Surgery 4 (Trauma Surgery, Urology) [ChK/CH-V4/09]

Acute scrotum is a urological emergency characterized by sudden onset of scrotal pain, swelling, and tenderness. It encompasses a spectrum of conditions affecting the testis, epididymis, and surrounding structures. Testicular torsion is the most critical cause of acute scrotum and requires immediate surgical intervention. Other common etiologies include epididymitis, orchitis, torsion of the testicular appendages, and scrotal trauma. Rapid and accurate differential diagnosis is essential to preserve testicular viability. Clinical evaluation includes detailed history taking and focused physical examination. Color Doppler ultrasonography is the imaging modality of choice for assessment of testicular perfusion. Laboratory investigations may assist in identifying infectious or inflammatory causes. Delayed diagnosis or management can result in testicular infarction and loss of reproductive function. Prompt recognition and appropriate treatment are crucial to achieve favorable clinical outcomes in patients with acute scrotum.

Renal colic is a severe, acute pain syndrome most commonly caused by obstruction of the urinary tract by urolithiasis. The pain typically originates in the flank and may radiate to the lower abdomen, groin, or genital region. Renal colic results from increased intraluminal pressure and ureteral smooth muscle spasm proximal to the obstruction. Nausea, vomiting, and haematuria are frequently associated symptoms. Non-contrast computed tomography is considered the imaging modality of choice for the diagnosis of renal colic. Ultrasonography may be used as an initial imaging tool, particularly in pregnant patients or those requiring radiation avoidance. Laboratory evaluation includes urinalysis to detect haematuria and blood tests to assess renal function and infection. Differential diagnosis includes other causes of acute abdominal or flank pain. Initial management focuses on pain control, hydration, and exclusion of complications such as infection or renal impairment. Definitive treatment depends on stone size, location, composition, and patient-related factors.

Haematuria is defined as the presence of red blood cells in the urine and represents a common urological symptom. It may be classified as microscopic or macroscopic, depending on whether it is detectable only by laboratory analysis or visible to the naked eye. Haematuria can originate from any part of the urinary tract, including the kidneys, ureters, bladder, prostate, and urethra. The etiology of haematuria ranges from benign conditions to malignant urological diseases. Urinary tract infections, urolithiasis, and trauma are frequent non-malignant causes of haematuria. Painless macroscopic haematuria is considered a hallmark symptom of urothelial carcinoma until proven otherwise. A structured diagnostic evaluation is essential to identify the underlying cause of haematuria. Laboratory investigations, including urinalysis and urine cytology, play a key role in the diagnostic process. Imaging modalities such as ultrasonography and computed tomography are used to assess the upper urinary tract. Cystoscopy remains the gold standard for evaluation of the lower urinary tract in patients with haematuria.