Updates in Non-traumatic Urological Emergencies

  • Angelo Naselli
  • Stefano Paparella
  • Pierpaolo Graziotti


Renal colic is by far the most frequent urological emergency. Diagnosis relies on clinical history, physical examination, urine dipstick test, serum analysis (blood cell count and level of creatinine, uric acid, ionized calcium, sodium, C-reactive protein, procalcitonin, if available, glucose and lactate), ultrasound and sometimes computed tomography scan (CT). Contrast and full-dose radiation CT scan is rarely required and limited mainly to cases of acute flank pain with uncertain aetiology. Renal colic may be complicated by sepsis which should be early recognized and treated with antibiotics and renal drainage, either by ureteral catheterization or percutaneous nephrostomy placement. Pain control is subordinated to sepsis treatment and based on non-steroidal anti-inflammatory drugs and alpha-blockers. Acute urinary retention is mainly resolved by urethral catheter indwelling, but sometimes it is demanding, requiring suprapubic drainage or cystoscopy. Acute scrotal pain may harbour testicular torsion, especially in young adults. Therefore, immediate manual detorsion or surgical exploration is recommended unless an alternate diagnosis of scrotal pain is certain. Clinical history and physical examination are usually enough to suspect a torsion. Indeed, ancillary tests, like Doppler ultrasound of the testis or pertechnetate scintigraphy, should never delay treatment. Priapism is a rare urgency. Low-flow priapism should be identified and treated immediately to avoid permanent erectile dysfunction. Finally, Fournier’s gangrene, emphysematous pyelonephritis and emphysematous prostatitis are rare but life-threatening urological infections which may have a subtle presentation and occur mostly in subjects with uncontrolled diabetes. They need a multi-speciality approach including invasive procedures, like surgery or drainage.


  1. 1.
    Fwu CW, Eggers PW, Kimmel PL, Kusek JW, Kirkali Z. Emergency department visits, use of imaging, and drugs for urolithiasis have increased in the United States. Kidney Int. 2013;83:479–86.PubMedPubMedCentralGoogle Scholar
  2. 2.
    Park YH, Jung RB, Lee YG, Hong CK, Ahn JH, Shin TY, Kim YS, Ha YR. Does the use of bedside ultrasonography reduce emergency department length of stay for patients with renal colic? A pilot study. Clin Exp Emerg Med. 2016;3(4):197–203.PubMedPubMedCentralGoogle Scholar
  3. 3.
    Sternberg KM, Littenberg B. Trends in imaging use for the evaluation and followup of kidney stone disease: a single center experience. J Urol. 2017;198(2):383–8. Scholar
  4. 4.
    Sternberg KM, Pais VM Jr, Larson T, Han J, Hernandez N, Eisner B. Is hydronephrosis on ultrasound predictive of Ureterolithiasis in patients with renal colic? J Urol. 2016;196(4):1149–52. Scholar
  5. 5.
    Heidenreich A, Desgrandschamps F, Terrier F. Modern approach of diagnosis and management of acute flank pain: review of all imaging modalities. Eur Urol. 2002;41(4):351–62.PubMedPubMedCentralGoogle Scholar
  6. 6.
    Kennish SJ, Bhatnagar P, Wah TM, Bush S, Irving HC. Is the KUB radiograph redundant for investigating acute ureteric colic in the non-contrast enhanced computed tomography era? Clin Radiol. 2008;63(10):1131–5.PubMedPubMedCentralGoogle Scholar
  7. 7.
    Sarofim M, Teo A, Wilson R. Management of alternative pathology detected using CT KUB in suspected ureteric colic. Int J Surg. 2016;32:179–82. Epub 2016 Jun 30.CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Rob S, Bryant T, Wilson I, Somani BK. Ultra-low-dose, low-dose, and standard-dose CT of the kidney, ureters, and bladder: is there a difference? Results from a systematic review of the literature. Clin Radiol. 2017;72(1):11–5.PubMedPubMedCentralGoogle Scholar
  9. 9.
    Xiang H, Chan M, Brown V, Huo YR, Chan L, Ridley L. Systematic review and meta-analysis of the diagnostic accuracy of low-dose computed tomography of the kidneys, ureters and bladder for urolithiasis. J Med Imaging Radiat Oncol. 2017;61:582.PubMedPubMedCentralGoogle Scholar
  10. 10.
    el-Assmy A, Abou-el-Ghar ME, el-Nahas AR, Refaie HF, Sheir KZ. Multidetector computed tomography: role in determination of urinary stones composition and disintegration with extracorporeal shock wave lithotripsy—an in vitro study. Urology. 2011;77(2):286–90.PubMedPubMedCentralGoogle Scholar
  11. 11.
    Lotan E, Weissman O, Guranda L, Kleinmann N, Schor R, Winkler H, Portnoy O. Can unenhanced CT findings predict interventional versus conservative treatment in acute renal colic? Am J Roentgenol. 2016;207(5):1016–21.Google Scholar
  12. 12.
    Palmer JS, Donaher ER, O'Riordan MA, Dell KM. Diagnosis of pediatric urolithiasis: role of ultrasound and computerized tomography. J Urol. 2005;174(4 Pt 1):1413–6.PubMedPubMedCentralGoogle Scholar
  13. 13.
    Muthusami P, Bhuvaneswari V, Elangovan S, Dorairajan LN, Ramesh A. The role of static magnetic resonance urography in the evaluation of obstructive uropathy. Urology. 2013;81(3):623–74.PubMedPubMedCentralGoogle Scholar
  14. 14.
    Levy MM, Fink MP, Marshall JC, Abraham E, Angus D, Cook D, Cohen J, Opal SM, Vincent JL, Ramsay G. International sepsis definitions conference. 2001 SCCM/ESICM/ACCP/ATS/SIS international sepsis definitions conference. Intensive Care Med. 2003;29(4):530–8.PubMedPubMedCentralGoogle Scholar
  15. 15.
    Holdgate A, Pollock T. Systematic review of the relative efficacy of non-steroidal anti-inflammatory drugs and opioids in the treatment of acute renal colic. BMJ. 2004;328(7453):1401.PubMedPubMedCentralGoogle Scholar
  16. 16.
    Afshar K, Jafari S, Marks AJ, Eftekhari A, MacNeily AE. Nonsteroidal anti-inflammatory drugs (NSAIDs) and non-opioids for acute renal colic. Cochrane Database Syst Rev. 2015;(6):CD006027.Google Scholar
  17. 17.
    Hollingsworth JM, Canales BK, Rogers MA, Sukumar S, Yan P, Kuntz GM, Dahm P. Alpha blockers for treatment of ureteric stones: systematic review and meta-analysis. BMJ. 2016;355:i6112.PubMedPubMedCentralGoogle Scholar
  18. 18.
    Ramsey S, Robertson A, Ablett MJ, Meddings RN, Hollins GW, Little B. Evidence-based drainage of infected hydronephrosis secondary to ureteric calculi. J Endourol. 2010;24(2):185–9. Scholar
  19. 19.
    Angulo JC, Gaspar MJ, Rodríguez N, García-Tello A, Torres G, Núñez C. The value of C-reactive protein determination in patients with renal colic to decide urgent urinary diversion. Urology. 2010;76(2):301–6.PubMedPubMedCentralGoogle Scholar
  20. 20.
    Jacobsen SJ, Jacobson DJ, Girman CJ, Roberts RO, Rhodes T, Guess HA, Lieber MM. Natural history of prostatism: risk factors for acute urinary retention. J Urol. 1997;158(2):481–7.Google Scholar
  21. 21.
    Emberton M, Fitzpatrick JM. The Reten-World survey of the management of acute urinary retention: preliminary results. BJU Int. 2008;101(Suppl 3):27–32.PubMedPubMedCentralGoogle Scholar
  22. 22.
    Ichsan J, Hunt DR. Suprapubic catheters: a comparison of suprapubic versus urethral catheters in the treatment of acute urinary retention. Aust N Z J Surg. 1987;57(1):33–6.PubMedPubMedCentralGoogle Scholar
  23. 23.
    Horgan AF, Prasad B, Waldron DJ, O’Sullivan DC. Acute urinary retention. Comparison of suprapubic and urethral catheterisation. Br J Urol. 1992;70(2):149–51.PubMedPubMedCentralGoogle Scholar
  24. 24.
    Villanueva C, Hemstreet GP 3rd. Difficult male urethral catheterization: a review of different approaches. Int Braz J Urol. 2008;34(4):401–11.PubMedPubMedCentralGoogle Scholar
  25. 25.
    Ahluwalia RS, Johal N, Kouriefs C, Kooiman G, Montgomery BS, Plail RO. The surgical risk of suprapubic catheter insertion and long-term sequelae. Ann R Coll Surg Engl. 2006;88(2):210–3.PubMedPubMedCentralGoogle Scholar
  26. 26.
    Radhakrishnan S, Marsh R, Sheikh N, Johnson P, Greene D. Urethral catheter induced pseudoaneurysm of the bulbar artery. Int J Urol. 2005;12(10):922–4.PubMedPubMedCentralGoogle Scholar
  27. 27.
    Kondo H, Yamada T, Kanematsu M, Kako N, Goshima S, Yamamoto N. Embolization for massive urethral hemorrhage. Abdom Imaging. 2007;32(2):262–3.PubMedPubMedCentralGoogle Scholar
  28. 28.
    Mamarelis G, Moris D, Vernadakis S. Fournier’s gangrene after urethral rupture: an uncommon complication of a common procedure. Am Surg. 2014;80(5):E150–1.PubMedPubMedCentralGoogle Scholar
  29. 29.
    Davis NF, Quinlan MR, Bhatt NR, Browne C, MacCraith E, Manecksha R, Walsh MT, Thornhill JA, Mulvin D. Incidence, cost, complications and clinical outcomes of iatrogenic urethral catheterization injuries: a prospective multi-institutional study. J Urol. 2016;196(5):1473–7.PubMedPubMedCentralGoogle Scholar
  30. 30.
    Canes D. Male urethral catheterization. N Engl J Med. 2006;355(11):1178–9.PubMedPubMedCentralGoogle Scholar
  31. 31.
    Barada JH, Weingarten JL, Cromie WJ. Testicular salvage and age-related delay in the presentation of testicular torsion. J Urol. 1989;142(3):746–8.PubMedPubMedCentralGoogle Scholar
  32. 32.
    Anderson JB, Williamson RC. Testicular torsion in Bristol: a 25-year review. Br J Surg. 1988;75(10):988–92.PubMedPubMedCentralGoogle Scholar
  33. 33.
    Tang YH, Yeung VH, Chu PS, Man CW. A 55-year-old man with right testicular pain: too old for torsion. Urol Case Rep. 2017;11:74–5.PubMedPubMedCentralGoogle Scholar
  34. 34.
    Seo YM, Myung NH, Hong JH. Missed spermatic cord torsion in an old man. Korean J Urol. 2013;54(10):718–20.PubMedPubMedCentralGoogle Scholar
  35. 35.
    Davenport M. ABC of general surgery in children. Acute problems of the scrotum. BMJ. 1996;312(7028):435–7.PubMedPubMedCentralGoogle Scholar
  36. 36.
    Watkin NA, Reiger NA, Moisey CU. Is the conservative management of the acute scrotum justified on clinical grounds? Br J Urol. 1996;78(4):623–7.PubMedPubMedCentralGoogle Scholar
  37. 37.
    McAndrew HF, Pemberton R, Kikiros CS, Gollow I. The incidence and investigation of acute scrotal problems in children. Pediatr Surg Int. 2002;18(5–6):435–7.PubMedPubMedCentralGoogle Scholar
  38. 38.
    Kadish HA, Bolte RG. A retrospective review of pediatric patients with epididymitis, testicular torsion, and torsion of testicular appendages. Pediatrics. 1998;102(1 Pt 1):73–6.PubMedPubMedCentralGoogle Scholar
  39. 39.
    Kravchick S, Cytron S, Leibovici O, Linov L, London D, Altshuler A, Yulish E. Color Doppler sonography: its real role in the evaluation of children with highly suspected testicular torsion. Eur Radiol. 2001;11(6):1000–5.PubMedPubMedCentralGoogle Scholar
  40. 40.
    Kodali SK, Abdullah ZS, Sharma P, Khan MU, Naeem M. Missed torsion in undescended testes detected by scintigraphy: testicular scintigraphy a decisive complementary tool. Clin Nucl Med. 2013;38(1):58–9.PubMedPubMedCentralGoogle Scholar
  41. 41.
    Ringdahl E, Teague L. Testicular torsion. Am Fam Physician. 2006;74(10):1739–43.PubMedPubMedCentralGoogle Scholar
  42. 42.
    Cornel EB, Karthaus HF. Manual derotation of the twisted spermatic cord. BJU Int. 1999;83(6):672–4.PubMedPubMedCentralGoogle Scholar
  43. 43.
    Sidler D, Brown RA, Millar AJ, Rode H, Cywes S. A 25-year review of the acute scrotum in children. S Afr Med J. 1997;87(12):1696–8.PubMedPubMedCentralGoogle Scholar
  44. 44.
    Rosenstein D, McAninch J. Urologic emergencies. 1. Med Clin North Am. 2004;88:495–518.PubMedPubMedCentralGoogle Scholar
  45. 45.
    Montague DK, et al. American Urological Association guideline on the management of priapism. J Urol. 2003;170(4 Pt 1):1318–24.PubMedPubMedCentralGoogle Scholar
  46. 46.
    Burnett AL, Bivalacqua TJ. Priapism current principles and practice. 2. Urol Clin North Am. 2007;34:631–42.PubMedPubMedCentralGoogle Scholar
  47. 47.
    Wagner MJ. 3. PEER VII: Physician’s evaluation and educational review in emergency medicine. ACEP; 2006 (revised 2007).Google Scholar
  48. 48.
    Broderick GA, et al. Priapism: pathogenesis, epidemiology, and management. J Sex Med. 2010;7(1 Pt 2):476–500.PubMedPubMedCentralGoogle Scholar
  49. 49.
    Eland IA, et al. Incidence of priapism in the general population. Urology. 2001;57(5):970–2.PubMedPubMedCentralGoogle Scholar
  50. 50.
    Furtado PS, et al. The prevalence of priapism in children and adolescents with sickle cell disease in Brazil. Int J Hematol. 2012;95(6):648–51.PubMedPubMedCentralGoogle Scholar
  51. 51.
    Olujohungbe AB, et al. A prospective diary study of stuttering priapism in adolescents and young men with sickle cell anemia: report of an international randomized control trial—the priapism in sickle cell study. J Androl. 2011;32(4):375–82.PubMedPubMedCentralGoogle Scholar
  52. 52.
    Samm BJ, Dmochowski RR. Urologic emergencies. 5. Postgrad Med. 1996;100:187–200.PubMedPubMedCentralGoogle Scholar
  53. 53.
    Ralph DJ, et al. The use of high-resolution magnetic resonance imaging in the management of patients presenting with priapism. BJU Int. 2010;106(11):1714–8.PubMedPubMedCentralGoogle Scholar
  54. 54.
    El-Bahnasawy MS, et al. Low-flow priapism: risk factors for erectile dysfunction. BJU Int. 2002;89(3):285–90.PubMedPubMedCentralGoogle Scholar
  55. 55.
    Muneer A, et al. Investigating the effects of high-dose phenylephrine in the management of prolonged ischaemic priapism. J Sex Med. 2008;5(9):2152–9.PubMedPubMedCentralGoogle Scholar
  56. 56.
    Burnett AL, et al. J Sex Med. 2013;10(1):180–94.PubMedPubMedCentralGoogle Scholar
  57. 57.
    Roberts JR, et al. Intracavernous epinephrine: a minimally invasive treatment for priapism in the emergency department. J Emerg Med. 2009;36(3):285–9.PubMedPubMedCentralGoogle Scholar
  58. 58.
    Keskin D, et al. Intracavernosal adrenalin injection in priapism. Int J Impot Res. 2000;12(6):312–4.PubMedPubMedCentralGoogle Scholar
  59. 59.
    Hubler J, et al. Methylene blue as a means of treatment for priapism caused by intracavernous injection to combat erectile dysfunction. Int Urol Nephrol. 2003;35(4):519–21.PubMedPubMedCentralGoogle Scholar
  60. 60.
    Gupta A, et al. Successful use of terbutaline in persistent priapism in a 12-year-old boy with chronic myeloid leukemia. Pediatr Hematol Oncol. 2009;26(1):70–3.PubMedPubMedCentralGoogle Scholar
  61. 61.
    Numan F, Cantasdemir M, Ozbayrak M, et al. Posttraumatic nonischemic priapism treated with autologous blood clot embolization. J Sex Med. 2008;5:173–9.PubMedPubMedCentralGoogle Scholar
  62. 62.
    Burnett AL. Surgical management of ischemic priapism. J Sex Med. 2012;9(1):114–20.PubMedPubMedCentralGoogle Scholar
  63. 63.
    Samm BJ, Dmochowski RR. Urologic emergencies. Postgrad Med. 1996;100:187–200.PubMedPubMedCentralGoogle Scholar
  64. 64.
    Cohen MS. Current experience and management of Fournier’s gangrene. Lecture presented at: 78th Annual Meeting of the Am Urol Assoc; 1983.Google Scholar
  65. 65.
    Eke N. Fournier’s gangrene: a review of 1726 cases. Br J Surg. 2000;87:718–28.PubMedPubMedCentralGoogle Scholar
  66. 66.
    Pastore AL, Palleschi G, Ripoli A, et al. A multistep approach to manage Fournier’s gangrene in a patient with unknown type II diabetes: surgery, hyperbaric oxygen, and vacuum assisted closure therapy: a case report. J Med Case Rep. 2013;7:1.PubMedPubMedCentralGoogle Scholar
  67. 67.
    Ulug M, Gedik E, Girgin S, et al. The evaluation of microbiology and Fournier’s gangrene severity index in 27 patients. Int J Infect Dis. 2009;13:e424–30.PubMedPubMedCentralGoogle Scholar
  68. 68.
    Grabe M, Bjerklund-Johansen TE, Botto H, et al. Fournier’s gangrene. In: Guidelines on urological infections. Arnhem: European Association of Urology (EAU); 2011; p. 76–8.Google Scholar
  69. 69.
    Ndubuisi E, Raphael JE. Fournier’s gangrene. Accessed Dec 2014.Google Scholar
  70. 70.
    Proud D, et al. Are we getting necrotizing soft tissue infections right? A 10-year review. ANZ J Surg. 2014;84:468.PubMedPubMedCentralGoogle Scholar
  71. 71.
    Thwaini A, Khan A, Malik A, et al. Fournier’s gangrene and its emergency management. Postgrad Med J. 2006;82:516–9.PubMedPubMedCentralGoogle Scholar
  72. 72.
    Kabay S, Yucel M, Yaylak F, et al. The clinical features of Fournier’s gangrene and the predictivity of the Fournier’s gangrene severity index on the outcomes. Int Urol Nephrol. 2008;40:997–1004.PubMedPubMedCentralGoogle Scholar
  73. 73.
    Chowla SN, Gallop C, Mydio JH. An analysis of repeated surgical debridement. Eur Urol. 2003;43:572–5.Google Scholar
  74. 74.
    Ferreira PC, et al. Fournier’s gangrene: a review of 43 reconstructive cases. Plast Reconstr Surg. 2007;119:175–84.PubMedPubMedCentralGoogle Scholar
  75. 75.
    Maguina P, Palmieri TL, Greenhalgh DG. Split thickness skin grafting for recreation of the scrotum following Fournier’s gangrene. Burns. 2003;29:857–62.PubMedPubMedCentralGoogle Scholar
  76. 76.
    Lee SH, Rah DK, Lee WJ. Penoscrotal reconstruction with gracilis muscle flap and internal pudendal artery perforator flap transposition. Urology. 2012;79:1390–4.PubMedPubMedCentralGoogle Scholar
  77. 77.
    Tremp M, Meyer Zu Schwabedissen M, Schaefer DJ, et al. The combined pedicled anterolateral thigh and vastus lateralis flap as filler for complex perineal defects. Ann Plast Surg. 2015;75(1):66–73.PubMedPubMedCentralGoogle Scholar
  78. 78.
    Janane A, Hajji F, Ismail TO, et al. Hyperbaric oxygen therapy adjunctive to surgical debridement in management of Fournier’s gangrene: usefulness of a severity index score in predicting disease gravity and patient survival. Actas Urol Esp. 2011;35:332–8.PubMedPubMedCentralGoogle Scholar
  79. 79.
    Chennamsetty A, et al. Contemporary diagnosis and management of Fournier’s gangrene. Ther Adv Urol. 2015;7:203.PubMedPubMedCentralGoogle Scholar
  80. 80.
    Jallali N, et al. Hyperbaric oxygen as adjuvant therapy in the management of necrotizing fasciitis. Am J Surg. 2005;189:462.PubMedPubMedCentralGoogle Scholar
  81. 81.
    Mallikarjuna MN, et al. Fournier’s gangrene: current practices. ISRN Surg. 2012;2012:942437.PubMedPubMedCentralGoogle Scholar
  82. 82.
    Narlawar RS, Raut AA, Nagar A, Hira P, Hanchate V, Asrani A. Imaging features and guided drainage in emphysematous pyelonephritis: a study of 11 cases. Clin Radiol. 2004;59:192–7.PubMedPubMedCentralGoogle Scholar
  83. 83.
    Shokeir AA, El-Azab M, Mohsen T, El-Diasty T. Emphysematous pyelonephritis: a 15-year experience with 20 cases. Urology. 1997;49:343–6.PubMedPubMedCentralGoogle Scholar
  84. 84.
    Tang HJ, Li CM, Yen MY, Chen YS, Wann SR, Lin HH, et al. Clinical characteristics of emphysematous pyelonephritis. J Microbiol Immunol Infect. 2001;34:125–30.PubMedPubMedCentralGoogle Scholar
  85. 85.
    Wan YL, Lee TY, Bullard MJ, Tsai CC. Acute gas-producing bacterial renal infection. Correlation between imaging findings and clinical outcome. Radiology. 1996;198:433–8.PubMedPubMedCentralGoogle Scholar
  86. 86.
    Somani BK, Nabi G, Thorpe P, Hussey J, Cook J, N’Dow J. Is percutaneous drainage the new gold standard in the management of emphysematous pyelonephritis? Evidence from a systematic review. J Urol. 2008;179:1844–9.PubMedPubMedCentralGoogle Scholar
  87. 87.
    Kelly HA, MacCallum WG. Pneumaturia. JAMA. 1898;31:375–81.Google Scholar
  88. 88.
    Schultz EH Jr, Klorfein EH. Emphysematous pyelonephritis. J Urol. 1962;87:762–6.PubMedPubMedCentralGoogle Scholar
  89. 89.
    Aboumarzouk et al. Emphysematous pyelonephritis: time for a management plan with an evidence-based approach. Arab J Urol. 2014;12:106–15.Google Scholar
  90. 90.
    Kuzgunbay B, Turunc T, Tokmak N, Dirim A, Aygun C, Ozkardes H. Tailored treatment approach for emphysematous pyelonephritis. Urol Int. 2011;86:444–7.PubMedPubMedCentralGoogle Scholar
  91. 91.
    Huang J-J, Tseng C-C. Emphysematous pyelonephritis: clinicoradiological classification, management, prognosis, and pathogenesis. Arch Intern Med. 2000;160:797–805.PubMedPubMedCentralGoogle Scholar
  92. 92.
    Lu YC, Chiang BJ, Pong YH, Huang KH, Hsueh PR, Huang CY, et al. Predictors of failure of conservative treatment among patients with emphysematous pyelonephritis. BMC Infect Dis. 2014;14:418.PubMedPubMedCentralGoogle Scholar
  93. 93.
    Wan YL, Lo SK, Bullard MJ, Chang PL, Lee TY. Predictors of outcome in emphysematous pyelonephritis. J Urol. 1998;159:369–73.PubMedPubMedCentralGoogle Scholar
  94. 94.
    Cook DJ, Achong MR, Dobranowski J. Emphysematous pyelonephritis. Complicated urinary tract infection in diabetes. Diabetes Care. 1989;12:229–32.PubMedPubMedCentralGoogle Scholar
  95. 95.
    Ahlering TE, Boyd SD, Hamilton CL, Bragin SD, Chandrasoma PT, Lieskovsky G, et al. Emphysematous pyelonephritis: a 5-year experience with 13 patients. J Urol. 1985;134:1086–8.PubMedPubMedCentralGoogle Scholar
  96. 96.
    Kapoor R, Muruganandham K, Gulia AK, Singla M, Agrawal S, Mandhani A, et al. Predictive factors for mortality and need for nephrectomy in patients with emphysematous pyelonephritis. BJU Int. 2010;105:986–9.PubMedPubMedCentralGoogle Scholar
  97. 97.
    Chen MT, Huang CN, Chou YH, Huang CH, Chiang CP, Liu GC. Percutaneous drainage in the treatment of emphysematous pyelonephritis: 10-year experience. J Urol. 1997;157:1569–73.PubMedPubMedCentralGoogle Scholar
  98. 98.
    Tienza A, Hevia M, Merino I, Velis JM, Algarra R, Pascual JI, et al. Case of emphysematous pyelonephritis in kidney allograft: conservative treatment. Can Urol Assoc J. 2014;8:E256–9.PubMedPubMedCentralGoogle Scholar
  99. 99.
    Ubee SS, McGlynn L, Fordham M. Emphysematous pyelonephritis. BJU Int. 2011;107:1474–8.PubMedPubMedCentralGoogle Scholar
  100. 100.
    Mariani AJ, Jacobs LD, Clapp PR, Hariharan A, Stams UK, Hodges CV. Emphysematous prostatic abscess: diagnosis and treatment. J Urol. 1983;129:385–6.Google Scholar
  101. 101.
    Granados EA, Riley G, Salvador J, et al. Prostatic abscess: diagnosis and treatment. J Urol. 1992;148:80–2.Google Scholar
  102. 102.
    Liu KH, Lee HC, Chuang YC, et al. Prostatic abscess in southern Taiwan: another invasive infection caused predominantly by Klebsiella pneumoniae. J Microbiol Immunol Infect. 2003;36:31–6.Google Scholar
  103. 103.
    Wen S-C, Juan Y-S, Wang C-J, et al. Emphysematous prostatic abscess: case series study and review. Int J Infect Dis. 2012;16:e344–9.Google Scholar
  104. 104.
    Arger PH. Computed tomography of the lower urinary tract. Urol Clin North Am. 1985;12:677–86.PubMedPubMedCentralGoogle Scholar
  105. 105.
    Lim JW, Ko YT, Lee DH, et al. Treatment of prostatic abscess: value of transrectal ultrasonographically guided needle aspiration. J Ultrasound Med. 2000;19:609–17.PubMedPubMedCentralGoogle Scholar
  106. 106.
    Chou YH, Tiu CM, Liu JY, et al. Prostatic abscess: transrectal color Doppler ultrasonic diagnosis and minimally invasive therapeutic management. Ultrasound Med Biol. 2004;30:719–24.Google Scholar
  107. 107.
    Oliveira P, Andrade JA, Porto HC, et al. Diagnosis and treatment of prostatic abscess. Int Braz J Urol. 2003;29:30–4.Google Scholar
  108. 108.
    Lin DC, Lin YM, Tong YC, et al. Emphysematous prostatic abscess after transurethral microwave thermotherapy. J Urol. 2001;166:625.Google Scholar
  109. 109.
    Lu DC, Lei MH, Chang SC, et al. Emphysematous prostatic abscess due to Klebsiella pneumoniae. Diagn Microbiol Infect Dis. 1998;31:559–61.Google Scholar
  110. 110.
    Bartkowski DP, Lanesky JR. Emphysematous prostatitis and cystitis secondary to Candida albicans. J Urol. 1988;139:1063–5.PubMedPubMedCentralGoogle Scholar
  111. 111.
    Bae GB, Kim SW, Shin BC, et al. Emphysematous prostatic abscess due to Klebsiella pneumoniae: report of a case and review of the literature. J Korean Med Sci. 2003;18:758–60.PubMedPubMedCentralGoogle Scholar
  112. 112.
    Patel NP, Lavengood RW, Fernandes M, et al. Gas-forming infections in genitourinary tract. Urology. 1992;39:341–5.PubMedPubMedCentralGoogle Scholar
  113. 113.
    Collado A, Palou J, Garcia-Penit J, Salvador J, De La Torre P, Vicente J. Ultrasound-guided needle aspiration in prostatic abscess. Urology. 1999;53:548–52.PubMedPubMedCentralGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2019

Authors and Affiliations

  • Angelo Naselli
    • 1
  • Stefano Paparella
    • 1
  • Pierpaolo Graziotti
    • 1
  1. 1.Urology DepartmentSan Giuseppe Hospital, Multimedica GroupMilanItaly

Personalised recommendations