Magnitude and outcome of urologic emergencies: prospective cohort study.

Abstract

Background: Urological emergencies, which range from acute urinary retention to life-threatening malignancies, represent a significant source of morbidity and mortality. Despite their prevalence in routine clinical practice, the spectrum and overall burden of these conditions in developing countries remain poorly characterized.

Method: A prospective cohort study was conducted at a tertiary hospital between August 2024 and February 2025, among all adult patients with urologic emergencies who visited the emergency department during the study period. Data collected by 2 research assistants from patient interviews by structured questionnaire, medical record reviews, and patients followed until discharge or transfer out from the emergency department.

Result: About 162 patients were included in the study, and urologic emergencies account for 12.2% (176/1446) of all surgical emergencies. The most common presentation of urologic emergency patients was flank pain, at 100 (61.7%), followed by urinary retention, at 23 (14.2%), and hematuria, at 12 (7.4%). Trauma related to the Genitourinary system, which is seen in 14(8.6%), is among the reasons for emergency visits during the study period. Urolithiasis accounts for 51.7% (77/149), followed by Benign prostatic hyperplasia (BPH), cervical cancer, and urethral stricture as the commonest underlying causes for non-traumatic causes. Emergency surgical intervention was done for (n = 151, 93%) of the patients, with the most common procedure performed for non-traumatic urologic emergencies being Ureteric stenting for 46 (30.5%), Percutaneous nephrostomy for 27(17.9%), transurethral catheterization for 23(15.2%), and stone extraction for (n = 19 12.5%). Patients who came within 1 month or less duration of symptoms have approximately 4.3 times higher odds of improved outcome when compared with those with duration of symptoms of >1month (AOR: 4,34; 95% CI: 1.45-12.99). Additionally, having increased abnormal creatinine at presentation has inversely affected improved outcome by an odds ratio of 0.1(95% CI: 0.01-0.82).

Conclusion: Urological emergencies account for a significant proportion of all emergency surgery presentations. Renal colic with or without obstructive uropathy is the leading cause of surgical emergency admissions in this geographic area. Delayed presentation of over 1 month and abnormal creatinine level at presentation negatively affect the outcome of patients.