Organization of emergency urological care

Definition and primary objective

The primary objective of emergency urology is to recognize a life-threatening or organ-threatening condition within the first few minutes while providing analgesia, stabilization, and safe referral or transfer.

Initial clinical assessment

The physician assesses severity and identifies infection, bleeding, obstruction, ischemia, or organ injury. At the same time, establish:

• symptom onset and changes in pain;
• temperature and urine output;
• previous surgery and instrumentation;
• the presence of stones, catheters, or stents;
• medications affecting hemostasis and immune status.

Danger signs (“red flags”)

• Hemodynamic instability.
• Fever with rigors, hypotension.
• Altered mental status.
• Oliguria/anuria, rising creatinine.
• A solitary functioning kidney or bilateral obstruction.
• Severe pain unresponsive to analgesics.
• Significant bleeding or signs of ischemia.

Minimum diagnostic workup

• Complete blood count.
• Creatinine, electrolytes.
• Urinalysis.
• If infection is suspected: urine culture before starting antibiotics, provided this does not delay treatment.
• If there is a systemic inflammatory response: lactate, blood cultures, and assessment of organ dysfunction.
• Ultrasonography is the initial bedside imaging modality.
• CT is used to clarify the level of obstruction, identify traumatic injury, or establish an alternative diagnosis.

Emergency management

The choice of drainage method depends on:

• the anatomy and level of obstruction;
• the severity of infection;
• equipment availability and the team's experience;
• the subsequent treatment strategy.

Principle: when life or organ function is threatened, definitive treatment of the cause is staged. For example, in infected obstruction, restore urinary drainage and treat the infection first; undertake definitive stone removal after stabilization.

Algorithm

Common errors

• Substituting a single laboratory result for an assessment of the patient's illness severity.
• Delaying lifesaving drainage while awaiting additional investigations.
• Automatically interpreting any positive urine test as a clinically significant infection without assessing symptoms and the systemic response.
• Failing to establish a follow-up review point and a definitive management strategy after emergency intervention.

Chapter references: EAU Guidelines on Urolithiasis (2026), Urological Infections (2026), Urological Trauma (2026); Surviving Sepsis Campaign: Adult Guidelines (2026).