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SurgSpace / Specialties / Urology
Urology
Kidneys, ureters, bladder, prostate and the male reproductive tract: stones and the obstructed infected kidney that cannot wait, bladder cancer surveyed and resected through the urethra, and a specialty that reached keyhole surgery before almost anyone else.
After, and when it goes wrong
Post-op & Emergencies
The expected course, the ward reads, and the calls that cannot wait.
The expected course and the ward reads, then the complications and the calls that cannot wait.
On the ward
Three boards, three reads
POD 0 · TURP on irrigation
Irrigation running, rosé and clearing
Catheter draining freely
Mild bladder spasms
Na+ 136
What is being watched, and what would change the night?
The read
Colour and flow: rosé that keeps clearing is the expected post-TURP evening, managed by titrating irrigation. The alarms are outflow stopping (clot blocking the catheter: washout promptly, before the bladder distends and re-bleeds), frank red darkening rather than clearing, and, in the classic teaching, the confused hyponatraemic patient of TUR syndrome, now rare with saline systems but still the reason the sodium is on the chart.
Day 1 · nephrostomy for infected obstruction
Nephrostomy drained 400 mL then stopped 3 hours ago
Temp 38.2 again
Flank dressing dry
Feels 'blocked' to flush per protocol
Why is a stopped nephrostomy an urgent call?
The read
Because this tube is the treatment: if it blocks, kinks or falls out of position, the kidney is obstructed and infected again, and the returning fever suggests exactly that. The move is examine the tube and dressing, gentle flush only per unit protocol, and early escalation to urology and interventional radiology for imaging or exchange: re-establishing drainage is the antibiotic that matters.
Day 1 · catheter for high-pressure chronic retention
Residual 1.6 L on catheterisation
Urine now 350 mL/hr
Creatinine 280 improving
Lying BP 118/74, standing dizzy
Is this diuresis a success or a problem?
The read
Both: the kidneys are unloading weeks of pressure, which is the point, but a post-obstructive diuresis at this rate can outrun oral intake and drop the circulation. Management is measurement: hourly urine, standing and lying pressures, electrolytes, and intravenous replacement of a fraction of losses when output stays torrential. The catheter, meanwhile, stays: this bladder and these kidneys have earned a slow rehabilitation.
Emergencies
The calls that cannot wait
The obstructed infected kidney
Recognise: Loin pain, fever and rigors with an obstructing stone or mass on imaging: sepsis with a mechanical cause.
First move: Cultures, antibiotics, resuscitation, and decompression tonight by stent or nephrostomy: this diagnosis moves consultants at 3 a.m., and should.
Testicular torsion
Recognise: Sudden severe unilateral testicular pain in a young male, high-riding tender testis, absent cremasteric reflex, often with vomiting.
First move: Theatre for exploration on the story alone: the organ's window is hours, imaging spends it, and both sides get fixed at the operation.
Clot retention
Recognise: Retention with frank haematuria: the bladder is full of clot a standard catheter cannot shift, on top of whatever is bleeding.
First move: A three-way catheter, manual washout until clear, then irrigation: and the source, tumour until proven otherwise, gets its workup once the bladder is empty and the patient stable.
Renal trauma
Recognise: Flank trauma with haematuria or haemodynamic change: the kidney bleeds into a space that hides volume well.
First move: Stability decides the road, as with the spleen: CT grading and conservative management for most, angioembolisation for the bleeding-but-stable, theatre for the crashing.
Hub shaped by the Surgical Specialties Lead with the Urology reviewer (open seat). Images and videos carry their source; educational use for supervised learning, not clinical guidance.