Urological emergencies, though less common than other surgical emergencies, require urgent attention due to their potential to increase morbidity and mortality if treatment is delayed [1] . These unexpected conditions, which can be traumatic or non-traumatic and affect any age or gender, present variably by geographic region [2] . Examples necessitating surgical intervention include testicular torsion, urethral injuries, renal lacerations, pyonephrosis, acute urine retention, and obstructive renal calculi. Common presentations in emergency settings encompass acute scrotal issues, priapism, renal colic, macroscopic haematuria, urinary tract infections, genitourinary trauma, and paraphimosis [3] . Urinary retention is frequently reported, accounting for 53% of cases in one study, with suprapubic catheterization as a common procedure [2] . Pediatric emergencies include acute scrotum, penile issues, hematuria, retention, abdominal masses, and genital abnormalities [4] . Urologic trauma, often from auto accidents, constitutes under 1% of multiple injuries [5] .

While diverse urological emergencies are managed at institutions like Cape Coast Teaching Hospital (CCTH), research on their spectrum, management options, and outcomes in Ghana remains limited. Existing Ghanaian studies, such as one focusing solely on adult urinary retention at Komfo Anokye Teaching Hospital [6] , highlight this gap. Prompt diagnosis and intervention are critical as these conditions can be life-threatening. Specific treatments include catheterization or cystostomy for retention, corporal aspiration for refractory priapism, orchidopexy for testicular torsion, antibiotics/debridement for Fournier’s gangrene, and clot evacuation for hematuria [7] .

In busy teaching hospitals like CCTH, understanding the range, causes, and optimal management of urological emergencies is vital. As significant contributors to morbidity and mortality, their accurate and timely management—often initiated in the emergency department—profoundly impacts patient outcomes. This study will therefore provide essential insights into emergency urological care, including influencing factors for presentation and management at CCTH.

The research conducted documented several urological emergencies, ranked by their frequency of occurrence. These emergencies included urinary tract infection, urine retention, hematuria, renal colic, epididymo-orchitis, Fournier gangrene, scrotal pain, priapism, cystitis, obstructive and reflux uropathy, bladder injury, and urethral injury. Among the cases, majority were males and while were females formed the minority.

Urinary tract infection is a significant global health concern, particularly in emergency departments. Statistics indicate that approximately one-third to one-half of individuals experience a urinary tract infection at least once in their lifetime. This study found a higher prevalence of UTI in adults, with a greater proportion in women, which aligns with reports from other sources [8] . Urinary tract infections are commonly associated with factors such as advanced age, gender, pregnancy, diabetes, and catheterization, as these are well-established risk factors for such infections [9] . Although the specific causative organism(s) could not be identified, cefuroxime, a second-generation cephalosporin antibiotic, was the most commonly prescribed treatment for the infection.

Urinary retention is the condition where an individual is unable to pass a sufficient amount of urine, either acutely or chronically. The research revealed a urine retention rate which was determined to be the second most prevalent urological emergency in the study. Prostatic hyperplasia emerged as the leading cause of urinary retention in this study. Benign prostatic hypertrophy is believed to be the primary reason for urine retention [10] . The majority of urinary retention cases in this study involved males aged 60 and above. The likelihood of experiencing urinary retention increases with age, especially for individuals over 60 [11] .

Haematuria showed a higher occurrence in males and individuals aged 60 years and older. This condition, characterized by blood in the urine, can manifest as either microscopic or macroscopic in both emergency and routine medical settings. Research suggests that approximately one in five patients seen by a urologist will have haematuria, with microscopic cases being more prevalent than macroscopic ones [12] . Haematuria can stem from various sources including infections, inflammation, cancers of the bladder, kidney, urethra, or prostate, trauma, urinary stones, catheter use, and benign prostatic hyperplasia. While there may be other factors at play, the surgical procedures listed in Table 4 could potentially result in haematuria [13] .

The occurrence of renal colic had a higher prevalence among men aged 30 - 59 years. Renal colic, which is commonly observed in men between the ages of 20 and 50, accounts for 1% of emergency service referrals. Typically associated with stone disease, renal colic presents as intense pain felt at the costovertebral angle. This pain is characterized as dull, persistent, and twisting in nature [14] .

Epididymo-orchitis presents as an inflammatory condition affecting the epididymis and the corresponding testis in males. The condition typically initiates in the epididymis and may progress to involve the testis. Common causes include sexually transmitted infections (STIs) and the presence of urethral catheters [15] , with a prevalence rate of 3.8% identified in our study. Treatment strategies for epididymo-orchitis involve the administration of empirical antibiotics before confirming the specific microbial cause, followed by adjustments based on the identified pathogen. Surgical intervention may be necessary if conservative approaches fail. Risk factors for this condition include prostatitis, bladder outlet obstruction, history of trauma or instrumentation, and engaging in sexual activity with multiple partners [15] .

Overall, Fournier gangrene made up 2.2% of all urological cases. Fournier gangrene is a rare and life-threatening urosurgical emergency caused by a polymicrobial infection in the perineal, genital, or perianal regions. Male patients, patients with alcoholism, and patients with immunocompromised conditions such as HIV and uncontrolled diabetes are more likely to develop FG [16] . Similarly, more males than females were harmed in our study.

Scrotal pain is the cause of about 2.5% to 5% of all urology consultations as reported elsewhere [17] . Only one case was as a result from iatrogenic cause as the other causes were not captured. It is worth noting that other conditions such as Epididymo-orchitis and Fournier gangrene observed in this study can present with scrotal pain.

Numerous studies have indicated that the prevalence of priapism among men with sickle cell disease (SCD) ranges from approximately 30% to 40% [18] . The precise etiology of priapism is often unknown or multifactorial, but generally results in the inflow of blood to the corpus cavernosum exceeding the outflow [19] .

Emergency procedures were necessary for 10.2% of the patients in this study. The most frequently performed emergency procedure was suprapubic catheterization, accounting for 29.4% of all emergency procedures performed in the current study. This rate was required in 24.14% of emergency procedure cases in other studies [20] .

Urological emergencies, although usually not posing an immediate threat to life, can result in severe outcomes if not promptly attended to. At Cape Coast Teaching Hospital, urinary tract infection emerged as the most frequently encountered emergency case. The majority of urological emergencies do not require immediate surgical interventions. Nevertheless, it is of utmost importance to promptly identify and address these emergencies through thorough clinical assessments to avoid potential complications in the future. Suprapubic catheterization was found to be the most commonly performed surgical procedure in such cases, followed by urethral catheterization.