What Are Urological Emergencies? Which Symptoms Need A&E?
In some urological problems every hour counts; with sudden testicular pain, being unable to pass urine or stone pain with fever, go to A&E without waiting.
In short
The main urological situations in which you should go to the emergency department without waiting are sudden, severe testicular pain (testicular torsion), being unable to pass urine at all, kidney stone pain with fever, a painful erection lasting more than 4 hours (priapism), rapidly spreading redness and pain in the genital area (Fournier's gangrene), and injuries to the genital area or kidney. In these situations, early treatment can prevent the loss of an organ and serious complications.
Most urological complaints can be assessed at a booked appointment. In some situations, however, every hour that passes matters for saving an organ or preventing a serious infection. Recognising the symptoms below prevents unnecessary waiting and delayed treatment.
Why is sudden testicular pain an emergency?
Particularly in adolescent boys and young men, sudden, severe testicular pain is one of the most important urological emergencies. The most dangerous cause is testicular torsion: the cord that supplies the testicle twists around itself and the testicle’s blood supply is cut off.
Symptoms:
- Severe testicular pain that wakes you from sleep or starts suddenly
- Nausea and vomiting
- Swelling of the testicle, which appears pulled up
- In young children, the pain may be described only as tummy ache
The chance of saving the testicle is high in the first hours and decreases as time passes. For this reason, do not wait for the pain to go away; go straight to A&E. Because surgery may be needed, it is best not to eat or drink on the way. For other urological problems in children, see the paediatric urology page.
When is being unable to pass urine an emergency?
Being unable to pass any urine even though the bladder is full is called acute urinary retention. It is most common in older men with an enlarged prostate. Cold and flu medicines, alcohol, constipation or the period after an operation can trigger it.
If you cannot pass urine and have increasing pain and a feeling of fullness in the lower abdomen, go to A&E. The bladder is usually emptied quickly with a catheter, after which treatment aimed at the cause is planned.
What should you do if kidney stone pain comes with fever?
Kidney stone pain alone can be very severe, but the real danger is when the stone blocks the urinary tract and the kidney becomes infected. This can turn into a serious infection that spreads rapidly into the bloodstream.
Go to A&E without waiting if you have:
- Fever and shivering together with stone pain
- A marked decrease in the amount of urine
- Stone pain and only one kidney
- Pain that cannot be controlled with medicines, or vomiting that will not stop
In a blocked and infected kidney, the flow of urine is first restored with a stent or a thin tube (catheter) placed into the kidney, and the stone is treated later. For stone treatment options, see the kidney stone treatment page.
Why is a prolonged erection (priapism) dangerous?
An erection that is unrelated to sexual desire, lasts more than 4 hours and is usually painful is called priapism. It can be caused by certain medicines, injections into the penis, blood disorders (for example sickle cell anaemia) and certain substances.
In prolonged priapism, the penile tissue does not receive enough oxygen, and permanent erectile dysfunction can develop. Rather than feeling embarrassed or waiting, go to A&E as soon as possible.
What can rapidly spreading redness in the genital area be a sign of?
Fournier’s gangrene is a serious, rapidly progressing soft tissue infection that starts in the genital area and around the anus. Diabetes, conditions that suppress the immune system and alcohol use increase the risk.
Warning signs:
- Rapidly increasing pain, swelling and redness of the scrotum or around the anus
- Darkening, bluish discolouration or blackening of the skin
- A foul-smelling discharge
- High fever and deterioration in general condition
This condition requires urgent antibiotic treatment and surgery; do not wait at home.
What should you do if the foreskin gets stuck behind the head of the penis?
In uncircumcised men and boys, when the foreskin has been pulled back and gets stuck behind the head of the penis and cannot be brought forward again, this is called paraphimosis. The trapped skin quickly swells and can disrupt the blood supply to the head of the penis. It can develop after a catheter is inserted, after washing or after sex.
Trying to force the skin back can increase the swelling. If there is marked swelling, pain and a change in colour of the head of the penis, go to A&E without delay. In most cases, the skin can be put back into place by hand with suitable pain relief.
Is blood with clots in the urine an emergency?
Visible blood in the urine does not always indicate a serious problem, but it must always be investigated. Urgent assessment is needed if clots are being passed with the bleeding, if you cannot pass urine because of clots, if you feel dizzy and weak, or if you take blood thinners. Even painless bleeding that happened only once calls for a visit to a urologist for further tests, particularly in smokers.
When should you go to A&E after an injury to the genital area or kidney?
After a blow, a fall or a road accident, the following signs need urgent assessment:
- Penile fracture: A cracking sound during forceful movement of the erect penis, sudden loss of erection, and rapidly developing swelling and bruising. It is usually repaired surgically.
- Blood coming from the urinary opening or being unable to pass urine after an injury: the urethra may have been injured. In this case, do not try to insert a catheter yourself or have one inserted before you have been assessed; the assessment should be carried out by a urologist.
- Blood in the urine after a blow to the flank or side: This may be a sign of kidney injury.
- After a blow to the testicle: pain and swelling that do not go away.
What should you bear in mind on the way to A&E?
- Note down when the symptoms started.
- If surgery is possible, stop eating and drinking.
- Take a list of the medicines you take with you, especially blood thinners.
- Bring your previous test and scan results.
- Do not wait for the pain to go away, and do not try medicines on your own.
When should you see a urologist?
With the emergency symptoms listed above, go to the nearest emergency department without waiting. After emergency treatment, it is important to book a follow-up appointment with a urologist so that the underlying cause (such as an enlarged prostate, stone disease or recurrent infection) can be treated in a planned way.
Op. Dr. Mücahit Kabar sees patients in Bursa (Nilüfer), Turkey, at Özel Medicabil Nilüfer Hastanesi (weekdays 08:30–12:00, +90 444 8 112) and Özel Jimer Hastanesi (weekdays 13:00–17:00, +90 444 45 67). Appointments for follow-up are booked through the hospitals’ online booking pages or appointment lines. Consultations are held in English or Turkish; the hospitals’ international patient departments can arrange interpreters for other languages. For questions or to share reports after emergency treatment, you can send a WhatsApp message to +90 541 622 54 82. Further details are on the contact page.
Dr. Kabar discussed this topic on a TV programme
Ürolojik hastalıklarda acil olan durumlar · Bursada Bugün
Frequently asked questions
If sudden testicular pain goes away, do I still need to see a doctor?
Yes. In testicular torsion, the cord can sometimes untwist by itself and the pain may ease, but the risk of it twisting again remains. Even if sudden testicular pain has passed, you should be examined by a urologist soon afterwards.
What can I do at home if I cannot pass urine?
A warm shower or sitting in warm water can sometimes help, but it is not right to wait for a long time when the bladder is full and there is pain in the lower abdomen. If you cannot pass urine at all, go to A&E; the bladder can usually be emptied easily with a catheter.
Is kidney stone pain always an emergency?
Stone pain can be very severe but is not always dangerous. If it comes with fever and shivering, if you are passing much less urine, if you have only one kidney or if the pain does not go away with medicines, the situation is urgent and should be assessed without waiting.
What happens if a prolonged erection does not go away on its own?
In a painful erection that is unrelated to sexual desire and lasts more than 4 hours, the penile tissue does not get enough blood flow. If treatment is delayed, permanent erectile dysfunction can develop. For this reason, you should go to A&E without waiting.
This page was prepared by Op. Dr. Mücahit Kabar for general information and does not replace a medical consultation. The right diagnosis and treatment for you are decided after examination and tests.