Urologic Emergencies

Overview. Relatively few urologic conditions could be described as true emergencies requiring at-that-moment care. But the following require urgent attention from a urologist or emergency room physician.

Acute Urinary Retention. The sudden inability to urinate can cause extreme pain and demands immediate treatment. Urinary retention can be caused by obstruction in the bladder or the urethra (the tube that carries urine from the bladder outside the body) or by a disruption in the signals between the nervous system and the bladder. It can result from a number of bladder conditions, including prostate cancer, benign prostatic hyperplasia, prostatitis, urethral stricture, bladder stones, blood clots, urinary tract infections, contracture of the bladder neck in reaction to medication or other causes, and nerve damage or neurogenic bladder. Acute urinary retention is accompanied by severe lower abdominal pain and, when not promptly treated, can lead to bladder damage and chronic kidney failure. Emergency catheterization to drain the bladder is usually the first line of treatment, followed by tests to determine the underlying cause of the episode.

Testicular Torsion. The sudden onset of pain in the scrotum or lower abdomen, blood in the semen, swelling or a lump in the testicle and redness of the scrotum can be indications of testicular torsion, in which one or more blood vessels to the testicle twist, cutting off the testicle’s blood supply. If the blood vessel or vessels are not untwisted promptly to restore the blood flow (within six hours for best results), tissue death will occur and the testicle may atrophy and die, requiring removal. After successful treatment, the testicle is generally “tacked” into place through a procedure known as an orchiopexy to ensure that torsion does not recur. Torsion occurs most commonly in adolescents and less commonly in infants, although it can occur at any age.

Priapism. A prolonged, painful penile erection persisting for more than four hours is not associated with sexual arousal, but rather a failure of blood to drain from the penis after it flows there during the erection’s onset. When not immediately treated, this condition can lead to scarring and permanent inability to achieve an erection. Priapism can result from diseases that affect blood circulation such as sickle cell disease and leukemia; or from certain medications, including injections used for treating erectile dysfunction (usually because of higher-than-prescribed doses). Emergency treatment includes draining the “trapped” blood with a needle inserted into the side of the penis.

Paraphimosis. Paraphimosis is a condition in which uncircumcised males or those who have not been properly circumcised develop inflammation in the foreskin (the fold of skin covering the head) of the penis, either from infection, poor hygiene, or trauma to the area. When this occurs, the foreskin retracts and cannot be returned to its normal position, trapping the blood flow and causing the glans (head) to further swell. If not immediately corrected, tissue death can result and gangrene may develop. Paraphimosis may occur at any age, but is most common during adolescence and among elderly men who need frequent catheterizations or have a history of poor hygiene and infections. Treatment aims to reduce the swelling and replace the foreskin over the glans.

Fournier’s Gangrene. A massive, rapidly progressive gangrenous infection of the genitalia is fatal in up to half of the cases and requires immediate attention. Fournier’s gangrene can be caused by a variety of organisms and is most commonly associated with diabetes. Immunosuppression, steroid use, alcohol abuse, and other infections can also be causes. Symptoms include severe pain to the penis, scrotum or perineum, with redness and tissue death rapidly occurring. A slower onset is also possible, with symptoms that include fever and chills along with genital discomfort. Fournier’s gangrene is generally treated by surgically removing the infected and dead tissue and administering a powerful course of antibiotics.