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

URINANALYSIS Color : Yellow Appearance : Cloudy Sp. Gravity : 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

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

Oral antibiotics for 3 – 5 days.

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

Urinanalysis Urine cultue U / S KUB

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

CT scan

Struvite stone ( MAP stone ). Urea splitting microorganisms.

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

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

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

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

Watchful surveillance

U/S in the first week of life

PUJ obstruction VUR Posterior urethral valve ( males only )

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

U/S

IVP

CT scan

VUR Voiding cystourethrogram

POSTERIOR URETHRAL VALVE Voiding cystourethrogram. Excretory urogram.

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

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

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

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

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

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

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

AUA self-administered questionnaire

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

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

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

TURP

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

T1b

DRE (nodular surface, induration) PSA TRUS Prostatic biopsy

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

Adenocarcinoma

Radical prostatectomy

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.

Investigations Urinanalysis CBC Renal function test Urine cytology Tumor markers

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

U/S

IVP

CYSTOSCOPY

By : CT scan TUR

T2b

TCC

Squamous cell carcinoma (due to Schistosomiasis)

Radical cystectomy