma, whether urologist present or not, is almost always managed non-surgically and supported by good level evidence.
clinicalEdward Cherullo34:40 ↗
Ureteral repair is not an emergency—it can be put on the back burner until other bleeding or issues are controlled.
clinicalLee Ponsky36:01 ↗
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