Haematuria and Urological Emergencies in Jaipur

What is haematuria and urological emergencies

Haematuria is the medical name for the presence of blood cells in your urine. You may see pink, red or dark brown urine, which is called gross haematuria. Sometimes the urine looks normal but blood cells are found only under a microscope; this is called microscopic haematuria.

Having blood in your urine does not always mean you have a serious condition. Certain foods like beetroot or some medicines can make urine look red or brown. Dehydration can also make urine darker, and in extreme cases it may appear bloody.

Drinking a lot of water helps wash the blood out of the system but it does not fix the underlying cause.

Urological emergencies are conditions that need urgent evaluation and treatment to prevent lasting damage.

These include:

• Acute urinary retention where you cannot pass urine
• Severe infections that spread to the kidneys or bloodstream
• Trauma to the urinary tract
• Testicular torsion which is a twisting of the spermatic cord that cuts off blood supply to the testis

Testicular torsion is a surgical emergency most commonly seen in adolescence. Priapism is a penile erection that persists beyond or is unrelated to sexual interest or stimulation; the ischaemic type is an emergency. Fournier gangrene is a rare but life-threatening necrotising infection of the external genitalia, perineum and perianal region. Large blood clots blocking urine flow out from the bladder also need immediate care.

Symptoms and warning signs that need urgent care the same day

See a doctor the same day if you notice pink, red or brown urine, especially if you also have:

• Pain in the flank, lower abdomen or groin
• Burning or pain while passing urine
• Difficulty starting or a weak stream
• Fever with chills
• Nausea or vomiting
• Swelling in the scrotum or penis

Sudden severe pain in one testicle, often with nausea and vomiting, is a classic sign of testicular torsion. The affected testis may sit higher than usual and the cremasteric reflex may be absent. In young children, testicular torsion can present as abdominal pain with nausea and vomiting, sometimes mimicking appendicitis.

Go to the emergency department immediately if you cannot pass urine at all, if you pass large blood clots, if you have a persistent painful erection lasting more than four hours, or if you notice rapidly spreading redness, swelling and severe pain in the genital or perineal area with fever. These are time-sensitive emergencies.

In testicular torsion, there is typically a four- to eight-hour window before irreversible ischaemic damage occurs. Delay in treatment may be associated with decreased fertility or may necessitate removal of the testis.

Causes and who is at higher risk

Common causes of blood in urine include:

• Urinary tract infections
• Urinary tract inflammation
• Kidney stones
• Enlarged prostate
• Cancers of the kidney, bladder or prostate

Other causes are:

• Heavy exercise
• Injuries to the urinary tract or muscles
• Recent internal exams such as cystoscopy
• Sickle cell disease
• Polycystic kidney disease
• Glomerular disease which damages the tiny filters in the kidneys

Certain medicines like SGLT2 inhibitors used for diabetes have been associated with Fournier gangrene.

Testicular torsion is usually caused by a bell clapper anomaly where the testis hangs freely inside the scrotum and can twist on the spermatic cord. This anomaly is the primary risk factor and is often present on both sides. Torsion can be complete, partial or intermittent.

It has a bimodal age distribution with a peak in the first year of life and a second surge in adolescence. Priapism can be ischaemic (low flow), arterial (high flow) after blunt perineal trauma, or stuttering (recurrent). Ischaemic priapism is usually idiopathic.

You may be more likely to have haematuria if you have a family history of kidney disease or stones, take blood-thinning medicines, have an enlarged prostate, or have had recent urinary tract procedures. Men over 50 are at higher risk for prostate-related causes. Anyone of any age can have blood in their urine.

How it is diagnosed: examination and tests

The doctor will ask about your symptoms, medical history and any medicines you take. A physical examination includes checking the abdomen, flanks and genital area. For acute scrotal pain, a clinical examination of the scrotum is recommended in all boys with right lower quadrant pain.

Testicular torsion is a clinical diagnosis; if history and examination suggest torsion, immediate surgical exploration is indicated and should not be postponed for imaging.

Initial tests usually include a urinalysis with a test strip and a microscopic examination of urine; a dipstick alone is not enough. A urine culture checks for infection.

Blood tests may include:

• Serum creatinine to assess kidney function
• PSA for men over 50
• Complement proteins if glomerular disease is suspected

Imaging typically starts with an ultrasound of the kidneys and bladder to look for:

• Cysts
• Stones
• Tumours
• Other causes

For testicular pain, scrotal ultrasound with colour Doppler is the mainstay; signs like the whirlpool sign, a redundant spermatic cord, altered testicular lie, size discrepancy and echotexture changes help confirm torsion. A CT scan may be done to look for masses in the urinary tract.

Cystoscopy allows direct examination of the bladder and urethra lining and is typically performed if you have gross haematuria. Urine cytology looks for cancer cells. If kidney filter damage is suspected, a kidney biopsy may be needed.

Treatment options without surgery, and when surgery is advised

Treatment depends entirely on the underlying cause. Urinary tract infections are usually treated with antibiotics. An enlarged prostate causing bleeding may be managed with alpha-blockers or 5-alpha-reductase inhibitors like finasteride or dutasteride. If medicines do not control the bleeding, surgery may be suggested. For cancers, care is multidisciplinary and may include surveillance, surgery, radiation, immunotherapy, chemotherapy or hormone therapy.

Sickle cell disease, chronic kidney disease and endometriosis have specific medical treatments. Drinking plenty of fluids helps flush the urinary tract but does not replace specific treatment.

Surgery is advised urgently for several emergencies. In testicular torsion, immediate surgical exploration is needed; if the testis appears salvageable, detorsion and fixation (orchiopexy) is performed, and the opposite testis is also fixed because the bell clapper anomaly is often bilateral. If the testis is completely black and necrotic, it is removed (orchiectomy).

For clot retention where large clots block urine flow, cystoscopy with clot evacuation and bladder washout is done under anaesthesia. If a urethral catheter cannot be passed, suprapubic catheterisation provides urinary diversion. For obstructive pyelonephritis, emergency percutaneous nephrostomy drains the kidney. Severe renal bleeding may need angioembolisation by interventional radiology.

In ischaemic priapism, decompression by aspiration and injection of sympathomimetic drugs is started within four to six hours; if this fails, surgical shunting or early prosthesis implantation may be considered. Arterial priapism is treated by selective embolisation. Fournier gangrene requires extensive surgical debridement, sometimes with faecal diversion.

Preparing for surgery for Haematuria and Urological Emergencies

When you arrive at Jaipur Hospital for an urgent urological problem, the team moves quickly. In the emergency department, a doctor will take a brief history and examine you. Blood tests such as a complete blood count, kidney function, and coagulation profile are usually done to check your fitness for anaesthesia and to guide treatment.

A urine sample is sent for culture and microscopy. Imaging such as an ultrasound of the kidneys and bladder or a CT scan may be performed to locate the source of bleeding, a stone, or an obstruction.

Tell the doctor about every medicine you take, especially blood thinners, aspirin, or drugs for diabetes such as SGLT2 inhibitors. Some of these may need to be held before a procedure.

If surgery or a procedure under anaesthesia is planned, you will be asked to fast for at least six hours. Clear fluids may be allowed up to two hours before; the anaesthetist will confirm this. An attendant should stay with you to help with consent forms and to take you home afterwards.

Bring:

• Your regular medicines
• Any recent test reports
• Your insurance or scheme cards (RGHS, MAA Yojana, CGHS, or private TPA details)
• A change of clothes

The hospital provides an in-house pharmacy and canteen with dietary meals if you need to stay.

How the operation is done for Haematuria and Urological Emergencies

The exact procedure depends on the emergency. Your surgeon will explain which option suits you after reviewing the imaging and your condition. Common techniques used at Jaipur Hospital include:

• Cystoscopy and clot evacuation: A thin telescope is passed through the urethra into the bladder under anaesthesia. Blood clots are washed out and the bladder is inspected for a bleeding point. This is done when clots block urine flow.
• Suprapubic catheterisation: If a urethral catheter cannot be passed — for example, because of a stricture or trauma — a catheter is placed through a small cut in the lower abdomen directly into the bladder. This diverts urine and relieves retention.
• Emergency nephrostomy: For obstructive pyelonephritis or a blocked kidney with infection, a drainage tube is inserted through the skin into the kidney under imaging guidance. This relieves the obstruction and allows infected urine to drain.
• Angioembolisation: For severe renal bleeding that does not stop with conservative measures, an interventional radiologist passes a catheter through the groin artery to the bleeding vessel and blocks it with tiny particles or coils.

On the day of the procedure, you will be taken to a modular operation theatre. The anaesthetist will give either spinal, general, or local anaesthesia with sedation, depending on the procedure and your health. The surgical team uses sterile drapes and monitoring equipment.

After the procedure, you are moved to the recovery area and then to a ward or the intensive care unit if close monitoring is needed. The hospital has a 24×7 intensive care unit and in-house diagnostic laboratory and imaging for any urgent checks.

Risks and possible complications of Haematuria and Urological Emergencies surgery

All procedures carry some risk. The specific risks depend on the technique used and your underlying condition. Common risks include bleeding, infection, and pain at the procedure site. For cystoscopy and clot evacuation, there is a small chance of injury to the urethra or bladder, or a urinary tract infection afterwards.

Suprapubic catheterisation can cause bleeding from the abdominal wall, bowel injury (rare), or catheter blockage. Emergency nephrostomy carries a risk of bleeding from the kidney, injury to nearby organs, or tube dislodgement. Angioembolisation may cause groin haematoma, damage to the artery, or reduced kidney function if blood flow is affected.

In studies of testicular torsion — another urological emergency — delay in treatment is linked to loss of the testis and reduced fertility. When surgery is done within six hours, testicular survival is high; after 24 to 48 hours, survival drops sharply. Atrophy of the testis can occur even after successful detorsion and fixation.

Some studies report antisperm antibodies after torsion, though their effect on fertility is debated. For Fournier gangrene, a rare but life-threatening infection, extensive surgical debridement is needed and complications such as sepsis, acute kidney injury, and limb loss have been reported.

Your surgical team will discuss the risks that apply to your situation. They take steps to reduce complications, such as giving antibiotics when indicated, using careful surgical technique, and monitoring you closely after the procedure.

Recovery and aftercare after Haematuria and Urological Emergencies surgery

Recovery varies with the procedure and the underlying cause. After cystoscopy or catheter placement, you may go home the same day or stay overnight. After nephrostomy or angioembolisation, a stay of two to five days is typical. The hospital stay range in our protocol is observation to three to five days.

In the first days, nurses will monitor your urine output, check the catheter or drainage tube, and give pain relief as needed. You will be encouraged to drink fluids to flush the urinary tract. If you have a catheter, you will be shown how to care for it before discharge. Antibiotics may be prescribed if there was infection.

At home, avoid heavy lifting and strenuous activity for one to two weeks. Keep the catheter or tube site clean and dry.

Watch for:

• Fever
• Increasing pain
• Blood clots in the urine that do not clear with fluids
• The catheter stopping drainage

If any of these occur, call the hospital on 0141-2551500 or 0141-2554139, or return to the 24×7 emergency department. A follow-up appointment is usually scheduled within one to two weeks to review healing, remove any tubes, and discuss further treatment if needed. The in-house pharmacy can dispense your medicines on discharge.

Results of Haematuria and Urological Emergencies surgery

How well the procedure works depends on the condition being treated. For clot retention, cystoscopy and washout usually restores urine flow immediately. For obstructive pyelonephritis, emergency nephrostomy rapidly decompresses the kidney and controls sepsis in most cases. Angioembolisation stops active renal bleeding in a high proportion of patients, though repeat procedures are sometimes needed.

In studies of testicular torsion, early surgery (within six hours) saves the testis in the majority of cases. Long-term endocrine function (testosterone levels) is generally preserved after torsion, whether the testis is saved or removed. However, semen quality can be affected.

Some studies show a significant number of men have reduced sperm count or motility years later, even after successful detorsion. Other studies find no overall difference compared to fertile controls. One study of pregnancy rates in partners of men with prior torsion found no decrease compared to the general population.

For haematuria due to other causes, the outlook depends on the underlying diagnosis. Infections typically clear with antibiotics. Stones may need further procedures. Cancers require multidisciplinary care. Your surgeon will discuss what to expect based on your specific diagnosis.

Cost and insurance for Haematuria and Urological Emergencies in Jaipur

The typical cost range for evaluation and treatment of urological emergencies at Jaipur Hospital is ₹5,000 to ₹1,50,000. The final amount depends on the condition, the procedure needed, the length of hospital stay, the type of anaesthesia, implants or stents used, medications, and whether intensive care is required.

Diagnostic tests such as CT scans, ultrasound, and laboratory investigations add to the total. Laparoscopic surgeries for related conditions (such as nephrectomy or pyeloplasty) have higher ranges in India, typically ₹2,00,000 to ₹3,00,000, but these are usually planned procedures rather than emergencies.

Jaipur Hospital is empanelled under RGHS, MAA Yojana, and CGHS. We also work with a panel of private insurers and TPAs. If you are covered under any of these schemes, bring your card and any pre-authorisation letter. The admissions team can help verify coverage and explain what is included.

For patients without insurance, a detailed estimate can be provided after the initial assessment. The hospital has an in-house pharmacy and diagnostic laboratory, so most tests and medicines are billed directly.