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Anheuser P, Michels G, Gakis G, Neisius A, Steffens J, Kranz J. [Position paper of the working group Urological Acute Medicine]. UROLOGIE (HEIDELBERG, GERMANY) 2023; 62:936-940. [PMID: 37115300 DOI: 10.1007/s00120-023-02090-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/23/2023] [Indexed: 04/29/2023]
Abstract
Emergency patients with acute genitourinary system diseases are frequently encountered in both outpatient and clinical emergency structures. It is estimated that one-third of all inpatients in a urology clinic initially present as an emergency. In addition to general emergency medicine knowledge, specialized urologic expertise is a prerequisite for the care of these patients, which is needed early and specifically for optimal treatment outcomes. It must be taken into account that, on the one hand, the current structures of emergency care still lead to delays in patient care despite positive developments in recent years. On the other hand, most hospital emergency facilities need urologic expertise on site. In addition, politically intended changes in our health care system, which drive an increasing ambulantization of medicine and condition a further centralization of emergency clinics, become effective. The aim of the newly established working group "Urological Acute Medicine" is to ensure and further improve the quality of care for emergency patients with acute genitourinary system diseases and, in consensus with the German Society of Interdisciplinary Emergency and Acute Medicine, to define precise task distributions and interfaces of both specialities.
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Affiliation(s)
- Petra Anheuser
- Klinik für Urologie, Asklepios Klinik Wandsbek, Alphonsstr. 14, 22403, Hamburg, Deutschland.
- Universitätsklinik und Poliklinik für Urologie, Universitätsklinikum Halle (Saale), Halle (Saale), Deutschland.
| | - Guido Michels
- Klinik für Akut- und Notfallmedizin, St. Antonius-Hospital gGmbH, Eschweiler, Deutschland
| | - Georgios Gakis
- Universitätsklinik und Poliklinik für Urologie, Universitätsklinikum Halle (Saale), Halle (Saale), Deutschland
| | - Andreas Neisius
- Abteilung für Urologie und Kinderurologie, Krankenhaus der Barmherzigen Brüder Trier, Medizincampus der Universitätsmedizin Mainz, Trier, Deutschland
| | - Joachim Steffens
- Klinik für Urologie und Kinderurologie, St. Antonius-Hospital gGmbH, Eschweiler, Deutschland
| | - Jennifer Kranz
- Universitätsklinik und Poliklinik für Urologie, Universitätsklinikum Halle (Saale), Halle (Saale), Deutschland
- Klinik für Urologie und Kinderurologie, Uniklinik RWTH Aachen, Aachen, Deutschland
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GÜN M, ÇAKMAK F, İKİZCELİ İ, ÖZKAN S, İPEKCİ A, BİBEROĞLU S, AKDENİZ YS. Evaluation Of Urological Emergency Cases Admitted To Emergency Department. ARCHIVES OF CLINICAL AND EXPERIMENTAL MEDICINE 2022. [DOI: 10.25000/acem.1219948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Aim: Especially in recent years, with the increase in the number of patients admitted to the emergency services the number of urological emergencies is increasing. Some of these require immediate attention. There are not enough studies on urological emergencies in our country. In this study, we aimed to investigate the demographic data of patients over the age of 18 who presented to the emergency department with non-traumatic urological emergency complaints.
Materials and Methods: This study was designed based on a 6-month prospective, cross-sectional study. After obtaining the approval of the ethics committee, patients over the age of 18 with urological emergency complaints were examined between 06.11.2019 and 06.05.2020.
Results: The ratio of urological emergencies to all patients was found to be 1.5%. 56.76% (n: 231) of the patients were male and 43.24% (n = 176) were female. In the study was found 44.7% of the patients to be urinary tract infection, 31.45% renal colic, 8.8% hematuria, 6.88% acute urinary retention. In our study, urology consultation was requested for 19% of urological emergency patients. Emergency intervention was applied to 21.13% of all urological emergency cases. Emergency operation was required for 1.47% of the patients. 10.81% of the patients required hospitalization.
Conclusion: As a result, urological emergencies are common. Among these cases, there may be diseases that require urgent intervention or surgery. It is very important for the patients the emergency physicians who evaluate the patient first to make a careful and meticulous evaluation and to make a urology consultation if necessary.
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Affiliation(s)
| | - Fatih ÇAKMAK
- İSTANBUL ÜNİVERSİTESİ - CERRAHPAŞA, CERRAHPAŞA TIP FAKÜLTESİ
| | | | - Seda ÖZKAN
- İSTANBUL ÜNİVERSİTESİ - CERRAHPAŞA, CERRAHPAŞA TIP FAKÜLTESİ
| | - Afsin İPEKCİ
- İSTANBUL ÜNİVERSİTESİ - CERRAHPAŞA, CERRAHPAŞA TIP FAKÜLTESİ
| | - Serap BİBEROĞLU
- İSTANBUL ÜNİVERSİTESİ - CERRAHPAŞA, CERRAHPAŞA TIP FAKÜLTESİ
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Diallo TO, Diabaté I, Barry M2, Bah OR. [Urological emergencies in a regional hospital in Senegal: a 20-month retrospective study]. Pan Afr Med J 2022; 42:302. [PMID: 36425543 PMCID: PMC9653540 DOI: 10.11604/pamj.2022.42.302.34654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 06/02/2022] [Indexed: 06/16/2023] Open
Abstract
INTRODUCTION urological emergencies are diverse and varied, and are frequently encountered in urological practices. The purpose of this work was to study the epidemiological features and management of urological emergencies at the regional hospital of Kolda, Senegal. METHODS we conducted a retrospective and descriptive study collecting data from the medical records of all patients admitted as a urological emergency for 20 months (January 2020 and August 31, 2021). RESULTS urological emergencies accounted for 3.6% of admissions to the Emergency Department and for 20.4% of urological consultations. The average age of patients was 51.9 ± 21.5 years, ranging from 1 to 98 years. Urinary retention was the most common urological emergency, observed in 249 cases (57.3%), followed by urogenital infections 89 (20.5%). Renal colic affected 48 (11%) of patients. Emergency management was based on urinary catheterization, which was performed in 193 patients (44.3%). The most common surgical procedures were suprapubic catheterization (42 patients; 51.9%) and emergency scrotal exploration (15 patients; 18.6%). CONCLUSION in our context, urological emergencies are dominated by urinary retention due to prostatic disorders and urethral stenosis. Traumatic emergencies are uncommon.
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Affiliation(s)
- Thierno Oumar Diallo
- Service d´Urologie, Hôpital Régional de Kolda, Kolda, Sénégal
- Service d´Urologie de l´Hôpital National Ignace Deen, Université de Conakry, Conakry, Guinée
| | | | - Mamadou 2 Barry
- Service d´Urologie de l´Hôpital National Ignace Deen, Université de Conakry, Conakry, Guinée
| | - Oumar Raphiou Bah
- Service d´Urologie de l´Hôpital National Ignace Deen, Université de Conakry, Conakry, Guinée
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Boissier R, Savoie PH, Long JA. [Epidemiology of urological emergencies in France]. Prog Urol 2021; 31:945-955. [PMID: 34420876 DOI: 10.1016/j.purol.2021.07.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 07/21/2021] [Indexed: 11/25/2022]
Abstract
INTRODUCTION To report the epidemiology and the care pathway for urological emergencies in France for the official report of the 115th Congres Francais d'Urologie. METHODS We made a request to the Institut de Veille Sanitaire and its network Surveillance Sanitaire des Urgences et des Décès (SurSaUD®). Within this system, the OSCOUR® network (Organisation de la surveillance coordonnée des urgences) centralizes in real time the data of emergency visits from more than 720 emergency departments throughout the national territory (>93% of the national territory covered by the OSCOUR® network). For each emergency defined by its CIM-10 code, the following data were collected from 2014 to 2019: age, gender, length of stay and post-emergency status (hospitalization vs. return home). RESULTS From 2014 to 2019, urological emergencies represented on average 4.2% of all emergencies, with an average 591,080±66,782 passages/year including 25% that resulted in hospitalization. Infectious disease represented 35% of all urological emergencies. The 3 most common urologic emergencies were: renal colic, acute urine retention and hematuria for men; acute cystitis, pyelonephritis and renal colic for women. CONCLUSION In an analysis of the OSCOUR® (Organisation de la surveillance coordonnée des urgences) registry, we determined the epidemiological profiles of the main urological emergencies with contemporary data.
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Affiliation(s)
- R Boissier
- Université Aix-Marseille, Service d'Urologie et de transplantation Rénale, CHU La Conception, AP-HM, Marseille, France.
| | - P H Savoie
- Service d'urologie, Hôpital d'Instruction des Armées Sainte Anne, BP 600, 83800 Toulon cedex 09, France
| | - J-A Long
- Service d'urologie et de la transplantation rénale, CHU Grenoble, France; TIMC-IMAG CNRS 5525, France
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Hamza BK, Ahmed M, Tolani MA, Awaisu M, Lawal AT, Oyelowo N, Bello A, Maitama HY. Spectrum of urological emergencies and surgical interventions in a single tertiary health center. Afr J Emerg Med 2021; 11:223-226. [PMID: 33680746 PMCID: PMC7905443 DOI: 10.1016/j.afjem.2021.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 01/22/2021] [Accepted: 02/02/2021] [Indexed: 11/18/2022] Open
Abstract
Objectives Emergency urologic conditions are relatively common, albeit rarely life threatening, there is often a need for prompt and expedient management in order to avert severe or permanent morbidities. This study aimed to evaluate the spectrum of Urologic emergencies and interventions offered in a tertiary hospital in Nigeria. Patients and methods We retrospectively reviewed the records of patients who were managed in our institution for emergency urologic conditions over a period of 6 years (2011–2017). The data extracted included; the demographic information, diagnosis and the treatment offered. The data obtained were analyzed using SPSS version 20. Data were displayed using mean +/− standard deviation and percentages. Results The records of a total of 681 patients were retrieved and they span across almost all ages with age range or 2–90 years. Urinary retention was the commonest emergency seen, accounting for 51.7% of the patients. Testicular torsion was the next most common (10%), others are bilateral ureteric obstruction and priapism with 5.4% and 5.3% respectively. Suprapubic cystostomy (SPC) was the commonest operative procedure performed (37.6%). The age range for patients with urinary retention was 3–90 years, though the peak incidence was in the 7th decade (37.3%). Patients with testicular torsion were young adults between the ages of 11 and 44 years. Conclusion Urinary retention was the commonest urologic emergency followed by testicular torsion. Though urethral catheterization was successful in most patients urinary retention, making it the commonest procedure. SPC was the commonest emergency operative procedure performed. Other emergencies occurred sporadically.
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Olivieri V, Ruggiero G, Abate D, Serra N, Fortunati V, Griffa D, Forte F, Corongiu E. Fatal infections in andrology. Atypical clinical presentation of a Fournier's disease. Arch Ital Urol Androl 2020; 92. [PMID: 33016049 DOI: 10.4081/aiua.2020.3.213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Accepted: 03/27/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Fournier disease (FD) is a worrisome infection of genital area caused by a polimicrobial infection and characterized by a rapid progression to necrosis. Scrotum, perineum and lower abdomen represent the primary sites of origin. Clinical presentation and laboratory strongly suggest FD, but if not precociously diagnosed, it may quickly evolve into septic syndrome and patient's death. CASE REPORT A 62 years old Caucasian male presented for fever and penile gross oedema recently occurred. No history of previous urinary tract infection, hematuria or genital trauma was referred. He did not complain any storage or voiding low urinary tract symptom (LUTS); no foci of infection in genitoperineal area was observed nor urethral discharge. The ultrasound (US) revealed a disomogeneous broad thickening of subcutaneous tissues with increased vascularity on Color-Doppler. When the penis was manipulated in order to reduce oedema, retract foreskin and evaluate the glans, clinical parametres rapidly worsened and the patient developed a septic shock with blood pressure falling down, dyspnoea and tachyarrhythmia, and he was fastly sent to Intensive Care Unit where it has been hemodynamically stabilized and subjected to antibiotic therapy. Considering the clinical absence of gangrene's foci, we opted for a conservative treatment by maintaining bladder catheter and drug therapy.
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Affiliation(s)
- Valerio Olivieri
- Division of Urology, Ivrea civil Hospital (ASL TO4), Ivrea (Turin).
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A systematic review of dedicated models of care for emergency urological patients. Asian J Urol 2020; 8:315-323. [PMID: 34401338 PMCID: PMC8356060 DOI: 10.1016/j.ajur.2020.06.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2019] [Revised: 01/20/2020] [Accepted: 04/21/2020] [Indexed: 11/09/2022] Open
Abstract
Objective To systematically evaluate the spectrum of models providing dedicated resources for emergency urological patients (EUPs). Methods A search of Cochrane, Embase, Medline and grey literature from January 1, 2000 to March 26, 2019 was performed using methods pre-published on PROSPERO. Reporting followed Preferred Reporting Items for Systematic Review and meta-analysis guidelines. Eligible studies were articles or abstracts published in English describing dedicated models of care for EUPs, which reported at least one secondary outcome. Studies were excluded if they examined pathways dedicated only to single presentations, such as torsion, or outpatient solutions, such as rapid access clinics. The primary outcome was the spectrum of models. Secondary outcomes were time-to-theatre, length of stay, complications and cost. Results Seven studies were identified, totalling 487 patients. Six studies were conference abstracts, while one study was of full-text length but published in grey literature. Four distinct models were described. These included consultant urologists allocated solely to the care of EUPs (“Acute Urological Unit”) or dedicated registrars or operating theatres (“Hybrid structures”). In some services, EUPs bypassed emergency department assessment and were referred directly to urology (“Urological Assessment Unit”) or were managed by other dedicated means. Allocating services to EUPs was associated with reduced time-to-theatre, length of stay and hospital cost, and improved supervision of junior medical staff. Conclusion Multiple dedicated models of care exist for EUPs. Low-level evidence suggests these may improve outcomes for patients, staff and hospitals. Higher quality studies are required to explore patient outcomes and minimum requirements to establish these models.
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Lippi G, Sanchis-Gomar F. Exertional hematuria: definition, epidemiology, diagnostic and clinical considerations. Clin Chem Lab Med 2019; 57:1818-1828. [PMID: 31188754 DOI: 10.1515/cclm-2019-0449] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 05/01/2019] [Indexed: 01/22/2023]
Abstract
Exertional hematuria can be considered a subcategory of exercise-induced hematuria, characterized by painless appearance of erythrocytes in urine after recent physical exercise, not directly attributable to external traumatic injuries to the genitourinary system, and spontaneously resolving with rest. Although its frequency has enormous heterogeneity, depending on the athlete population, duration and intensity of exercise, technique used for identifying or quantifying hematuria and relative diagnostic thresholds, what clearly emerges from the scientific literature is that a certain degree of hematuria is commonplace after non-contact sports, especially running. This exertional hematuria, which appears self-limiting, may be attributable to some frequently concomitant causes, involving organs of the genitourinary system, and mostly encompassing bladder or urethral injuries. Renal injuries caused by internal movements, vascular spasm and ischemia are also potential causes of increased glomerular permeability to erythrocytes, whilst the presence of preexisting genitourinary diseases cannot be ruled out, especially when post-exercise hematuria is recurrent or endures. Therefore, whenever hematuria is observed in a random urine specimen, recent sports performance (especially running) should be investigated and urinalyses scheduled for the following days. When no temporal association of hematuria with exercise can be found, when genitourinary traumas have been excluded or hematuria persists for >72 h, specific diagnostic investigations should be planned to identify possible genitourinary diseases.
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Affiliation(s)
- Giuseppe Lippi
- Section of Clinical Biochemistry, University of Verona, Piazzale LA Scuro, 37134 Verona, Italy
| | - Fabian Sanchis-Gomar
- Department of Physiology, Faculty of Medicine, University of Valencia and INCLIVA Biomedical Research Institute, Valencia, Spain
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