Approach to diagnosis and treatment to urologic emergencies
Keywords:Diagnostic strategies, Emergency urology, Therapeutic approaches, Urologic, Urologic emergencies
Acute urinary retention, which is an emergency presents a significant challenge, for healthcare providers especially among elderly men. This condition often leads to dysfunction and genital pain causing distress and anxiety for those affected. The likelihood of experiencing acute urinary retention increases with age, with men in their 70s facing a 10% risk that escalates to, over 30% in their 80s. Dealing with both dysfunction and acute pain adds complexity to the clinical management of these cases. This summary highlights the role played by emergency physicians in the management of this troubling urologic emergency. The initial approach involves conducting an evaluation that includes assessing medical history performing physical examinations and conducting relevant diagnostic tests. Promptly identifying the causes, which can range from prostatic hyperplasia and urethral strictures to infections or neurogenic conditions is crucial. Pain relief is an immediate concern, prompting the administration of analgesics to alleviate patient discomfort. Concurrently, urinary catheterization, skillfully performed by the emergency physician, effectively resolves the urinary obstruction, providing substantial relief. Referral to urologists ensures a comprehensive etiological assessment and the formulation of an individualized management plan. In summary, effectively managing retention, with associated erectile dysfunction and genital pain, requires a collaborative effort between emergency physicians and urological specialists. By identifying the cause, providing skilled pain management and expertly performing urinary catheterization emergency physicians play a crucial role in relieving patient discomfort.
Motterle G, Morlacco A, Iafrate M, Marta B, Giuliano F, Orest X, et al. The impact of COVID-19 pandemic on urological emergencies: a single-center experience. World J Urol. 2021;39(6):1985-9.
Günther P, Rübben I. The acute scrotum in childhood and adolescence. Dtsch Arztebl Int. 2012;109(25):449-57.
Makris K, Spanou L. Acute Kidney Injury: Definition, Pathophysiology and Clinical Phenotypes. Clin Biochem Rev. 2016;37(2):85-98.
Keller LJ, Glauser J. Urinary Tract Infection Updates and Recent Developments. Current Emergency and Hospital Medicine Reports. 2020;8(2):41-4.
Borghi L, Nouvenne A, Meschi T. Nephrolithiasis and urinary tract infections: ‘the chicken or the egg’ dilemma? Nephrol Dialysis Transplantation. 2012;27(11):3982-4.
Okeke CJ, Obi AO, Odoemene CA, Ojewola RW, Afogu EN, Odo C, et al. Urological emergencies in a Nigerian teaching hospital: Epidemiology and treatment. Niger J Clin Pract. 2021;24(3):400-405.
Zhu C, Wang D-Q, Zi H, Qiao H, Jia-Min G, Lu-Yao L, et al. Epidemiological trends of urinary tract infections, urolithiasis and benign prostatic hyperplasia in 203 countries and territories from 1990 to 2019. Military Med Res. 2021;8(1):64.
Iqbal N, Assad S, Hussain I, Yumna H, Hafsa K, Muhammad AF, et al. Comparison of outcomes of tubed versus tubeless percutaneous nephrolithotomy in children: A single center study. Turk J Urol. 2018;44(1):56-61.
Hsu L, Li H, Pucheril D, Raymond L, James P, Jesse S, et al. Use of percutaneous nephrostomy and ureteral stenting in management of ureteral obstruction. World J Nephrol. 2016;5(2):172-81.
Srikanth P, Kay HE, Tijerina AN, Arjun VS, Aaron AL, Stuart JW, et al. Review of the current management of radiation-induced ureteral strictures of the pelvis. AME Med J. 2021;7:8.
Ayoub CH, El-Asmar JM, Abdulfattah S, El-Hajj A. Telemedicine and Telementoring in Urology: A Glimpse of the Past and a Leap Into the Future. Frontiers in Surgery. 2022;9.
Henderson J. The Aging Urology Population and its impact on Hospital Stay. Urol Nephrol Open Access J. 2016;3(4):112.
Myoclinic. Benign prostatic hyperplasia (BPH). 2023; Avaiable at: https://www.mayoclinic. org/diseases-conditions/benign-prostatic-hyperplasia/symptoms-causes/syc-20370087. Accessed on 23 September 2023.
Patel AB, Osterberg EC, Satarasinghe PN, Jessica LW, Sabah TA, Saad LS, et al. Urethral Injuries: Diagnostic and Management Strategies for Critical Care and Trauma Clinicians. J Clin Med. 2023;12(4):1495.
Fruh SM. Obesity: Risk factors, complications, and strategies for sustainable long-term weight management. J Am Assoc Nurse Pract. 2017;29(S1):S3-14.
Shashar R, Chatumi S, Amiel G. Gender-specific medicine in urology. Harefuah. 2021;160(9):603-7.
Pandit SR, Venugopal P, Keshavamurthy R, Chawla A. Challenges and gender-based differences for women in the Indian urological workforce: Results of a survey. Indian J Urol. 2022;38(4):282-6.
Elbatanouny AM, Ragheb AM, Abdelbary AM, Fathy H, Massoud AM, Abd El Latif A, et al. Percutaneous nephrostomy versus JJ ureteric stent as the initial drainage method in kidney stone patients presenting with acute kidney injury: A prospective randomized study. Int J Urol. 2020;27(10):916-21.
Manikandan R, Kumar S, Dorairajan LN. Hemorrhagic cystitis: A challenge to the urologist. Indian J Urol. 2010;26(2):159-66.
Alnajjar LI, Alrashidi NS, Almutairi N, Noura A, Omar SK, Sajjad A, et al. Effect of an antimicrobial stewardship program in the prevention of antibiotic misuse in patients with spinal cord injury undergoing minor urologic procedures: a single-group, quasi-experiment study. BMC Infect Dis. 2023;23(1):368.
Stoumpos AI, Kitsios F, Talias MA. Digital Transformation in Healthcare: Technology Acceptance and Its Applications. Int J Environ Res Public Health. 2023;20(4).
Ramanayake RP, Ranasingha S, Lakmini S. Management of emergencies in general practice: role of general practitioners. J Family Med Prim Care. 2014;3(4):305-8.
Peerapen P, Thongboonkerd V. Kidney Stone Prevention. Adv Nutr. 2023;14(3):555-69.