6 Urological Emergencies That Can Be Treated
Mar 29, 2018

Tracy Campbell
Core Spirit member since Dec 24, 2020
Reading time 7 min.

Urology is the medical specialty that deals with the urinary tract in both men and women and with the male reproductive system in men. Many urological problems are chronic, such as benign prostatic hypertrophy and urinary incontinence, and can be evaluated by a urologist in clinic. However, certain urological problems are emergencies and require prompt medical attention to ensure future health.

Even though urology is considered a surgical specialty, many urological problems—including emergencies—affect diverse organ systems. Thus, urologists must possess knowledge of internal medicine, gynecology, pediatrics, psychiatry, and more to best treat health issues. Furthermore, urologists, like all specialists, often consult with other types of physicians to provide optimal care.

According to the American Urological Association, there are seven urology subspecialties:

pediatric urology

renal (kidney) transplantation

calculi (kidney stones)

male infertility

female urology (think urinary incontinence)

neurourology (think voiding disorders and erectile dysfunction)

urologic oncology (cancer)

Here are six urological emergencies that you should know about. Being able to recognize their signs and symptoms will ensure prompt and effective treatment. Many of these conditions affect men; however, some affect both men and women.

1 Priapism

Jokes made about priapism belie the very serious nature of this condition. Priapism is defined as an erection that lasts more than four hours, which has nothing to do with sexual stimulation. Moreover, priapism can’t be relieved by ejaculation.

The most common form is low-flow or ischemic priapism. With priapism, the cavernosal bodies, which compose the shaft of the penis, are rigid while the glans or tip is flaccid. Furthermore, the penis is exquisitely tender, which is enough reason for most men to seek immediate medical attention.

Priapism is usually caused by obstruction of venous outflow; it is essentially a compartment syndrome of the penis.

About 25 percent of priapism cases are attributable to sickle cell disease, metastatic cancer or leukemia. Misuse of drugs, like cocaine, MDMA (ecstasy), methamphetamine (crystal meth), and marijuana, can also lead to priapism. Additionally, priapism can be an adverse effect of prescription medications like calcium-channel blockers, antipsychotics and warfarin (blood thinner).

Sustained decreases in arterial flow can result in the following:

Edema (swelling)





Necrosis (tissue death)

If left untreated, priapism can ruin future sexual function. Thus, swift treatment is necessary. The longer that priapism goes untreated, the greater the risk of permanent penile dysfunction. The goal of treatment is detumescence, or reduction in penile swelling.

Penile blood gases can be drawn to confirm diagnosis of priapism. Initially, priapism can be treated with the oral medications pseudoephedrine (a sympathomimetic) or baclofen (a muscle relaxer). Typically, however, these oral medications don’t work all that well so a large-gauge (18-gauge) needle is inserted into the corporal body or shaft of the penis and blood is aspirated or removed. Phenylephrine is then injected into the penis.

Pseudoephedrine, which activates the sympathetic system, is used to treat priapism because erections are mediated by parasympathetic input. Pseudoephedrine counters these parasympathetic effects. Of note, ejaculation is mediated by the sympathetic nervous system. (Medical students remember this distinction using the mnemonic “point and shoot.”)

In severe cases of priapism, a surgical shunt can be placed.

2 Testicular Torsion

Contrary to what some might have you believe, testicles can’t switch places. However, the spermatic cord, which supplies blood to the epididymis and testis, can twist.

Testicular torsion usually affects babies and adolescent boys but can occur at any age. Testicular torsion is rare in men aged 30 and older.

Two risk factors for testicular torsion include undescended testicles and testicular tumors.

Boys or men with testicular torsion experience immediate onset of sharp pain at a specific point followed by swelling of the testicle. Nausea and vomiting accompany the pain. Furthermore, boys and men who present with testicular torsion often have a history of such pain followed by repositioning of the testicle on its own.

Both this clinical history and physical examination are key in diagnosing testicular torsion. Ultrasound confirms diagnosis, but if evaluation by ultrasound is unavailable, immediate surgical exploration is necessary. In addition to confirming diagnosis, ultrasound can also rule out malignancy, which could be causing the testicular torsion.

As with priapism, time is of the essence. If surgery is performed within the first six hours, the chance of saving the testis is 80 percent. If more than 12 hours passes, the success rate for surgery drops to below 20 percent.

Surgery involves detorsion or untwisting of the testicle. Enough time is given to determine whether circulation to the testis resumes, and this revascularization is confirmed with Doppler ultrasound. In the case of necrosis of the testis, orchiectomy, or removal of the testicle, is performed.

3 Acute Urinary Retention

Acute urinary retention (AUR) occurs most commonly in men with benign prostatic hypertrophy (BPH) or enlargement of the prostate. Remember that the prostate surrounds the urethra, and its enlargement obstructs the flow of urine.

Although most common in men with BPH, AUR can occur as a result of a variety other things that inhibit bladder emptying including the following:

Diabetic neuropathy

Parkinson’s disease

Multiple sclerosis

Medications like opiates and anticholinergics

Blood clots secondary to hematuria

AUR often occurs in an inpatient or hospital setting when patients are taking medications that decrease bladder emptying and have limited ability to get out of bed and move around. Moreover, constipation, which is also common in hospital settings, can make urinary retention worse.

Typically, AUR is a painful condition. However, in some people with chronic decompensation of the bladder, this condition may not be painful. If left untreated, AUR can proceed to overflow incontinence, and then, after several days, to acute renal failure. Thus, AUR must be treated quickly to relieve pain and prevent complications.

Acute renal failure is first treated with placement of a urethral catheter to drain the urine. In men with BPH, a curved catheter is used because the prostatic urethra is positioned at an angle. If a urinary stricture is present, a urologist will need to relieve the AUR using cystoscopy, urethral dilators and so forth.

4 Fournier’s Gangrene

Fournier’s gangrene is rare. It’s a form of necrotizing fasciitis (“flesh-eating” disease) that affects the male genitals and perineum, or strip of real estate between the scrotum and anus.

As with any necrotizing fasciitis, infection eats through the soft tissue. With Fournier’s gangrene, this infection affects the dartos, Scarpa’s and Colles’ fascias.

Fournier’s gangrene progresses rapidly, and if treatment is delayed, bad things happen.

Here are some risk factors that contribute to the development of Fournier’s gangrene:

Poor perineum hygiene



Urethral strictures

Perirectal abscess


Infection with Fournier’s gangrene is pretty serious and includes the following signs and symptoms:

Scrotal pain

Perineal pain






Crepitus (crackling under the skin)

Of note with Fournier’s gangrene, the pain described by the patient is usually out of proportion to the physical exam.

Fournier’s gangrene is treated by removal or debridement of dead or necrotic tissue as well as administration of broad-spectrum antibiotics. Typically, more than one surgery is required, and once all the dead tissue is removed, reconstructive surgery is performed. In other words, successful treatment of Fournier’s gangrene is a long process.

Because the testes have their own separate blood supply, they can usually be saved in people with Fournier’s gangrene. The testes can be tucked into a “thigh pouch” during recovery to facilitate further management.

Proper wound care and frequent dressing changes are important during recovery. Furthermore, men with diabetes should have their glucose levels controlled and receive adequate nutrition to facilitate wound healing.

Research suggests that the mortality rate of Fournier’s gangrene ranges between 20 and 40 percent.

5 Paraphimosis

Paraphimosis occurs only in men who are uncircumcised and thus have a foreskin. Typically, this condition occurs in men who are lying supine in bed for long periods of time like in the hospital. In this position, the foreskin naturally retracts and edema or swelling collects in the penis, and penile pain ensues. In people with altered consciousness, this pain may go unnoticed for some time until it’s too late and the penis becomes necrotic secondary to decreased blood flow to the area (ischemia).

Treatment of paraphimosis involves manual reduction of the glands, pushing it back into its normal positioning. This procedure is very painful but necessary for proper treatment. Because this reduction is pretty painful, pain medications, penile blocks, and even sedation may be necessary.

Like other conditions detailed in this article, paraphimosis is a true medical emergency which requires prompt medical attention before permanent damage transpires.

6 Emphysematous Pyelonephritis

Pyelonephritis is a urinary tract infection of the kidneys. When this infection is caused by gas-producing bacteria, it’s called emphysematous pyelonephritis. Emphysematous pyelonephritis usually occurs in people with diabetes and is usually caused by E. Coli. This infection can also spread systemically and causes sepsis, which is life threatening. All in all, emphysematous pyelonephritis is pretty scary.

People with emphysematous pyelonephritis can expect treatment with intravenous antibiotics and supportive care. Additional treatment of pyelonephritis depends on how far the infection has spread within the kidney. If the infection is confined to the parenchyma, conservative treatment may work. This conservative treatment involves placement of a nephrostomy tube to drain the pus-filled material. If infection of the kidney is more widespread and sepsis is also present, surgical removal of the kidney (nephrectomy) may be needed.

7 Conclusion

Fortunately, many of these emergency urological presentations occur infrequently. Nevertheless, all these conditions and illnesses are emergencies and require prompt medical attention. If you or a loved one suspect any of these problems, please contact emergency services and your physician immediately. With all of these conditions, time is of the essence and prompt medical attention is necessary to prevent future disability or even death.

On a final note, as previously mentioned, most of these conditions affect men. Nevertheless, acute urinary retention can also affect women, and pyelonephritis usually affects young adult women.

Even if you suspect that you may be experiencing one of these conditions and it turns out that you’re not, it’s always a good idea to follow up with a physician about the symptoms that prompted your concerns in the first place. You may also request referral to a urologist for any concerns that you may have about your urinary tract and genitals. Please remember that your physician is there to help you attain the health care that you desire and need.

by Naveed Saleh For Very Well

Tracy Campbell

Leave your comments / questions for this practitioner

To write a comment please
Category filter
Concern filter
Type filter

All categories

Wellness Coaching
$20 USD
50 & Beyond Health & Wellbeing Discovery Session

Join me for a comprehensive look into what it will take to stay physically and mentally strong as you move through the second half of your life.

We all want to age without the fear of suffering from a chronic illness and still have the energy and strength to live the life we want.

The number one reason people fail to stay healthy as they age is the inability to consistently follow the right habits and behaviours for health transformation.

Through working with 1000's of clients over the last 20 years, I have been able to develop a coaching program that not only looks at nutrition, exercise, sleep and stress management but also how to develop the right mindset needed to succeed.

Having a plan is not as important as having the ability to implement it.

If you are someone who struggles to follow healthy habits consistently. Or you are someone who wants to learn more about what they need to do personally to avoid chronic illness. Then my 30-minute Discovery Session is ideal for you.

From the 30 minutes we spend together, we will go through in specific detail what it is you can do today when it comes to what to eat, how to get the most from exercise, how to develop a powerful sleep routine and how to build a healthy environment needed to live a healthy life.

And with over 20 years of coaching experience in the health & wellness industry, I have witnessed firsthand what it takes to consistently follow the right habits and behaviours for lasting change.

Expect to hear things that will challenge what you have always been told about nutrition, exercise, sleep and stress management. As someone who is over 50 and is stronger, fitter and healthier than I was in my 20s, 30s, & 40s, I am well-placed to know what works and doesn't as we move through this period of our lives.

Chris Deavin
Cognitive Psychology
$99 USD
Check Your Vibes! Find out how much Positive and Negative energy you have!

The Energy Leadership™ Index (ELI) assessment is the proprietary, research-backed assessment tool, created by iPEC, that takes something abstract, like the way a person views the world, and turns it into something tangible—a metric that you can see and feel and even reevaluate in the future.

You’ve probably taken personality tests, like Myers Briggs, DiSC, and Enneagram, but this is different. And transformational.

The ELI is an attitudinal assessment tool that captures how an individual currently perceives and approaches work and life. This means that you learn to make change happen in real-time when you encounter a moment of self-doubt, fear, or frustration.

With the awareness and insights gained through the Energy Leadership Index debrief, you have the opportunity to reshape your attitudes and worldview and transform your life into the one you envision.

Our worldview is the result of a combination of many different aspects: our past experiences, level of consciousness, perception of situations. Each of us has a unique combination of all seven levels of energy which, in turn, creates your typical viewpoints, perceptions, and beliefs about life.

Learning about your energetic makeup can help you to reframe your perspective, shift your consciousness, and increase your energy level as a result. Discover your unique energetic makeup by taking an ELI Assessment!

This comes with an hour debrief - As an FYI the price is what it is because there is a price to me- I have to pay the institution for the assessment and the scoring. Then I'll walk you thorugh your results.

David Jacks
Emotional Stress Release
$80 USD
healing session
Oxygen to the rescue! Great for Mental Health, Brain Injury, Detox, inflammation

Hyperbaric Oxygen Chambers are one of the oldest and safest treatments available. Oxygen detoxifies and heals. I was introduced to Hyperbaric Oxygen Chambers (HBOC) by Dr. Amen, a world reknown Psychiatrist. Oxygen is great for ADD, Mood Disorders, Trauma, Insomnia, Brain injuries, Wound healing and Inflammation.

This is from Dr. Amen's Clinic: "If you are struggling with a mental health condition, recovering from a concussion or traumatic brain injury (TBI), or dealing with cognitive or memory problems, hyperbaric oxygen therapy may be for you. People all over the world have reported recovering from a variety of conditions and experiencing dramatic improvements with this type of popular therapy."

Most people will feel a difference off of one treatment, especially if you typically have trouble sleeping. You will sleep like a rock.

David Jacks
Bach flower therapy
$35 USD

**This type of service is ONLY for clients who already know the remedies they want to take.

The standalone treatment bottle service is offered to US residents only .**

Iose Cocuzza, NC, CGP, BFRP

Related Articles

View All
Registered individuals enjoy all the possibilities of Core Spirit.