Urological Emergencies in Clinical Practice

1. Presenting Symptoms of Urological Emergencies Hashim Hashim and John Reynard Flank Pain Haematuria Oliguria, anuria and inability to pass urine Suprapubic pain Scrotal pain and swelling Priapism Back pain and urological symptoms 2. Lower Urinary Tract Emergencies John Reynard Acute urinary retention 3. Non-Traumatic Renal Emergencies John Reynard Acute flank pain - ‘ureteric’ or ‘renal’ colic Other non-stone causes of acute flank pain Acute pyelonephritis Pyonephrosis Perinephric abscess Emphysematous pyelonephritis Acute pyelonephritis, pyonephrosis, perinephric abscess and emphysematous pyelonephritis - making the diagnosis Xanthogranulomatous pyelonephritis 4. Other Infective Urological Emergencies Hashim Hashim and John Reynard Urinary Septicaemia Empirical treatment of septicaemia Prostatic infections and prostatic abscess Fournier’s gangrene Epididymo-orchitis Peri-urethral abscess 5. Traumatic Urological Emergencies John Reynard Renal injuries Ureteric injuries Pelvic fractures and injuries to the urinary system Types of pelvic fracture Bladder injuries associated with pelvic fractures Combined bladder and posterior urethral injuries following pelvic fracture Urethral injuries associated with pelvic fractures Abdominal and pelvic imaging in pelvic fracture and what to do where imaging cannot or has not been done Suprapubic catheterisation versus open suprapubic cystostomy in patients with posterior urethral disruption Problems imaging the bladder in patients with urethral rupture Bladder injuries o Types of perforation o Making the diagnosis o Imaging studies o Extraperitoneal and Intraperitoneal perforation during resection of a bladder tumour (TURBT) o The delayed diagnosis of iatrogenic bladder perforation o Bladder perforation during TURP o Bladder perforation following pelvic fractures o Bladder injury during caesariansection o Spontaneous rupture after bladder augmentation o Surgical repair of bladder injuries Posterior urethral injuries Anterior urethral injuries Penetrating anterior urethral injuries Testicular injuries Penile injuries Penile fracture 6. Scrotal and Genital Emergencies John Reynard and Hashim Hashim Torsion of the testis and testicular appendages Priapism Paraphimosis Foreign bodies in the urethra and attached to the penis 7. Post-Operative Emergencies after Urological Surgery Hashim Hashim and John Reynard Shock due to blood loss Anaphylaxis - after administration of intravenous contrast or antibiotics Scrotal swelling after scrotal surgery Wound dehiscence leading to burst abdomen Post-circumcision bleeding Blocked catheter post-TURP and clot retention The TUR syndrome Displaced catheter post-radical prostatectomy Compartment syndrome of the lower limb associated with the lithotomy position Mechanisms of LLCS in the lithotomy position 8. Ureteric Colic in Pregnancy John Reynard 9. Management of Urological Neoplastic Conditions Presenting as Emergencies John Reynard and Hashim Hashim Testicular cancer Malignant ureteric obstruction Spinal cord compression in patients with urological disease 10. Common Emergency Urological Procedures John Reynard and Nigel Cowan Urethral catheterisation Suprapubic catheterisation Blocked catheter post-TURP Blocked catheter post-TURBT Blocked catheters following bladder augmentation or neobladder JJ stent insertion Percutaneous nephrostomy insertion Failure to deflate balloon for removal of a urethral catheter