Overview of common urological emergencies based on talk to Junior Doctors in training

1. Urological EmergenciesUrological Emergencies
Mr Daben Dawam
Consultant Urological Surgeon
Southend University Hospital NHS
Foundation Trust
United Kingdom

2. UROLOGICALUROLOGICAL
EMERGENCIESEMERGENCIES
 Acute urine Retention
 Haematuria
 Ureteric Colic (beware 0f AAA > 50years of age)
 Scrotal Painful swelling (?Testicular torsion)
 Trauma( kidney, bladder, urethra, genitals)
 Fournier’s gangrene
 Penile fracture
 Laceration of foreskin
 Priapism

3. UROLOGICALUROLOGICAL
EMERGENCIESEMERGENCIES
Urine Retention
- Acute
- Chronic
Use smallest compatible catheter size 14 or
16FG
Document residual vol, blood or not
Serum urea and electrolytes

4. UROLOGICALUROLOGICAL
EMERGENCIESEMERGENCIES
Chronic Urine Retention
- Post decompression diuresis/ haematuria
- admit patient
- Monitor fluid balance as i/v fluids may
be
required

5. UROLOGICALUROLOGICAL
EMERGENCIESEMERGENCIES
Haematuria
-Haematuria Clinic
Visible haematuria 2WW
Non visible haematuria urgent but not 2WW
- Clinical
-Imaging : USS, CTU
-Endoscopy: Flexible cystoscopy, Rigid
cystoscopy+/- TURBT

6. UROLOGICALUROLOGICAL
EMERGENCIESEMERGENCIES
Ureteric Colic (beware 0f AAA > 50years
of age)

8. Ureteric ColicUreteric Colic

9. Ureteric colicUreteric colic

11. Beware AAA presenting as ”colic”Beware AAA presenting as ”colic”

12. Ruptured AAARuptured AAA

14. NephrostomyNephrostomy

15. Obstructed infected kidneyObstructed infected kidney
Resuscitation
Urgent nephrostomy

17. Acute scrotumAcute scrotum
Epididymo-orchitis vs torsion

18. Torsion of TestisTorsion of Testis

19. UROLOGICALUROLOGICAL
EMERGENCIESEMERGENCIES
Trauma( kidney, bladder, urethra, genitals)

21. Grading Severity of Renal InjuriesGrading Severity of Renal Injuries

22. UROLOGICAL EMERGENCIESUROLOGICAL EMERGENCIES

23. UROLOGICAL EMERGENCIESUROLOGICAL EMERGENCIES

24. Extraperitoneal bladder ruptureExtraperitoneal bladder rupture

25. Intraperitoneal bladder ruptureIntraperitoneal bladder rupture

26. CT Urogram of patient with extra-CT Urogram of patient with extra-
peritoneal bladder ruptureperitoneal bladder rupture

27. Urethrogram showing complete urethralUrethrogram showing complete urethral
rupture(Cystogram from IVU)rupture(Cystogram from IVU)

28. Combined micturiting cystogram and retrogradeCombined micturiting cystogram and retrograde
urethrogram showing complete bulbo-urethrogram showing complete bulbo-
membranous urethral rupturemembranous urethral rupture

29. Fournier’s gangreneFournier’s gangrene
Necrotizing fascitis

33. Fourniere’s gangreneFourniere’s gangrene

34. Penile fracturePenile fracture
‘Crack or Pop’ sound
Pain
Detumescence
Bruising

36. Penile FracturePenile Fracture

38. UROLOGICALUROLOGICAL
EMERGENCIESEMERGENCIES
Laceration of foreskin

39. PriapismPriapism

40. PriapismPriapism
Prolonged penile erection without sexual
stimulation
Low Flow (ischaemic) and High Flow (non-
ischaemic usually due to post traumatic AV
fistula)
Risk Group- Afro-Caribean Sickle cell
disease, Other haemoglobinopathies,
Substance abuse, pelvic malignancies

41. PriapismPriapism
Low flow –
- oxygen,,hydration, Aspiration with
phenylepinephrine irrigation
- Shunts
High Flow- Embolise AV fistula
(interventional radiologist)