Urology

A

• Acute Prostatitis vs Chronic Pelvic Pain Syndrome — Diagnosis & Treatment

  Differentiate acute bacterial prostatitis from chronic pelvic pain syndrome. Treat acute infection with targeted antibiotics and avoid prostatic massage; CPPS requires multimodal, non‑antibiotic management.
• Acute Scrotum in Adults - Ultrasound Based Algorithm

  Acute scrotal pain in an adult requires immediate exclusion of testicular torsion. Color Doppler ultrasound is the preferred imaging test when it can be obtained without delaying surgery, but a high-probability torsion presentation warrants urgent urologic exploration even before imaging. Epididymitis, orchitis, incarcerated hernia, trauma, tumor, infarction, and Fournier gangrene remain important alternatives.
• Acute Urinary Retention - Bladder Decompression and Evaluation

  Place a catheter promptly, manage pain, monitor for post obstructive diuresis, and evaluate reversible causes such as medications and outlet obstruction.
• Acute Urinary Retention — Catheterization and Workup

  Acute urinary retention is painful or painless inability to empty the bladder with significant postvoid residual urine. Immediate bladder decompression is the priority, followed by evaluation for obstruction, medication effects, infection, neurologic disease, renal dysfunction, and complications that determine whether the patient can be discharged with a catheter or requires admission.
• Asymptomatic Microscopic Hematuria — Evaluation

  Microscopic hematuria is ≥3 RBC/HPF on a properly collected urinalysis with microscopy. After treating obvious benign causes and assessing renal disease, use the 2025 AUA/SUFU low/negligible-, intermediate-, and high-risk framework to decide between repeat urinalysis, cystoscopy with renal ultrasound, or cystoscopy with axial upper-tract imaging.

B

• Bladder Injury in Trauma - Cystography and Management

  Traumatic bladder injury should be suspected after pelvic trauma when gross hematuria, pelvic fracture, inability to void, suprapubic pain, or unexplained pelvic fluid is present. Retrograde CT cystography or conventional cystography is the diagnostic test when rupture is suspected. Intraperitoneal rupture generally requires operative repair, while uncomplicated extraperitoneal rupture is usually managed with catheter drainage and follow-up imaging.

E

• Emphysematous Pyelonephritis - Diabetes and Urgent Drainage

  Emphysematous pyelonephritis is a necrotizing gas-forming renal infection, strongly associated with diabetes and urinary obstruction, that can rapidly cause septic shock and multiorgan failure. Treatment requires immediate sepsis resuscitation, broad-spectrum IV antibiotics, CT definition of gas and obstruction, urgent drainage of an obstructed or infected collecting system, glucose control, and early urology/interventional radiology involvement. Nephrectomy is reserved for failure of less invasive source c
• Erectile Dysfunction — PDE5i to Advanced Therapies

  Assess cardiovascular risk and reversible causes. First‑line PDE5 inhibitors with patient‑centered titration; second‑line vacuum devices or intracavernosal injections; surgical prosthesis for refractory cases.

F

• Fournier Gangrene — Early Broad-Spectrum Antibiotics and Aggressive Debridement

  Rapidly progressive necrotizing infection of the perineum and genitalia; secure airway if needed, start broad-spectrum antibiotics covering polymicrobial flora, obtain urgent surgical source control with repeated debridements, and coordinate ICU care.

G

• Gross Hematuria with Clot Retention - Three Way Catheter and Irrigation

  Gross hematuria with clot retention is a urologic emergency because organized clot can obstruct the bladder outlet, causing severe pain, urinary retention, hydronephrosis, and continued bleeding. Immediate treatment is large-caliber catheter drainage, manual clot evacuation, and continuous bladder irrigation through a three-way hematuria catheter. Persistent bleeding, inability to clear clot, hemodynamic instability, or suspected upper-tract/structural injury requires urgent urology intervention.

I

• Infected Obstructing Stone — Urgent Decompression

  An infected obstructed urinary collecting system is a urologic emergency because antibiotics cannot reliably sterilize a pressurized obstructed kidney. Start sepsis care and broad-spectrum antibiotics immediately, obtain cultures, and arrange urgent decompression with a ureteral stent or percutaneous nephrostomy before definitive stone treatment.
• Interstitial Cystitis/Bladder Pain Syndrome — Evaluation & Management

  Diagnosis of exclusion characterized by chronic bladder/pelvic pain with urinary urgency/frequency. Start with education, diet modification, and pelvic floor PT; escalate to oral/intravesical therapies and neuromodulation.
• Ischemic Priapism - Aspiration and Phenylephrine

  Painful rigid erection over 4 hours is a compartment syndrome of the penis; perform aspiration and intracavernosal phenylephrine with irrigation and consider shunt for refractory cases.
• Ischemic Priapism — Aspiration and Phenylephrine

  Painful erection lasting more than 4 hours is a urologic emergency; aspirate corporal blood and inject phenylephrine promptly.
• Ischemic Priapism — Aspiration, Phenylephrine, and Surgical Shunts

  Painful erection >4 hours with dark, acidotic cavernosal blood. Provide analgesia, perform aspiration/irrigation, and inject intracavernosal phenylephrine; escalate to shunt procedures if refractory. Address sickle cell–related cases with hydration/oxygen/alkalinization and hematology involvement.
• Ischemic Priapism — ED Management

  Acute ischemic priapism is a painful, rigid erection lasting about 4 hours or longer caused by failure of cavernosal blood outflow. It is a compartment-like ischemic emergency. Diagnosis is usually clinical, supported by corporal blood gas or Doppler when the subtype is uncertain. Immediate aspiration, irrigation, and intracavernosal phenylephrine are first-line, with urgent urologic escalation when detumescence is not achieved.

M

• Male Infertility — Basic Workup & Referral

  Start with two semen analyses, endocrine labs when indicated, and targeted exam; treat reversible causes and refer for advanced reproductive techniques or surgical options when appropriate.

N

• Nephrolithiasis (Renal Colic) — ED Evaluation & Treatment

  Nephrolithiasis causes renal colic when a urinary stone obstructs the ureter. Most uncomplicated stones pass spontaneously, but infection with obstruction, acute kidney injury in a solitary or functionally single kidney, uncontrolled symptoms, or persistent obstruction requires urgent urologic involvement. Noncontrast CT is the most sensitive diagnostic study, while ultrasound is preferred in pregnancy and useful in younger or recurrent-stone patients to reduce radiation. NSAIDs are first-line analgesia whe
• Nephrostomy Tube Obstruction or Infection - Initial Care

  A malfunctioning nephrostomy tube can cause recurrent obstruction, urinary extravasation, infection, sepsis, or loss of renal function. Initial care distinguishes mechanical obstruction or dislodgement from pyelonephritis and infected obstruction. Stabilize septic patients, obtain cultures, confirm tube position and patency, avoid forceful flushing, and involve interventional radiology or urology early when drainage is impaired.

O

• Obstructing Ureteral Stone with Infection - Urgent Decompression

  Fever and obstruction with pyelonephritis or sepsis require urgent urinary drainage by ureteral stent or nephrostomy plus broad antibiotics.

P

• Paraphimosis — Emergency Reduction

  Paraphimosis is entrapment of a retracted foreskin behind the glans, producing a constricting band that can impair venous and eventually arterial flow. It is a urologic emergency treated with prompt analgesia, edema reduction, and manual replacement of the foreskin; failed reduction or ischemia requires urgent urologic intervention.
• Paraphimosis & Phimosis — Emergency Reduction & Care

  Paraphimosis is an emergency: reduce edema and restore foreskin position to avoid necrosis. Phimosis is chronic and treated with topical steroids or circumcision based on severity/age.
• Penile Fracture - Urgent Surgical Repair

  Penile fracture is rupture of the tunica albuginea of an erect corpus cavernosum, typically producing an audible snap or pop, immediate detumescence, pain, swelling, and ecchymosis. It is a clinical surgical emergency. Prompt operative exploration and tunical repair provides better erectile and curvature outcomes than conservative treatment. Evaluate for associated urethral injury when there is blood at the meatus, gross hematuria, or inability to void.
• Peyronie Disease — Evaluation & Treatment

  Fibroproliferative disorder causing penile curvature and deformity. Differentiate active vs stable phase; treat with intralesional collagenase and modeling for eligible curvature; surgery for severe or complex deformities.

R

• Renal Mass Incidentaloma — Workup & Partial Nephrectomy Candidacy

  For incidental renal masses, stratify by size and imaging features. Favor nephron‑sparing surgery (partial nephrectomy) when feasible; active surveillance for small (<2 cm) masses in select patients; consider thermal ablation for poor surgical candidates.

T

• Testicular Torsion - Emergency Detorsion and Orchiopexy

  Acute scrotal pain with high riding testis and absent cremasteric reflex is torsion until proven otherwise; attempt immediate detorsion and urgent surgical fixation.
• Testicular Torsion — Do-Not-Delay Detorsion and Bilateral Orchiopexy

  Acute unilateral testicular pain with high-riding transverse testis and absent cremasteric reflex. Do not delay for imaging—attempt manual detorsion if trained (“open book”) and arrange immediate surgical exploration with bilateral orchiopexy.
• Testicular Torsion — Do‑Not‑Miss, Manual Detorsion, and Urgent Orchiopexy

  Severe unilateral scrotal pain with high‑riding, horizontal testis and absent cremasteric reflex suggests torsion. Do not delay urology; consider manual detorsion if OR is not immediately available; urgent exploration with bilateral orchiopexy.
• Testicular Torsion — Urgent Detorsion

  Sudden unilateral scrotal pain with high riding testis and absent cremasteric reflex is a urologic emergency; obtain emergent urology consultation for surgical detorsion and fixation.
• Testicular Torsion — Urgent Management

  Testicular torsion is a time-critical urologic emergency caused by twisting of the spermatic cord and loss of testicular perfusion. A high-probability clinical presentation warrants immediate urologic exploration without delaying for imaging. Doppler ultrasound is useful when the diagnosis is uncertain and can be obtained without delaying surgery. Manual detorsion is a temporizing maneuver, not definitive treatment.

U

• Urethral Stricture — Diagnosis & Management

  Suspect with weak stream and recurrent UTIs; evaluate with uroflow, post‑void residual, urethroscopy, and retrograde urethrogram. Choose dilation/DVIU for short bulbar strictures; prefer urethroplasty for longer/recurrent disease.

V

• Varicocele — Indications for Treatment

  Treat palpable varicocele in infertile men with abnormal semen parameters or in adolescents with testicular asymmetry; microsurgical subinguinal ligation preferred; avoid treating incidental subclinical varicoceles.