A Clinical Guide to Urologic Emergencies

LC record available at https://lccn.loc.gov/2020040342LC ebook record available at https://lccn.loc.gov/2020040343

Cover Design: Wiley

Cover Images: X‐ray and ultrasound images © Hunter Wessells, Image of the kidneys and their association with adjacent organs © Daniel Burke, University of Washington

To all those who served in the COVID‐19 pandemic and to those we lost.

To the patients, students, residents, fellows and colleagues at UW Medicine and Harborview who contributed to the knowledge in this volume, as well as my family for their unwavering support. H.W.

To my patients, colleagues, and students past, present and future. To my family for their support. To my mentors of emergency medicine, Drs. Mii, Toyooka and Morita for enlightening and inspiring me. S.H.

To my parents for the effort they put into my education, my masters for guiding my curiosity, my patients for their trust, my hospital’s staff support along over 35 years and my family for their patience and for inspiring my work. R.G.G.

Justin S. AhnDepartment of Urology, UCSF School of Medicine, San Francisco, CA, USA

Nayib FakihDivision of Urology, Hospital Universitario San Ignacio, Pontificia Universidad Javeriana, Bogota, Colombia

Nicolas FernandezDivision of Pediatric Urology, Seattle Children's Hospital, University of Washington, Seattle, WA, USA

Bradley D. FiglerDepartment of Urology, University of North Carolina‐Chapel Hill, Chapel Hill, NC, USA

Ariel FredrickLahey Hospital and Medical Center, Lahey Institute of Urology at Portsmouth and Rochester, Portsmouth and Rochester, NH, USA

Dr. Juan FulláClinica Las Condes, Las Condes, Chile

Reynaldo G. GómezUrology Service, Hospital del Trabajador, Santiago, Chile

Marios HadjipavlouGuy's Hospital, London, UK

Lindsay A. HampsonDepartment of Urology, UCSF School of Medicine, San Francisco, CA, USA

Jonathan D. HarperDepartment of Urology, University of Washington School of Medicine, Seattle, WA, USA

Sarah K. HoltDepartment of Urology, University of Washington School of Medicine, Seattle, WA, USA

Shigeo HorieDepartment of Urology, Juntendo University Graduate School of Medicine, Tokyo, Japan

Akio HoriguchiDepartment of Urology, National Defense Medical College, Tokorozawa, Japan

Steven J. HudakUT Southwestern Medical Center, Dallas, TX, USA

Kazuyoshi IijimaDepartment of Urology, Nagano Municipal Hospital, Nagano, Japan

Akash A. KapadiaDepartment of Urology, University of Washington School of Medicine, Seattle, WA, USA

Haruaki KatoDepartment of Urology, Nagano Municipal Hospital, Nagano, Japan

Kosuke KitamuraDepartment of Urology, Juntendo University Graduate School of Medicine, Tokyo, Japan

Rajeev KumarAll India Institute of Medical Sciences, New Delhi, India

Rachel McKenzieDepartment of Urology, University of Washington School of Medicine, Seattle, WA, USA

Joseph MenoDepartment of Urology, University of Washington School of Medicine, Seattle, WA, USA

Nnenaya MmonuDepartment of Urology, UCSF School of Medicine, San Francisco, CA, USA

Yosuke NakajimaKawasaki Municipal Ida Hospital, Kawasaki, Japan

Brusabhanu NayakAll India Institute of Medical Sciences, New Delhi, India

Tomohiko OguchiDepartment of Urology, Nagano Municipal Hospital, Nagano, Japan

Kevin OstrowskiDepartment of Urology, University of Washington School of Medicine, Seattle, WA, USA

Rishi R. SekarDepartment of Urology, University of Washington School of Medicine, Seattle, WA, USA

Davendra SharmaSt George's Hospital, London, UK

Alexander J. SkokanHarborview Medical Center, University of Washington School of Medicine, Seattle, WA, USA

Nitin SrivastavaAll India Institute of Medical Sciences, New Delhi, India

Hong TruongDepartment of Urology, Thomas Jefferson University Hospital, Philadelphia, PA, USA

Alex J. VanniCenter for Reconstructive Urologic Surgery, Lahey Hospital and Medical Center, Burlington, MA, USA

Laura G. VelardeUrology Service, Hospital del Trabajador, Santiago, Chile

Humberto G. VillarrealLoma Linda University Medical Center, Loma Linda, CA, USA

Thomas J. WalshDepartment of Urology, University of Washington School of Medicine, Seattle, WA, USA

Dana A. WeissThe Children's Hospital of Philadelphia, Philadelphia, PA, USA

Hunter WessellsDepartment of Urology, University of Washington School of Medicine, Seattle, WA, USA

Jonathan WingateMadigan Army Medical Center, Tacoma, WA, USA

Seiji YanoDepartment of Urology, Nagano Municipal Hospital, Nagano, Japan

Norman ZambranoClinica Las Condes, Las Condes, Chile

The burden of urological disease worldwide is driven by a range of common conditions, some of which impair health acutely and others through chronic pathophysiological processes. Urological emergencies, when untreated, can lead to death, permanent disability, and lifelong reductions in quality of life. History is replete with examples including urinary stone disease in ancient Egypt and descriptions of combat wounds by Ambrose Pare in the Renaissance; this book will highlight common indications for acute urological intervention as well the emergence of unforeseen mechanisms of injury such as necrotizing genital skin infections associated with the introduction of novel sodium‐glucose cotransporter 2 (SGLT2) inhibitors for diabetes and the contemporary battlefield injuries of such immense complexity as to require the re‐engineering of military care.

Variation in population demographics, access to care, workforce capacity, and technology have a profound effect on how a given segment of the population will experience illness. The Global Burden of Disease, a tool to quantify health loss from hundreds of diseases, injuries, and risk factors, demonstrates that the determinants of health vary greatly by geography, whether continent‐, country‐, or county‐level. These disparities have been brought into sharper focus by the pandemic of COVID‐19, which exerts a disproportionate impact on individuals from minority populations in the United States and worldwide. These same at‐risk populations also shoulder an excess burden of disease due to war, cyclic violence, road traffic injuries, and diseases for which access to emergency care is essential.

Population growth worldwide, changing epidemiology of disease, and human migration and displacement will exacerbate emergency urological needs across the lifespan and across the spectrum of global wealth. For healthcare providers in high income countries (HIC), motor vehicle collisions, obstructing urinary calculi, urinary tract infections (UTI), and the cumulative burden of urological diseases associated with aging and comorbid chronic disease such as diabetes and cardiovascular disease will drive urgent and emergent healthcare utilization. Urological surgery to improve health in low and middle‐income countries (LMIC) has a critical focus on the broader impact of road traffic accidents, urethral stricture, advanced benign prostatic obstruction and genitourinary infections. The Lancet Commission on Global Surgery achieved consensus that HIC actors should work in equal partnership with LMIC actors and should situate efforts to improve the delivery of surgical care within the broader health systems strengthening agenda.