Skip to main content
SpringerLink
Log in

Urology

  • Chapter
  • First Online:
Oncologic Emergency Medicine

  • 2292 Accesses

Abstract

Urologic oncologic issues are frequently encountered in the ED as the genitourinary system is one of the most common sites where cancers originate. In this chapter, we discuss the assessment and management of genitourinary cancers in the ED, including hematuria, urinary retention, hydronephrosis, and common urologic postoperative issues. The mainstay of urologic assessment is patient stabilization, ensuring appropriate urinary tract drainage, a detailed history and physical examination, genitourinary imaging, and ensuring appropriate urologic follow-up. Initial ED management is essential in acute presentations that ultimately require an urgent urologic consultation. Even for issues eventually worked up in the outpatient setting, initial triage, assessment, and coordination of care in the ED are the cornerstones of timely oncologic care.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 169.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 219.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 299.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Similar content being viewed by others

References

  1. Davis R, Jones JS, Barocas DA, Castle EP, Lang EK, Leveillee RJ, et al. Diagnosis, evaluation and follow-up of asymptomatic microhematuria (AMH) in adults: AUA guideline. J Urol. 2012;188(6 Suppl):2473–81.

    Article  PubMed  Google Scholar 

  2. Jung H, Gleason JM, Loo RK, Patel HS, Slezak JM, Jacobsen SJ. Association of hematuria on microscopic urinalysis and risk of urinary tract cancer. J Urol. 2011;185(5):1698–703.

    Article  PubMed  Google Scholar 

  3. Boorjian SA, Raman JD, Barocas DA. Evaluation and management of hematuria. In: Partin AW, Peters CA, Kavoussi LR, Dmochowski RR, Wein AJ, editors. Campbell-Walsh-Wein urology. 12th ed. Philadelphia: Elsevier; 2020. p. 16, 247-59.

    Google Scholar 

  4. Aycock RD, Kass DA. Abnormal urine color. South Med J. 2012;105(1):43–7.

    Article  PubMed  Google Scholar 

  5. Linder BJ, Bass EJ, Mostafid H, Boorjian SA. Guideline of guidelines: asymptomatic microscopic haematuria. BJU Int. 2018;121(2):176–83.

    Article  PubMed  Google Scholar 

  6. Georgieva MV, Wheeler SB, Erim D, Smith-Bindman R, Loo R, Ng C, et al. Comparison of the harms, advantages, and costs associated with alternative guidelines for the evaluation of hematuria. JAMA Intern Med. 2019;179(10):1352–62.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Morey AF, Brandes S, Dugi DD 3rd, Armstrong JH, Breyer BN, Broghammer JA, et al. American Urological Assocation. Urotrauma: AUA guideline. J Urol. 2014;192(2):327–35.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Son HW, Kim DY, Lee OK, Park SE, Cho YW. Severe hypotension following urethral catheterization during general anesthesia in a patient with bladder cancer -a case report. Korean J Anesthesiol. 2012;62(1):91–5.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Sutera SP, Skalak R. The history of Poiseuille’s law. Annu Rev Fluid Mech. 1993;25(1):1–20.

    Article  Google Scholar 

  10. Expert Panel on Urological Imaging, Wolfman DJ, Marko J, Nikolaidis P, Khatri G, Dogra VS, Ganeshan D, et al. ACR Appropriateness Criteria® Hematuria. J Am Coll Radiol. 2020;17(5S):S138–47.

    Google Scholar 

  11. Lee CT, Katz J, Fearn PA, Russo P. Mode of presentation of renal cell carcinoma provides prognostic information. Urol Oncol. 2002;7(4):135–40.

    Article  PubMed  Google Scholar 

  12. Moreira DM, Gershman B, Lohse CM, Boorjian SA, Cheville JC, Leibovich BC, et al. Paraneoplastic syndromes are associated with adverse prognosis among patients with renal cell carcinoma undergoing nephrectomy. World J Urol. 2016;34(10):1465–72.

    Article  CAS  PubMed  Google Scholar 

  13. Thompson RH, Kurta JM, Kaag M, Tickoo SK, Kundu S, Katz D, et al. Tumor size is associated with malignant potential in renal cell carcinoma cases. J Urol. 2009;181(5):2033–6.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Chlapoutakis K, Theocharopoulos N, Yarmenitis S, Damilakis J. Performance of computed tomographic urography in diagnosis of upper urinary tract urothelial carcinoma, in patients presenting with hematuria: systematic review and meta-analysis. Eur J Radiol. 2010;73(2):334–8.

    Article  PubMed  Google Scholar 

  15. Blute ML, Leibovich BC, Lohse CM, Cheville JC, Zincke H. The Mayo-Clinic experience with surgical management complications and outcome for patients with renal cell carcinoma and venous tumour thrombus. BJU Int. 2004;94(1):33–41.

    Article  PubMed  Google Scholar 

  16. Méjean A, Ravaud A, Thezenas S, Colas S, Beauval JB, Bensalah K, et al. Sunitinib alone or after nephrectomy in metastatic renal-cell carcinoma. N Engl J Med. 2018;379(5):417–27.

    Article  PubMed  Google Scholar 

  17. Siva S, Ellis RJ, Ponsky L, Teh BS, Mahadevan A, Muacevic A, et al. Consensus statement from the international radiosurgery oncology consortium for kidney for primary renal cell carcinoma. Future Oncol. 2016;12(5):637–45.

    Article  CAS  PubMed  Google Scholar 

  18. Sadow CA, Silverman SG, O’Leary MP, Signorovitch JE. Bladder cancer detection with CT urography in an academic medical center. Radiology. 2008;249(1):195–202.

    Article  PubMed  Google Scholar 

  19. Grivas PD, Davenport M, Montie JE, Kunju LP, Feng F, Weizer AZ. Urethral cancer. Hematol Oncol Clin North Am. 2012;26(6):1291–314.

    Article  PubMed  Google Scholar 

  20. Asimakopoulos AD, De Nunzio C, Kocjancic E, Tubaro A, Rosier PF, Finazzi-Agrò E. Measurement of post-void residual urine. Neurourol Urodyn. 2016;35(1):55–7.

    Article  PubMed  Google Scholar 

  21. International Continence Society. Urinary retention. Last updated June 2018. https://www.ics.org/committees/standardisation/terminologydiscussions/urinaryretention. Accessed 15 June 2020.

  22. Halbgewachs C, Domes T. Postobstructive diuresis: pay close attention to urinary retention. Can Fam Physician. 2015;61(2):137–42.

    PubMed  PubMed Central  Google Scholar 

  23. Donat SM, Russo P. Ureteral decompression in advanced nonurologic malignancies. Ann Surg Oncol. 1996;3(4):393–9.

    Article  CAS  PubMed  Google Scholar 

  24. Mostbeck GH, Zontsich T, Turetschek K. Ultrasound of the kidney: obstruction and medical diseases. Eur Radiol. 2001;11(10):1878–89.

    Article  CAS  PubMed  Google Scholar 

  25. Dason S, Braga LHP. Prenatal hydronephrosis. In: Dahm P, Dmochowski R, editors. Evidence-based urology. 2nd ed. Hoboken/Chichester: John Wiley & Sons; 2018. p. 187–96.

    Google Scholar 

  26. Pearle MS, Pierce HL, Miller GL, Summa JA, Mutz JM, Petty BA, et al. Optimal method of urgent decompression of the collecting system for obstruction and infection due to ureteral calculi. J Urol. 1998;160(4):1260–4.

    Article  CAS  PubMed  Google Scholar 

  27. Dilauro MD, Dason S, Athreya S. Prophylactic balloon occlusion of internal iliac arteries in women with placenta accreta: literature review and analysis. Clin Radiol. 2012;67(6):515–20.

    Article  CAS  PubMed  Google Scholar 

  28. Weltings S, Schout BMA, Roshani H, Kamphuis GM, Pelger RCM. Lessons from literature: nephrostomy versus double J ureteral catheterization in patients with obstructive urolithiasis-which method is superior? J Endourol. 2019;33(10):777–86.

    Article  PubMed  Google Scholar 

  29. Rosen A, Jayram G, Drazer M, Eggener SE. Global trends in testicular cancer incidence and mortality. Eur Urol. 2011;60(2):374–9.

    Article  PubMed  Google Scholar 

  30. Bosl GJ, Goldman A, Lange PH, Vogelzang NJ, Fraley EE, Levitt SH, et al. Impact of delay in diagnosis on clinical stage of testicular cancer. Lancet. 1981;318(8253):970–3.

    Article  Google Scholar 

  31. Moul JW, Paulson DF, Dodge RK, Walther PJ. Delay in diagnosis and survival in testicular cancer: impact of effective therapy and changes during 18 years. J Urol. 1990;143(3):520–3.

    Article  CAS  PubMed  Google Scholar 

  32. Stephenson AJ, Russo P, Kaplinsky R, Sheinfeld J. Impact of unnecessary exploratory laparotomy on the treatment of patients with metastatic germ cell tumor. J Urol. 2004;171(4):1474–7.

    Article  PubMed  Google Scholar 

  33. Arnold PM, Morgan CJ, Morantz RA, Eckard DA, Kepes JJ. Metastatic testicular cancer presenting as spinal cord compression: report of two cases. Surg Neurol. 2000;54(1):27–33.

    Article  CAS  PubMed  Google Scholar 

  34. Robinson AG, Wei X, Karim S, Raphael MJ, Bedard PL, Booth CM. Venous thromboembolism during chemotherapy for testicular cancer: a population-based study. Clin Oncol (R Coll Radiol). 2020;32(10):e188–93.

    Article  CAS  Google Scholar 

  35. Stephenson A, Eggener SE, Bass EB, Chelnick DM, Daneshmand S, Feldman D, et al. Diagnosis and treatment of early stage testicular cancer: AUA guideline. J Urol. 2019;202(2):272–81.

    Article  PubMed  Google Scholar 

  36. Gilligan T, Lin DW, Aggarwal R, Chism D, Cost N, Derweesh IH, et al. Testicular cancer, version 2.2020, NCCN clinical practice guidelines in oncology. J Natl Compr Cancer Netw. 2019;17(12):1529–54.

    Article  CAS  Google Scholar 

  37. Ciancio G, Soloway M. Renal cell carcinoma invading the hepatic veins. Cancer. 2001;92(7):1836–42.

    Article  CAS  PubMed  Google Scholar 

  38. Psutka SP, Leibovich BC. Management of inferior vena cava tumor thrombus in locally advanced renal cell carcinoma. Ther Adv Urol. 2015;7(4):216–29.

    Article  PubMed  PubMed Central  Google Scholar 

  39. Koster A, Dyke CM, Aldea G, Smedira NG, McCarthy HL, Aronson S, et al. Bivalirudin during cardiopulmonary bypass in patients with previous or acute heparin-induced thrombocytopenia and heparin antibodies: results of the CHOOSE-ON trial. Ann Thorac Surg. 2007;83(2):572–7.

    Article  PubMed  Google Scholar 

  40. Labbate C, Hatogai K, Werntz R, Stadler WM, Steinberg GD, Eggener S, et al. Complete response of renal cell carcinoma vena cava tumor thrombus to neoadjuvant immunotherapy. J Immunother Cancer. 2019;7(1):1–6.

    Article  Google Scholar 

  41. American Cancer Society. Key statistics for penile cancer. Last medical review: 25 June 2018; last revised 8 Jan 2020. https://www.cancer.org/content/dam/CRC/PDF/Public/8783.00.pdf. Accessed 17 June 2020.

  42. Lucky MA, Rogers B, Parr NJ. Referrals into a dedicated British Penile Cancer Centre and sources of possible delay. Sex Transm Infect. 2009;85(7):527–30.

    Article  CAS  PubMed  Google Scholar 

  43. Skeppner E, Andersson SO, Johansson J-E, Windahl T. Initial symptoms and delay in patients with penile carcinoma. Scand J Urol Nephrol. 2012;46(5):319–25.

    Article  PubMed  Google Scholar 

  44. Stratton KL, Culkin DJ. A contemporary review of HPV and penile cancer. Oncology (Williston Park). 2016;30(3):245–9.

    Google Scholar 

  45. Protzel C, Alcaraz A, Horenblas S, Pizzocaro G, Zlotta A, Hakenberg OW. Lymphadenectomy in the surgical management of penile cancer. Eur Urol. 2009;55(5):1075–88.

    Article  PubMed  Google Scholar 

  46. Nassiri N, Kogan S, Gibbon DG, Graham A. Multimodal endovascular palliation for femoral arterial blowout in the setting of metastatic vulvar carcinoma. Ann Vasc Surg. 2015;2(1):127.e11–5.

    Article  Google Scholar 

  47. Bhageerathy PS, Thomas A, Thomas V, Keshava SN, Peedicayil A. Femoral arterial blowout post groin recurrence in vulvar carcinoma - novel endovascular management. Indian J Surg Oncol. 2016;7(4):456–9.

    Article  PubMed  PubMed Central  Google Scholar 

  48. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2019. CA Cancer J Clin. 2019;69(1):7–34.

    Article  PubMed  Google Scholar 

  49. Mak KS, Lee LK, Mak RH, Wang S, Pile-Spellman J, Abrahm JL, et al. Incidence and treatment patterns in hospitalizations for malignant spinal cord compression in the United States, 1998–2006. Int J Radiat Oncol Biol Phys. 2011;80(3):824–31.

    Article  PubMed  Google Scholar 

  50. Crnalic S, Hildingsson C, Bergh A, Widmark A, Svensson O, Löfvenberg R. Early diagnosis and treatment is crucial for neurological recovery after surgery for metastatic spinal cord compression in prostate cancer. Acta Oncol. 2013;52(4):809–15.

    Article  PubMed  Google Scholar 

  51. Huggins C, Hodges CV. Studies on prostatic cancer: I. the effect of castration, of estrogen and of androgen injection on serum phosphatases in metastatic carcinoma of the prostate. J Urol. 2002;167(2 Part 2):948–51.

    Article  CAS  PubMed  Google Scholar 

  52. Shore ND, Saad F, Cookson MS, George DJ, Saltzstein DR, Tutrone R, et al. Oral relugolix for androgen-deprivation therapy in advanced prostate cancer. N Engl J Med. 2020;382(23):2187–96.

    Article  CAS  PubMed  Google Scholar 

  53. O’Connor AR, Coakley FV, Meng MV, Eberhardt S. Imaging of retained surgical sponges in the abdomen and pelvis. Am J Roentgenol. 2003;180(2):481–9.

    Article  Google Scholar 

  54. Shabsigh A, Korets R, Vora KC, Brooks CM, Cronin AM, Savage C, et al. Defining early morbidity of radical cystectomy for patients with bladder cancer using a standardized reporting methodology. Eur Urol. 2009;55(1):164–76.

    Article  PubMed  Google Scholar 

  55. Duivenvoorden WCM, Daneshmand S, Canter D, Lotan Y, Black PC, Abdi H, et al. Incidence, characteristics and implications of thromboembolic events in patients with muscle invasive urothelial carcinoma of the bladder undergoing neoadjuvant chemotherapy. J Urol. 2016;196(6):1627–33.

    Article  PubMed  Google Scholar 

  56. Donahue TF, Bochner BH, Sfakianos JP, Kent M, Bernstein M, Hilton WM, et al. Risk factors for the development of parastomal hernia after radical cystectomy. J Urol. 2014;191(6):1708–13.

    Article  PubMed  Google Scholar 

  57. Jain S, Nyirenda T, Yates J, Munver R. Incidence of renal artery pseudoaneurysm following open and minimally invasive partial nephrectomy: a systematic review and comparative analysis. J Urol. 2013;189(5):1643–8.

    Article  PubMed  Google Scholar 

  58. Ghoneim TP, Thornton RH, Solomon SB, Adamy A, Favaretto RL, Russo P. Selective arterial embolization for pseudoaneurysms and arteriovenous fistula of renal artery branches following partial nephrectomy. J Urol. 2011;185(6):2061–5.

    Article  PubMed  Google Scholar 

  59. Potter SR, Kavoussi LR, Jackman SV. Management of diaphragmatic injury during laparoscopic nephrectomy. J Urol. 2001;165(4):1203–4.

    Article  CAS  PubMed  Google Scholar 

  60. Chetta A, Aiello M, Olivieri D. Diaphragm paralysis after nephrectomy. Thorax. 2006;61(6):549.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Urology, The Ohio State University, Columbus, OH, USA

    Shawn Dason, Cheryl T. Lee & Ahmad Shabsigh

Authors
  1. Shawn Dason
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Cheryl T. Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ahmad Shabsigh
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Shawn Dason .

Editor information

Editors and Affiliations

  1. Former Professor and Founding Chair (Retired), The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Knox H. Todd

  2. Professor and Chair, Department of Radiation Medicine, Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA

    Charles R. Thomas, Jr.

  3. Professor and Chair, Department of Emergency Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Kumar Alagappan

Rights and permissions

Reprints and permissions

Copyright information

© 2021 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Dason, S., Lee, C.T., Shabsigh, A. (2021). Urology. In: Todd, K.H., Thomas, Jr., C.R., Alagappan, K. (eds) Oncologic Emergency Medicine. Springer, Cham. https://doi.org/10.1007/978-3-030-67123-5_31

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-67123-5_31

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-67122-8

  • Online ISBN: 978-3-030-67123-5

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation