Kidney and urological disorders

Haematuria (blood in urine)

Haematuria is visible or microscopic blood in the urine from infection, schistosomiasis, stones, trauma, glomerular disease, bleeding disorders, obstruction or cancer. Assess with urinalysis, culture, blood tests and ultrasound, treat the cause (antibiotics, praziquantel, stone care), and refer persistent, clot-forming or suspected malignant haematuria for cystoscopy.

Phimosis and paraphimosis

Phimosis is inability to retract the foreskin, treated with gentle retraction, topical steroid cream for 4–6 weeks and circumcision if it fails. Paraphimosis is a retracted foreskin trapped behind the glans – an emergency needing manual reduction under local anaesthesia, or a dorsal slit or circumcision.

Hydrocele

A hydrocele is fluid in the tunica vaginalis causing a painless, transilluminating scrotal swelling. Observe small asymptomatic hydroceles, especially in children, and treat persistent or large ones by hydrocelectomy with analgesia.

Testicular torsion

Testicular torsion is twisting of the spermatic cord that cuts off the testis's blood supply, causing sudden severe scrotal pain – a surgical emergency. Refer immediately for detorsion and orchidopexy, giving analgesia and preoperative ceftriaxone.