Clinical Observation on Urologic Emergency

Moon, Moo Sung; Wang, Chong Soon

Abstract

Rapid and accurate management is necessary for the emergency patients, but there is a few comprehensive and analyzed references about them and still the definition and the criteria of the urologic emergency are not defined. So a clinical observation was made on 382 patients, admitted to the Department of Urology through the emergency room of the Severance hospital during 5 years from January, 1972 to December, 1976. They were observed as following orders; annual, age, sex, symptoms, emergency managements, diagnostic procedures, diagnoses, associated diseases, and mortality rate etc. The results are as follows: 1. Urologic emergency patients were 382 (male 265, female 117). They were 1.4 % of the patients admitted through the emergency room, and 19.3% of the in-patients of the Department of Urology. 2. Symptoms and signs of the urologic emergency were pain (209 cases), gross hematuria (48 cases), acute retention (42 cases), acute genitourinary infection (38 cases), genitourinary injury (66 cases), shock (13 cases), and uremia(24 cases). 3. I.V.P. was the most common diagnostic procedure, but bone X-ray and the cystourethrogram were more common in genitourinary injury. 4. Emergency managements were performed in 227 cases. Pain control was most common (52t), then indwelling of the Foley catheter and transfusion were next. 5. In pain, flank or abdominal pain was most common (191 cases) and the most common cause. was lower 1/3 ureteral stone. 6. The causes of the gross hematuria were genitourinary tumor (11 cases), calculi(10 cases), acute cystitis(9 cases), and acute pyelonephritis (7 cases). 7. Acute retentions were commonly developed in old aged men and the most common cause was B.P.H. (42. 9%), then urethral stricture (23. 8%). 8. Acute genitourinary infections were most common in 3rd decade women. 9. Genitourinary injuries were most commonly occurred in the spring (34. 8%). The most common cause was kick or blow (43.9%) and the most common organ was urethra (40%). The most common combined injury was pelvic bone fracture (36. 8%). 10. The causes of the shock were genitourinary injury(84.6%) and bladder tumor (15. 4%). 11. The most common cause of uremia was genitourinary tumor (25%), then ureteral stricture (20. 8%). 12. In 30 cases, the presumptive diagnoses were different from the definite diagnoses. 43.3% of them were suspected as urinary calculi, but confirmed as acute pyelonephritis, ureteral stricture and tumor etc. 13. Associated diseases were common in old aged patients and cardiovascular (33%) or respiratory diseases (28.4%) were common. 14. Conservative treatment was most commonly performed, but suprapubic transvesical prostatectomy was more common in acute retention. 15. 7 patients were died and the mortality rate was 1.8%.