Department of Urology, Pavol Jozef Šafárik University in Košice, Faculty of Medicine, https://www.upjs.sk/lekarska-fakulta/klinika/urologia/

Injuries of the urinary tract and male genitalia represent important urological emergencies and are often associated with trauma. These injuries may result from blunt, penetrating, or iatrogenic mechanisms. The urinary tract includes the kidneys, ureters, bladder, and urethra, all of which may be affected by trauma. Renal injuries are the most common type of urinary tract trauma. Hematuria is a key clinical sign suggesting injury to the urinary tract. The severity of renal trauma is classified using the American Association for the Surgery of Trauma (AAST) grading system. Most low-grade renal injuries can be managed conservatively. Ureteral injuries are relatively rare but are often iatrogenic in origin. Delayed diagnosis of ureteral injury may lead to significant morbidity. Bladder injuries are frequently associated with pelvic fractures. Bladder trauma is classified as intraperitoneal or extraperitoneal. Retrograde cystography is the diagnostic gold standard for suspected bladder injury. Urethral injuries commonly occur in association with pelvic trauma or straddle injuries. Blood at the urethral meatus is a classic sign of urethral injury. Retrograde urethrography should be performed before urethral catheterization when injury is suspected. Injuries of the male genitalia include trauma to the penis, scrotum, testes, and epididymis. Penile fracture is caused by rupture of the tunica albuginea of the corpus cavernosum. Immediate surgical repair is recommended in cases of penile fracture. Testicular trauma may result in contusion, rupture, or dislocation. Scrotal ultrasonography with Doppler is the imaging modality of choice for testicular injuries. Testicular rupture requires urgent surgical exploration. Genital injuries may be associated with significant psychological impact. Early recognition and prompt management are essential to preserve organ function. Associated injuries to other organ systems are common and must be assessed. Initial evaluation follows standard trauma protocols, including stabilization of the patient. Imaging plays a crucial role in the assessment of urological trauma. Conservative management is preferred when clinically appropriate. Surgical intervention is indicated in hemodynamically unstable patients or high-grade injuries. Long-term complications may include strictures, infertility, erectile dysfunction, and chronic pain. A multidisciplinary approach is often required for optimal management of urinary tract and genital injuries.

Urolithiasis refers to the formation of calculi within the urinary tract and represents a common urological disorder. Urinary stones may occur in the kidneys, ureters, bladder, or urethra. The majority of urinary calculi are composed of calcium oxalate or calcium phosphate. Other stone types include uric acid, struvite, and cystine stones. Stone formation results from urinary supersaturation with lithogenic substances. Additional contributing factors include low urine volume, metabolic abnormalities, and dietary influences. Renal colic is the typical clinical presentation of obstructing ureteral stones. Hematuria is a frequent accompanying sign of urolithiasis. Non-contrast computed tomography is the imaging modality of choice for suspected urolithiasis. Ultrasonography may be used as an initial imaging method, particularly in selected patient populations. Laboratory evaluation includes urinalysis, serum biochemistry, and stone analysis when available. Acute management focuses on analgesia, hydration, and assessment for complications. Urgent intervention is required in cases of obstructive urolithiasis with infection or renal impairment. Conservative management may be appropriate for small, non-complicated stones. Medical expulsive therapy can facilitate spontaneous stone passage in selected patients. Interventional treatment options include extracorporeal shock wave lithotripsy, ureteroscopy, and percutaneous nephrolithotomy. The choice of treatment depends on stone size, location, composition, and patient-specific factors. Recurrent stone formers require metabolic evaluation to identify underlying risk factors. Preventive strategies include adequate fluid intake and dietary modification. Long-term follow-up is essential to reduce recurrence and prevent complications associated with urolithiasis.

Urinary tract infections (UTIs) are among the most common infectious diseases encountered in urological practice. According to EAU terminology, UTIs are classified as lower urinary tract infections (lUTIs) or upper urinary tract infections (uUTIs). Lower urinary tract infections primarily involve the bladder and urethra, with cystitis being the most frequent clinical entity. Typical symptoms of lUTIs include dysuria, urinary frequency, urgency, and suprapubic pain. Upper urinary tract infections affect the kidneys and renal pelvis and are most commonly referred to as acute pyelonephritis. Upper UTIs are usually associated with systemic symptoms such as fever, flank pain, chills, and malaise. UTIs are further categorized as uncomplicated or complicated based on patient-related and anatomical factors. Uncomplicated UTIs occur in healthy, non-pregnant individuals with a structurally and functionally normal urinary tract. Complicated UTIs are associated with factors such as urinary tract obstruction, indwelling catheters, renal impairment, or immunosuppression. Escherichia coli remains the most common causative pathogen in both uncomplicated lUTIs and uUTIs. Diagnosis of UTIs is based on clinical presentation supported by urinalysis and urine culture. Imaging of the urinary tract is not routinely required in uncomplicated lUTIs. In suspected uUTIs or complicated infections, imaging is recommended to exclude obstruction or other complications. Antimicrobial therapy should be guided by local resistance patterns and culture results whenever possible. EAU guidelines emphasize antimicrobial stewardship to reduce the development of antibiotic resistance. Asymptomatic bacteriuria should not be treated except in specific clinical situations, such as pregnancy or prior to urological procedures. Recurrent UTIs require careful evaluation to identify modifiable risk factors. Prevention strategies include behavioral measures and, in selected cases, prophylactic antimicrobial or non-antimicrobial approaches. Prompt recognition and appropriate management of uUTIs are essential to prevent sepsis and renal damage. Adherence to EAU guidelines ensures standardized, evidence-based management of upper and lower urinary tract infections. Infections of the male reproductive system represent a significant cause of morbidity in urological practice. These infections may involve the prostate, epididymis, testes, seminal vesicles, or urethra. Acute and chronic prostatitis are among the most common inflammatory conditions affecting the male reproductive organs. Epididymitis and orchitis frequently present with scrotal pain, swelling, and systemic symptoms of infection. Sexually transmitted pathogens play an important role in infections of the male reproductive system, particularly in younger patients. Ascending infection from the lower urinary tract is a common pathogenic mechanism. Laboratory evaluation includes urinalysis, microbiological cultures, and inflammatory markers. Imaging modalities such as ultrasonography are useful in assessing complications, including abscess formation. Early diagnosis and appropriate antimicrobial therapy are essential to prevent long-term sequelae. Untreated or recurrent infections may result in infertility, chronic pain, or structural damage to the reproductive organs.

Urinary incontinence is a prevalent condition characterized by the involuntary loss of urine, with significant implications for physical health and psychosocial well-being. The etiology of urinary incontinence is multifactorial, involving dysfunction of the lower urinary tract, pelvic floor muscles, and neural control mechanisms. Common subtypes include stress, urge, mixed, and overflow incontinence, each with distinct pathophysiological mechanisms. The prevalence of urinary incontinence increases with age and is higher among women, particularly following pregnancy, childbirth, and menopause. In men, urinary incontinence is frequently associated with prostate disease or as a complication of prostate surgery. Urinary incontinence is associated with reduced quality of life, increased risk of depression, and social isolation. Diagnosis relies on a comprehensive clinical assessment, including patient history, physical examination, and, when indicated, urodynamic testing. Conservative management strategies, such as pelvic floor muscle training and bladder retraining, are considered first-line therapies. Pharmacological and surgical interventions may be indicated for patients with moderate to severe symptoms or refractory disease. Ongoing research focuses on improving diagnostic accuracy and developing minimally invasive treatment modalities to optimize patient outcomes. Neurogenic bladder dysfunction is a loss of bladder control caused by damage to the brain, spinal cord, or nerves, resulting in either an overactive (spastic) or underactive (flaccid) bladder. Common causes include stroke, spinal cord injury, MS, Parkinson’s, and diabetes. Symptoms range from incontinence and frequency to urine retention. Types of Neurogenic Bladder Overactive (Spastic/Hyperreflexic): The bladder muscle contracts automatically, causing frequency, urgency, and urge incontinence. Underactive (Flaccid/Hypotonic): The bladder muscle does not contract, leading to urinary retention, overflow incontinence (dribbling), and inability to empty fully. Mixed: Features of both overactive and underactive. Detrusor-Sphincter Dyssynergia: The bladder contracts while the sphincter muscle remains closed, preventing emptying.

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.

Laboratory examinations in urology play a crucial role in the assessment of diseases of the urinary tract and male reproductive system. Urinalysis is a fundamental diagnostic tool used to detect infection, hematuria, proteinuria, and metabolic abnormalities. Blood laboratory tests provide essential information about renal function, electrolyte balance, and systemic inflammation. Measurement of prostate-specific antigen (PSA) is widely used in the evaluation of prostatic diseases. Imaging examinations are indispensable for the anatomical and functional assessment of the urogenital system. Ultrasonography is frequently employed as a first-line imaging modality due to its availability and non-invasive nature. Computed tomography offers high-resolution visualization of the urinary tract and is particularly valuable in the detection of urolithiasis. Magnetic resonance imaging provides superior soft-tissue contrast and is especially important in prostate imaging. Conventional radiographic examinations retain a role in the evaluation of selected urological conditions. The integration of laboratory and imaging examinations enables accurate diagnosis, risk stratification, and therapeutic decision-making in urology.

Article about basic examination in Urology, how to take history, how to perform physical examination. History taking is very important part of any medical investigation. How to take general informations about patient (family history, occupational informations, previous surgery, labours and current medication) is well known. Also, groups of specific urological symptoms are listed here. Much of the genitourinary tract is hidden from view. The testes and epididymes can be identified separately. If epididymal infection is present or testicular torsion is suspected, the examination must be gentle. Observation of the colour of the scrotal wall may reveal hyperaemia. The absence of a cremasteric reflex contraction when the scrotum, or the area close to the scrotum, is touched is also an important sign to elicit. The loss of this reflex is not diagnostic of one pathology, but its presence is strongly against a diagnosis of torsion.

Trauma is defined as a physical injury or a wound to living tissue caused by an extrinsic agent. Trauma is the sixth leading cause of death worldwide, accounting for 10% of all mortalities. It accounts for approximately 5 million deaths each year worldwide and causes disability to millions more. About half of all deaths due to trauma are in people aged 15–45 years and in this age it is the leading cause of death.