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Compared to other surgical fields there are relatively few emergencies in urology. For this reason we may become unaccustomed to caring for the acutely ill patient. Therefore, it is important to keep certain guiding principles in mind when confronted with a patient with an emergent urologic condition.

The first step in the management of urologic emergencies is to recognize the clinical significance. One must distinguish among genuinely life-threatening problems such as urosepsis or kidney rupture, urgent problems such as testicular torsion, and merely troublesome conditions such as cystitis in a healthy young woman. This may be more easily said than done. The practitioner is challenged both by the broad spectrum of urologic emergencies and by the even more numerous possible diagnoses mimicking urologic symptoms. For example, a patient with a long history of renal colic may present with acute flank pain, tachycardia, tachypnea, and hypotension. If renal ultrasound is normal (lack of upper tract dilatation) and urinalysis reveals no microhematuria, abdominal ultrasonography and/or computed tomography (CT), as indicated in a diagnostic algorithm, will lead to the correct diagnosis of ruptured abdominal aneurysm.

Major cardiac complications presenting as myocardial infarction, myocardial ischemia, cardiac failure, or life-threatening dysrhythmias contribute significantly to perioperative morbidity and mortality. Preventive strategies are of major importance since even despite adequate treatment these events are associated with poor outcome.

Anaphylaxis is a severe, life-threatening, generalized or systemic hypersensitivity reaction resulting from the sudden release of mast cell and basophil-derived mediators ( Kemp and Lockey 2002 ).

Urosepsis is caused by the invasion, from a focus in the urinary tract, of pathogenic or commensal microorganisms, or their constituents into the body, prompting a complex response by the synthesis of endogenous mediators responsible for the clinical phenomena ( Dinarello 1984 ; Van Amersfoort et al. 2003 ). Progress of sepsis to severe sepsis and septic shock correlates with an increased risk of death.

Fournier’s gangrene is a synergistic polymicrobial necrotizing fasciitis of the perineum and genitalia. It can progress to a fulminant soft tissue infection that spreads rapidly along the fascial planes, causing necrosis of the skin, subcutaneous soft tissue, and fascia, with associated systemic sepsis. If it is not diagnosed early and treated promptly, significant morbidity with prolonged hospital stay and even mortality will ensue.

In view of anatomical, physiological, and functional modifications, pregnancy can be responsible for many urological disorders, some of which may be life-threatening for the mother and fetus, requiring emergency treatment. Pregnancy often makes diagnosis difficult because many investigative procedures are inadvisable in pregnant women. The therapeutic possibilities are also limited, and many drugs and certain surgical procedures are contraindicated, present a risk of inducing labor, or are harmful to the fetus. Therefore, finding a compromise between the patient’s comfort and the normal development of the fetus is sometimes necessary. The risk-benefit ratio should be particularly well analyzed, which requires perfect knowledge of the particularities of urological disorders in pregnant women.

Pediatric urologic emergencies fortunately remain rare occurrences within the emergency department of a hospital or ambulatory care center. More commonly, congenital anomalies noted at birth, or benign lesions that prompt significant parental anxiety (such as benign scrotal conditions), often result in a visit to the emergency department for evaluation. These urgencies nonetheless require both the appropriate investigations and management in order to allay patient and parental concern. The objective of this chapter is to therefore cover common emergent and urgent pediatric urologic consultations encountered from birth through childhood. Prenatal diagnoses and their respective management options (such as fetal obstructive uropathy) will not be considered, as they are beyond the scope of this chapter and do not necessarily reflect the typical urologic conditions encountered in the emergency department. The chapter will progress via an anatomical top-down approach, emphasizing various conditions from adrenal disorders to scrotal and testicular pathology.

Autonomic dysreflexia is an acute syndrome characterized by abrupt onset of excessively high blood pressure caused by uncontrolled sympathetic nervous system discharge in patients with spinal cord injury (SCI). Autonomic dysreflexia is potentially life-threatening.

Failure of upper urinary drainage represents a relatively common urologic emergency. Obstruction of the upper urinary tract can be related to a variety of underlying clinical scenarios. In the current era, technologic advances have facilitated an accurate diagnosis and streamlined treatment. Nonetheless, correct management involves attention to presenting clinical signs and symptoms and an awareness of subtle nuances related to the underlying etiology. In this chapter, we describe the presenting signs and symptoms, differential diagnosis, radiographic testing, laboratory evaluation, acute management, follow-up, and pitfalls associated with failure of upper urinary tract drainage.