Urology Emergencies for Rural Surgeons: Presented at the ARSI Conference at Kulu, November 2016


Unlike the other surgical specialties’ Urology does not have too many emergencies? Hence most of the Urologists do not plan for emergencies and the emergencies are left to the general surgeons to treat. It is very important for the rural surgeons to know the basics in handling the urological emergencies. In general, the urological emergencies cause a lot of stress to the patients and require immediate relief. For instance it is terrible to have urinary obstruction and ureteric colic could be as painful as labor pain. We have a look at some of the common ones that were presented at the annual conference of the Association of Rural Surgeons of India.


Urinary retention could be either acute or chronic. Sometimes chronic retention can present with overflow incontinence. The following table lists the various causes of retention.


It is more common in men and is due to bladder outflow obstruction secondary to prostate. Men especially in the rural areas ignore the lower urinary tract symptoms and retention comes as a surprise and is often precipitated by postponing voiding [for example while traveling]. Sometimes bleeds or prostatic infarcts or infection could be the precipitating factor. It is uncommon in women and is related to prolapsed uterus or stones. Some factors are common to both.

Most of the time simple catheterization should suffice for relieving the obstruction. Antibiotics should be given prior to the procedure that should be carried out under sterile conditions. Temporary relief could be provided using spinal or long needle to aspirate the bladder and remove as much urine as possible to get sufficient time for preparation. Plenty of lubricant should be used and curve of the urethra should be in mind to make sure the catheter is pushed gently in the correct direction.

If catheterization is not successful then Suprapubic bladder drainage is carried out. It should be remembered that later the Urologists need to use this track for scopies especially in case of stricture urethra and hence it should be place at a sufficiently higher level above the pubic bones. Rapid decompression of the distended bladder can cause severe bleeding and hence the decompression should be slow by clamping the tubing of the Urosac.
It is important to check the hourly urine output after relieving the obstruction and replace the output with normal saline if it exceeds 200 ml per hour. This is to avoid acute renal failure and electrolyte imbalance. Serum potassium levels should also be monitored.


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