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

Urology Emergency management

Other urological emergencies

Presentations that require immediate senior assessment and early Urology involvement.

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Other emergency pattern flowchart

  1. Which emergency pattern?Perineal sepsis, prolonged erection, genitourinary trauma, penile injury or another rapidly evolving presentation.
  2. Unstable, septic, ischaemic or major trauma?Do not wait for a complete diagnostic work-up before escalation.
  3. Yes — Immediate senior reviewABCDE, analgesia, relevant sepsis/trauma/haemorrhage pathway and immediate Urology/surgical involvement.
    No — identify the patternFocused history, genital/perineal examination, urinalysis and targeted bloods/imaging.
  4. Time-critical diagnosis present?Fournier gangrene, painful rigid priapism, penile fracture, testicular torsion or significant urinary-tract trauma.
  5. Yes — condition-specific emergency planKeep nil by mouth where surgery is possible and document onset/mechanism; specialist management must not be delayed.
    No — discuss and safety-netAgree investigation, disposition and follow-up with the appropriate senior service.

Contact Urology immediately

UrosepsisUse the current NICE/DBTH sepsis pathway and seek urgent source control when obstruction is possible.
Fournier gangreneResuscitate, start the current severe-infection pathway and obtain immediate surgical/Urology review.
Testicular torsionTime-critical surgical assessment; do not delay for imaging when suspicion is high.
Renal or testicular traumaFollow the trauma pathway and involve Urology early; imaging and transfer depend on stability and injury pattern.
Penile fractureUrgent Urology assessment; record mechanism, timing, examination and urethral symptoms.
PriapismUrgent time-sensitive assessment. Determine duration and likely ischaemic versus non-ischaemic presentation with senior/Urology input.

Focused assessment

Fournier gangrene

  • Pain/swelling, erythema, necrosis, crepitus or foul discharge
  • Diabetes, immunocompromise, obesity or recent perineal procedure
  • Broad-spectrum antibiotics under current local guidance and urgent surgical debridement pathway

Priapism

  • Duration, pain, rigidity, medicines/recreational drugs, trauma and haemoglobinopathy risk
  • Painful fully rigid corpora suggest ischaemic priapism: a medical emergency
  • Urgent Urology assessment; specialist aspiration/blood gas and stepwise treatment

Trauma / penile fracture

  • Mechanism, haemodynamic state, haematuria, ability to void and blood at meatus
  • Renal injury can occur without haematuria
  • Stable suspected renal trauma generally requires contrast CT with appropriate phases

Scope

This page identifies escalation priorities only. Condition-specific procedural or drug instructions must come from current DBTH-approved pathways and the responsible specialist.