Urological Emergencies & Obstruction
Recognise infected obstruction, retention and acute scrotal emergencies without delaying specialist care.
Quick revision ↓ Medical Dictionary
01Renal colic and dangerous alternatives
Colicky flank pain radiating towards the groin may accompany a ureteric stone, but assess observations, urine output, renal function and pregnancy possibility where relevant. Aortic disease, abdominal pathology and infection can mimic stone pain. Provide appropriate analgesia and use imaging selected for the clinical context. Absence of visible haematuria does not safely exclude a stone.
02Infected obstruction
Fever or sepsis with an obstructed collecting system is a urological emergency. Obtain urgent specialist help, cultures where feasible and prompt antimicrobial treatment under local guidance. Drainage with a ureteric stent or nephrostomy may be necessary for source control. Definitive stone treatment is generally deferred until infection is controlled; antibiotics alone may leave the obstructed infected system untreated.
03Retention and safe drainage
Painful inability to pass urine with a distended bladder suggests acute retention. Evaluate the history, medication, neurological findings and possible urethral injury. Trained staff arrange appropriate drainage; repeated traumatic catheter attempts should be avoided. After relief of substantial obstruction, monitor urine output and electrolytes because post-obstructive diuresis can produce fluid and electrolyte depletion.
04Acute scrotum
Sudden severe testicular pain, nausea or an abnormal testicular lie raises concern for torsion. Arrange immediate surgical or urological assessment. Imaging may help selected uncertain presentations but must not delay intervention when suspicion is high. Age or an initially atypical examination does not reliably eliminate torsion; epididymal infection and other alternatives require considered assessment rather than assumption.
05Haematuria and continuity
Visible haematuria needs evaluation even if it settles or occurs during anticoagulant treatment. Clot retention, haemodynamic compromise or obstruction requires urgent care. Document renal function, imaging findings and a plan for remaining investigations. Any temporary stent or catheter needs an identified owner, review date and removal or exchange plan to prevent a lost device causing later harm.
High-Yield Revision
- Sepsis plus urinary obstruction requires urgent source-control assessment.
- Suspected torsion is time critical.
- Temporary urinary devices need a dated follow-up plan.
Common Pitfalls
- Assuming every flank pain is uncomplicated renal colic.
- Repeating traumatic catheter attempts without escalation.
References & Further Reading
Read the relevant guideline sections alongside these original clinical teaching cases. Local pathways, available services and individual patient factors determine care.
Reference review: 27 September 2026. Consult current local protocols for prescribing, procedures and escalation.