Scope of the problem

Urinary-related complaints are found in many patients presenting to the emergency department (ED). The wide variety of complaints can be staggering, overshadowed only by their cost to the health care system. Careful evaluation may uncover undiagnosed congenital abnormalities threatening future renal function, serious infections, or disease complications. Identification of urosepsis allows prompt treatment to prevent subsequent morbidity and mortality.

This chapter focuses on dysuria, hematuria, nephrolithiasis, urinary tract infection (UTI), and acute urinary retention. These categories alone account for billions of health care dollars, and several million ED visits annually. As such, it is important for practitioners to have knowledge of anatomy, evaluation, and treatment.

Anatomic essentials

Urologic anatomy is essentially identical from renal unit to bladder in both sexes (Figure 37.1). It differs from bladder to meatus in obvious ways. The renal unit and the gonads have a similar embryologic origin, so pain in one location is often referred to the other. The kidneys themselves are retroperitoneal organs, relatively protected by the inferior ribs posteriorly.

After formation of urine in the glomerular unit, urine travels into the renal calyces which merge to form the renal pelvis. This renal pelvis cones down to form the ureter. The ureter travels caudally and arises out of the posterior pelvic brim as it crosses over the iliac vessels, then inserts into the bladder itself through a small narrowed intramural portion. It is in these anatomic points of narrowing that calculi of the renal system can potentially lodge.