DR. MOHAMMED ALTURKI COSULTANT UROLOGIST

Evaluation of the Urologic Patient The urologist has the ability to make the initial evaluation and diagnosis and to provide medical and surgical therapy for all diseases of the genitourinary (GU) system.

Evaluation of the Urologic Patient History: ( anxiety, language barrier, or educational background effect the history )

History chief complain ( it provides the initial information and clues to begin formulating the differential diagnosis. ) the duration, severity, chronicity, periodicity, and degree of disability are important considerations.

Pain Obstruction inflammation renal pain: Pain is usually caused by acute distention of the renal capsule, generally from inflammation or obstruction Pain of renal origin may be associated with gastrointestinal symptoms Pain arising from the GU tract may be quite severe Renal pain may also be confused with pain resulting from irritation of the costal nerves, most commonly T10-T12

Pain  Ureteral Pain Ureteral pain is usually acute and secondary to obstruction. Vesical Pain Constant suprapubic pain that is unrelated to urinary retention is seldom of urologic origin. Inflammatory conditions of the bladder usually produce intermittent suprapubic discomfort. Prostatic Pain. Prostatic pain is usually secondary to inflammation with secondary edema and distention of the prostatic capsule

 Penile Pain.  usually secondary to inflammation in the bladder or urethra.  Testicular Pain.  primary or referred.  Acute or chronic

Hematuria greater than three red blood cells/HPF is significant. Microscopic hematuria Gross-hematuria

The most common cause of gross hematuria in a patient older than age 50 years is bladder cancer.

Evaluation of the Urologic Patient Lower Urinary Tract Symptoms Irritative Symptoms Frequency. Nocturnal Dysuria Obstructive Symptoms Decreased force of urination Urinary hesitancy Intermittency Postvoid dribbling Straining CIS Neurogenic UB

 Incontinence.  Continuous Incontinence.  Stress Incontinence  Urgency Incontinence  Overflow Urinary Incontinence Enuresis.

Sexual Dysfunction  (( impotence ))  Loss of Libido  Impotence.  Failure to Ejaculate  Absence of Orgasm  Premature Ejaculation  Hematospermia It almost  Pneumaturia

 Urethral Discharge  Fever and Chills

 Medical History  Family History  Medications  Previous Surgical Procedures  Smoking and Alcohol Use  Allergies

PHYSICAL EXAMINATION  General Observations  Abdomen  External Genitalia  DRE

PHYSICAL EXAMINATION

Evaluation of the Urologic Patient  Investigation:- urine analysis microscopic Dipstick Spaceman collection male female Neonates and Infants

Urine analysis  Color  The normal pale yellow color of urine is due to the presence of the pigment urochrome  Turbidity  Freshly voided urine is clear.  Cloudy urine is most commonly due to phosphaturia.  Pyuria

 Lipiduria  hyperoxaluria  hyperuricosuria

Evaluation of the Urologic Patient  Specific Gravity and Osmolality  to  reflects the patient’s state of hydration  Osmolality (50 and 1200 mOsm/L. )  pH Urinary pH is usually acidic in patients with uric acid and cystine lithiasis. Alkalinization of the urine is an important feature of therapy in of these conditions

 abnormal substances commonly tested for with a dipstick include (1) blood, (2) protein, (3) glucose, (4) ketones, (5) urobilinogen and bilirubin, and (6) white blood cells.  Hematuria

 Proteinuria  healthy adults excrete 80 to 150 mg of protein in the urine daily,  Normally, urine protein is about 30% albumin, 30% serum globulins, and 40% tissue proteins.  Glucose and Ketones  almost all the glucose filtered by the glomeruli is reabsorbed in the proximal tubules  renal threshold corresponds to serum glucose of about 180 mg/dL

 Bilirubin and Urobilinogen  Normal urine contains no bilirubin and only small amounts of urobilinogen Leukocyte Esterase and Nitrite Tests

 Wish you all the best

MCQ.