Urinary symptoms and Investigations Hussein L.Hashem urologist

Heamaturea -always abnormal whether micro. Or macroscopical. -may be due to a lesion any wher in the urinary tract.

Heamaturea Onset of Heam.; -Intial H.-------- usually ant. Urethra. -Terminal H.-------usually trigone of the bladder{stone}or prostatic urethra. -Total H.---------usually upper tract or bladder.

Heamaturea Associated symptoms: -With pain --------usually stone. -with dysurea +urgency +frequency-----usually infection. -asso. With clot -----usually melgnancy

Pain It is unpleasant sensory and emotoinal experience. I-upper tract pain : -typically fixed deep and bursting in character. -is colicky with sharp exacerbations aginst a constant background when due to ureteric obstruction. -is liable to be reffered to the groin ,scrotum or labium as the stone move distally in the ureter.

Pain II-lower tract pain i -bladder pain : commonlly felt as suprapubic discomfort warsening as the bladder fill. -usually associated with dysurea ,freq.,urgency when the cause is cystitis. -may be reffered to the tip of the penis. ii-prostatic pain :penterating ache in the pernium and rectum sometime ass. With inguinal pain. iii-Urethral pain :usually felt as burning sensation in the vulva or penis especially durig voiding.

Urgency Inapproprait contraction of the detrusor ms. During filling phase. normal 1st sensation at 150cc desire to void at 400-500cc Urge incontenence:unability to delay voiding after percieving that the bladder is fill. Noctuia : increase frequency at night which may disturb sleep pattern. normal—1-2durng sleeping time. Hesitancy : delay in intiating voiding,usually occure when there is bladder outlet obstruction.

Investigation Collection: Urine: Collection: -midstream in adult with cleaning of the external meatus using hebitane. -using collection bag in children.

Urine Dipstick: for R.B.C________heamaturea protien_________infection or nephrotic syndrom. nitrate________infection sugar__________D.M PH specific gravity.

Urine Microscopical: W.B.C. R.B.C R.B.C cast Hyaline cast. Crystal ova ------------- bacteria

Urine Cytological : for urine sediment_________urothilial tumour e.g Ca bladder. Bacteriological test : Clean catch midstream specimen -----100,000 organism/ml indicate infection. Biochemical exam.: electrolyte-----Calcium ------uric acid these are usually use for patients ------Na of recurrent stone -------Po4 ----------- glucose.

Investigation Renal function test: more than 70% of renal function must be lost before renal failure become evidant. -blood urea-----3.5-7 mmol/dl -serum creatinine-----80-120 mmol/dl. glomerular filteration rate{G.F.R}---80-120 ml/min.

Imaging -ultra sound {u.s}: advantage ----- no radiation -------non invasive. ---------cheep. ------available. -------no prepration. disadvantage-------operater dependant

Sample of us pictures

Imaging K.U.B{kidney ureter and bladder} showing ----radio opaque shaddow. About 90% of renal stone are radiopaque. -------fracture ribs. -------vert. coloum abn.

Imaging I.V.U.{intra venous urogram} dye –iodine -------high osmolarity. -------low osmolarity. Associated with less allergic reaction or nephrotoxity. Preperation : -no thing by mouth for 6 hrs. -modest fluid restriction -laxative.

Imaging Contraindcation: obsolute c.i. Hx of allergy to the dye. relative c.i --- hx of asthma ,sever allergic disease. ----D.M. nephropathy. -----multple myloma. ------hyper uricose urea. ------amyloidosis -------preexisting chr. Renal failure.

I.V.U. Sequence of film of I.V.U. - Plain------bonny structure +calcification - nephrogram{1min.}-----to assess function whther nomal,delay,or not visualise. -tomogram----to assess renal out line for the presence of mass or small calcification. -early film {5min} -----for hydronephrosis filling defect distended calyces. -late film {15-20min.} ---to assess ureter and bladder

Spcial films of I.V.U. -retrograde pylogram for better delination of the ureter &renal pelvis in obstructed kidney. Antigrade pyelogram also for better delination of ureter and renal pelvis when the lower ureter obstructed. Urethrogram :to assess urethra and exclusion of urethral stricture

urethrogram

Other imaging investigation Spiral C.T scan this now consider the 1st line of imaging investigation in renal trauma or colic Also use for staging of tumours in the urinary system. -M.R.I{magnectic resonence imaging} Also use staging of renal tumour in patient allergic to iodine dye .