Evaluation of the Urologic Patient DR. MOHAMMED ALTURKI COSULTANT UROLOGIST Evaluation of the Urologic Patient

General presentation, assessment and investigation of urinary tract diseases

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: The history is effected by: Anxiety. Language barrier or by Educational background

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

Hematuria > 3 RBC/HPF is significant. Is the hematuria gross or microscopic? Time of the haematuria associated with pain or not ? Is the patient passing clots? If the patient is passing clots, do the clots have a specific shape?

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

Common cause of Haematuria Infection (UTI) Kidney and bladder stone Trauma Tumors kidney diseases blood disorder

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.

(( impotence )) Sexual Dysfunction Loss of Libido Impotence. Failure to Ejaculate An ejaculation may result from several causes: (1) androgen deficiency, (2) sympathetic dnervation, (3) pharmacologic agents, and (4) bladder neck and prostatic surgery Absence of Orgasm Premature Ejaculation Hematospermia It almost always results from nonspecific inflammation of the prostate and/or seminal vesicles and resolves spontaneously, usually within several weeks 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 Pyuria Color Turbidity 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

chyluria Lipiduria hyperoxaluria hyperuricosuria

Evaluation of the Urologic Patient Specific Gravity and Osmolality 1.001 to 1.035 reflects the patient’s state of hydration Osmolality (50 and 1200 mOsm/L. ) is a measure of the amount of material dissolved in the urine pH A urinary pH between 4.5 and 5.5 is considered acidic, pH between 6.5 and 8 is considered alkaline. Urinary pH is usually acidic in patients with uric acid and cystine stone. Alkalinization of the urine is an important feature of therapy in both 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 Hematuria of nephrologic origin (casts and significant proteinuria.

Glucose and Ketones 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, of which the major component is Tamm- Horsfall protein 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

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