Updates in Non-traumatic Urological Emergencies

Abstract

Renal colic is by far the most frequent urological emergency. Diagnosis relies on clinical history, physical examination, urine dipstick test, serum analysis (blood cell count and level of creatinine, uric acid, ionized calcium, sodium, C-reactive protein, procalcitonin, if available, glucose and lactate), ultrasound and sometimes computed tomography scan (CT). Contrast and full-dose radiation CT scan is rarely required and limited mainly to cases of acute flank pain with uncertain aetiology. Renal colic may be complicated by sepsis which should be early recognized and treated with antibiotics and renal drainage, either by ureteral catheterization or percutaneous nephrostomy placement. Pain control is subordinated to sepsis treatment and based on non-steroidal anti-inflammatory drugs and alpha-blockers. Acute urinary retention is mainly resolved by urethral catheter indwelling, but sometimes it is demanding, requiring suprapubic drainage or cystoscopy. Acute scrotal pain may harbour testicular torsion, especially in young adults. Therefore, immediate manual detorsion or surgical exploration is recommended unless an alternate diagnosis of scrotal pain is certain. Clinical history and physical examination are usually enough to suspect a torsion. Indeed, ancillary tests, like Doppler ultrasound of the testis or pertechnetate scintigraphy, should never delay treatment. Priapism is a rare urgency. Low-flow priapism should be identified and treated immediately to avoid permanent erectile dysfunction. Finally, Fournier’s gangrene, emphysematous pyelonephritis and emphysematous prostatitis are rare but life-threatening urological infections which may have a subtle presentation and occur mostly in subjects with uncontrolled diabetes. They need a multi-speciality approach including invasive procedures, like surgery or drainage.