**6. Anesthesia for urologic emergency**

Urologic emergencies requiring surgical intervention are relatively rare. This section reviews both the common and rare urologic emergencies such as renal trauma, bladder trauma, ure‐ thral trauma, scrotal trauma, testicular torsion and fournier gangrene.

Testicular torsion occurs due to rotation of spermatic cord around. This rotation blocks the blood flow of testis and impairs venous drainage. As a result of this pathology, edema, isch‐ emia and necrosis develop. Testicular torsion is common in the two periods of life. While first peak is at age of 1–2 years, second peak is common in adolescence. Testicular torsion is rarely observed after the age of 40 [57].

#### **6.1. Preoperative considerations**

In patients with fournier gangrene, there is usually rapid development of severe toxemia leading to sepsis and progressive organ dysfunction. The appropriate administration of intra‐ venous fluid therapy to maintain an effective circulating volume and prevent and inadequate tissue perfusion is a core element of the preoperative practice of the anesthesia [58].

#### **6.2. Intraoperative considerations**

Routine monitorization is advised for all patients with urological emergencies. The patient with the risk of hypovolemia and hypotension, central venous catheterization must be per‐ formed to monitor the central venous pressure and providing rapid fluid transfusion. Invasive arterial blood pressure must be done to follow blood pressure in patients with the risk of hypotension.

#### **6.3. Choice of anesthesia**

Most common anesthetic plan is general anesthesia in trauma patients, but neuraxial block‐ ade can be chosen for testicular torsion. If effected area is localized in patients with fournier gangrene or the patient is not septic, neuraxial blockade can be chosen, too. The sensorial block level must be chosen according to the level of legion. Th10 sensorial block level can be enough for testicular torsion.
