1. UROLOGICAL EMERGENCY

2. Symptoms PAIN: Renal colic (ureteric colic) Testicular torsion
Phimosis/Para-Phimosis/Balanoposthitis
VOIDING DIFFICULTY: BPH
(Bladder tamponde)
HEMATURIA: Pain or Painless
TRAUMA: Penile fracture
Renal/Peri-Renal contussion

3. Renal Colic
Symptom complex that is characteristic for the presence of obstructing urinary tract calculi
Caused by distention of the renal capsule or stretching of the ureter
Local mechanisms: inflammation, edema, hyperperistalsis, and mucosal irritation etc.

4. Renal Colic Mostly occurs during night or early morning
Abrupt in onset
Partially obstructing, continuously moving calculus appears to create the greatest amount of colic

5. Renal Colic Pain radiation of renal colic:
flank, abdomen, groin, testis (UPJ stone), labia majora
Midureteral stone:
lateral flank and abdomen
Stone near UVJ:
scrotum or vulva
urinary frequency and urgency

6. Associated symptoms and signs of renal colic
Nausea
Vomiting
Ileus
Intestinal stasis
Diarrhea

7. Differential diagnosis of renal colic
Gastroenteritis
Acute appendicitis
Colitis
Salpingitis

8. Renal Colic
PE U/A
KUB IVP
Renal echo CT scan (Helical CT)
R-P

9. Treatment of renal colic at ER
Narcotic analgesics
NSAIDS
Calcium channel blockers
Hydration
ESWL
Consult urologist

10. Admission Indications
Concurrent UTI ( not pyuria)
Solitary kidney & complete obstruction
Uncontrolled pain
Intractable emesis
Large stone ( diameter > 0.5 cm)

11. Acute Scrotal Pain Testicular Torsion
Potentially infarction and infertility
Epididymitis/Orchitis

12. Testicular Torsion Differential Dx: Epididymitis/Orchitis
Sudden onset of severe pain
Radiated to inguinal canal & LLQ/RLQ
Boys to young man
4 hours of warm ischemia
Color dupplex & emergent exploration
Manual detorsion: The open book method
Consult Urologist stat

13. Renal Function Evaluation
ACUTE RENAL FAILURE
Oliguria < 500 ml/ 24 hrs
Prerenal Renal Postrenal
Urine Na < > > 40
Urine osmo > < < 400
U/S cre ratio > 40: < 20:1 < 20:1
BUN/cre ratio > 20: : <10: 1