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Following continent bladder substitution, acute life-threatening situations are rare, but there are complications that require immediate attention. In this chapter we focus on emergencies that are specific for continent bladder replacement. Emergencies specific to surgery, such as blood loss, lymphoceles, thrombosis, abscess, and anastomotic insufficiency are not discussed.

Despite the remarkable improvement in the results of renal transplantation during the last decade, surgical and medical complications continue to contribute significantly to the morbidity and mortality of allograft recipients. Moreover, in live-donor renal transplantation the risks to living donors are small, but real. The objective of the present chapter is to review the complications that may affect the safety of both the donors and recipients as well as the efficacy of the graft. A special emphasis on the surgical complications in both the donors and recipients will be done. Other medical problems that may interfere with the proper diagnosis and prompt management of surgical emergencies will be discussed shortly.

There are limited reports of open salvage procedures in the urological literature. Surgical outcome reports from institutions across the world are readily available; however, in-depth discussion about associated complications is sparse. Many reports simply list complications in table format. This stems from the reluctance to discuss complications and associated failures. Although failed operations due to technical error may be difficult to accept, the documentation and recognition of predisposing factors will limit further mishaps. Some outcomes are unavoidable due to the condition of the patient and these cases should serve as reminders that surgery cannot cure every ailment. Being open to sharing our failures and heeding the warnings of others will allow surgeons and patients to gain something positive from these complicated situations.

Owing to the nature of the urinary tract, the urologist is afforded the opportunity to address many urgent or emergency procedures using endoscopic and percutaneous access. Such procedures are often less physiologically stressful to the patient and can be performed with less intensive preparation than their open counterparts. A large part of urological practice is endoscopic or percutaneous in nature, but this chapter is limited to those procedures that are frequently performed in the urgent or emergent setting.

Percutaneous transcatheter embolization is defined as the intravascular deposition of autologous blood clots or alternatively particulate, liquid, or solid agents to produce intentional vessel occlusion.

We would like to present the case of a 65-year-old man who underwent a radical cystoprostatectomy plus ureterosigmoidostomy (Mainz Pouch II) in 1996, due to a high-grade invasive transitional cell carcinoma of the bladder. He had an uneventful postoperative period and was free of disease in his 2-year follow-up visit (1998). Clinically, he had total control over his anal voiding, with no diurnal or nocturnal urine leakage. However, 2 years after surgery his intravenous pyelogram showed a stenosis of the left ureterosigmoidal anastomosis, and sonography revealedmild to moderate ureterohydronephrosis. He also had an obstructive 1-cm left renal pelvic stone.

Urological emergencies are rare for the andrologist. However, a patient with priapism can challenge any urological surgeon. Early in my career, I followed the normal paradigm for relief of priapism, but each successive step met with less than spectacular results. Initially at least, my efforts appeared successful, a distal glanular shunt would lead to rapid detumescence, but within hours the penis would again be rigid, and the patient would again be crying in pain. The standard of carewould next be to performamore proximal surgical shunt such as a shunt between the corpus spongiosum and the corpus cavernosum. This was done diligently, as I had learned during residency. Yet within hours I would receive a call from the nurses on the floor that the penis was again rigid and the patient in pain. After cavernosal blood gases would demonstrate ongoing anoxia, off I would go to the operating room for yet a third attempt at surgical relief, now utilizing a saphenous vein to corpus cavernosum shunt. I was not alone in this experience, for as the local andrologist I would receive calls fromprivate practice urological surgeons in my locale with questions about patients with priapism whose medical course followed a similar track.

A 31-year-old male was evaluated in the emergency department. He complained of a painful erection that had been present for 48 h. He had been at a party where he used intranasal cocaine and methamphetamine as well as oral sildenafil. His erection was not coincident with any erotic stimulus. He denied any similar past episodes, as well as recent or remote perineal trauma. His erectile function had always been good. His past medical history was unremarkable except for frequent alcohol and tobacco use. His family history was unremarkable for sickle cell anemia, hematologic malignancies, or bleeding dyscrasias.

The technological advancements in this last quarter of a century have been a great help to both patients and doctors, but their constant evolution brings home to us that we are still a long way from achieving perfection.

Total rupture of the posterior urethra is a topic that interests all surgeons: general surgeons, orthopedic surgeons, and urological surgeons, because it is a serious trauma occurring with ever greater frequency and presenting with severe pathology since the urinary and sexual dysfunction of the patient, who is generally young, interferes with his family and social environment.