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Emergencies
Overview
Some urological conditions have serious or life-threatening consequences and require immediate medical attention. These medical emergencies include
• acute urinary retention,
• Fournier’s gangrene,
• paraphimosis,
• priapism, and
• testicular torsion.
While these conditions are unrelated and have different symptoms, they all require urgent care. Delaying treatment in some cases can result in surgical removal of testicles (orchiectomy), permanent inability to achieve an erection (impotence), or death.
Acute Urinary Retention
Acute urinary retention is the sudden inability to urinate and is usually symptomatic of another condition that needs treatment.
Incidence and Prevalence
Anyone can experience acute urinary retention. The causes and rate of occurrence varies greatly between genders until about age 60, when men are more often affected as a result of benign prostatic hyperplasia (BPH).
Risk Factors
Kidney stones, prostate cancer, prostatitis, and BPH are risk factors in men. Women with a history of kidney stones or urinary tract infections (UTIs), pregnant women, and those who have had recent gynecological surgery are at higher risk.
Causes
Acute urinary retention is caused by obstruction in the bladder or the tube that carries urine from the bladder outside the body (urethra), a disruption of sensory information in the nervous system (e.g., spinal cord or nerve damage), or a situation or event that causes the bladder to become distended.
Factors associated with acute urinary retention include the following:
• Alcohol consumption
• Allergy or cold medications containing decongestants or antihistamines
• Certain prescription drugs (e.g., ipratropium bromide, albuterol, epinephrine) that cause the urethra to become narrow
• Delaying urination for a long time
• Long period of inactivity or bed rest
• Prolonged exposure to cold temperatures
• Spinal cord injury/nerve damage
• Surgery (e.g., complication of anesthesia)
• Urinary system obstruction (e.g., benign prostatic hyperplasia (BPH), kidney stones)
• urinary tract infection
Signs and Symptoms
Acute urinary retention produces severe lower abdominal pain, a distended abdomen, and/or the sudden inability to pass urine.
Complications that may develop with untreated urinary retention include bladder damage and chronic kidney failure.
Diagnosis
Diagnosis is based on a sudden lack of urinary output and bladder swelling (distention) observed during a physical examination.
Treatment
Treatment should be obtained within 5 hours of the onset of symptoms to avoid the development of complications. The underlying cause of urinary retention (e.g., kidney stones) must be diagnosed and treated as well.
A small tube (catheter) is inserted into the bladder through the urethra to drain the urine. Catheterization relieves pain and distention.
Prognosis
Depending on the underlying cause, the recurrence rate can be up to 70% within a week after initial treatment. BPH is responsible for most recurrences.
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