Department of Urology
Urinary symptoms
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? Hematuria
? Pain
? Lower urinary tract symptoms
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(Obstructive/irritative)? Urinary incontinence
? Anuria
? Urinary retention
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Urological Emergencies
Investigations
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? Routine Investigations: RFT, Urine examination
? Specific investigations: Uroflometry, USG, X-
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Ray KUB, IVU, RGU, CT Urogram, MR UrogramHematuria
-Always abnormal whether micro. or macroscopic.
-may be due to a lesion any where in the urinary tract.
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Associated symptoms
? pain --------usually stone.
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? dysuria +urgency +frequency-----usuallyinfection
? Blood clots -----usually malignancy
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Questions to be asked..? Is hematuria gross or microscopic ?
? At what time of micturation does it occurs?
? Is associated with pain?
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? Is the patient passing clots?? Do the clots have any specific shape?
Pain
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Quite severe and usually associated with eitherobstruction or inflammation.
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Upper tract :-fixed deep and bursting in character.
-Colicky with sharp exacerbations against a
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constant background when due to ureteric
obstruction.
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-Is liable to be referred to the groin ,scrotumor labium as the stone moves distally in the
ureter.
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Lower tract pain? Bladder pain : commonly felt as suprapubic
discomfort worsening as the bladder fills.
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-usually associated with dysuria, frequency, urgency
when the cause is cystitis.
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-may be referred to the tip of the penis.? Prostatic pain :penetrating ache in the perineum and
rectum sometime a/w inguinal pain.
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? Urethral pain :usually felt as burning sensation in the
vulva or penis especially during voiding.
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Lower urinary tract symptoms? Irritative symptoms
? Frequency
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? Nocturia
? Urgency
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? Dysuria? Obstructive
? Loss of flow
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? Hesitancy
? Intermittency
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? Straining? Post void dribbling
Incontinence
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? Continuous incontinence? Stress incontinence
? Urgency incontinence
? Overflow incontinence
? Enuresis
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Anuria
? No urine output or ,50 ml urine output within
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24 hrs.? Differential diagnosis: urinary retention (full
bladder)
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? Causes :
? Pre-renal
? Renal
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? Post renalRoutine Investigation
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Renal function test:
more than 70% of renal function must be lost
before renal failure become evident.
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-blood urea-----3.5-7 mmol/dl
-serum creatinine-----80-120 mmol/dl.
glomerular filtration rate{G.F.R}---80-120
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ml/min.Urine Examination
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Collection:-midstream in adults with cleaning of the
external meatus.
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-using collection bag in children.Urine Examination
Physical
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Chemical examination
examination
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? Blood? Color
? Proteins
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? Turbidity
? Specific
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? Glucosegravity(1.001
? Ketones
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-1.035)
? Urobilinogen
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? pH(5.5-6.5)? White blood cells
Microscopic examination
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? W.B.C.? R.B.C
? R.B.C cast
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? Hyaline cast.
? Crystal
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? Bacteria? Yeast
Specific Investigations
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? Uroflometry
? Measures the volume of urine released from the
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body? The speed with which it is released
? How long the release takes
Ultasonography
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A painless and non-invasive procedure to
? Visualize urological organs and structures
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? To perform biopsies? Diagnosing tumors, cancer, stones and
congenital abnormalities
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? Assessment of flankpain during pregnancy
? Post-operative evaluation of patients with renal
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transplantSample of us pictures
X-ray KUB
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K.U.B{kidney, ureter and bladder}showing ----radio opaque shadow. About 90% of renal
stone are radiopaque.
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-------fracture ribs.
-------vertebral column abnormality.
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Intravenous Urogram (IVU)A test which X-rays the urinary system using
intravenous dye which is excreted by kidney for
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assessment of
? Renal and ureteral anatomy
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? Level of ureteral obstruction? Renal function
Sequence of film of I.V.U.
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- Plain------bony structure +calcification- Nephrogram{1min.}-----to assess function whether
nomal, delay, or not visualized.
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-Tomogram----to assess renal out line for the presence
of mass or small calcification.
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-Early film {5min} -----for hydronephrosisfilling defect
distended calyces.
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-Late film {15-20min.} ---to assess ureter and bladder
Retrograde Urethrogram(RGU)
? Study to evaluate
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anterior and posterior
urethra using
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perurethral contrast.Other imaging investigation
? Spiral C.T scan: now consider the 1st line of
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imaging investigation in renal trauma or colic
? M.R.I {magnetic resonance imaging}
Thank you...
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