Urological Emergency Cases

UROLOGICAL EMERGENCY CASES
1. Acute urinary retention

2. Flank pain
3. Hematuria
4. Trauma of GU Tract
5. Scrotal Problems
6. Urological emergencies in pregnancy
1.ACUTE URINARY RETENTION
Definition:
 Acute retention is sudden onset of inability of voiding for more than 6 hour
without any past medical history of urologic problem
 Chronic retention is chronic or elongated episodes of urinary retention and
mostly accomplished by upper tract damage.
Mechanism
A. Organic Obstuction
 Benign prostatic hyperplasia
 Prostate cancer
 Urethral stricture
 Posterior urethral valve
 Urethral tumor
 Bladder neck contracture
 Urethral stones
 Stone impacted in bladder neck
B. Functional Obstruction
 Neurogenic bladder
 Detrusor sphinchter dyssnergia
Signs and symptoms

1. Fail of passing urine
2. Pain in suprapubic area
3. Fever and chills (in complicated chronic retention)
4. Flank pain(bilaterally) in chronic retention
5. Tenderness in suprapubic area
6. Lower abdominal distention (bladder ball) by palpating the suprapubic area.
Diagnosis in the E.R
1. Laboratory
UA Creatinine
CBC Na+
UREA K+
2. Radiology
A.Ultrasound:- Bilateral hydronephrosis
Bladder dilated
Enlargment of prostate
Management
1. In the E.R :– Immediate catheterization
- Suprapubic tube insertion
2. Late management: treat the main cause
2. FLANK PAIN
It’s a pain which located in the flank area ( either right or left) between the costal margin
superiorly and anterior superior spike inferiorly iliac, anterior axillary line(anteriorly) and
paraspinal muscles posteriorely.
Mechanism of flank pain from urological cause

 The kidney itself is not painful. The nervous endings are located in the capsule.
Renal obstruction Renal hydronephrosis Expanding of capsule Celiac plexus Pain
(vomiting, nausea) gastric nerves
 Irritation of ureteral mucosa by a stone or a clot Pain
Renal causes of flank pain

1. Acute pyelonephritis
2. Chronic pyelonephritis
3. Renal tumors
4. Renal stones
5. Ureteral stones which obstruct the urinary tract
6. Bladder outlet obstruction (which cause reflux)
7. Tumor of abdominal organs which cause compression on the kidney ( liver, colon,
ovary, uterine)
How to asses flank pain?
E.g. 25 years old pt, complaining of R.Flank pain. What would you ask?
1. what are characteristic of pain?

Colicky?? Continuous?? Tolerated?? Sharp??
2 . Define the occurate site of pain?
Put your finger on the site of pain
3 . Is the pain localized or spread to another area?
4 . Is it related to moving?
5 . How long time of complaing? Is it the first episode?
6 . Any response to analgesics? What type of analgesics?
7 . Any lutis?
8 . Fever, chills , nausea, vomiting?
9. Hematuria?
10 . Previous history of passing stones
11 . Any history of trauma?
Physical Examination
like physical examination of any pt focus on the flank area.
Examine the abdomen like other pts
DDx:
1. Renal causes
2. Pneumonia
3. Acute gastro-enteritis
4. Acute hepatitis
5. Acute pancreatitis
6. Acute appendicitis
7. Colonic volvulus
8. Ovarian cyst torsion
Diagnostic Assessment of pt with flank pain
1. Clinical history
2. P.E
3. Lab tests:
CBC Creatinine
UA Na+
UREA K+
MANAGEMENT
Analgesics
1. Ketorolac Tromethamine
First and best choice IV/IM, 10mg
Contraindications
Asthma
HTN
Peptic ulcer
2. Diclofenac Sodium, Pottasium
1V/IM ,75mg
3. Paracetamol IV/IM
Important in pregnant women

Safe
Not good line NSAIDs
4. Central analgesics
Tramadol IV/IM
Diluted in NS and slow infusion
Morphine or Pethidine
Diluted in NS and slowly infused
5. Giving IV Fluid:- Conficted
Not clear
After stabilization the pain what to do?

Increased WBC
1. Patient with UTI +ve
Severe Flank Pain Admission
Distress, fever and chills
Decreased Hb
Increased Creatinine
normalWBC
2. Patient with UTI +ve
Tolerable Flank Pain Outpatient , refer to urologist
No distress,no fever
Normal Hb
Normal Creatinine
3. Pregnant woman: admit until stablilasation of pain.

3 .HEMATURIA
The presence of blood in urine.
RBC in urine : 0-1 in HPF
Classified as Microscopic and Macroscopic
Microscopic > 5RBC in HPF
Macroscopic: Direct vision
How to asses patient with hematuria?

1. HISTORY
When did it started?
Macroscopic or microscopic?
History of trauma?
Clear blood or with clots?
Other signs ( flank pain, fever, chills)
Any menses?
Smoking ? how many pack and year?
Is it the first time? Or recurrent?
Painful or painless?
At the initial voiding or at he end?
In children any cough with blood ( good pasture syndrome)
Any site for bleeding ( except the bladder) ..Hematologic disease?
Any medications?
2. P.E
General, like any pt
Check B.p,P, Temp
Emergency Management
1. Laboratory
UA Na+ PTTK
CBC K +
INR
UREA PLT ABO Group
Creatinine PT
2. Ask patient to void and assess:
 Well voiding No need for catheterization
 Can’t void Catheterize pt and irrigate bladder by NS 0.9% till stop bleeding
3. Radiology
US: as initial imaging
CT Scan without and with contrast media later
DDx:
1. Renal , ureteral, bladder, prostatic, urethral tumours

2. Renal , ureteral, bladder stones
3. Hematologic disease
4. GU trauma
5. Infection and inflammation ( Glomerulonephritis)
6. Tumors of abdominal organ, which invade the urinary tract (Colon, pancreas,ovarian,
uterine, etc)
7. Bladder outlet obstruction: BPH, Bladder neck tumor, urethral stricture, Bladder neck
stone etc.
Indications of Admission
1. Low HB with continuous bleeding ( need blood transfusion)

2. General signs with bleeding : fever, chills, vomiting, nausea, distress pt
3. Increased renal function ( increased creatinin) because of urinary tract obstruction
4. Pregnant women with hematuria
5. Small child till discovering the cause
6. Hypovolemic shock because of bleeding.

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Urological Emergency Cases

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UROLOGICAL EMERGENCY CASES

1. Acute urinary retention

1.ACUTE URINARY RETENTION

Signs and symptoms

Mechanism of flank pain from urological cause

Renal obstruction Renal hydronephrosis Expanding of capsule Celiac plexus Pain

(vomiting, nausea) gastric nerves

 Irritation of ureteral mucosa by a stone or a clot Pain

Renal causes of flank pain

1. what are characteristic of pain?

Diagnostic Assessment of pt with flank pain

Important in pregnant women

After stabilization the pain what to do?

3. Pregnant woman: admit until stablilasation of pain.

How to asses patient with hematuria?

1. Renal , ureteral, bladder, prostatic, urethral tumours

1. Low HB with continuous bleeding ( need blood transfusion)

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