Emergency urology in children

Special considerations

• Different causes of disease (congenital anomalies, testicular torsion, infections).
• Difficulty assessing symptoms, as a child may be unable to describe pain.
• Drug doses and instrument sizes must be adapted.
• A legal representative provides informed consent. When life or an organ is immediately threatened and consent cannot be obtained in time, act within the exceptions provided by law and document the grounds for doing so.

Common emergencies

• Testicular torsion.
• Acute urinary retention (congenital urethral valves, neurogenic bladder).
• Urinary tract infections (pyelonephritis).
• Trauma (kidney, urethra).
• Urinary tract stones (rare).

Diagnosis

• Ultrasonography is the modality of choice.
• CT in trauma, with dose reduction.
• Voiding cystourethrography to assess valves and reflux.

Emergency management

• Testicular torsion: when clinical suspicion is high, perform immediate surgical exploration and orchiopexy without delaying for imaging. Late presentation does not remove the need for surgery.
• Acute retention: catheterization with an age-appropriate size or cystostomy.
• Pyelonephritis: age-appropriate intravenous antibiotics and hospital admission.
• Renal trauma: conservative treatment if stable; surgery only for ongoing bleeding.
• Urethral trauma: perform urethrography when clinically suspected; avoid repeated blind attempts and use expert controlled access or cystostomy as indicated.

Algorithm