BPH

6 Urological Emergencies You Need To Know

The urinary tract is part of the renal system. This system comprises of organs and structures that help to eliminate toxins from the body1.

The kidney, urethra, and the ureters are the main parts o the renal system. The kidneys filter blood. This removes toxins, as well as an excess ion. The kidneys also remove metabolic waste products.

Urology is a term that refers to treating and diagnosing a range of conditions with the urinary system.

There are a few conditions that may resolve on its own. In some cases, however, urological emergencies may occur. This can lead to severe complications if no action is taken. Both men and women are at risk of experiencing a urological emergency.

We take a look at six of the essential urological issues that men should know about. We also consider the symptoms that each may cause. This allows a man to recognize the issue before it starts to create serious complications.

1) Acute Urinary Retention

Acute urinary retention is the first urological emergency we want to discuss. This is a condition where the man’s ability to pass urine voluntarily is inhibited. It means the patient can’t urinate. This problem is relatively common among men and can sometimes be a sign of something serious.

This condition is often acute. There are, however, cases where urinary retention becomes a chronic concern. This can lead to longer-term complications. It may cause complete urinary obstruction.

Benign prostatic hyperplasia is often the cause behind acute urinary retention. In about 53% of cases where acute urinary retention is diagnosed in men, an enlarged prostate is the cause2.

The prostate becomes enlarged, which causes it to put pressure on the bladder and urethra. In some cases, a significant enlargement of the prostate causes a restriction in the urethra. This makes it difficult for urine to pass from the bladder through the urethra.

Some of the symptoms a patient may experience with acute urinary retention include3:

  • It may be hard to initiate a stream of urine. (urinary hesitancy)

  • The man may not be able to empty their bladder.

  • The stream of urine may be weak.

  • Sometimes, urine may dribble.

  • There may be small amounts of urine that leak involuntarily during the day.

  • There may be a feeling of pressure in the abdomen.

  • Some men may not have an urge to pass urine when they need to.

  • In other cases, a more frequent need to urinate may be present. (frequent urination).

  • Nocturia is common, too, causing a patient to get up to urinate during the night.

Apart from an enlarged prostate, there are other causes or urinary retention too. Obstructive retention may also be caused by bladder or kidney stones. Thee are also cases where cancer causes obstructive acute urinary retention.

Non-obstructive urinary retention has a range of other potential causes. These include:

  • Stroke

  • Pelvic injury

  • Pelvic and renal trauma

  • Urethral injury

  • Impaired muscle function

  • Impaired nerve function

  • Injury to the brain

  • Injury to the spinal cord

  • Urinary tract infections

In women, infundibular pelvic ligament injury may be another potential suspected cause.

Treatment depends on the cause. Suprapubic cystostomy is only one potential treatment option to help empty the bladder. To drain urine, a percutaneous nephrostomy may also sometimes be used. A nephrostomy tube is used in this case.

2) Testicular Torsion

Testicular torsion is another important urological emergency that men need to be concerned about. This condition affects the testicles and can sometimes cause severe pain. When not treated quickly, there are serious complications that can develop.

Testicular torsion refers to a detachment of tissues that surround the testes. The testes are also known as testicles. In some cases, this causes the testicles to twist around a cord.

The cord is known as the spermatic cord. The condition causes a restriction in blood flow to the testes. In turn, symptoms will start to develop. Thus, the patient should visit an emergency department.

Swelling and pain are the main symptoms associated with testicular torsion. Some men may experience extreme pain in their testicles when the condition develops. In many cases, the pain originates in the area where the scrotum is located. A lot of men will only experience pain on one side of their scrotum.

Other symptoms may also signal testicular torsion. This is especially the case when the condition gradually develops. The one testicle may become more significant than the other. There may be redness on the scrotum too. Sometimes, the skin at the scrotum region may become darker.

Some men experience nausea as a symptom. There are also cases where the patient may vomit when they have testicular torsion.

This is a relatively rare urological emergency in men. Treatment should be initiated quickly. A doctor may start with a physical examination.

Untwisting of the spermatic cord is essential. If the condition is not treated within 12 hours, the man is at risk of serious complications. An orchidectomy may be needed in such a case. This refers to the removal of the affected testicle4.

When testicle torsion is not treated, fertility may be affected. Even though only a single testicle is needed to make sperm, it has been shown that sperm count is reduced when men experience complications due to testicular torsion.

3) Priapism

Priapism is a relatively rare problem among men but still poses as a serious medical condition. The condition refers to an erection that lasts too long. Generally, a man with priapism will find that their erection does not go away for several hours.

In some cases, the erection may occur without any sexual stimulation. This is a painful condition that can cause serious complications.

While a somewhat rare condition, there are a few men with a high risk of developing priapism. This is usually the case in men with sickle cell anemia5.

There are two types of priapism. This includes nonischemic priapism and ischemic priapism. Ischemic priapism is sometimes called low-flow priapism. High-flow priapism refers to the nonischemic type of condition.
With ischemic priapism, the penile shaft will be rigid. The glans, however, will be soft. With nonischemic priapism, the penile shaft will not be fully rigid.

Ischemic priapism is likely to cause a man to experience progressive pain in their penis. Both of these conditions will cause an erection that lasts for more than four hours.

Blood disorders are common causes of priapism. This includes leukemia and sickle cell anemia. Thalassemia and multiple myeloma may also cause priapism.

Some prescription medications can cause priapism too. This includes injection into the penis. The injection may contain phentolamine, papaverine, or alprostadil.

Some antidepressants have also been linked to a risk of priapism. This includes sertraline, bupropion, and fluoxetine. There are also alpha-blockers and certain drugs used for anxiety disorders that may increase the risk of priapism.

Blood thinners are also to be taken into account, along with hormone therapies. This includes testosterone replacement therapy. A penile fracture and other injuries may also be contributing factors. Treatment should be initiated quickly. This can prevent complications. Erectile dysfunction is a possible complication.

4) Paraphimosis

Paraphimosis is another urological emergency that only affects men. This condition only happens in men who have not undergone a circumcision procedure. The condition causes problems with the foreskin. The foreskin starts to swell. This causes the foreskin to become stuck. It won’t pull over the tip of the penis as it should.

When the foreskin swells, it causes blood flow to become restricted. This can lead to problems with the penis itself. Treatment is needed early on to prevent complications from happening. It is crucial to recognize paraphimosis as a severe condition. Men should also know that this is different from phimosis.

The primary symptom would be the fact that the foreskin will not return to its position where it covers the tip of the man’s penis. Swelling may be observed in the foreskin. There may also be pain symptoms that accompany the swelling. Sometimes, there may be a blue or dark red color on the tip of the patient’s penis.

Several potential causes have been linked to paraphimosis. This includes infections. Trauma that directly affects the genital region may also lead to paraphimosis. When the foreskin is pulled back forcefully, a man may also experience this condition.

Men with an extremely tight foreskin are at a higher risk for paraphimosis too.

Ice may be applied to the penis. This can help to reduce the inflammation. Blood or pus may sometimes be drained with a needle. Hyaluronidase is also sometimes injected into the penis. This helps to reduce the amount of swelling.

When the condition is severe, a small incision may be made. This can help to reduce the tension in the penis. In some cases, a doctor may also prefer to do a circumcision. This would completely eliminate the risk of experiencing paraphimosis again in the future.

5) Emphysematous Pyelonephritis

Emphysematous Pyelonephritis is a severe condition. It requires immediate medical attention to prevent severe complications from occurring. The condition is most prevalent among people with diabetes. This is an infection that affects renal parenchyma6.

This is considered a necrotizing form of bacterial nephritis. It is an acute and multifocal bacterial infection. The infection extends toward the renal capsule.

It causes the gas to accumulate within the kidneys, as well as the perinephric space. About 85% of cases where emphysematous pyelonephritis is diagnosed account for patients with diabetes. Women are more likely to develop this condition, but it can occur in men too.

In the majority of cases, the left kidney is affected by Emphysematous Pyelonephritis. Enterobacteriaceae is usually the type of bacteria that causes the infection. There are also cases where Candida or Streptococcus species causes Emphysematous Pyelonephritis.

Various symptoms may occur. Some include7:

  • Fever

  • Chills

  • Severe abdominal pain

  • Nausea

  • Vomiting

  • Flank pain

  • An increase in flank mass

  • Urinary symptoms

  • Pyuria

Sometimes, gross hematuria may be a symptom too. In most cases of Emphysematous Pyelonephritis, nephrectomy is the treatment of choice8. This means the affected kidney is removed during a surgical procedure. Surgery is not performed immediately, however.

The condition causes a severe case of illness. The patient will also be weak. Thus, transference to an intensive care unit is critical. The cardiorespiratory status needs to be stabilized before surgery is considered.

6) Fournier’s Gangrene

Fournier’s Gangrene is yet another serious condition. It can be life-threatening, primarily when the patient is not provided prompt treatment. The condition generally affects the genital area. This is a type of necrotizing fasciitis. Apart from the genitals, the perianal regions of the patient’s body may be affected as well.

Fournier’s Gangrene is caused by necrotizing fasciitis. This is a condition that causes the soft tissue in the body to die. In many cases, soft tissue is killed rather quickly. This is why prompt medical treatment is so necessary.

Different types of soft tissue may be affected by Fournier’s Gangrene and necrotizing fasciitis. This includes blood vessels, nerves, and even muscle tissue. Fournier’s Gangrene itself is considered an infrequent condition. When the disease develops, the patient needs to understand the urgency of the situation.

In most cases, men are the individuals affected by the condition. The penis and scrotum are two common locations for Fournier’s Gangrene in male patients. Different organisms may cause the condition. Affected tissue may be removed, especially when the condition is severe.

Conclusion

Several problems can occur with the urinary system. In men, these problems can sometimes damage the man’s reproductive health too.

Recognizing signs of common urological emergencies is important. This ensures action is taken before the man experiences complications. When signs of the problems noted in this post are experienced, men should see a doctor get a diagnosis and treatment.

Sources

  1. StatPearls [Internet]. (2019) Physiology, Renal. [online] Available at: https://www.ncbi.nlm.nih.gov/books/NBK538339/
  2. American Family Physician. (2018) Urinary Retention in Adults: Evaluation and Initial Management. [online] Available at: https://www.ncbi.nlm.nih.gov/pubmed/30277739
  3. Medtronic. About Urinary Retention. [online] Available at: https://www.medtronic.com/uk-en/patients/conditions/urinary-retention.html
  4. Urology Care Foundation. What is Testicular Torsion? [online] Available at: https://www.urologyhealth.org/urologic-conditions/testicular-torsion
  5. Mayo Clinic. Priapism. [online] Available at: https://www.mayoclinic.org/diseases-conditions/priapism/symptoms-causes/syc-20352005
  6. BJU International. (2011) Emphysematous pyelonephritis. [online] Available at: https://www.ncbi.nlm.nih.gov/pubmed/20840327
  7. Medscape. (2019) What is emphysematous pyelonephritis? [online] Available at: https://www.medscape.com/answers/245559-19970/what-is-emphysematous-pyelonephritis
  8. Medscape. (2017) Emphysematous Pyelonephritis (EPN) Treatment & Management. [online] Available at: https://emedicine.medscape.com/article/2029011-treatment

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