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Urological Emergencies
Winter Park Urology Associates is here to serve Orlando for all your Urological
Emergency Needs. Our staff is ON-CALL 24 hours a day, via main number 365
Days a Year!
Hours: 8:30 a.m. -
5:00 p.m., weekdays Tel: 407.897.3499
Emergencies: Staff is on-call 24 hours a day, via main number please call and have the staff team notified if this is after normal
practice hours.
There are seven conditions that are considered urological emergencies. If you
suspect you have one of these, you should seek medical attention from your
urologist or an emergency room physician as soon as possible.
Acute Urinary Retention
This is defined as
the sudden (acute) inability to urinate. It is a relatively common problem that
causes agonizing suprapubic pain and demands urgent relief. Causes include
benign prostatic hyperplasia, a noncancerous enlargement of the prostate gland;
urethral stricture, a narrowing of the tube that carries urine from the bladder
out of the body; blood clots; prostate cancer; bladder neck contracture;
myopathic bladder; neurogenic bladder, a loss of bladder control caused by
damage to the nerves controlling the bladder; reactions to medications, such as
allergy or cold medications containing decongestants or antihistamines, which
may produce a side effect that prevents the bladder opening from relaxing; and
psychogenic problems, nonorganic problems originating in the mind. Initial
management involves draining the bladder by the least invasive method possible,
usually some form of catheterization. Once this is accomplished, the underlying
cause of the acute episode of retention should be determined and treated.
Testicular Torsion
Testicular torsion
is a surgical emergency characterized by a sudden onset of pain in the scrotum;
the pain may alternately be located to the lower abdomen or inguinal region.
Although torsion can occur at any age, the peak incidence is in adolescence,
with a smaller peak in pediatric patients between 0 and 3 years.
The
condition usually manifests itself as a painful testicular mass. It occurs when
one or more of the blood vessels that supply the testicle twists back on itself,
cutting off blood supply to the testicle. Unless detorsion (untwisting) of the
blood vessel(s) can be accomplished and blood flow restored promptly, necrosis
(death of the tissue) will occur and the testicle will die. In most cases, if
this can be accomplished within 6 hours of the onset of pain, the testicle will
survive and remain normal. After 12 hours or more the rate of testicular salvage
drops precipitously to about 20%. After detorsion the testicle usually is
"tacked" in place so that repeat torsion does not occur. This is done via a
procedure known as an orchiopexy. Because there is a high incidence of torsion
occurring on the side opposite the initial problem, an orchiopexy usually is
performed on the other testicle as well.
Priapism
This condition is a prolonged, painful erection of the penis that can persist
for anywhere up to a few days. Such erections are not associated with sexual
arousal or activity, but are caused by a failure of blood flowing into the penis
to drain back as it would normally. Because there is little room for blood to
circulate in the penis, it quickly becomes stagnant, acidifies and loses oxygen.
Without oxygen, the red blood cells become stiff and even less able to drain out
of the penis.
In most cases, priapism
results either from the use of certain medications or medical conditions. Penile
injections used to treat some forms of impotence can cause priapism, although
this usually occurs only if a man inadvisably increases his dosage. In some
cases, psychiatric medications, such as antidepressants, seem to cause priapism,
although precisely how this occurs is uncertain. Certain medical conditions and
diseases also can cause priapism. Such conditions typically thicken the blood or
cause red blood cells to lose their flexibility and mobility; sickle-cell anemia
and leukemia are the most common causes.
If not treated early
enough, priapism can scar the penis and lead to impotence. Fortunately, the pain
and discomfort of priapism induces most men experiencing the condition to seek
treatment within four to six hours. Treatment typically involves draining the
stagnant blood with a needle inserted into the side of the penis. Medications
that act on the blood vessels also can be injected to help shrink blood vessels
and decrease blood flow into the penis.
Fournier's Gangrene
This is a massive, rapidly progressive gangrenous infection of the genitalia. It
begins as an extension of an infection from urinary, perianal, abdominal or
retroperitoneal sites, or as a secondary result of local trauma. It can be
caused by a wide range of aerobic and anaerobic organisms. It can occur in any
age group, but most often occurs in persons 50 or older. Most patients have an
underlying systemic disease, of which diabetes is the most common.
Immunosupression, alcohol abuse, steroid use and other infections also are
associated with Fournier's gangrene. It often presents rapidly with severe pain
of the penis, scrotum or perineum, with rapid progression from erythrema
(redness) to necrosis (death of the tissue) sometimes within hours. Other cases
have a slower, more insidious, onset, with generalized symptoms of malaise,
fever, chills or sweats and genital discomfort.
This is a serious
condition, with mortality rates up to 50% being reported. The mainstay of
treatment is aggressive surgical debridement (cutting away of infected or
necrotic tissue) and triple drug antibiotic therapy. Flagyl, ampicillin and
gentamicin are the usual first choices. An exploration of the abdomen and
diverting colostomy occasionally are necessary as well.
Paraphimosis
This is a condition particular to uncircumcised males and those who may not have
been appropriately or completely circumcised. It is characterized by an
inflammation of the foreskin of the penis, causing the foreskin to become
inflamed and swollen. The inflammation may be caused by infection or may be
associated with poor personal hygiene; it occasionally develops after direct
trauma to the area, which results in swelling. When this occurs, the foreskin
becomes retracted behind the head (glans) of the penis and cannot be returned to
its normal position covering the head. In effect, it becomes stuck behind glans,
where it acts like a tourniquet, trapping the return flow of blood from the
penis within the glans and producing even greater swelling.
If the condition
persists, the inflow of blood to the head of the penis also will be cut off,
causing ischemia (lack of oxygen) and possible necrosis (death) to that part of
the penis. If the condition is not relieved rapidly, gangrene may develop. The
probable outcome is excellent if the condition is diagnosed and treated rapidly.
Autonomic Dysreflexia
This is a syndrome characteristic of persons who have suffered a spinal cord
injury. It is characterized by a major sympathetic nervous response to visceral
stimulation. It usually occurs three to six months after the initial injury.
Symptoms include sweating, piloerection (hairs standing on end), a pounding
headache, bradycardia (slow heartbeat), and a sense of "impending doom" on the
patient's part. Autonomic dysreflexia can occur in response to stimulation of
the bladder, urethra or rectum in patients with a spinal cord lesion at T5 or
higher. Treatment is to drain the bladder with the placement of a catheter.
Lower Extremity Weakness in
Advanced Prostate Cancer
Occasionally patients present with untreated metastatic prostate cancer and
signs that spinal cord compression is causing lower extremity weakness and lax
anal sphincter tone. These patients need emergency treatment (i.e., neurosurgery
or radiation therapy) to decrease their tumor mass and relieve the spinal cord
compression.
Anytime there is a Urological Emergency, please call (407)
897-3499 and speak to our office.
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