1 Urology An introduction Rami S. Al-Azab,MD Onco-Urologist Division of Urology Department of Surgery

2 Urology The branch of Medicine which deals with diseases of the Urinary tract in both sexes and the Genital tract in males. Though it is a surgical sub-specialty it has a medical part. …this includes all ages from neonates onward.

3 All kinds of patients

4

5 Major Subspecialties in Urology are: 1-Endourology 2-Onco-Urology 3-Pediatric Urology 4-Female Urology 5-Infertility, 6-recontructive Urology 7-Kidney Transplant 8-Andrology 9-laparoscopic Urology 10-Voiding dysfunctions and Urodynamics. The urinary tract is the commonest tract in the body to be afflicted by congenital anomalies.

6 The Urinary tract Kidneys,Ureters,Bladder,Urethra. The Kidneys are situated in the upper part of the retroperitoneum. Each kidney has a cortex and a collecting system,(the calyces and the renal pelvis,which continues as the ureter. The ureters traverses the retroperitoneum down to the pelvis to empty into the bladder

7 …ANATOMY The bladder is a global structure which receives,stores and empty urine. The urethra conveys the urine to the outside. The urinary tract is lined by Transitional epithelium.

8

9

10

11 The kidney vasculature

12 Male urinary system

13 Prostate gland

14 Prostate gland

15 The Ureter

16 The Collecting system

17 IVU

18

19

20

21 Male genital system

22 Seminal Vesicles

23 Pelvic wall anatomy

24 Lower Urinary Tract Innervation +M 3 Pelvic Nerve (Parasympathetic ) ACh +N Pudendal Nerve (Somatic) ACh -3-3 +1+1 Hypogastric Nerve (Sympathetic) NE

25 Urology Evaluation of Urology patient History ( Symptoms): Pain: Renal, Ureteral, Vesical, Prostatic, Penile, Testicular, Hematuria: Gross versus Microscopic, Timing of Hematuria, Association with Pain, Presence of Clots. Fever and Chills

26 Pain arising from the GU tract and its sites of radiation

27 History ( Symptoms): Lower Urinary Tract Symptoms: Irritative Symptoms: Obstructive Symptoms: Incontinence Enuresis,

28 Sexual Dysfunction Loss of Libido, Impotence (Erectile dysfunction). Failure to Ejaculate, Premature Ejaculation Hematospermia Pneumaturia, Urethral Discharge,

29 Over the past month, how often have you: Had the sensation of not completely emptying your bladder after you finished urinating? Had to urinate again less than 2 hours after you finished urinating? Found that you stopped and started again several times when you urinated? Found it difficult to postpone urination? Had a weak urinary stream? Had to push or strain to begin urination? Had to get up to urinate from the time you went to bed at night until you got up in the morning? American Urological Association (AUA) Symptom Index for BPH

30

31 Physical examination.

32 Physical examination.

33 Physical examination.

34 BUT only 1/2 of nodules are CA, and most men with CA have no nodules. Prostate Cancer Diagnosis Digital Rectal Exam (DRE)

35 Physical examination.

36 Laboratory tests: Urinalysis. Urine culture and sensitivity. Kidney function tests. PSA 24-h urine collection.

37 Urinalysis Bacteriuria Hematuria Pyuria Glycosuria Proteinuria

38 Imaging Conventional: Conventional: U/S, KUB…. Contrast studies: IVU,MCUG,Retrograde urethrogram,pyelography….CT-scan, Functional imaging TPA,DMSA,MAG3,MRI,Angiography

39 The kidney (Intra-operative)

40

41

42

43 Bilateral Nephrocalcinosis

44 Vesico-ureteric reflux

45 Nuclear scanning for renal functional assesment

46 Micturating cysto- urethrography (MCUG)

47 Abdominal MRI showing right PUJ obstruction

48 Huge Neuroblastoma in a 1-year-old child

49 Left RCC Before ….and …after IV contrast

50 Rt Renal cell carcinoma with LN Metastasis

51 Transitional Cell Carcinoma of the renal pelvis

52 Right testicular tumour by an MRI

53 Massive Adrenal mass

54 Case presentation 1 58 year old male patient. Presented to the OPD complaining of poor stream, nocturia and feeling of incomplete void….AUA score O/E: empty bladder. DRE: 50-gram benign feeling prostate.

55 ……case presentaion Uroflowmetry. Residual urine assesment. Labs: KFT,PSA,UA,U C&S Imaging. …….Management

56 BPH: Proliferation of glandular tissue

57 BPH

58 Case presentation 2 37 year old,female patient, housewife, presented to the E/R with a chief compaint of left sided loin pain radiating to the left groing, the pain is stabbing in nature,sometimes colicky, associated with darkening of urine and some urgency and frequency. O/E: mild-Moderate left renal angle tenderness

59 Case presentation 2 Pain management takes priority in this case. Labs: UA,U C&S,CBC,KFT. Imaging: KUB,U/S abdomen. IVU

60

61

62