In most of the emergencies involving urological organs (kidneys, bladder, prostate, penis and testes) a prompt diagnosis and treatment is required.
Emergencies may be due to injuries or due to a disease that suddenly manifests as an acute condition.
Urological emergencies may include:
- Acute testicular pain: Sudden pain in the testis is usually due to torsion. It is also manifested in testicular infection or testicular cancer. If in doubt always seek help in accident & emergency department or from a urologist.
- Blood in the urine: Presence of blood in the urine itself is not an emergency but needs attention. However blood clots may form in the urinary bladder and cause obstruction to the urine flow which then becomes an emergency. Blood in large quantities is easily seen and in small quantities does not show up easily to the naked eye. Visible or invisible blood should not be present in the urine. If blood is present in the urine it needs attention and therefore tests need to be done to find out the cause.
- Fractured penis: Spontaneous fracture can occur during sexual intercourse resulting in rupture of the fibrous sheath of the penis. The pain is sudden at the time of fracture and swelling usually appears with spontaneous loss of erection. This condition needs prompt medical attention and treatment.
- Injuries (Trauma): Apart from penis and testes urinary organs are situated deep in the abdomen and well protected by muscles and bones (For example kidneys are protected by rib cage). Most of the major injuries of the urinary tract are associated with injuries to other abdominal organs. The injury could be in the form of blunt (vehicular accidents, assaults and sports accidents) or penetrating (knife or bullet wounds) injury. Scrotal and testicular injuries are rare and usually to fall or direct hit.
- Kidney Pain and colic: pain in kidney is usually caused by obstruction or by infection. Pain is typically felt in the back and may be felt in the groin and in scrotum and testis. Pain is likely to be caused by stone, infection or blood clot.
- Paraphimosis: In this condition foreskin of the penis retracts and remains so with a tight (constriction) ring around the ‘neck’ of the penis (behind glans penis)
- Permanent erection: This also known as priapism (named after Greek fertility god Priapus). The penile erection in priapism persists beyond or unrelated to sexual stimulation. Priapism is a urological emergency and needs prompt assessment and treatment.
- Severe urinary infection: Severe bladder infection can cause urinary frequency, bleeding, discomfort and fever. In addition, loin pain and shivering with fever manifest if the infection occurs in the kidney.
- Spinal cord compression: Small number of prostate cancer patients may suffer from spinal cord compression due to the tumour spreading to the vertebral column. Initial presentation is often vague but rapid progression within a short time there may be loss of power and sensation in legs and loss of bowel and bladder control
- Torsion Testis: Testicular torsion is a result of twisting of the spermatic cord. This is a true emergency as testis is likely to die if not treated within four hours. The main symptom of torsion of testis is pain.
- Urinary retention: In this condition the person is unable to pass urine and can be caused by enlargement of prostate (in men), constipation, infection, surgery, medications and sometimes due to nerve problems and psychological conditions. The relief from retention is achieved by passing a tube called catheter through the urethra.
Mr Vinod Nargund is a Consultant Urological Surgeon specialising in Urological cancer, male sexual and fertility problems. He was trained in Urology at the City Hospital Belfast, the Royal Infirmary Bradford and the Churchill and John Radcliffe Hospitals in Oxford. You can view all of his qualifications on his biography page.