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

  Use focused history and exam to triage acute scrotal pain; prioritize torsion when suspected and use Doppler ultrasound to evaluate for epididymitis, torsion, or other causes when time allows.
• 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

  Painful inability to void with suprapubic fullness; decompress with catheterization, treat precipitating causes, and plan follow up for trial of void.
• Asymptomatic Microscopic Hematuria — Evaluation

  Use risk‑based evaluation for ≥3 RBC/hpf on two properly collected urinalyses. Exclude infection/benign causes first. Cystoscopy and upper tract imaging are guided by age, sex, smoking, and risk factors.

B

• Bladder Injury in Trauma - Cystography and Management

  Differentiate extraperitoneal and intraperitoneal bladder injury with retrograde cystography; manage extraperitoneal with catheter drainage and intraperitoneal with operative repair.

E

• Emphysematous Pyelonephritis - Diabetes and Urgent Drainage

  Life threatening gas forming renal infection common in diabetes; start broad IV antibiotics, urgent drainage, and intensive monitoring with multidisciplinary care.
• 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

  Manage hemodynamics, place a large three way catheter, evacuate clots, begin continuous bladder irrigation, and address anticoagulation and source control.

I

• Infected Obstructing Stone — Urgent Decompression

  Urologic emergency with sepsis risk; start broad antibiotics and arrange emergent drainage via ureteral stent or nephrostomy.
• 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

  Low-flow priapism >4 hours: aspirate and irrigate corporal bodies and inject intracavernosal phenylephrine; treat underlying causes including sickle cell disease.

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

  Provide NSAID analgesia and antiemetics; image with noncontrast CT (or ultrasound in pregnancy); start tamsulosin for distal ureteral stones 5–10 mm; urgent urology for obstructed infected stone.
• Nephrostomy Tube Obstruction or Infection - Initial Care

  Assess for obstruction or infection in patients with nephrostomy tubes; ensure drainage, obtain cultures, start antibiotics when indicated, and arrange urgent exchange when blocked or infected.

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 & 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.
• Paraphimosis — Emergency Reduction

  Retracted foreskin trapped behind the glans causing venous congestion and pain; reduce promptly with compression, osmotic methods, or dorsal slit when necessary.
• Penile Fracture - Urgent Surgical Repair

  Sudden pop with swelling and deformity during intercourse suggests tunica albuginea rupture; evaluate urethra and perform urgent repair.
• 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

  Urologic emergency with time-dependent salvage; do not delay surgery for imaging when classic findings; attempt manual detorsion if immediate surgery not available.

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.