Download MBBS Urology Presentations 3 Basics Of Urology Lecture Notes

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Basics of Urology



Department of Urology

Urinary symptoms

? Hematuria
? Pain
? Lower urinary tract symptoms

(Obstructive/irritative)

? Urinary incontinence
? Anuria
? Urinary retention

Urological Emergencies


Investigations

? Routine Investigations: RFT, Urine examination

? Specific investigations: Uroflometry, USG, X-

Ray KUB, IVU, RGU, CT Urogram, MR Urogram
Hematuria

-Always abnormal whether micro. or macroscopic.
-may be due to a lesion any where in the urinary tract.

Associated symptoms

? pain --------usually stone.

? dysuria +urgency +frequency-----usually

infection

? Blood clots -----usually malignancy
Questions to be asked..

? Is hematuria gross or microscopic ?
? At what time of micturation does it occurs?
? Is associated with pain?
? Is the patient passing clots?
? Do the clots have any specific shape?

Pain

Quite severe and usually associated with either

obstruction or inflammation.


Upper tract :

-fixed deep and bursting in character.

-Colicky with sharp exacerbations against a

constant background when due to ureteric

obstruction.

-Is liable to be referred to the groin ,scrotum

or labium as the stone moves distally in the

ureter.
Lower tract pain

? Bladder pain : commonly felt as suprapubic

discomfort worsening as the bladder fills.

-usually associated with dysuria, frequency, urgency

when the cause is cystitis.

-may be referred to the tip of the penis.

? Prostatic pain :penetrating ache in the perineum and

rectum sometime a/w inguinal pain.

? Urethral pain :usually felt as burning sensation in the

vulva or penis especially during voiding.

Lower urinary tract symptoms

? Irritative symptoms

? Frequency

? Nocturia

? Urgency

? Dysuria

? Obstructive

? Loss of flow

? Hesitancy

? Intermittency

? Straining

? Post void dribbling
Incontinence

? Continuous incontinence
? Stress incontinence
? Urgency incontinence
? Overflow incontinence
? Enuresis

Anuria

? No urine output or ,50 ml urine output within

24 hrs.

? Differential diagnosis: urinary retention (full

bladder)

? Causes :

? Pre-renal
? Renal
? Post renal



Routine Investigation

Renal function test:
more than 70% of renal function must be lost

before renal failure become evident.

-blood urea-----3.5-7 mmol/dl
-serum creatinine-----80-120 mmol/dl.
glomerular filtration rate{G.F.R}---80-120

ml/min.


Urine Examination

Collection:
-midstream in adults with cleaning of the

external meatus.

-using collection bag in children.

Urine Examination

Physical

Chemical examination

examination

? Blood

? Color

? Proteins

? Turbidity

? Specific

? Glucose

gravity(1.001

? Ketones

-1.035)

? Urobilinogen

? pH(5.5-6.5)

? White blood cells
Microscopic examination

? W.B.C.

? R.B.C

? R.B.C cast

? Hyaline cast.

? Crystal

? Bacteria

? Yeast

Specific Investigations

? Uroflometry

? Measures the volume of urine released from the

body

? The speed with which it is released
? How long the release takes
Ultasonography

A painless and non-invasive procedure to

? Visualize urological organs and structures

? To perform biopsies

? Diagnosing tumors, cancer, stones and

congenital abnormalities

? Assessment of flankpain during pregnancy

? Post-operative evaluation of patients with renal

transplant

Sample of us pictures
X-ray KUB

K.U.B{kidney, ureter and bladder}

showing ----radio opaque shadow. About 90% of renal

stone are radiopaque.

-------fracture ribs.

-------vertebral column abnormality.

Intravenous Urogram (IVU)

A test which X-rays the urinary system using

intravenous dye which is excreted by kidney for

assessment of

? Renal and ureteral anatomy

? Level of ureteral obstruction

? Renal function
Sequence of film of I.V.U.

- Plain------bony structure +calcification

- Nephrogram{1min.}-----to assess function whether

nomal, delay, or not visualized.

-Tomogram----to assess renal out line for the presence

of mass or small calcification.

-Early film {5min} -----for hydronephrosis

filling defect

distended calyces.

-Late film {15-20min.} ---to assess ureter and bladder
Retrograde Urethrogram(RGU)

? Study to evaluate

anterior and posterior

urethra using

perurethral contrast.

Other imaging investigation

? Spiral C.T scan: now consider the 1st line of

imaging investigation in renal trauma or colic

? M.R.I {magnetic resonance imaging}
Thank you...