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

2. 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.

3. Evaluation of the Urologic Patient History: The history is effected by: Anxiety. Language barrier or by Educational background

4. 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.

5. 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

6. 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

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

8. 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?

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

10. 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

11. Incontinence. Continuous Incontinence. Stress Incontinence
Urgency Incontinence
Overflow Urinary Incontinence
Enuresis.

12. (( 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

13. Urethral Discharge
Fever and Chills

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

15. PHYSICAL EXAMINATION General Observations Abdomen External Genitalia
DRE

17. PHYSICAL EXAMINATION

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

20. 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

21. chyluria
Lipiduria
hyperoxaluria
hyperuricosuria

23. 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

24. 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.

25. 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

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

28. Wish you all the best