Urologic Emergencies: Overview 1
Emergencies in urology are rarely life-threatening.
Even some of the most concerning conditions such as pyonephrosis or renal trauma are urgent but usually not emergent.
Important questions to consider before acting are:
1. Is the patient well enough to undergo an operation?
2. Will an operation improve the situation or is a minimally invasive approach or patience a better course of action?
3. Have you considered possible concomitant pathology or injuries?
4. Should you involve a general surgeon, internist, or intensivist in the patient’s care?
5. Would additional imaging be helpful?
Contrast-enhanced computerized tomography of the abdomen and pelvis with delayed imaging of the urinary collection system plays a critical role in the evaluation and management of abdominal trauma involving the urinary system.
Ultrasound is often indispensable in the differentiation of orchitis and testicular torsion, and a cystogram diagnoses a bladder perforation as intraperitoneal or extraperitoneal. In each of these examples, findings on radiographic imaging will significantly alter one’s choice of management.
The urologist should be familiar with the options for imaging and the interpretation of those images.
Do not be afraid to involve other urologists or other services in the care of the patient, particularly if you are unfamiliar with the management of the acutely ill patient.