Download MBBS Urology Presentations 3 Basics Of Urology Lecture Notes

Basics of Urology

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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 Urogram
Hematuria

-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-----usually

infection

? 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 either

obstruction 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 ,scrotum

or 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 renal



Routine 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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? Glucose

gravity(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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transplant

Sample 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 hydronephrosis

filling 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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