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Urologic surgical procedures and urologic devices are widespread, and their complications may result in an ED visit. In general, consult the urologist for these situations. Whenever possible, contact the urologist who performed the original operation.

Extracorporeal shock wave lithotripsy is the application of repetitive high-intensity sound waves to fragment GU calculi. Typically postlithotripsy complications include the following signs and symptoms: abdominal and flank pain, nausea, vomiting (especially 48 hours postprocedure), skin ecchymosis, or ureteral colic and fever. Hematuria is common after lithotripsy but is generally self limited (<24 hours). These presenting complaints may also be the indication of more serious problems.1–3 Supportive therapy for complications is important: IV fluid hydration, antiemetics (if needed), analgesics, monitoring complete blood count, serum creatinine levels with urine output, and antibiotic treatment, if indicated.

Perinephric and renal hematomas (usually secondary to subcapsular renal hemorrhage with rupture) are serious complications. Suspect the diagnosis when there is severe flank pain and evidence of hemorrhage (flank hematoma, fall in hematocrit, hypotension, syncope). Diagnosis is by CT or US. Acute management may include fluid resuscitation, blood transfusions, analgesics, and antibiotics. Most patients are managed conservatively, with close monitoring of hemodynamic status, urine output, and laboratory studies to assess for decreasing hematocrit and renal function. Consult the urologist early on, because specific treatments, such as embolization and nephrectomy, may be required.1–3

Steinstrasse (“street of stone”) refers to the postlithotripsy dispersal of stone fragments, usually within the ureters. When an accumulation of these calculi, or one large fragment, becomes lodged, flank or groin pain, urinary obstruction, and superimposed infection can ensue. Patients can be asymptomatic or may present with flank pain, nausea, vomiting, fever, hematuria, or dysuria. Steinstrasse can be visualized on plain abdominal radiographs.

Treatment options may include conservative management, repeat lithotripsy, or percutaneous nephrostomy.2

There are case reports of rare events in which lithotripsy caused injury to other abdominal viscera and surrounding structures secondary to the high energy used and close proximity of the other organs to the kidney. Complications include bowel perforation, GI mucosal erosions and hemorrhages, ureteric perforations, and splenic subcapsular hemorrhage, abscess to psoas muscle, and pseudoaneurysm of a superior mesenteric artery branch.4,5 Patients may present with flank or abdominal pain, signs of peritonitis, and fall in hematocrit. Diagnosis usually requires imaging: CT with contrast or US. Obtain surgery and urology consultation for definitive treatment.4,5

Vasectomies are most commonly an outpatient procedure with a low failure rate and risk of side effects. However, acute postoperative complications include bleeding and scrotal hematoma, local wound infections (cellulitis and abscess), epididymitis, and painful sperm granulomas. Patients may develop persistent testicular pain or congestive epididymitis (pain and testicular tenderness on the affected side) months to years later.6

Management includes pain medication and consideration for antibiotics, especially in cases of immunosuppression. When there is no evidence of bleeding or wound infection, treatment options for postvasectomy epididymitis include ice packs, scrotal support, and analgesia with ...

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