Chapter 67 · Practical algorithms

Clinical case reviews: common errors and how to avoid them

Error 1: Delayed drainage in infected obstruction.

Solution: remember that antibiotics without drainage are ineffective in obstruction.

Error 2: Repeated blind catheterization attempts in the presence of signs of urethral injury.

Solution: with urethral bleeding, urinary retention, perineal hematoma, or a relevant mechanism, perform urethrography and proceed to expert controlled access or cystostomy.

Error 3: Conservative treatment of penile fracture.

Error 4: Overlooking a solitary kidney in renal colic.

Solution: always establish whether the patient has a solitary kidney—this makes management urgent.

Error 5: Prescribing antibiotics without a culture in complicated infection.

Solution: obtain a culture before antibiotics, provided this does not delay treatment.

Error 6: Underestimating TUR syndrome.

Solution: stop irrigation, assess ABC, check sodium, osmolality, and neurological status; use 3% NaCl for severe symptoms according to the protocol, and a diuretic only for hypervolemia.

Error 7: Omitting ultrasonography when obstruction is suspected.

Solution: ultrasonography is a rapid and readily available way to detect hydronephrosis.

Error 8: Using qSOFA to rule out sepsis.

Solution: a low qSOFA score does not remove the need for antibiotics, resuscitation, and source control when sepsis is clinically suspected.

Error 9: Waiting for Doppler ultrasonography when testicular torsion is highly likely.

Solution: immediate surgical exploration; ultrasonography only for uncertainty and without delay.

Error 10: Confusing PCN with PCNL.

Error 11: Prescribing antibiotics for asymptomatic bacteriuria without an indication.

Solution: treat only the established exceptions and assess the catheter and clinical symptoms.

Error 12: Stopping anticoagulation without a resumption plan.

Solution: after hemostasis, document reassessment of thrombotic risk and the timing of treatment resumption.

Appendices