Most acute urologic processes in their classic presentation are easily distinguished from nonurologic causes of the acute abdomen. Unfortunately, nonclassic presentations of urologic disease are common, and even the most astute practitioner may be fooled. Genitourinary organs share neural pathways with other visceral structures. The kidneys are richly innervated by autonomic fibers from the celiac plexus, the thoracic and upper lumbar splanchnic nerves, the intermesenteric plexus, and the superior hypogastric plexus. The testes and lower ureters receive a blend of sympathetic and parasympathetic innervation from the autonomic nervous system through the pelvic ganglia. These plexes also supply innervation to other intraabdominal visceral structures. Because of this significant overlap of autonomic innervation between the genitourinary structures and other visceral organs, referred pain is common. The iliohypogastric, ilioinguinal, and genitofemoral nerves arise from the lower thoracic and upper lumbar segments of the spinal cord and supply cutaneous innervation to the lower abdomen and the genitalia. A number of retroperitoneal inflammatory processes, whether originating from a genitourinary organ or otherwise, may cause irritation of these nerves. Inflammatory processes may thus cause referral of pain to the lower abdominal quadrants or the genitalia. In this article, an attempt is made to present those genitourinary disease entities that are most commonly confused with non-urologic causes of the acute abdomen. Because of space limitations, a number of disease processes, such as acute renovascular events, spontaneous rupture of the bladder, and severe prostatic infections, will not be discussed. This is not to deny their importance as disease entities but rather acknowledges their infrequent presentations as acute abdominal processes. Three primary areas are included in this article: renal and perirenal infections, obstructions of the ureter and renal pelvis, and acute intrascrotal events.
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