# General Urology for Non-Urologists — GCMD Library living collection

Updated: n/a · 1 episodes · 37 cited statements

## Episodes
### Core Concepts
- [Essential urology for general surgeons with Drs. Ponsky and Cherullo](https://team.globalcastmd.com/watch/essential-urology-for-general-surgeons-with-drs-ponsky-and-cherullo-13657) — podcast · 46:04 · [machine version](https://team.globalcastmd.com/watch/essential-urology-for-general-surgeons-with-drs-ponsky-and-cherullo-13657.md)

## Chapters
- [0:00](https://team.globalcastmd.com/watch/essential-urology-for-general-surgeons-with-drs-ponsky-and-cherullo-13657?t=0) Introductions and background of Cleveland urologists (Ep 1)
- [4:29](https://team.globalcastmd.com/watch/essential-urology-for-general-surgeons-with-drs-ponsky-and-cherullo-13657?t=269) Testicular torsion: diagnosis, manual detorsion, and surgical management (Ep 1)
- [9:17](https://team.globalcastmd.com/watch/essential-urology-for-general-surgeons-with-drs-ponsky-and-cherullo-13657?t=557) Chronic testicular pain workup and management (Ep 1)
- [11:08](https://team.globalcastmd.com/watch/essential-urology-for-general-surgeons-with-drs-ponsky-and-cherullo-13657?t=668) Colovesical fistula: presentation, imaging, and multidisciplinary approach (Ep 1)
- [14:27](https://team.globalcastmd.com/watch/essential-urology-for-general-surgeons-with-drs-ponsky-and-cherullo-13657?t=867) Bladder repair technique for colovesical fistula (Ep 1)
- [18:11](https://team.globalcastmd.com/watch/essential-urology-for-general-surgeons-with-drs-ponsky-and-cherullo-13657?t=1091) Postoperative urinary retention: alpha-blockers and trial-of-void protocol (Ep 1)
- [23:07](https://team.globalcastmd.com/watch/essential-urology-for-general-surgeons-with-drs-ponsky-and-cherullo-13657?t=1387) Urethral trauma: retrograde urethrogram and avoiding catheter placement (Ep 1)
- [27:55](https://team.globalcastmd.com/watch/essential-urology-for-general-surgeons-with-drs-ponsky-and-cherullo-13657?t=1675) Renal trauma: non-operative management and surgical approach (Ep 1)
- [35:05](https://team.globalcastmd.com/watch/essential-urology-for-general-surgeons-with-drs-ponsky-and-cherullo-13657?t=2105) Ureteral injury: identification, primary repair, and temporizing measures (Ep 1)
- [41:03](https://team.globalcastmd.com/watch/essential-urology-for-general-surgeons-with-drs-ponsky-and-cherullo-13657?t=2463) Final advice: understanding post-op retention and multidisciplinary collaboration (Ep 1)

## Statements
Every statement is attributed, typed, and timestamped; the link is the citation.
- Testicular torsion should be treated like appendicitis—it is never wrong to explore a scrotum in fear of torsion to fix it. — Edward Cherullo (clinical) [Ep 1 · 4:59](https://team.globalcastmd.com/watch/essential-urology-for-general-surgeons-with-drs-ponsky-and-cherullo-13657?t=299)
- Testicular torsion classically appears at ages 10-11, 12-14, 15-16 when testicles grow during puberty; very rare when older or younger. — Edward Cherullo (epidemiological) [Ep 1 · 5:40](https://team.globalcastmd.com/watch/essential-urology-for-general-surgeons-with-drs-ponsky-and-cherullo-13657?t=340)
- In very early torsion, ultrasound can still show arterial flow because the pathology is venous outflow obstruction first, then arterial inflow obstruction. — Edward Cherullo (clinical) [Ep 1 · 6:28](https://team.globalcastmd.com/watch/essential-urology-for-general-surgeons-with-drs-ponsky-and-cherullo-13657?t=388)
- 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. — Edward Cherullo (clinical) [Ep 1 · 6:51](https://team.globalcastmd.com/watch/essential-urology-for-general-surgeons-with-drs-ponsky-and-cherullo-13657?t=411)
- Untwisting a torsed testicle is like opening a book—twist toward the ipsilateral thigh. — Edward Cherullo (clinical) [Ep 1 · 7:08](https://team.globalcastmd.com/watch/essential-urology-for-general-surgeons-with-drs-ponsky-and-cherullo-13657?t=428)
- Fix the torsed testicle with non-absorbable fine suture, usually 5-0 Prolene, to dartos fascia to prevent re-torsion. — Edward Cherullo (clinical) [Ep 1 · 7:28](https://team.globalcastmd.com/watch/essential-urology-for-general-surgeons-with-drs-ponsky-and-cherullo-13657?t=448)
- Pex the contralateral testicle because it may have the same anatomic abnormality that caused torsion on the first side. — Edward Cherullo (clinical) [Ep 1 · 7:37](https://team.globalcastmd.com/watch/essential-urology-for-general-surgeons-with-drs-ponsky-and-cherullo-13657?t=457)
- 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. — Edward Cherullo (clinical) [Ep 1 · 8:08](https://team.globalcastmd.com/watch/essential-urology-for-general-surgeons-with-drs-ponsky-and-cherullo-13657?t=488)
- 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. — Lee Ponsky (clinical) [Ep 1 · 9:37](https://team.globalcastmd.com/watch/essential-urology-for-general-surgeons-with-drs-ponsky-and-cherullo-13657?t=577)
- 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. — Lee Ponsky (clinical) [Ep 1 · 10:32](https://team.globalcastmd.com/watch/essential-urology-for-general-surgeons-with-drs-ponsky-and-cherullo-13657?t=632)
- Pneumaturia is a clear sign of colovesical fistula, though patients may not understand what is happening and need to be asked about it. — Lee Ponsky (clinical) [Ep 1 · 11:39](https://team.globalcastmd.com/watch/essential-urology-for-general-surgeons-with-drs-ponsky-and-cherullo-13657?t=699)
- 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. — Lee Ponsky (clinical) [Ep 1 · 12:13](https://team.globalcastmd.com/watch/essential-urology-for-general-surgeons-with-drs-ponsky-and-cherullo-13657?t=733)
- The pathophysiology for colovesical fistula creation is almost always colorectal (chronic diverticulitis, colon cancer, inflammatory bowel disease)—very rarely is the primary pathology urologic. — Edward Cherullo (epidemiological) [Ep 1 · 13:17](https://team.globalcastmd.com/watch/essential-urology-for-general-surgeons-with-drs-ponsky-and-cherullo-13657?t=797)
- Pinhole bladder defects from colovesical fistula do not require closure—patients do well without transmural abscesses or fistulization to staple lines. — Edward Cherullo (clinical) [Ep 1 · 16:03](https://team.globalcastmd.com/watch/essential-urology-for-general-surgeons-with-drs-ponsky-and-cherullo-13657?t=963)
- Any permanent material in the urothelial tract (staples, Ethibond, Prolene) will collect urinary salts and start to form stones. — Edward Cherullo (clinical) [Ep 1 · 17:09](https://team.globalcastmd.com/watch/essential-urology-for-general-surgeons-with-drs-ponsky-and-cherullo-13657?t=1029)
- 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. — Edward Cherullo (clinical) [Ep 1 · 17:22](https://team.globalcastmd.com/watch/essential-urology-for-general-surgeons-with-drs-ponsky-and-cherullo-13657?t=1042)
- 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. — Edward Cherullo (clinical) [Ep 1 · 17:58](https://team.globalcastmd.com/watch/essential-urology-for-general-surgeons-with-drs-ponsky-and-cherullo-13657?t=1078)
- For postoperative urinary retention after straightforward abdominal surgery, recommend starting all patients on an alpha-blocker (tamsulosin or Rapaflo for quicker onset). — Lee Ponsky (clinical) [Ep 1 · 20:20](https://team.globalcastmd.com/watch/essential-urology-for-general-surgeons-with-drs-ponsky-and-cherullo-13657?t=1220)
- 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. — Lee Ponsky (clinical) [Ep 1 · 21:27](https://team.globalcastmd.com/watch/essential-urology-for-general-surgeons-with-drs-ponsky-and-cherullo-13657?t=1287)
- Postoperative urinary retention often unmasks underlying BPH or other lower urinary tract problems that patients were not aware of before surgery. — Edward Cherullo (clinical) [Ep 1 · 23:20](https://team.globalcastmd.com/watch/essential-urology-for-general-surgeons-with-drs-ponsky-and-cherullo-13657?t=1400)
- With blood at the meatus or pelvic fracture, do not instrument the urethra—get a retrograde urethrogram first to assess urethral integrity. — Edward Cherullo (clinical) [Ep 1 · 25:28](https://team.globalcastmd.com/watch/essential-urology-for-general-surgeons-with-drs-ponsky-and-cherullo-13657?t=1528)
- 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. — Edward Cherullo (clinical) [Ep 1 · 25:44](https://team.globalcastmd.com/watch/essential-urology-for-general-surgeons-with-drs-ponsky-and-cherullo-13657?t=1544)
- 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. — Edward Cherullo (clinical) [Ep 1 · 26:28](https://team.globalcastmd.com/watch/essential-urology-for-general-surgeons-with-drs-ponsky-and-cherullo-13657?t=1588)
- 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. — Lee Ponsky (opinion) [Ep 1 · 27:22](https://team.globalcastmd.com/watch/essential-urology-for-general-surgeons-with-drs-ponsky-and-cherullo-13657?t=1642)
- 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. — Lee Ponsky (clinical) [Ep 1 · 28:04](https://team.globalcastmd.com/watch/essential-urology-for-general-surgeons-with-drs-ponsky-and-cherullo-13657?t=1684)
- 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. — Edward Cherullo (clinical) [Ep 1 · 29:08](https://team.globalcastmd.com/watch/essential-urology-for-general-surgeons-with-drs-ponsky-and-cherullo-13657?t=1748)
- For renal trauma, try to avoid surgical exploration unless forced—angioembolization is preferred for partial injury to save some kidney. — Lee Ponsky (clinical) [Ep 1 · 30:41](https://team.globalcastmd.com/watch/essential-urology-for-general-surgeons-with-drs-ponsky-and-cherullo-13657?t=1841)
- 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. — Lee Ponsky (clinical) [Ep 1 · 31:07](https://team.globalcastmd.com/watch/essential-urology-for-general-surgeons-with-drs-ponsky-and-cherullo-13657?t=1867)
- Urologic trauma, whether urologist present or not, is almost always managed non-surgically and supported by good level evidence. — Edward Cherullo (clinical) [Ep 1 · 34:40](https://team.globalcastmd.com/watch/essential-urology-for-general-surgeons-with-drs-ponsky-and-cherullo-13657?t=2080)
- Ureteral repair is not an emergency—it can be put on the back burner until other bleeding or issues are controlled. — Lee Ponsky (clinical) [Ep 1 · 36:01](https://team.globalcastmd.com/watch/essential-urology-for-general-surgeons-with-drs-ponsky-and-cherullo-13657?t=2161)
- For ureteral injury, dissect out both ends of the ureter and assess whether there could be multiple injuries or dissection of different portions. — Lee Ponsky (clinical) [Ep 1 · 36:21](https://team.globalcastmd.com/watch/essential-urology-for-general-surgeons-with-drs-ponsky-and-cherullo-13657?t=2181)
- Thermal ureteral injury requires excision of affected areas because of risk of delayed necrosis; non-thermal injury does not require excision. — Lee Ponsky (clinical) [Ep 1 · 37:03](https://team.globalcastmd.com/watch/essential-urology-for-general-surgeons-with-drs-ponsky-and-cherullo-13657?t=2223)
- The ureter has watershed blood supply—best at the upper ureter (near kidney) and lower ureter, worst in the mid-ureter. — Lee Ponsky (clinical) [Ep 1 · 37:43](https://team.globalcastmd.com/watch/essential-urology-for-general-surgeons-with-drs-ponsky-and-cherullo-13657?t=2263)
- For ureteral repair, spatulate the ends, use fine absorbable suture (not permanent to avoid urothelial stone formation), run or interrupt, place over a stent (usually 26 Fr double-J stent), and leave a drain. — Lee Ponsky (clinical) [Ep 1 · 38:12](https://team.globalcastmd.com/watch/essential-urology-for-general-surgeons-with-drs-ponsky-and-cherullo-13657?t=2292)
- Pass the double-J stent up to the kidney through the defect, pass the lower end to the bladder, confirm with X-ray or cystoscopy that proximal end is in kidney and distal end is in bladder. — Lee Ponsky (clinical) [Ep 1 · 38:43](https://team.globalcastmd.com/watch/essential-urology-for-general-surgeons-with-drs-ponsky-and-cherullo-13657?t=2323)
- To temporize ureteral injury without urologist: put a big clip on the end of the ureter and place percutaneous nephrostomy tube, or leave the divided ureter end open with a drain (less ideal because it creates inflammatory response). — Edward Cherullo (clinical) [Ep 1 · 39:14](https://team.globalcastmd.com/watch/essential-urology-for-general-surgeons-with-drs-ponsky-and-cherullo-13657?t=2354)
- If one ureter is divided, there is a chance the other ureter was also divided—not a rare occurrence in urologic literature—so always check the contralateral ureter. — Edward Cherullo (clinical) [Ep 1 · 40:14](https://team.globalcastmd.com/watch/essential-urology-for-general-surgeons-with-drs-ponsky-and-cherullo-13657?t=2414)

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