Emergency Urology

Go to an emergency department now if

• You cannot pass urine at all and your lower abdomen feels full and painful
• You have sudden severe pain in a testis, with or without swelling and vomiting
• You have loin or back pain together with fever or shivering
• You are passing heavy blood or clots, or you cannot pass urine because of clots
• You have had an injury to the abdomen, pelvis or genitals and cannot pass urine, or there is blood at the tip
• You have an erection that has lasted more than four hours
• The foreskin has been pulled back and cannot be returned, and the tip is swelling

Why these are urgent

Acute urinary retention

The bladder fills and cannot empty. It is intensely painful and, left long enough, pressure travels back up to the kidneys. Draining the bladder with a catheter relieves it quickly, and the cause is then investigated once the immediate problem is dealt with.

Blocked and infected kidney

A stone obstructing the ureter with infection behind it is the most dangerous common urological emergency. Antibiotics alone cannot clear infection from a blocked system, so the kidney has to be drained urgently. This can deteriorate into sepsis within hours.

Testicular torsion

The testis twists on its cord and cuts off its own blood supply. The window for saving it is measured in hours, and the best chance is within roughly the first six. Sudden severe testicular pain is treated as torsion until proven otherwise, particularly in adolescents and young men.

Heavy bleeding into the urine

Clots can block the bladder outlet completely, which is both painful and unsafe. Treatment is washing the bladder out and keeping it irrigated while the source of bleeding is identified.

Injury to the urinary tract

Trauma to the kidney, bladder or urethra, often accompanying pelvic fractures. Attempting to pass a catheter when the urethra is injured can make matters worse, which is why imaging comes first.

Prolonged unwanted erection

A painful erection lasting more than four hours damages the erectile tissue permanently if it is not relieved. Treatment is time critical.

Severe infection of the genital tissues

A rapidly spreading infection of the skin and soft tissue of the perineum and genitals, more common in diabetes. It progresses very fast and needs immediate surgery and antibiotics.

What happens when you arrive

Assessment is deliberately quick. Observations, an examination, urine and blood tests, and imaging where it will change the immediate decision.

Relief usually comes before investigation. That means draining the bladder, draining an obstructed kidney with a stent or a tube placed through the skin, washing out clots, or taking someone to theatre without delay where a testis or tissue is at risk. The underlying cause is then addressed properly once the emergency has been controlled.

Afterwards

An emergency is the event, not the diagnosis. Retention usually has a cause behind it, most often the prostate, and it needs a plan rather than an indefinite catheter. An obstructed infected kidney means there is still a stone to deal with once the infection has settled.

Follow up after a urological emergency is where the recurrence is prevented, so it is worth attending even when everything feels resolved.