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EVALUATION OF THE UROLOGIC PATIENT
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:
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.
PainObstructioninflammation
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.
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 haematuriaassociated 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.
Evaluation of the Urologic Patient
Lower Urinary Tract Symptoms Irritative Symptoms
Frequency.Nocturnal Dysuria
Obstructive Symptoms Decreased force of urination Urinary hesitancy IntermittencyPostvoid dribblingStraining
CISNeurogenic UB
Incontinence. Continuous Incontinence. Stress Incontinence Urgency Incontinence Overflow Urinary Incontinence
Enuresis.
Sexual Dysfunction
(( impotence )) 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 OrgasmPremature 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
microscopicDipstick
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
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.
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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