2. A 50 year old diabetic female presented with burning micturition associated with urinary frequency & suprapubic pain.

4. URINANALYSIS Color : Yellow Appearance : Cloudy Sp. Gravity : 1.033 pH : 6.5 Protein : Negative Glucose : Negative Ketone : Negative Bilirubin : Negative WBCs : 40 – 50 / HPF RBCs : 7-10 / HPF Casts : None Crystals : None Squamous epithelia : 2 -3 / HPF

6. Dx. : Cystitis Causative microorganism : Most likely E.coli

8. Oral antibiotics for 3 – 5 days.

9. If this patient presented to you with recurrent infection associated with left loin pain, nausea & hematuria; how would you evaluate her ?

10. Urinanalysis Urine cultue U / S KUB

11. URINANALYSIS Color : Yellow Appearance : Cloudy Sp. Gravity : 1.033 pH : 8 Protein : Negative Glucose : Negative Ketone : Negative Bilirubin : Negative WBCs : 40 – 50 / HPF RBCs : 12 - 15 / HPF Squamous epithelia : 2 -3 / HPF

14. CT scan

16. Struvite stone ( MAP stone ). Urea splitting microorganisms.

18. PCNL Controlling the infection (pre, peri, postoperatively) Good hydration Good glycemic control

19. If this patient neglects herself & develops fever & chills associated with costovertebral angle tenderness; what is the most likely diagnosis & how would you treat her ?

20. Dx. : Acute pyelonephritis Management : - Hospitalization - Parenteral antibiotics ( 7 – 10 days )

22. A 27 year old pregnant lady discovered during prenatal U/S to have antenatal hydronephrosis. How would you interfere ?

23. Watchful surveillance

25. U/S in the first week of life

27. PUJ obstruction VUR Posterior urethral valve ( males only )

29. PUJ obstruction U/S : AP diameter of the renal pelvis, kidney size. IVP CT scan Radionuclide renography : the best radiographic study.

30. U/S

31. IVP

32. CT scan

33. VUR Voiding cystourethrogram

35. POSTERIOR URETHRAL VALVE Voiding cystourethrogram. Excretory urogram.

38. A 70 year old male presented with hesitancy, decreased force & caliber of stream, sensation of incomplete bladder emptying, excessive straining, urgency, frequency & nocturia.

40. Lower urinary tract symptoms : 1- Obstructive symptoms 2- Irritative symptoms

42. UTI BPH Urethral stricture Bladder neck contracture Vesical stone Ca prostate Neurogenic bladder disorders

44. History Previous urethral instrumentation, urethritis, or trauma Hematuria & pain Hx of neurologic diseases, stroke, DM, back injury

45. Physical examination DRE : smooth, firm, elastic enlargement of the prostate. Focused neurologic examination.

46. Lab findings Urinanalysis : to exclude infection or hematuria RFT Serum PSA (optional)

47. Additional tests Upper tract imaging (optional) Cystometrograms & urodynamic profiles (optional)

49. AUA self-administered questionnaire

51. A-Watchful waiting For mild symptom scores (0-7)

52. B-Medical therapy Alpha blockers 5 alpha reductase inhibitors Combination therapy

53. C-Surgical treatment Indications : Refractory urinary retention Recurrent UTI Recurrent gross hematuria Bladder stones Renal insufficiency Bladder diverticulum

55. TURP

57. Indications Too large prostate Associated bladder pathology Dorsal lithotomy position is not possible

59. T1b

61. DRE (nodular surface, induration) PSA TRUS Prostatic biopsy

62. Additional tests RFT CBC Alkaline phosphatase Bone scan Axial imaging (CT & MRI)

64. Adenocarcinoma

66. Radical prostatectomy

68. A 65 year old smoker male presented with painless, intermittent hematuria for the last 6 months associated with urinary frequency, poor appetite & weight loss. He is a worker in a rubber industry.

70. Investigations Urinanalysis CBC Renal function test Urine cytology Tumor markers

71. Imaging modalities U/S : fixed mass EXU : filling defect CT & MRI : looking for LN Cystoscopy : is the definitive method Molecular markers : done on the tissue

72. U/S

73. IVP

74. CYSTOSCOPY

76. By : CT scan TUR

78. T2b

81. TCC

83. Squamous cell carcinoma (due to Schistosomiasis)

85. Radical cystectomy