Initial assessment of the urological patient

General principles

Management must be based on the clinical presentation, hemodynamics, laboratory findings, and available imaging. In an emergency, an investigation is requested to answer a specific question, not merely “for completeness.”

Clinical assessment

The physician assesses severity and identifies infection, bleeding, obstruction, ischemia, or organ injury. Establish:

• symptom onset and progression;
• temperature and urine output;
• a history of surgery and instrumentation;
• the presence of stones, catheters, or stents;
• use of anticoagulants and immunosuppressants.

Danger signs

As in Chapter 1 (see Section 1.3).

Minimum diagnostic workup

• CBC, creatinine, electrolytes.
• Urinalysis; culture if infection is suspected.
• In a systemic inflammatory response: lactate and blood cultures.
• Ultrasonography is the initial investigation.
• CT as indicated.

Emergency management

Practical principle: assess ABCDE first, then address pain, vital signs, and any potentially reversible cause in parallel.

In infected obstruction, the initial goal is to restore drainage and treat infection; definitive treatment of the cause follows stabilization.

Algorithm