From the Research
No, a patient with active penile bleeding, a UTI, and a kidney stone should not be discharged from the emergency department. Active bleeding from the penis requires further evaluation and management before discharge is appropriate. The bleeding could indicate complications such as trauma to the urinary tract from the stone, severe infection, or other urological emergencies. The patient should be stabilized, the source of bleeding identified, and appropriate treatment initiated. This may include IV antibiotics for the UTI (such as ceftriaxone 1-2g IV or ciprofloxacin 400mg IV), pain management (ketorolac 30mg IV or morphine 4-8mg IV as needed), and possibly urological consultation. Imaging studies like CT urography may be necessary to fully evaluate the stone and urinary tract. Discharge should only be considered once bleeding has stopped or significantly decreased, infection is controlled, pain is manageable with oral medications, and the patient can maintain adequate hydration. The combination of active bleeding with infection and a kidney stone represents a potentially serious condition that requires complete evaluation and initial treatment in the controlled setting of the emergency department, as suggested by recent studies on urinary tract infections and their management 1, 2. In particular, the study by 2 highlights the importance of considering the patient's history of kidney stones when selecting antibiotic therapy, as it may impact the likelihood of resistance to certain antibiotics. However, the most recent and highest quality study on the topic of UTI management, 1, provides guidance on the appropriate use of antibiotics in this setting, which should be considered in conjunction with the patient's overall clinical presentation. Additionally, the management of bleeding in the emergency department, as discussed in 3, emphasizes the importance of rapid and controlled haemostasis, which may be relevant in this patient's care. Overall, the patient's condition requires careful evaluation and management to minimize the risk of morbidity, mortality, and to improve quality of life.