DRIUrology clinical guide
Draft clinical resource — local clinical approval required before intranet publication

Urology Emergency management

Urological emergencies

Initial DRI Emergency Medicine assessment, escalation and referral routes.

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Emergency front-door flowchart

  1. Urological presentationRecord observations, assess ABCDE and identify the dominant presentation.
  2. Immediate threat?Instability, sepsis, major bleeding, anuria/AKI, infected obstruction, torsion, necrotising infection or significant trauma.
  3. Yes — act nowResuscitate, use the relevant DBTH emergency pathway and obtain immediate ED senior and Urology/surgical review.
    No — continueComplete a focused history, examination, urinalysis and presentation-specific investigations.
  4. Choose the presentationOpen the focused pathway below; reassess and escalate if physiology or diagnosis changes.

Start here

  1. Assess ABCDE, observations and NEWS2 where applicable.
  2. Treat immediate threats and use current DBTH sepsis, major-haemorrhage or trauma pathways when indicated.
  3. Choose the presentation below and contact Urology early for instability, diagnostic uncertainty, obstruction with infection, torsion or failed initial management.
Acute urinary retentionImmediate bladder drainage and escalationGross haematuriaClot retention, bleeding severity and cancer referralRenal colic and pyelonephritisImaging, analgesia, sepsis and infected obstructionAcute testicular pain and paraphimosisTime-critical torsion assessment and urgent reductionOther emergenciesConditions requiring immediate specialist discussion