Magnitude of urological emergencies and immediate management at Muhimbili national hospital

Abstract

Background: Urological emergencies can cause morbidity and mortality. There are different forms of urological emergencies like: Acute urine retention, Priapism, Fournier’s gangrene, Penile fracture, Gross haematuria with clot retention, Paraphimosis, Genitourinary injury and testicular torsion. When emergency intervention is not taken, it can lead to renal failure, testicular atrophy, penile auto amputation, erectile dysfunction, infertility and death. Despite most urological emergencies ending with emergency surgical intervention performed in the urology department and being associated with short-and long-term morbidities, there is still no available data on magnitude, types, causes, immediate management, and treatment outcome. This study aims at providing data about social demographic characteristics, magnitude, types, causes, immediate management and treatment outcome of urological emergencies at MNH. Objectives: To assess magnitude of different types, immediate management and treatment outcome of urological emergencies at MNH. Methodology: A cross-sectional observational study was conducted within seven months from September 2020 to March 2021, involving patients with different Urological emergencies. A total of 80 patients were involved in this study. Demographic data, clinical presentation, causes, immediate treatment and treatment outcome were recorded using a questionnaire and analyzed by SPSS version 24. All patients with urological emergencies admitted into the emergency department, MOI and MNH were recruited in the study. A standardized pre-tested english questionnaire was filled by the investigator. Data were extracted directly from the patients, patients’ files/ operation notes and operating staff. Data was presented by using frequency, mean, standard deviation and P value less than 0.05 was considered significant. Results: During the research period of seven months, there were 80 patients with different types of urological emergencies. During the same period, the total numbers of patients admitted with other urological conditions were 1752, and the proportion of urological emergencies was 4.6%. The proportion of patients with different types of Urological emergencies at MNH were; acute urine retention 42.5%, Genitourinary injury 18.6%, Gross haematuria with clot retention 15%, Fournier’s gangrene 8.8%, Priapism 7.5%, Testicular torsion 3.8% and Paraphimosis 3.8% of the total emergencies. Immediate treatment of patients with urological emergencies at MNH were; SPC 31.3% and urethral catheterization 15% for patients with AUR, urethral catheterization, clot evacuation and irrigation with normal saline 13.8% for patients with gross haematuria with clot retention, debridement of gangrenous part 8.8% for patients with Fournier’s gangrene, laparatomy 7.5% and URS plus DJ stent 2.5% for patients with Genitourinary injury. Treatment outcome of the patients who were attended at MNH with urological emergencies were 93.8% successful, mortality rate of 3.75% and complication rate of 2.54%. Conclusion: Acute urine retention and genitourinary injury were the commonest urological emergencies at MNH.