Definition and Overview
A urology emergency refers to any urologic condition that requires urgent medical attention from a urologist or an emergency room. There are not many urologic problems that are considered as emergencies, so the list is limited to only a handful of conditions. These conditions, when left untreated, are potentially life-threatening or may result in serious long-term complications or consequences.
Cause of Condition
There are different types of urologic emergencies with varying causes and risk factors. These include:
1. Acute urinary retention - This condition occurs when a person is suddenly unable to urinate and, at the same time, feels severe pain in the lower abdominal area, usually due to an obstruction either in the urethra or the bladder as a result of an underlying condition such as prostate cancer, bladder stones, urinary tract infection, or blood clots, among others. Less common causes include benign prostatic hyperplasia, neurogenic bladder, bladder neck contracture, prostatitis, and urethral stricture.
This urologic emergency is treated with emergency catheterization, which drains the accumulated urine from the bladder. Before the patient is sent home, however, he will be given tests to try and diagnose what caused the problem and to help prevent recurrences. If any underlying conditions are found, corresponding treatment may be necessary. When not treated urgently, the person may suffer from bladder damage or kidney failure, both of which can lead to fatal consequences.
2. Renal colic - Renal colic occurs most often due to renal stones that cause obstruction, thus causing pain around the flank. As the stones progress through the ureter, the pain may radiate towards the abdomen. Male patients may also feel some pain in the testes while female patients may also experience painful labia majora.
3. Paraphimosis - This is a condition wherein the foreskin of the penis becomes inflamed, as a result of infection, trauma, or lack of proper hygiene. The inflammation may cause the foreskin to retract, impairing proper blood flow and causing the swelling to worsen. Treatment is primarily geared towards bringing the swelling down, then repairing the foreskin or putting it back over the glans. However, when left untreated, paraphimosis can lead to tissue death in the penis and, eventually, to gangrene. Since it affects the foreskin, this condition is limited to men who did not undergo circumcision or those who were not properly circumcised.
4. Testicular torsion - A testicular torsion occurs when the blood vessels in the testicles twist, hampering normal blood flow and cutting off the blood supply the testicles receive. There is a small window of just six hours during which the twisted blood vessels should be untwisted. If this is not treated in time, the potential consequences include tissue death and testicle atrophy. If the latter occurs, the testicle would have to be removed. An emergency treatment to repair testicular torsion is also used to perform an orchiopexy, which ensures that the testicles do not twist again.
5. Priapism - A patient suffering from priapism will experience a penile erection that lasts longer than four hours. This erection does not have anything to do with sexual arousal; it occurs when the blood that flows to the penis is unable to drain out of it, prolonging the erection with pain. There are some risk factors that increase a person’s likelihood of experiencing this condition, but they are mostly associated with underlying conditions or diseases that affect blood circulation. Some examples are leukemia or sickle cell disease. This urology emergency may also occur as a side effect of taking erectile dysfunction drugs at excessive doses. This emergency is treated by draining out the blood that is trapped in the penis. The potential consequences of priapism, if emergency treatment is not provided, are penile scarring and a permanent inability to have erections.
6. Fournier’s Gangrene - With an almost 50% fatality rate, Fournier’s Gangrene is an infection of the genitals that rapidly progresses, causing tissue death and thus requiring emergency treatment. The infection may stem from a variety of root causes, but susceptibility to it has been linked to steroid use, excessive alcohol consumption, and even underlying diseases such as diabetes. Symptoms linked with this condition include redness, swelling, and extreme pain in the scrotum or perineum. Some may also have fever and chills. Fournier’s Gangrene is treated with emergency surgery that aims to remove the tissues that have been infected and those that have died. After this, the patient undergoes a course of antibiotics to fight off the remaining infection.
The strongest indicators of urologic emergencies are:
- Severe abdominal pain
- Severe pain in the genital area
- Inability to urinate
- Signs of an infection, such as swelling and redness
Although most urology emergencies affect the penis, thus making them more common among men, some emergencies may also affect children and women. In pediatric cases as well as emergencies among pregnant women, special considerations have to be made during treatment. The important thing is at the onset of severe pain, the patient is given prompt emergency medical attention to ensure that no long-term consequences will occur.
Who to See and Types of Treatment Available
Emergencies in urology can be brought immediately to the attention of a urologist or to the emergency room. The emergency department of a hospital is equipped in dealing with any kind of emergency.
Emergencies are usually treated in two stages, with the first geared primarily towards relieving the pain and other symptoms. This is usually done by draining out urine, blood, or infection, depending on the specific emergency condition. In some cases, surgery may be necessary. This is followed by other forms of treatment or diagnostic tests needed to avoid recurrences.
- American Urological Association