Emergency Urological Disease in Men: Symptoms, Quick Identification and Effective Action

Urologic emergencies significantly impact the functioning of the urinary tract or male reproductive organs and require immediate attention to prevent severe complications, including loss of function, severe infections, and even death. Recognising these emergencies and acting swiftly is crucial. Below, we delve into some common urological emergencies in men, their symptoms, and recommended actions.

Testicular Torsion

Testicular torsion occurs when blood vessels in the testicle twist and cut off the testicle's blood supply. If the blood vessels or vessels are not untwisted quickly to restore blood flow (within six hours for best results), the testicle may atrophy and die, necessitating removal. Symptoms of testicular torsion are:

• Sudden, severe testicular pain
• Swelling in the scrotum
• Abdominal pain
• Nausea and vomiting

Immediate medical intervention is essential. Surgery is often required to untwist the cord and restore blood flow. Delayed treatment can lead to testicular loss.

Acute Urinary Retention

Acute urinary retention is the sudden inability to urinate, often caused by an obstruction in the urinary tract or nervous system issues. It can result from various bladder conditions, including benign prostate enlargement, prostate cancer, bladder stones, blood clots, urinary tract infections, and nerve damage. Some symptoms of acute urinary retention include:

• Painful, urgent need to urinate
• Inability to urinate despite the urge
• Lower abdominal pain and swelling

Emergency catheterisation is required to drain urine from the bladder and relieve pain. Sometimes, diversion of urine is done through a tube in the lower abdomen (SPC). Further treatment addresses the underlying cause, which could range from benign prostatic hyperplasia (BPH) to neurological disorders.

Fournier's Gangrene

Fournier's gangrene is a life-threatening necrotising fasciitis affecting the perineum, scrotum, and genital area. It can result from various organisms and is most commonly associated with diabetes, alcoholism, or immune suppression. Symptoms of Fournier’s gangrene include:

• Severe pain in the genital area
• Swelling and redness in the genital and anal areas
• Fever and malaise

Immediate surgical debridement and broad-spectrum antibiotics are crucial. Delays in treatment can lead to widespread infection and high mortality rates.

Priapism

Priapism is a prolonged, often painful erection not related to sexual stimulation, lasting more than four hours. It is a failure of blood to drain from the penis after it flows there during the erection's onset. If treatment is delayed, this can lead to scarring and damage to the spongy tissue of the penis leading to a permanent inability to get an erection. The two types of priapism are ischemic priapism and non-ischemic priapism. The symptoms of priapism are:

• Erections lasting for more than 4 hours
• Penile pain
• Rigid penile shaft with soft glans.

Ischemic priapism is a medical emergency. Initial treatment is therapeutic aspiration with or without irrigation of the corpora. If this fails, intracavernous injection of sympathomimetic drugs is the next step. Non-ischemic priapism, often caused by trauma, may resolve on its own but should still be evaluated by a urologist.

Paraphimosis

Paraphimosis occurs when the foreskin, once retracted behind the glans penis, cannot be returned to its normal position, leading to swelling and impaired blood flow. If not immediately treated, tissue death can occur, and gangrene may develop. Symptoms include:

• Foreskin and the tip of the penis can get swollen and painful.
• Unable to return the foreskin to its normal position over the tip of the penis.
• Discoloration of the glans.

Manual reduction is often attempted first by squeezing the tip of the penis to help the foreskin move back over the glans. However, severe cases may require a dorsal slit or circumcision to relieve the constriction and restore blood flow.

Ureteric colic

Many times in patients with kidney stones, there can be severe colicky pain of sudden origin, suggesting the dropping of the stone from the kidney to the ureter; it may be associated with nausea or vomiting and needs urgent care in the form of intravenous analgesics to break the pain cycle, later on, the patient may be evaluated for the stone and may require medical or surgical treatment.

Acute kidney infection (Emphysematous Pyelonephritis)

This is a severe infection of the kidney, especially in patients with uncontrolled diabetes mellitus, leading to high-grade fever with chills, nausea, vomiting, pain in the flanks and falling blood pressure in case of severe infection with septicemia. Infection is usually caused by gas-forming bacteria in the kidney. These patients require emergency hospitalisation, intravenous fluids and broad-spectrum antibiotics. They may require drugs to control low blood pressure and, sometimes, require urgent diversion of urine from the kidney in the form of DJ stenting or PCN (internal or external tubes for diversion). In some patients, the infection can be quite severe and even fatal.

Urological emergencies in men require prompt recognition and swift medical intervention. Knowing the symptoms and appropriate actions can significantly improve outcomes. If you or someone you know experiences symptoms of any urological emergency, seek immediate medical attention. Early intervention is the key to successful treatment and recovery.

Understanding these emergencies empowers men to act decisively, ensuring timely medical care that can prevent long-term complications and preserve health and quality of life.